To Trial Of Org 10172 In Acute Stroke Treatment Research Articles

Correlation between serum parathyroid hormone-associated protein concentration and acute ischemic stroke

Objective To investigate the correlation between serum Parathyroid hormone-related protein (PTHrP) and acute ischemic stroke (AIS). Methods from October 2020 to March 2021, 134 patients with AIS and 34 healthy individuals were enrolled. Serum PTHrP concentration was measured by enzyme-linked immunosorbent assay (ELISA) and subgroup analysis was performed according to Trial of Org 10 172 in acute stroke treatment (TOAST) classification. The severity of AIS was assessed by the National Institutes of Health stroke scale (NIHSS) score and the volume of cerebral infarction was assessed based on head magnetic resonance imaging. The correlation of serum PTHrP concentration with various indicators was analyzed. The 90-day functional prognosis of patients was assessed by the modified Rankin scale. Patients were divided into favorable outcomes group and unfavorable outcomes group and the difference in serum PTHrP concentration between the two groups was compared. Whether serum PTHrP was associated with AIS prognosis was analyzed by Logistic regression.Results The serum PTHrP concentration in AIS group was higher than that in the control group (P=0.000), and the serum PTHrP concentrations of the three common etiological subtypes, LAA, CE and SAO, were higher than those in the control group (all P<0.01). The AUC for distinguishing AIS patients and healthy control by serum PTHrP concentration was 0.751(P<0.0001). The serum PTHrP concentration in the AIS group was associated with the cumulative smoking volume (r=0.201, P=0.021) and APTT (r=-0.188, p=0.034). Serum PTHrP was not associated with TOAST classification (P=0.091), NIHSS score and cerebral infarction volume (all P>0.05), and there was no significant difference in serum PTHrP concentration between the favorable outcomes group and unfavorable outcomes group (P> 0.05). Univariate logistic regression showed that serum PTHrP concentration was not a prognostic factor of AIS [OR=1.000 95% CI (0.999, 1.002) P=0.678]. Conclusion Serum PTHrP concentration was significantly increased in AIS patients. Serum PTHrP might be ancillary for early identification of AIS. Serum PTHrP concentration correlated with cumulative smoking volume and APTT in AIS patients, and could possibly be used to assess the true smoking volume of patients and analyze coagulation function. However, serum PTHrP concentration was not associated with TOAST classification, NIHSS score, cerebral infarction volume and 90-day prognosis, which meant it cannot be used to evaluated the etiology, severity and prognosis of AIS patients.

No Histological Difference between Large Atherosclerotic and Cardiogenic Embolic Thrombus.

Background The continuous development of endovascular treatment technology provides more opportunities for the histological study of thrombus. According to Trial of Org 10 172 in Acute Stroke Treatment (TOAST), clinicians take different strategies in anticoagulant or antiplatelet therapy. There are some patients still suffering from recurrent stroke while they took anticoagulant or antiplatelet drugs regularly for secondary prevention. In view of that, we found that histological analysis of thrombus can provide guidance for secondary prevention. Aim Exploring the histological characteristics differences between large atherosclerotic and cardiogenic embolic thrombosis in order to guide clinical secondary prevention of the two stroke subtypes. Methods A total of 54 patients with acute ischemic stroke were collected from December 2019 to April 2021. Identify stroke subtypes according to TOAST classification. Stain thrombus specimens with hematoxylin-eosin staining, and perform statistical analysis on the components (red blood cells and fibrin/platelets) of thrombus. Results In cardiogenic thrombi, the composition of RBCs was dominant (51.38 ± 18.463%) compared to that of fibrin/platelets (48.62 ± 18.463%). Similarly, among the thrombi of large artery atherosclerotic, RBCs (50.40 ± 20.100%) compared to fibrin/platelets (49.60 ± 20.100%). There was no statistical difference in RBCs or fibrin/platelet composition of both cardiogenic and atherosclerotic thrombi (P = 0.89). Conclusions The histologic composition of thrombi in cardiogenic and atherosclerotic had no statistical difference. These thrombi are all mixed thrombus, which are rich in RBCs, fibrinogen, and platelets. Anticoagulation combined with antiplatelet may be a more effective secondary prevention strategy.

Trousseau Syndrome Related Cerebral Infarction: Clinical Manifestations, Laboratory Findings and Radiological Features

We summarized the clinical manifestations, laboratory data, and brain MRI of patients with Trousseau syndrome related cerebral infarction and compared them to patients with other types of cerebral infarction. Through our present research, we hope to aid the neurologists in recognizing and diagnosing this syndrome. A total of 31 patients at our institution were identified with cerebral infarction resulting from Trousseau syndrome. We have also selected the 180 patients who have suffered from cerebral infarction as control groups and these patients were distributed to large-artery atherosclerosis group; cardio-embolism group; small-artery occlusion group, according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The clinical data and neuroimage of these patients were collected. All our 31 cancer patients were confirmed by pathological biopsy to be adenocarcinomas and the most common cancers are gastric and lung cancers. Patients with Trousseau syndrome exhibited high serum carbohydrate antigen CEA, CA 125 and CA 199 levels. Compared to patients with other types of cerebral infarction, patients with Trousseau syndrome had an increased severity and worse prognosis. Besides, patients had the highest mean level of plasma D-dimer. We also found multiple lesions in multiple vascular territories was the most frequent type of DWI patterns in patients of Trousseau syndrome. Trousseau syndrome can progress rapidly and become life-threatening. For patients who developed unexplained cerebral infarction involving multiple arterial territories, with elevated plasma D-dimer and cancer antigens, Trousseau syndrome should always be considered.

Influence of Sex Difference on Distribution of Risk Factors and Etiologic Subtypes of Acute Ischemic Stroke: Reality of Facts.

Sex-related differences have been documented in risk factors distribution, etiologic subtypes, diagnostic evaluation, offered management, and outcome of patients with acute ischemic stroke (AIS) from all over the world. Nevertheless, studies from Saudi Arabia are lacking. This study aimed to investigate the influence of sex on distribution of risk factors and etiologic subtype of AIS in patients admitted to our hospital. Record of patients admitted to King Fahd Hospital of the University between 2010 and 2017 with ischemic stroke (IS) were reviewed. Base line characteristics, risk factors, and etiologic subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification were compared between men and women. Among 453 patients with IS, 300 (66.2%) were men and 153 (33.7%) were women. The mean age of all patients was 61.5 ± 14.5 years. Women were older than men (P = 0.00). Hypertension (P = 0.00), atrial fibrillation (P = 0.00), and past history of stroke (P = 0.03) were more frequent in women compared to men. Fewer carotid Doppler studies (47.1 vs. 68.3%, P = 0.00) and echocardiogram (75.1 vs. 83%, P = 0.01) were done in women as compared to men. Cardioembolic etiologic subtype (26.1 vs. 17.7%) was found more frequently, whereas small vessel occlusive (23.5 vs. 31%) and large artery disease less (10.5 vs. 16.3%) frequently in women. Significant sex-related differences were found in risk factors and subtypes of AIS in our cohort of patients. Findings of our study are in general comparable with studies from all over the world.

Abstract WP268: Association of Serum Troponin Obtained During Stroke Codes With Cardioembolic Stroke

Introduction: Troponin is a marker of cardiac ischemia and is elevated in about 30 % of stroke patients. We investigated if the elevation of troponin during an acute stroke code is associated with a cardioembolic source. Methods: We performed a retrospective chart review of patients evaluated for acute strokes from July 2014 to March 2018. Patients included in the study were all given intravenous alteplase, had blood drawn for troponins during the acute stroke code and had confirmation of a new stroke on neuroimaging during hospitalization. Patients who were on dialysis or had a glomerular filtration rate of ≤40 ml/min on initial laboratory evaluation were excluded. Stroke etiology was classified as large vessel, cardioembolic, small vessel, other determined etiology or undetermined, according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke subtypes were treated as categorical variables. Troponin was considered as a trichotomous categorical variable, with cut-off points at ≥0.01 ng/ml and ≥0.05 ng/ml. Results: 144 patients met the inclusion criteria. In this cohort, 42.31% of patients in the cardioembolic group had troponin levels of ≥0.05 ng/ml compared to 0% in the small vessel group, 5.88% in the large vessel group and 15.87 % in the undetermined origin group. A troponin level of ≥0.05 ng/ml obtained during a stroke code showed a significant difference between cardioembolic and non-cardioembolic strokes (OR, 5.40; 95% CI, 2.34-12.46; P<0.001), with high specificity (88.04%) but low sensitivity (42.31%) to exclude non-cardioembolic stroke. Conclusions: A troponin level of ≥0.05 ng/ml obtained during a stroke code showed a significant difference between cardioembolic and non-cardioembolic strokes. This finding may have implications for patient treatment, as anticoagulation is the treatment of choice for secondary prevention of stroke in most cases of cardioembolic stroke. A troponin level of ≥0.05 ng/ml may prompt a more thorough search for a cardioembolic source in cases in which such a source is not identified on initial evaluation.

Relationship Between Carotid Stenosis and Infarct Volume in Ischemic Stroke Patients.

BackgroundStroke is a serious health problem all over the world. Ischemia causes 85% of strokes and 75% of these ischemic strokes occur within the area supplied by the internal carotid artery (ICA).Material/MethodsThis study included 47 acute stroke patients who were in the large-artery atherosclerosis group according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and who had an infarct in the area supplied by the internal carotid artery. We sought to determine whether there was a significant correlation between the infarct volume of the patients as measured by diffusion-weighted magnetic resonance imaging (DW MRI), their National Institutes of Health Stroke Scale (NIHSS), and degree of carotid stenosis as identified by carotid computed tomography angiography (CTA).ResultsA significant correlation was observed between the percentage of carotid artery stenosis and infarct volume (p<0.001). In addition, there was a significant positive correlation between the NIHSS and infarct volume; the correlation was of moderate strength (r=0.366, p=0.001).ConclusionsOur findings indicate that the percentage of carotid artery stenosis could be useful in predicting the infarct volume of the stroke.

Endothelial function and arterial stiffness indexes in subjects with acute ischemic stroke: Relationship with TOAST subtype

Background and aimsOnly one study has examined endothelial function in subjects with acute ischemic stroke and no study has yet assessed arterial stiffness and reactive hyperemia peripheral arterial tonometry (RH-PAT) in ischemic stroke and its clinical subtypes. Our study aimed to evaluate arterial stiffness and endothelial dysfunction indexes in patients with acute ischemic stroke and the relationship between endothelial dysfunction indexes and arterial stiffness markers and stroke subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification. MethodsWe enrolled 98 patients with a diagnosis of acute ischemic stroke and 105 hospitalized patients without a diagnosis of acute ischemic stroke. Arterial stiffness analysis was conducted by applanation tonometry to record radial artery pressure waveform continuously; augmentation index (Aix) and pulse wave velocity (PWV) were calculated. The reactive hyperemia index (RHI) was assessed by peripheral arterial tonometry. ResultsIn comparison to controls, ischemic stroke subjects had higher mean levels of PWV, Aix, and significantly lower mean RHI values. Compared to subjects with lacunar and cardioembolic stroke, those with Large Artery AtheroSclerosis (LAAS) subtype of stroke had higher median levels of PWV and significantly lower median levels of RHI. On multinomial logistic regression analysis of predictive variables of stroke subtype (lacunar vs. LAAS and lacunar vs. cardioembolic), we observed a negative association between RHI value and LAAS subtype and a negative association of PWV with cardioembolic subtype. ConclusionsOur findings underline the relationship between endothelial and arterial stiffness index correlations in patients with acute ischemic stroke, also suggesting the use of a combination of PAT and arterial stiffness indexes to better categorize patients with ischemic stroke.

The prognosis of acute symptomatic seizures after ischaemic stroke

ObjectiveAcute symptomatic seizure (AS) after ischaemic stroke is defined as a seizure occurring ≤7 days of the stroke. There remains a lack of information on the prognosis of AS after...

Etiology and Risk Factors of Posterior Circulation Infarction Compared with Anterior Circulation Infarction

Many clinicians regard posterior circulation infarction (PCI) as different from anterior circulation infarction (ACI), leading them to apply different treatments. Few studies have validated this practice by directly comparing the etiology and risk factors of PCI and ACI. We compared the etiology and risk factors of 2245 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. Stroke etiology in each patient was classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Our sample included 482 patients (21.5%) with PCI and 1763 (78.5%) with ACI. The most frequent etiology for both infarction types was small-artery occlusion, occurring in 37.6% of patients with PCI and 37.1% of those with ACI. Cardioembolism caused infarction in a significantly smaller proportion of patients with PCI (5.4%) than in patients with ACI (13.3%; odds ratio [OR] = .373; 95% confidence interval [CI], .245-.566). Frequencies of other stroke etiologies were similar between the 2 patient groups. Analysis of risk factor frequencies in the 2 groups showed hypertension to be the most common, occurring in 47.9% of patients in either group. Multivariable analysis identified 2 factors as conferring greater risk of PCI than ACI: male gender (OR = 1.392; 95% CI, 1.085-1.786) and diabetes mellitus (OR = 1.667; 95% CI, 1.275-2.180). The same analysis identified 2 factors as conferring greater risk of ACI: atrial fibrillation (OR = .530; 95% CI, .295-.951) and heart valve disease (OR = .433; 95% CI, .203-.922). Frequencies of other possible risk factors were similar between the 2 groups. These findings suggest that PCI and ACI are more similar than different in their etiology and risk factors and that the 2 types of infarction should be treated based more on etiology and risk factors than on their posterior or anterior localization.

Left atrial dilatation frequency in the ischemic stroke

OBJECTIVE:The study aimed to evaluate the frequency of left atrial dilatation in cases of first-ever acute ischemic stroke with or without atrial fibrillation in a cohort of patients hospitalized for ischemic stroke.METHODS:Files of 120 patients admitted to our hospital with the diagnosis of acute ischemic stroke were investigated. All patients had at least one brain imaging. Etiology of stroke was categorized according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Transthoracic and/or transoesophageal echocardiography was used to measure left atrium size. Optimal cut-off value of left atrial diameter was determined as 4 cm. SPSS 11.5 was used for statistical analyses.RESULTS:In 40% of the patients, left atrial dilatation was detected. Nineteen patients with left atrial dilatation had atrial fibrillation, which was statistically significant (p<0.05). Ninety-four (30.8%) patients with no atrial fibrillation had left atrial dilatation. In the TOAST classification trial, as a statistically significant finding, left atrial dilatation was detected 68.9% of the patients with cardioembolic infarcts. The most frequently encountered risk factor in patients was hypertension.CONCLUSION:Left atrial dilatation is an important marker for cerebrovascular diseases, and if accompanied by atrial fibrillation becomes even more significant.

The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke

Background: Previous studies on pathophysiology suggest a role of inflammation in atherothrombotic stroke and intracardiac thrombosis in cardioembolic stroke. We explored the magnitude of D-dimer, fibrinogen and C-reactive protein (CRP) as biomarkers in acute ischemic cerebral stroke and their relation to ischemic stroke subtypes and their impact on stroke outcome after 30 days. Methods: The study was performed on 100 patients, admitted to Neurology Department, Menoufiya University, within 24 hours of acute ischemic stroke. Patients were subjected to clinical data collection, general and neurological examination, laboratory assessment (routine and biomarkers), brain computerized tomography (CT), magnetic resonance imaging (MRI), MRA, carotid and vertebrobasilar duplex and cardiac assessment. The patients were classified according to Trial of ORG 10172 in acute stroke treatment (TOAST) classification. Severity and disability were assessed by Scandinavian stroke scale and modified Rankin scale at admission and at 30 days. Results: We found that D-dimer, fibrinogen and CRP were significantly higher in patients than in controls (P < 0.001). D-dimer and fibrinogen were higher in cardioembolic stroke while CRP was higher in atherothrombotic subtype. The biomarkers were correlated significantly with the severity and disability of stroke at onset and 30 days. Conclusions: These three biomarkers in acute ischemic stroke can be considered as non-invasive tools which add important information regarding etiology and outcome. J Neurol Res. 2015;5(6):277-282 doi: http://dx.doi.org/10.14740/jnr362w

Association of E-selectin Gene Polymorphism (S128R) with Ischemic Stroke and Stroke Subtypes

E-selectin is an important inflammatory cytokine involved in the pathogenesis of various diseases such as atherosclerosis and stroke. We investigated the association of E-selectin gene polymorphism (S128R) with ischemic stroke and its subtypes. We studied 610 patients with ischemic stroke and 610 age- and sex-matched healthy controls. The ischemic stroke was classified according to Trial of Org10172 in Acute Stroke Treatment (TOAST). E-selectin gene polymorphism (S128R) was determined by polymerase chain reaction-restriction fragment length polymorphism technique. We found statistically significant difference in the genotypic distribution between patients and controls (for AC vs. AA, χ(2) = 49.5; p < 0.001, odds ratio = 5.47(95 % CI, 3.25-9.21). A significant difference was observed in the frequency of C and A alleles in patients and controls (for C vs. A, χ(2) = 47.4; p < 0.001, odds ratio = 5.13 (95 % CI, 3.06-8.57). Multiple logistic regression analysis revealed that the most predictive risk factor for stroke was AC genotype (adjusted odds ratio = 1.450 (95 % CI, 1.23-2.75) and p = 0.001), hypertension, smoking, and diabetes (p = 0.001 in each case). We also found a significant association of AC genotype with intracranial large artery atherosclerosis (p < 0.01, odds ratio = 9.37, (95 % CI, 5.31-16.5) and small artery occlusion (p < 0.0001, odds ratio = 9.81 (95 % CI, 4.94-19.4). Our results indicate that the individuals bearing AC genotype of E-selectin gene polymorphism (S128R) are more prone to stroke than AA genotype.

Improved Detection of Silent Atrial Fibrillation Using 72-Hour Holter ECG in Patients With Ischemic Stroke

Adequate diagnosis of atrial fibrillation (AF), including paroxysmal AF, is an important part of stroke workup. Prolonged ECG monitoring may improve the detection of paroxysmal, previously undiagnosed AF (unknown AF). Therefore, we evaluated systematic 72-hour Holter ECG monitoring to detect unknown AF for the workup of patients with stroke. Unselected survivors of a stroke or transient ischemic attack (TIA) without known AF were enrolled in a prospective, multicenter cohort study of 72-hour Holter ECG monitoring in 9 German secondary and tertiary stroke centers between May 2010 and January 2011. In addition to standardized workup of stroke pathogenesis according to the German Stroke Unit protocol, all patients underwent 72-hour Holter ECG monitoring directly after admission. All ECGs were centrally analyzed by 2 independent observers. We determined the proportion of unknown AF and compared the detection rates of 72- and 24-hour monitoring. A total of 1135 patients were enrolled (mean age, 67 years [SD, 13.1 years], 45% women, 29% TIA). Unknown AF was detected in 49 out of 1135 patients (4.3%, [95% confidence interval, 3.4-5.2%]) by 72-hour ECG monitoring. Unknown AF was diagnosed in 29 patients (2.6%) within the first 24 hours of ECG monitoring, and in 20 more patients only by 72 hours of ECG monitoring. The number needed to screen by 72-hour ECG was 55 patients (95% confidence interval [35-123]) for each additional AF diagnosis. Patients with unknown AF were significantly older and had more often a history of previous stroke. Patients with unknown AF were equally distributed within categories of pathogenesis according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. In unselected survivors of stroke or TIA, 72-hour ECG monitoring is feasible and improves the detection rate of silent paroxysmal AF.

Are 25 SNPs from the CARDIoGRAM study associated with ischaemic stroke?

The Coronary Artery Disease Genome-Wide Replication and Meta-Analysis Study (CARDIoGRAM) reported 25 single-nucleotide polymorphisms (SNPs) on 15 chromosomes to be associated with coronary artery disease (CAD) risk. Because common vascular risk factors are shared between CAD and ischaemic stroke (IS), these SNPs may also be related to IS overall or one or more of its pathogenetic subtypes. We performed a candidate gene study comprising 3986 patients with IS and 2459 control subjects. The 25 CAD-associated SNPs reported by CARDIoGRAM were examined by allelic association analysis including logistic regression. Weighted and unweighted genetic risk scores (GRSs) were also compiled and likewise analysed against IS. We furthermore considered the IS main subtypes large-vessel disease (LVD), small-vessel disease and cardioembolic stroke [according to Trial of Org 10172 in Acute Stroke Treatment (TOAST)] separately. SNP rs4977574 on chromosome 9p21.3 was associated with overall IS [odds ratio (OR) = 1.12; 95% confidence interval (CI): 1.04-1.20; P = 0.002] as well as LVD (OR = 1.36; 95% CI: 1.13-1.64; P = 0.001). No other SNP was significantly associated with IS or any of its main subtypes. Analogously, the GRSs did not show any noticeable effect. Besides the previously reported association with SNPs on chromosome 9p21, this study did not detect any significant association between IS and CAD-susceptible genetic variants. Also, GRSs compiled from these variants did not predict IS or any pathogenetic IS subtype, despite a total sample size of 6445 participants.

TOAST classification of isolated pontine infarction

Background Through the analysis of various imaging and angiography data, including computed tomography angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA), this article aims to understand the relation between pontine infarction and posterior circulation lesions, classify different types of causes of isolated pontine infarction, and compare the clinical characteristics of different classification methods. Methods Eighty-five cases with first-onset isolated pontine infarction were selected. On the basis of imaging examinations, they were divided into the following categories: vertebrobasilar large-artery disease (VLAD); basal artery branch disease (BABD); small artery disease (SAD); type of other reasons and type of uncertain causes. According to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification standard, all patients were divided into the following categories: large artery atherosclerosis (LAA), small artery occlusion (SAO), cardiac embolism (CE), stroke of other determined etiology (SOE), stroke of undetermined etiology (SUE). Results According to imaging classification, BABD was the most common type, accounting for 50.59% (43/85); SAD accounted for 28.23% (24/85); VLAD accounted for 14.12% (12/85); type of uncertain causes accounted for 7.06% (6/85); type of other reasons was not found. Based on the TOAST classification, SAO was the most common type, accounting for 67.06% (57/85); LAA accounted for 30.59% (26/85); SUE accounted for 2.35% (2/85); CE and SOE were not found. Conclusion Based on the TOAST classification, small artery occlusion is the most common etiology of isolated pontine infarction. It is favorable for formulating specific treatment to make TOAST classification based on a variety of imaging data.

The Progressive Course of Neurological Symptoms in Anterior Choroidal Artery Infarcts

Infarctions of the anterior choroidal artery affect multiple anatomical structures, leading to a wide spectrum of neurological deficits with frequent symptom fluctuation or progression. To assess etiological mechanisms, frequency, and predictors of symptom progression, as well as its impact on prognosis. Anterior choroidal artery infarct patients were prospectively identified via predefined infarct locations with ischemic lesions ≥1·5 cm vertical diameter in cerebral imaging. Definition of neurological progression was ≥2 National Institutes of Health Stroke Scale points in motor function or ≥4 in total National Institutes of Health Stroke Scale. Stroke etiology was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. We assessed demographical data, risk factors, and acute phase parameters in order to find predictors of neurological progression. Thirty patients fulfilled the inclusion criteria. Eighteen patients (60%) had neurological progression during days 1-3. Despite similar stroke severity at admission (median National Institutes of Health Stroke Scale in progressive infarcts 4·5 versus 4; P = 0·72), patients with progression had more severe deficits at day 3 (median National Institutes of Health Stroke Scale 9 vs. 3·5; P = 0·04) and worse three-month outcome. Only 31% of patients with progression scored <2 in the modified Rankin Scale compared with 89% without progression (P = 0·01) after three-months. No statistically significant differences regarding possible predictors of progression were found. Magnetic resonance imaging findings and etiological assessment suggest overlapping mechanisms of small and large vessel disease. Neurological deterioration is frequent in anterior choroidal artery infarcts and is associated with worse outcome. While mechanisms of small and large vessel disease seem to overlap in anterior choroidal artery infarction, we were not able to identify predictors of neurological progression.

Left atrial dilatation in undetermined group according to TOAST classification: echocardiographic assessment of stroke patients

To investigate the left atrial dilatation in an undetermined etiological group according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) and to evaluate the relationship between left atrial dilatation and stroke volume and localization. Materials and methods: Files of patients admitted to our hospital (2000-2010) with acute ischemic stroke diagnosis were investigated. The size of their left atrium was registered using the data from transthoracic echocardiogram. Lesion size and localization were registered using brain MRI. Stroke etiology was categorized according to TOAST classification. The relationship between left atrial dilatation and stroke volume and localization in the undetermined group was investigated. Results: It was detected that 47% patients had left atrial dilatation. A significant difference was observed in the occurrence of left atrium dilatation for the undetermined group compared to the other groups and infarct volume was found to be larger in patients having left atrial dilation (P < 0.038). Conclusion: Left atrial dilatation is an important etiological factor in the undetermined-cause group and it also affects stroke volume.

Stroke subtype predicts outcome in young and middle-aged stroke sufferers

There are few studies on long-term outcome after ischemic stroke (IS) for young and middle-aged stroke sufferers in relation to etiologic subtypes. Here, we report 2-year outcome in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). SAHLSIS comprises 600 patients with IS before the age of 70years. Etiologic subtype of IS was classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST). Recurrent vascular events and death were registered using several overlapping methods. Functional outcome was assessed according to the modified Rankin Scale (mRS). After 2years, 55 (9.2%) patients had suffered a recurrent stroke, 15 (2.5%) had a transient ischemic attack (TIA), 4 (0.7%) had a coronary event, and 24 (4.0%) had died. The number of recurrent stroke, TIA, and death differed significantly between etiologic stroke subtypes. The highest rates were observed in large-vessel disease (LVD), whereas small-vessel disease and cryptogenic stroke showed the lowest recurrence and mortality rates. LVD was a significant predictor of the composite outcome (recurrent stroke, TIA, coronary event and/or death) independently of cardiovascular risk factors and stroke severity. Stroke subtype also predicted functional outcome 2years after index stroke, but this association was not retained after adjustment for stroke severity. In young and middle-aged stroke patients, stroke subtype predicts recurrent vascular events and/or death 2years after index stroke independently of cardiovascular risk factors and stroke severity. Thus, it is important to take the etiologic subtype of IS in account when assessing the risk of recurrence both in the clinical setting and in future studies.

Changes of plasma fibrinogen level among acute ischemic stroke subtypesaccording to TOAST criteria and effects of Songling Xuemaikang

To investigate the changes of plasma fibrinogen level among acute ischemic stroke (ACI) subtypes according to Trial of Org10172 in Acute Stroke Treatment (TOAST) criteria and effects of Songling Xuemaikang. The 160 patients with acute ischemic stroke were divided into two groups randomly: treatment group 85 cases (Songling Xuemaikang + Shuxuetong + Aspirin enterie coated tablets), control group 75 cases (Shuxuetong + Aspirin enterie ccoated tablets). The plasma fibrinogen was detected before and after treatment. Compared with OC subtype, Fbg was higher in LAA, CE and SAO subtypes (P < 0.05). Compared with UE subtype, Fbg was higher in LAA, CE and SAO subtypes (P < 0.05). There was a significantly difference between LAA and SAO (P < 0.05). In LAA, SAO, CE of treatment group,the Fbg level were lowered significantly at the 15th day compared with pretherapy (P < 0.05). There was a significantly difference of Fbg between treatment group and control group In LAA, SAO and CE subtypes at the 15th day (P < 0.05). Fbg produces a marked effect at the pathomechanism of LAA, SAO and CE subtypes. Songling Xuemaikang can depress the plasma fibrinogen level of ACI, and be an effective adjunctive therapy on ACI.

Self-perceived psychological stress and ischemic stroke: a case-control study

BackgroundA growing body of evidence suggests that psychological stress contributes to coronary artery disease. However, associations between stress and stroke are less clear. In this study, we investigated the possible association between ischemic stroke and self-perceived psychological stress, as measured by a single-item questionnaire, previously reported to be associated with myocardial infarction.MethodsIn the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), 600 consecutive patients with acute ischemic stroke (aged 18 to 69 years) and 600 age-matched and sex-matched population controls were recruited. Ischemic stroke subtype was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Self-perceived psychological stress preceding stroke was assessed retrospectively using a single-item questionnaire.ResultsPermanent self-perceived psychological stress during the last year or longer was independently associated with overall ischemic stroke (multivariate adjusted odds ratio (OR) 3.49, 95% confidence interval (CI) 2.06 to 5.93). Analyses by stroke subtype showed that this association was present for large vessel disease (OR 3.91, 95% CI 1.58 to 9.67), small vessel disease (OR 3.20, 95% CI 1.64 to 6.24), and cryptogenic stroke (OR 4.03, 95% CI 2.34 to 6.95), but not for cardioembolic stroke (OR 1.48, 95% CI 0.64 to 3.39).ConclusionIn this case-control study, we found an independent association between self-perceived psychological stress and ischemic stroke. A novel finding was that this association differed by ischemic stroke subtype. Our results emphasize the need for further prospective studies addressing the potential role for psychological stress as a risk factor for ischemic stroke. In such studies ischemic stroke subtypes should be taken into consideration.