scholarly journals The relationship of leukoaraiosis, haemorrhagic transformation and prognosis at 3 months after intravenous thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction

2020 ◽  
Vol 41 (11) ◽  
pp. 3195-3200
Author(s):  
Xiaowei Liu ◽  
Jiatang Zhang ◽  
Chenglin Tian ◽  
Jun Wang
Keyword(s):  
Elderly Patients ◽  
Cerebral Infarction ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
The Elderly ◽  
Acute Cerebral Infarction ◽  
Bleeding Events ◽  
Clinical Prognosis ◽  
Haemorrhagic Transformation ◽  
The Relationship

Abstract Backgroud As the elderly stroke population continues to increase, we will have to confront greater challenges regarding how to choose suitable patients to reduce thrombolysis-related bleeding events and accurately judge their prognosis. Therefore, we evaluated the relationship among leukoaraiosis (LA), haemorrhagic transformation (HT) and the prognosis at 3 months after intravenous (IV) thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction (ACI). Methods We prospectively and consecutively chose 125 elderly patients aged ≥ 60 years with ACI who could accept and be suitable for IV recombinant tissue plasminogen activator (rtPA) after excluding 6 cases. Brain computed tomography(CT) was used to assess LA by using the modified Van Swieten scale (mVSS) before treatment and the modified Rankin scale (mRS) to appraise prognosis at 3 months after IV rtPA. Binary logistic regression was used to analyse the predictors of HT and the prognosis of ACI. Results Our data indicated that by brain CT, 26.4% of all patients showed severe LA, and the rate of HT and symptomatic intracranial haemorrhage (sICH) were 12.0% and 9.6%, respectively. Severe LA was evidently associated with HT (odds ratio [OR] 3.272, 95% confidence interval [CI] 1.010–10.598, P = 0.048) rather sICH (P > 0.05). Moreover, we also found that severe LA was associated with poor functional prognosis (OR 5.266, 95% CI 1.592–17.419, P = 0.006). Conclusion Our results showed that LA was associated with HT and adverse clinical prognosis rather sICH after IV rtPA in elderly patients aged ≥60 years with ACI. Although LA may increase the risk of bleeding but not fatal haemorrhage after IV thrombolysis, therefore, we should actively select an appropriate elderly population for thrombolytic treatment and have reasonable judgments on the outcomes.

scholarly journals Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction

2020 ◽  
Vol 48 (5) ◽  
pp. 030006051989535
Author(s):  
Fan Sun ◽  
Heng Liu ◽  
Hui-xiao Fu ◽  
Shuo Zhang ◽  
Xu-dong Qian ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Cerebral Haemorrhage ◽  
Recombinant Tissue Plasminogen Activator ◽  
Serum Levels ◽  
Acute Cerebral Infarction ◽  
Bleeding Complications ◽  
Therapeutic Effects ◽  
Clinical Trial Evidence

Objective Cerebral infarction has a poor prognosis and causes a serious burden on families and society. Recombinant tissue plasminogen activator (rt-PA) and urokinase (UK) are commonly used thrombolytic agents in the clinic. However, direct and powerful clinical trial evidence to determine the therapeutic effect of rt-PA and UK on intravenous thrombolysis is lacking. Methods In this study, 180 patients with acute cerebral infarction were treated with rt-PA or UK. The National Institutes of Health Stroke Scale (NIHSS) scores, Barthel index, bleeding complications, and biomarkers were evaluated. Results No significant differences in NIHSS or Barthel scores were found between the groups. However, UK increased the risk of intracranial haemorrhage compared with rt-PA. rt-PA had increased activity in reducing serum levels of MMP-9 than UK. Conclusion Intravenous thrombolysis with rt-PA and UK in the time window of acute cerebral infarction can achieve similar therapeutic effects, but rt-PA can further reduce the risk of cerebral haemorrhage and is relatively safer than UK.

Guidelines on intravenous thrombolysis in the treatment of acute cerebral infarction – 2021 version

2021 ◽  
Vol 84/117 (4) ◽  
Author(s):  
Jiří Neumann ◽  
Daniel Šaňák ◽  
Aleš Tomek ◽  
Michal Bar ◽  
Roman Herzig ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Intravenous Thrombolysis ◽  
Acute Cerebral Infarction

scholarly journals Effect of Comprehensive Cerebral Protection Program on Cerebral Oxygen Metabolism and Vascular Endothelial Function in Elderly Patients with Acute Cerebral Infarction

2019 ◽  
Author(s):  
Meihong ZHOU ◽  
Zhaojun HUANG
Keyword(s):  
Elderly Patients ◽  
Cerebral Infarction ◽  
Endothelial Function ◽  
Oxygen Metabolism ◽  
Acute Cerebral Infarction ◽  
Control Group ◽  
Cerebral Oxygen ◽  
Vascular Endothelial ◽  
Vascular Endothelial Function ◽  
Cerebral Oxygen Metabolism

Background: We aimed to explore the effect of comprehensive cerebral protection on cerebral oxygen metabolism and vascular endothelial function in elderly patients with acute cerebral infarction. Methods: A total of 168 elderly patients with acute cerebral infarction treated in The First Affiliated Hospital of Nanchang University, China from January 2016 to January 2018 were selected. The patients were divided into a control group and an observation group using random number method, n=84. Patients in the observation group were given comprehensive cerebral protection treatment, and patients in the control group were treated with conventional standardized treatments. The changes of cerebral oxygen metabolism, hemorheology and vascular endothelial function before and after treatment were compared between the two groups. Results: After treatment, oxygen content in arteries and internal jugular veins (Da-vO2), ofoxygen uptake fraction (OEF), Oxygen saturation (SpO2), nitric oxide (NO) were increased in both groups in comparison to before treatment, jugular venous oxygen saturation (SjvO2), brain oxygen uptake rate (ERO2), endothelin (ET), intracranial pressure (ICP), whole blood viscosity, plasma viscosity, reduced viscosity of whole blood, and hematocrit were decreased. However, the changes in the observation group were larger than those in the control group, the difference was statistically significant (P<0.05). Conclusion: The treatment of cerebral infarction in elderly patients with acute cerebral infarction can effectively improve the cerebral oxygen metabolism and vascular endothelial function and improve the blood rheology, which has important clinical value.

scholarly journals The Relationship between the Acute Confusing State and the Comorbidities of the Elderly Patient

2019 ◽  
Vol 70 (7) ◽  
pp. 2415-2419 ◽  
Author(s):  
Valeria Carmen Albu ◽  
Raluca Elena Sandu ◽  
Andreea Lili Barbulescu ◽  
Elena-Anca Tartea ◽  
Emilia Burada ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Elderly Patient ◽  
Elderly Patients ◽  
Neurological Examination ◽  
The Elderly ◽  
Cardiovascular Pathology ◽  
Wide Range ◽  
Neurology Clinic ◽  
The Relationship ◽  
Hepatic Pathology

The aim of the study was to assess the correlations between the acute confusing syndrome and different comorbidities found in a group of 126 elderly patients with this diagnosis, who were admitted to the Neurology Clinic of the Neuropsychiatry Hospital of Craiova. The main syndromes highlighted at the neurological examination were confusing, pyramidal and vestibular syndromes. The acute confusing syndrome has a multifactorial etiology, due to the wide range of comorbidities encountered in elderly patients. In our study the most frequent comorbidities were cardiovascular pathology, diabetes mellitus, dyslipidemia, cerebrovascular renal, hepatic pathology.

scholarly journals Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study

2018 ◽  
Vol 9 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Ayodele Sasegbon ◽  
Laura O’Shea ◽  
Shaheen Hamdy
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Elderly Person ◽  
Oropharyngeal Dysphagia ◽  
The Elderly ◽  
Common Source ◽  
Increased Risk ◽  
The Mean ◽  
The Relationship ◽  
New Onset

IntroductionElderly people are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are multifactorial. Our aim was to identify if sepsis is associated with OPD in the elderly during hospitalisation in the absence of known other risk factors for OPD.MethodsA hospital electronic database was searched for elderly patients (≥65 years) referred for assessment for suspected dysphagia between March 2013 and 2014. Exclusion criteria were age <65 years, pre-existing OPD or acute OPD secondary to acute intracranial event, space-occupying lesion or trauma. Data were collected on factors including age, sex, comorbidities, existing OPD, sepsis, microbiology, recovery of OPD and medication. Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.ResultsA total of 301 of 1761 screened patients referred for dysphagia assessment met the inclusion criteria. The prevalence of sepsis and subsequent OPD was 16% (51/301). The mean age was 83 years (median 81 years). The most common comorbidity was dementia (31%). The majority (84%) failed to recover swallowing during their hospital stay, 12% had complications of aspiration and 35% died. The most common source of sepsis was from the chest (55%). Other factors contributing to the risk for dysphagia included delirium (22%) and neuroactive medication (41%). However, 10% of patients had sepsis and subsequent OPD without other identified risk factors.ConclusionThe prevalence of sepsis and subsequent dysphagia is significant and should be taken into account in any elderly person in hospital with new-onset OPD without other predisposing risk factors.

Comparative study on the efficacy and safety of alteplase and urokinase in the treatment of acute cerebral infarction

2020 ◽  
pp. 1-6
Author(s):  
Hua Bao ◽  
Hao-Ran Gao ◽  
Min-Lu Pan ◽  
Lei Zhao ◽  
Hai-Bin Sun
Keyword(s):  
Treatment Group ◽  
Cerebral Infarction ◽  
Early Stage ◽  
Intravenous Thrombolysis ◽  
Acute Cerebral Infarction ◽  
Neurological Injury ◽  
Control Group ◽  
Efficacy And Safety ◽  
Time Period ◽  
And Control

BACKGROUND: Acute cerebral infarction (ACI) is a common cerebrovascular disease in clinical practice. OBJECTIVE: The present study aims to investigate the efficacy and safety of alteplase and urokinase in treating ACI. METHODS: A total of 96 patients with ACI, who were treated with alteplase and urokinase, were selected as the main subjects. Among these patients, 45 patients with ultra-early acute cerebral infarction, who received intravenous thrombolysis with RT-PA (alteplase), were included in the treatment group, while 51 patients with acute cerebral infarction, who were treated with urokinase in the same time period, were included in the control group. RESULTS: The National Institute of Health Stroke Scale (NIHSS) scores were significantly lower in the treatment group and control group (P< 0.05) at two hours, seven days and 14 days after thrombolysis, when compared to those before thrombolysis. The bleeding rate was significantly lower in the control group, when compared to the treatment group (P< 0.05). CONCLUSION: The intravenous thrombolysis with urokinase or alteplase in the ultra-early stage of acute cerebral infarction can reduce the neurological injury symptoms and effectively improve the prognosis of patients with stroke. Urokinase is lower in risk of bleeding, but better in safety, when compared to alteplase.

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