The impact of recanalization on ischemic stroke outcome: A clinical case presentation

Abstract BackgroundThe outbreak of a novel coronavirus since December 2019 in Wuhan, became an emergency of major international concern. As of March 5, 2020, the SARS-CoV-2 epidemic has caused 80,565 confirmed infections with 3,015 fatal cases in China. The SARS-CoV-2 outbreak is a major challenge for clinicians. In our clinic, we found a rare case that a COVID-19 patient combined with ischemic stroke.Case PresentationA 79-year-old man was admitted to the Hubei Provincial Hospital of Chinese Traditional Medicine due to right limb weakness for 1 day and slight cough for 1 week. At presentation, his body temperature was 37.3°C (99.0°F) with some moist rales. Neurological examination showed right limb weakness, and the limb muscle strength was grade 4. The left leg and arms were unaffected. In addition, runs of speech were not fluent enough with tongue deviation. Laboratory studies showed lymphopenia and eosinophilic granulocytopenia. Chest CT revealed bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, with a peripheral lung distribution. Real-time polymerase chain reaction (RT-PCR) from throat swab sample was positive for SARS-CoV-2 nucleic acid. This patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care until his discharge. Clopidogrel (75 mg) and atorvastatin (20 mg) were administered orally to treat acute ischemic stroke. After twelve days of treatment, he can walk normally and communicate with near fluent language.ConclusionWe report an even more unusual case, a patient who was hospitalized for right limb weakness and was later diagnosed with COVID-19. Here, SARS-CoV-2 infection caused hypoxemia and excessive secretion of inflammatory cytokines, which contribute to the occurrence and development of ischemic stroke. Once COVID-19 patients show acute ischemic stroke, neurologists should cooperate with infectious disease doctors to help patients.

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The Impact of Recanalization on Ischemic Stroke Outcome

Stroke ◽

10.1161/01.str.0000258112.14918.24 ◽

2007 ◽

Vol 38 (3) ◽

pp. 967-973 ◽

Cited By ~ 936

Author(s):

Joung-Ho Rha ◽

Jeffrey L. Saver

Keyword(s):

Ischemic Stroke ◽

Stroke Outcome ◽

The Impact

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The impact of native leptomeningeal collateralization on rapid blood flow recruitment following ischemic stroke

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x20941265 ◽

2020 ◽

Vol 40 (11) ◽

pp. 2165-2178

Author(s):

Atsushi Kanoke ◽

Yosuke Akamatsu ◽

Yasuo Nishijima ◽

Eric To ◽

Chih C Lee ◽

...

Keyword(s):

Blood Flow ◽

Ischemic Stroke ◽

Independent Predictor ◽

Mouse Strains ◽

Collateral Flow ◽

Stroke Outcome ◽

Slight Improvement ◽

Cortical Stroke ◽

The Impact ◽

Cortical Perfusion

The leptomeningeal collateral status is an independent predictor of stroke outcome. By means of optical coherent tomography angiography to compare two mouse strains with different extent of native leptomeningeal collateralization, we determined the spatiotemporal dynamics of collateral flow and downstream hemodynamics following ischemic stroke. A robust recruitment of leptomeningeal collateral flow was detected immediately after middle cerebral artery (MCA) occlusion in C57BL/6 mice, with continued expansion over the course of seven days. In contrast, little collateral recruitment was seen in Balb/C mice during- and one day after MCAO, which coincided with a greater infarct size and worse functional outcome compared to C57BL/6, despite a slight improvement of cortical perfusion seven days after MCAO. Both strains of mice experienced a reduction of blood flow in the penetrating arterioles (PA) by more than 90% 30-min after dMCAO, although the decrease of PA flow was greater and the recovery was less in the Balb/C mice. Further, Balb/C mice also displayed a prolonged greater heterogeneity of capillary transit time after dMCAO in the MCA territory compared to C57BL/6 mice. Our data suggest that the extent of native leptomeningeal collaterals affects downstream hemodynamics with a long lasting impact in the microvascular bed after cortical stroke.

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Faculty Opinions recommendation of Commensal microbiota affects ischemic stroke outcome by regulating intestinal γδ T cells.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726248274.793520588 ◽

2016 ◽

Author(s):

Martin Schwab

Keyword(s):

T Cells ◽

Ischemic Stroke ◽

Γδ T Cells ◽

Stroke Outcome ◽

Commensal Microbiota

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Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

Current Drug Therapy ◽

10.2174/1574885515666191227155624 ◽

2020 ◽

Vol 15 (4) ◽

pp. 420-422

Author(s):

Dhruvkumar M. Patel ◽

Mukundkumar V. Patel ◽

Jayanti K. Gurumukhani ◽

Maitri M. Patel ◽

Himal J. Mahadevia ◽

...

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Neurological Deficit ◽

Clinical Case ◽

Complete Recovery ◽

Acute Onset ◽

Diabetic Patients ◽

Focal Neurological Deficit ◽

Random Blood Sugar ◽

Resident Doctor

Background: Hypoglycemia may rarely present as hemiparesis and sometimes it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 80 mg % in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy. Clinical Case: A 58-year-old male, who was a known case of diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. Resident doctor not aware of previous sugar repeated RBS before thrombolysis which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25 % dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld. : In Diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.

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The impact of antihypertensive use in the treatment of acute ischemic stroke in patients receiving alteplase

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.07.037 ◽

2021 ◽

Author(s):

Megan A. Rech ◽

Elisabeth Donahey ◽

Joshua M. DeMott ◽

Laura L. Coles ◽

Gary D. Peksa

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

The Impact

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A case series of ischemic stroke with coronavirus disease 2019 in two Egyptian centers

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00259-z ◽

2020 ◽

Vol 56 (1) ◽

Author(s):

Nevine El Nahas ◽

Tamer Roushdy ◽

Eman Hamid ◽

Sherien Farag ◽

Hossam Shokri ◽

...

Keyword(s):

Ischemic Stroke ◽

Severe Acute Respiratory Syndrome ◽

Cerebrovascular Disorders ◽

Case Series ◽

Neurological Manifestations ◽

Case Presentation ◽

Novel Virus

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that has been reported to have various neurological manifestations. Cerebrovascular disorders have been encountered as a coronavirus disease 2019 (COVID-19) presentation in our center during the pandemic. Case presentation We are presenting 10 cases with cerebrovascular manifestations after having COVID-19 few days prior to stroke. Conclusion Cerebrovascular manifestations can occur in association with COVID-19 and may have significant implications on prognosis and management.

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Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

BMC Neuroscience ◽

10.1186/s12868-021-00610-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shuhong Yu ◽

Yi Luo ◽

Tan Zhang ◽

Chenrong Huang ◽

Yu Fu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Odds Ratio ◽

Poor Outcome ◽

Net Reclassification Improvement ◽

Potential Biomarker ◽

The Impact ◽

The Relationship ◽

Integrated Discrimination Improvement

Abstract Background It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients. Methods A total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission. Results As EMR decreased, the risk of poor outcome increased (p < 0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.09; 95% CI 0.03–0.34; p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend < 0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 2.61%, p = 0.382; integrated discrimination improvement: 2.41%, p < 0.001). Conclusions EMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

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