Evaluating the Role of Oxidative Stress in Acute Ischemic Stroke

Abstract Background The role of oxidative stress in neuronal injury due to ischemic stroke has been an interesting topic in stroke research. Malondialdehyde (MDA) has emerged as a sensitive oxidative stress biomarker owing to its ability to react with the lipid membranes. Total antioxidant power (TAP) is another biomarker to estimate the total oxidative stress in stroke patients. We aimed to determine the oxidative stress in acute stroke patients by measuring MDA and TAP. Materials and Methods MDA and TAP were determined in 100 patients with ischemic stroke and compared with that in 100 age- and sex-matched healthy adults. Demographic data, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), and disability measured by the Barthel index (BI) were recorded. The association of MDA and TAP with other variables was analyzed by paired t-test. Results Of the whole sample, 74% represented males. The mean NIHSS score was 13.11 and BI was 38.87. MDA was significantly higher in stroke patients (7.11 ± 1.67) than in controls (1.64 ± 0.82; p = 0.00). TAP was significantly lower in stroke patients (5.72 ± 1.41) than in controls (8.53 ± 2.4; p = 0.00). The lipid profile and blood sugar levels were also significantly higher in stroke patients. There was no association of MDA and TAP with other variables. Conclusion We found that oxidative stress was associated with acute ischemic stroke. However, we could not establish an association between oxidative stress and the severity of acute stroke.

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Role of Interleukin-6 Correlated to C. pneumoniae Infection as a Biomarker for Prediction of Stroke Severity in Young Patients with Acute Ischemic Stroke

Asian Journal of Neuroscience ◽

10.1155/2014/649106 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

M. V. Padma Srivastava ◽

Ashu Bhasin ◽

Rama Chaudhry ◽

Sakshi Sharma ◽

S. Vivekanandhan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Interleukin 6 ◽

Sandwich Elisa ◽

Stroke Severity ◽

Causative Role ◽

Stroke Patients ◽

Blood Samples ◽

Acute Cerebral Ischemia

Background. Stroke in young is the leading cause of morbidity and mortality in the Indian subcontinent with a reported incidence of 15–30% of all stroke patients. The mechanisms for stroke in the young may include unconventional risk factors such as infections. Causative role of C. pneumoniae infection in patients with acute ischemic stroke (AIS) remains unresolved till date, although the link between C. pneumoniae and cerebrovascular disease has been investigated in many studies. This study examined the upregulation of IL-6 after acute cerebral ischemia and correlated the same with the C. pneumoniae antibody titres (IgG, IgA, and IgM). Methods. We studied blood samples from eighty (n=80) acute stroke patients and healthy age- and sex-matched controls. Venous blood samples were drawn within one week from the onset of stroke. Detection of IgA, IgG, and IgM antibodies to C. pneumoniae was done with a validated microimmunofluorescence (MIF) technique from 5 mL of serum in all subjects. Interleukin-6 was estimated with sandwich ELISA method. Results. The IL-6 levels were elevated in patients with a mean 28.9 ± 8.6 pg/mL as compared to 4.7 + 1.8 pg/mL in healthy age-matched controls (95% CI: 37.7 to 78.4; P=0.004). On correlation of IL-6 to stroke severity, it was found that 30 patients with NIHSS between 0 and 15 had mean IL-6 of 24.6 pg/mL and 50 patients had NIHSS of 18.8 (severely affected) with a mean IL-6 of 43.8 pg/mL. On multivariate analysis after adjusting for sex, hypertension, diabetes mellitus, smoking, and alcohol, the IgA seropositivity yielded an adjusted OR for stroke (4.72; 95% CI: 1.61, 13.83; P=0.005), while IgG seropositivity did not show a statistically significant result. We also observed that 81% of cases were seropositive for IgA versus 32% of controls (P=0.003) followed by IgG, as 52.7% of cases were seropositive versus 17.3% of controls (P=0.05). Multiple regression analysis was done with IL-6 as dependent variable to antibody with IL-6 as dependent variable to Cp-IgA, Cp-IgG, and IgM with 10.4% change in the IL-6 titres showing statistical significant result F(4,115) = 3.32, P=0.01. Conclusions. IL-6 has important role after acute ischemic stroke and is correlated with stroke severity and may correlate to acute or chronic infectious states with C. pneumonia.

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Neutrophil to lymphocyte ratio, stroke severity and short term clinical outcomes in acute ischemic stroke

Neurology Asia ◽

10.54029/2021cmz ◽

2021 ◽

Vol 26 (3) ◽

pp. 479-484

Author(s):

Ilkin Iyigundogdu ◽

Eda Derle ◽

Seda Kibaroglu ◽

Ufuk Can

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neutrophil To Lymphocyte Ratio ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Short Term ◽

Lymphocyte Ratio ◽

Potential Indicator

Background: Neutrophil to lymphocyte ratio is an easily evaluated systemic inflammation indicator. However, there are limited reports on neutrophil to lymphocyte ratio and functional outcome in ischemic stroke. In this study, we aimed to evaluate the association of neutrophil to lymphocyte ratio and stroke severity, short term functional outcomes and mortality in patients with acute ischemic stroke. Methods: The clinical data of patients who were > 18 age-old and hospitalized with acute ischemic stroke in Baskent University Hospital, Ankara, Turkey between January 2018 and May 2019 were studied retrospectively. Neutrophil to lymphocyte ratio were measured. The neutrophil to lymphocyte ratio and National Institute of Health Stroke Scale (NIHSS) score at admission, mortality during hospitalization and Modified Rankin Scale (mRS) score at discharge of the patients with acute ischemic stroke were correlated. Results: Among the acute ischemic stroke patients due to the exclusion criteria, the data of 134 patients were evaluated. Median age of the patients were 76± 12.5 years and 82 patients (61.2%) were male. The median NIHSS scores of the patients at admission was 5±4.5. Mortality during the hospitalization was seen in 8 patients (6%). The median neutrophil to lymphocyte ratio value of the patients at admission were found to be 2.6±3.4. Neutrophil to lymphocyte ratio and NIHSS scores of the patients at admission, duration of the hospitalization, mRS scores at discharge and mortality during hospitalization were found to be positively correlated. Conclusion: Neutrophil to lymphocyte ratio is a simple and easily measured marker and can be used as a potential indicator for prognosis in acute ischemic stroke. However further prospective multicenter investigations are required to confirm the role of neutrophil to lymphocyte ratio for predicting the prognosis in acute ischemic stroke patients.

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Abstract WP51: Neurological Severity and Infarct Size in Patients With Acute Ischemic Stroke During DOAC Treatment for Nonvalvular Atrial Fibrillation

Stroke ◽

10.1161/str.48.suppl_1.wp51 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yo Shibata ◽

Asako Nakamura ◽

Masahiro Yasaka ◽

Takahiro Kuwashiro ◽

Seiji Gotoh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Infarct Size ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Anticoagulant Therapy ◽

Therapeutic Range ◽

Control Group ◽

Stroke Severity ◽

Stroke Patients

Background and purpose: Less severe and smaller infarct are features in acute stroke patients treated with warfarin within a therapeutic range of PT-INR than in those without. But it remains unclear the severity and size of infarct in acute stroke patients treated with direct oral anticoagulants [DOAC]. We investigated the features of acute stroke in patients treated with DOAC, warfarin or without. Methods: We enrolled consecutive 190 non-valvular atrial fibrillation patients (mean age 78; 63% male) who developed acute ischemic stroke and classified them into 4 groups, 109 patients with no anticoagulant therapy [Control group], 25 patients with DOAC therapy [DOAC group], 19 patients treated with warfarin within a therapeutic range of PT-INR [>= 1.6 in patients aged 70 years old or older, >= 2.0 in those aged younger than 70 years old, Warfarin well controlled group], and 37 patients treated with warfarin with subtherapeutic PT-INR values [Warfarin not controlled group]. Infarcts sizes were defined as the maximum diameter of infarct, using the brain MRI diffusion-weighted image. Stroke severity on admission were assessed by the National Institutes of Health Stroke Scale[NIHSS].We compared them among the groups. Results: There were no significant differences in preadmission CHADS2 score among the 4 groups. The median infarct size were 31mm (interquartile (IQR) 13-59) in the control group, 10mm (IQR 7.4-38) in the DOAC group, 12mm (IQR 8.0-45) in the warfarin well controlled group, and 24mm (IQR 13-67) in the warfarin not controlled group. The size of infarct was significantly smaller in the DOAC group than the control group (P=0.01). The NIHSS on admission was 4 ([IQR] 2-15) in the control group, 2 (1-6) in the DOAC group, 4 (1-17) in the warfarin well controlled group and 5 (3-17) in e warfarin not controlled group. Stroke severity on admission was also more favorable in the DOAC group when compared with the control group (P=0.03) Conclusions: Smaller and less severe infarct may be feature of acute ischemic stroke during DOAC therapy when compared to that without any anticoagulant therapy.

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Blood biomarkers for stroke: the role of thioredoxin in diagnosis and prognosis of acute ischemic stroke

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0122-7 ◽

2019 ◽

Vol 56 (1) ◽

Author(s):

Mohammed I. Oraby ◽

Radwa A. Rabie

Keyword(s):

Oxidative Stress ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Solid Phase ◽

Oxidative Stress Marker ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Stroke Severity ◽

Diagnosis And Prognosis

Abstract Background Oxidative stress plays a crucial role in the pathophysiology of acute ischemic stroke. Thioredoxin exists and released from cells during inflammation and oxidative stress and was recognized as an oxidative-stress marker. Objective The objective of this study was to assess the role of thioredoxin as an oxidative stress biomarker in diagnosis and prognosis of acute ischemic stroke in a sample of patients recruited from Beni-Suef Governorate, north Upper Egypt. Methods A case control study included 100 subjects; 50 patients with first-ever acute ischemic stroke presented within 24 h from the onset and 50 healthy volunteers as a control. Clinical, functional, and radiological evaluation was done for the patients, and all patients and control were subjected to routine laboratory tests and assessment of serum level of thioredoxin by solid-phase sandwich enzyme-linked immunosorbent assay. Results Thioredoxin was significantly higher in acute stroke patients compared to control group (p value = 0.001). Thioredoxin level was significantly higher in hypertensive patients (p value = 0.007), patients who had carotid stenosis ≥50% (p value = 0.001), patients with poor outcome (p value = 0.009), and in patients with cardio-embolic stroke (p value = 0.001). Significant positive correlation was found between thioredoxin level and volume of infarction (r = 0.501 and p = 0.001), stroke severity at presentation (r = 0.503 and p = 0.021) and clinical outcome after 3 months (r = 0.551 and p value = 0.001). Conclusion Thioredoxin as a marker of oxidative stress can be used as a new diagnostic and prognostic blood biomarker for stroke.

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Prestroke statin use enhances collateralization in acute ischemic stroke patients

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201012 ◽

2020 ◽

Vol 38 (4) ◽

pp. 311-321

Author(s):

Jiaying Zhu ◽

Mengmeng Ma ◽

Jinghuan Fang ◽

Jiajia Bao ◽

Shuju Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Statin Therapy ◽

Cerebral Artery ◽

Functional Outcomes ◽

Collateral Circulation ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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Role of some inflammatory biomarkers in prediction of short-term outcome in acute ischemic stroke

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00294-4 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Yosria Abd Al Hameed AlTaweel ◽

Rania Sanad Nageeb ◽

Pakinam Mahmoud Metwally ◽

Ahmed Elsayed Badawy

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Severity ◽

Short Term ◽

Laboratory Assessment ◽

Term Outcome ◽

Neutrophil Lymphocyte Ratio ◽

Short Term Outcome ◽

Wbc Count

Abstract Background Several factors affect acute ischemic stroke (AIS) outcomes. Objective This study aimed to assess the role of the leukocyte count, neutrophil/lymphocyte ratio (NLR), and c reactive protein (CRP) as early predictors of outcome in AIS patients. Methods This study was conducted on 60 AIS patients. They were subjected to detailed history taking, clinical examination, brain imaging, and laboratory assessment including the CRP, white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and NLR which is calculated by dividing ANC by ALC. Neurological scales were used to assess the level of consciousness by the Glasgow Coma Scale (GCS) and stroke severity by the National Institute of Health Stroke Scale (NIHSS) at the first 48 h of stroke onset as well as 1 week and 2 weeks later for the assessment of short-term functional neurological outcome. Results Sixty percent of the patients had unfavorable outcomes assessed by the Modified Rankin Scale (mRS). Patients with unfavorable outcomes had higher NIHSS scores. NLR was positively correlated with WBC count, ANC, and CRP. The higher WBC, NLR, and NIHSS, the unfavorable the outcome was. Conclusion The higher WBC, the NLR, and the level of CRP at the onset of AIS, the more severe stroke and the poorer the short-term outcome are expected.

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Association of Anemia with Stroke Severity in Acute Ischemic Stroke Patients

Cureus ◽

10.7759/cureus.2870 ◽

2018 ◽

Author(s):

Muhammad F Khan ◽

Ibrahim Shamael ◽

Qamar Zaman ◽

Asad Mahmood ◽

Maimoona Siddiqui

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Severity ◽

Stroke Patients

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Role of Monitoring in Management of Acute Ischemic Stroke Patients

Stroke ◽

10.1161/01.str.0000094423.34841.bb ◽

2003 ◽

Vol 34 (11) ◽

pp. 2599-2603 ◽

Cited By ~ 76

Author(s):

Anna Cavallini ◽

Giuseppe Micieli ◽

Simona Marcheselli ◽

Silvana Quaglini

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients

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Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.10 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Amy K Starosciak ◽

Italo Linfante ◽

Gail Walker ◽

Osama O Zaidat ◽

Alicia C Castonguay ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Predictive Power ◽

Rescue Therapy ◽

Univariate Analysis ◽

Stroke Patients ◽

Good Outcome ◽

Poor Outcome

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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