Kidney Function and White Matter Disease in Young Stroke Patients

ABSTRACTBackground:Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms.Methods:A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models.Results:None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88–2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85–2.20), p = 0.19), deep white matter (RR = 1.16 (0.85–1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81–2.22), p = 0.25), or the volume of lacunes (MD = −4.71 (−351.59–342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (−1.57–3.48), p = 0.46).Conclusions:The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.

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Study of lipid profile of diabetic and nondiabetic young stroke patients

Medpusle International Journal of Medicine ◽

10.26611/10211122 ◽

2019 ◽

Vol 11 (2) ◽

pp. 68-72

Author(s):

S P Toshniwal ◽

◽

S Yadav ◽

A Dhakne ◽

A Khan ◽

...

Keyword(s):

Lipid Profile ◽

Stroke Patients ◽

Young Stroke

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Glia-Specific Activation of All Pathways of the Unfolded Protein Response in Vanishing White Matter Disease

Journal of Neuropathology & Experimental Neurology ◽

10.1097/01.jnen.0000228201.27539.50 ◽

2006 ◽

Vol 65 (7) ◽

pp. 707-715 ◽

Cited By ~ 77

Author(s):

Barbara van Kollenburg ◽

Jantine van Dijk ◽

James Garbern ◽

Adri A. M. Thomas ◽

Gert C. Scheper ◽

...

Keyword(s):

White Matter ◽

Unfolded Protein Response ◽

White Matter Disease ◽

Unfolded Protein ◽

Vanishing White Matter Disease ◽

The Unfolded Protein Response ◽

Protein Response ◽

Vanishing White Matter

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Risk factors and mechanisms of stroke in young adults: The FUTURE study

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x17707138 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1631-1641 ◽

Cited By ~ 10

Author(s):

Mayte E van Alebeek ◽

Renate M Arntz ◽

Merel S Ekker ◽

Nathalie E Synhaeve ◽

Noortje AMM Maaijwee ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Future Study ◽

The Elderly ◽

Classification Systems ◽

Unknown Etiology ◽

Stroke Patients ◽

Young Stroke ◽

Starting Point ◽

The Future

Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30–40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as “unknown etiology”. Risk factors of 656 young stroke patients (aged 18–50) of the FUTURE study were categorized according to the “International Pediatric Stroke Study” (IPSS), with stratification on gender, age and stroke of “unknown etiology”. Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as “stroke of unknown etiology” using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly . This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.

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Increased serum QUIN/KYNA is a reliable biomarker of post-stroke cognitive decline

Molecular Neurodegeneration ◽

10.1186/s13024-020-00421-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Adrien Cogo ◽

Gabrielle Mangin ◽

Benjamin Maïer ◽

Jacques Callebert ◽

Mikael Mazighi ◽

...

Keyword(s):

White Matter ◽

Cerebral Artery ◽

Quinolinic Acid ◽

Neuronal Death ◽

Artery Occlusion ◽

Serum Biomarkers ◽

Diabetic Mice ◽

Stroke Patients ◽

Cerebral Artery Occlusion

Abstract Background Strokes are becoming less severe due to increased numbers of intensive care units and improved treatments. As patients survive longer, post-stroke cognitive impairment (PSCI) has become a major health public issue. Diabetes has been identified as an independent predictive factor for PSCI. Here, we characterized a clinically relevant mouse model of PSCI, induced by permanent cerebral artery occlusion in diabetic mice, and investigated whether a reliable biomarker of PSCI may emerge from the kynurenine pathway which has been linked to inflammatory processes. Methods Cortical infarct was induced by permanent middle cerebral artery occlusion in male diabetic mice (streptozotocin IP). Six weeks later, cognitive assessment was performed using the Barnes maze, hippocampi long-term potentiation using microelectrodes array recordings, and neuronal death, white matter rarefaction and microglia/macrophages density assessed in both hemispheres using imunohistochemistry. Brain and serum metabolites of the kynurenin pathway were measured using HPLC and mass fragmentography. At last, these same metabolites were measured in the patient’s serum, at the acute phase of stroke, to determine if they could predict PSCI 3 months later. Results We found long-term spatial memory was impaired in diabetic mice 6 weeks after stroke induction. Synaptic plasticity was completely suppressed in both hippocampi along with increased neuronal death, white matter rarefaction in both striatum, and increased microglial/macrophage density in the ipsilateral hemisphere. Brain and serum quinolinic acid concentrations and quinolinic acid over kynurenic acid ratios were significantly increased compared to control, diabetic and non-diabetic ischemic mice, where PSCI was absent. These putative serum biomarkers were strongly correlated with degradation of long-term memory, neuronal death, microglia/macrophage infiltration and white matter rarefaction. Moreover, we identified these same serum biomarkers as potential predictors of PSCI in a pilot study of stroke patients. Conclusions we have established and characterized a new model of PSCI, functionally and structurally, and we have shown that the QUIN/KYNA ratio could be used as a surrogate biomarker of PSCI, which may now be tested in large prospective studies of stroke patients.

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Progressive white matter disease in Sjögren’s syndrome

Rheumatology ◽

10.1093/rheumatology/keaa628 ◽

2020 ◽

Author(s):

Yung-Wen Cheng ◽

Hsiang-Cheng Chen ◽

Sin-Yi Lyu ◽

Yao-Feng Li ◽

Chun-Chi Lu

Keyword(s):

White Matter ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

White Matter Disease ◽

Sjögren‘S Syndrome

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Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BMC Neurology ◽

10.1186/s12883-021-02125-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenjuan Xu ◽

Xiaoyu Zhang ◽

Huan Chen ◽

Zhangning Zhao ◽

Meijia Zhu

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Risk Factor ◽

Factor Score ◽

Unfavorable Outcome ◽

Stroke Patients ◽

Young Stroke ◽

Stroke In Young Adults ◽

Risk Factor Score ◽

Stroke In Young

Abstract Background Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations. Methods Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome. Results Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome. Conclusions Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

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