scholarly journals Serum S-100 Protein, Relationship to Clinical Outcome in Acute Stroke

1997 ◽  
Vol 34 (4) ◽  
pp. 366-370 ◽  
Author(s):  
Hagosa D Abraha ◽  
Richard J Butterworth ◽  
Philip M W Bath ◽  
Wassif S Wassif ◽  
John Garthwaite ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Barthel Index ◽  
Protein Concentration ◽  
Protein A ◽  
Haemorrhagic Stroke ◽  
Poor Clinical Outcome ◽  
Anterior Circulation ◽  
S 100

The clinical significance of serum S-100 protein, a protein released by damaged brain tissue, was assessed in patients with acute ischaemic or haemorrhagic stroke and matched controls. Serum S-100 protein concentration was significantly elevated in patients with ischaemic stroke [median (SQR): 0·27 (0·09) μg/L, n = 68] and haemorrhagic stroke [0·43 (0·23) μg/L, n = 13] compared to controls [0·11 (0·03) μg/L, n = 51, P<0·0001]. Although patients with haemorrhagic stroke had higher serum S-100 concentrations compared to patients with ischaemic stroke, this was not quite statistically significant. Serum S-100 concentrations were related to infarct size, large (total anterior circulation) infarcts concentrations having the highest [0·40 (0·22) μg/L], and small vessel (‘lacunar’) infarcts concentrations having the lowest [0·20 (0·06) μg/L, P<0·0005] concentrations. S-100 protein concentration was also significantly related to clinical outcome at three months measured using three disability and handicap scales ( n = 81): modified Barthel index ( rs=–0·285, P = 0·01), modified Rankin score ( rs = 0·313, P = 0·004) and Lindley score ( rs = 0·262, P = 0·018) with high values associated with poor clinical outcome. Similarly high values of serum S-100 protein were observed in patients who died or were discharged to an institution [median (SQR): 0·63 (0·29) μg/L and 0·37 (0·13) μg/L, respectively] compared to those who were discharged home [0·26 (0·11) μg/L, P = 0·13]. The present study suggests measurement of serum S-100 protein could be a useful prognostic marker of clinical outcome in acute stroke. Whether S-100 concentrations can be altered by therapeutic intervention in acute stroke remains to be elucidated. Indexing terms: acute stroke/serum S-100/Barthel index/Rankin scale.

Serum S-100 Protein, Relationship to Clinical Outcome in Acute Stroke

1997 ◽  
Vol 34 (5) ◽  
pp. 546-550 ◽  
Author(s):  
Hagosa D Abraha ◽  
Richard J Butterworth ◽  
Philip M W Bath ◽  
Wassif S Wassif ◽  
John Garthwaite ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Barthel Index ◽  
Protein Concentration ◽  
Protein A ◽  
Haemorrhagic Stroke ◽  
Poor Clinical Outcome ◽  
Anterior Circulation ◽  
S 100

The clinical significance of serum S-100 protein, a protein released by damaged brain tissue, was assessed in patients with acute ischaemic or haemorrhagic stroke and matched controls. Serum S-100 protein concentration was significantly elevated in patients with ischaemic stroke [median (SQR): 0·27 (0·09)μg/L, n = 68] and haemorrhagic stroke [0·43 (0·23)μg/L, n=13] compared to controls [0·11 (0·03)μg/L, n = 51, P<0·0001]. Although patients with haemorrhagic stroke had higher serum S-100 concentrations compared to patients with ischaemic stroke, this was not quite statistically significant. Serum S-100 concentrations were related to infarct size, large (total anterior circulation) infarcts concentrations having the highest [0·40 (0·22) μg/L], and small vessel (‘lacunar’) infarcts concentrations having the lowest [0·20 (0·06)μg/L, P<0·0005] concentrations. S-100 protein concentration was also significantly related to clinical outcome at three months measured using three disability and handicap scales ( n = 81): modified Barthel index ( rs=–0·285, P = 0·01), modified Rankin score ( rs = 0·313, P = 0·004) and Lindley score ( rs = 0·262, P = 0·018) with high values associated with poor clinical outcome. Similarly high values of serum S-100 protein were observed in patients who died or were discharged to an institution [median (SQR): 0·63 (0·29)μg/L and 0·37 (0·13)μg/L, respectively] compared to those who were discharged home [0·26 (0·11)μg/L, P = 0·13]. The present study suggests measurement of serum S-100 protein could be a useful prognostic marker of clinical outcome in acute stroke. Whether S-100 concentrations can be altered by therapeutic intervention in acute stroke remains to be elucidated. Indexing terms: acute stroke/serum S-100/Barthel index/Rankin scale.

scholarly journals In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

2020 ◽  
Author(s):  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
Niko Sillanpää ◽  
Sara Protto
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ordinal Logistic Regression Analysis ◽  
Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

scholarly journals Electrocardiographic Abnormalities in Hospitalized acute Cerebrovascular Events

2020 ◽  
Vol 38 (4) ◽  
pp. 166-171
Author(s):  
Abu Saleh Mohammed Sirajum Munir ◽  
Quazi Tarikul Islam ◽  
Mahmudur Rahman Siddiqui
Keyword(s):  
Hospital Mortality ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Haemorrhagic Stroke ◽  
Qt Prolongation ◽  
Stroke Patients ◽  
Ecg Changes ◽  
College Hospital ◽  
Medical College ◽  
St Depression

Background: - Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction or ischaemia. Repolarization and ischemic-like electrocardiographic (ECG) changes observed during acute phase of stroke may cause diagnostic and management dilemmas for the physicians. Aim:- The aim and objective of this study to identify the prevalence of ECG changes in acute stroke patients admitted to medicine units of Dhaka Medical College Hospital. Materials and Method: - This 6-month period observational study was carried out among 100 of acute stroke patients admitted in different medicine wards of Dhaka Medical College Hospital (DMCH). ECG was done in all patients after their admission to hospital within 48 hours of developing their symptoms. Association of various types of ECG changes were identified and observed. Results: - Among 100 patients,55% had ischaemic stroke and 45% had haemorrhagic stroke. 43.63% aged between 61-70 years had ischaemic stroke and 28.28% aged between 61-80 years had haemorrhagic stroke. Female had higher frequency of ischaemic stroke 52.72% and male had higher frequency of haemorrhagic stroke 75.56%. Abnormal ECG found 84.44% in haemorrhagic stroke and 54.54% in ischaemic stroke. Of all abnormal ECG, ST depression is most frequent and 42.22% in haemorrhagic stroke, T inversion is next 20% in ischaemic stroke, AF is present in 18.18% in ischaemic stroke and QT prolongation is found in 17.77% in hemorrhagic stroke. There considerable variation of ECG changes according to CT scan evidence of particular area of brain involvement like ST depression (28.88%) found in gangliothalamic bleed in haemorrhagic stroke, AF is found (16.36%) in insular area involvement in ischaemic stroke, T inversion is more (12.72%) in large MCA territory infarctive stroke and QT prolongation (11.11%) is found in intracerebral haemorrhage including SAH. Predictable early in hospital mortality is associated with AF 37.5% and with QT prolongation 31.25%. Conclusion:- In haemorrhagic stroke the ECG abnormalities were more frequent then in ischaemic stroke. The most common abnormalities were ST depression, T wave inversion, AF and QT prolongation. AF and QT prolongation has association of early in hospital mortality. J Bangladesh Coll Phys Surg 2020; 38(4): 166-171

scholarly journals Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: A prospective analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261080
Author(s):  
Laura Sánchez-Cirera ◽  
Saima Bashir ◽  
Adina Ciscar ◽  
Carla Marco ◽  
Verónica Cruz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Haemorrhagic Stroke ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Stroke Subtype ◽  
Cross Sectional ◽  
Stroke Subtypes ◽  
Artery Disease

Background and purpose The Frank’s sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank’s sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. Methods Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank’s sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. Results The Frank’s sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p<0.05). A similar prevalence was found in the different ischaemic stroke subtypes. The Frank’s sign was significantly associated with age, particularly in patients older than 70 who had vascular risk factors. Atherosclerotic plaques found in carotid ultrasonography were significantly more frequent in patients with the Frank’s sign (63.6%, p<0.05). Analysing the ESUS, we also found an association with age and a higher prevalence of the Frank’s sign in patients with vascular risk factors and a tendency to a high prevalence of atherosclerosis markers. Conclusion The Frank’s sign is prevalent in all aetiopathogenic ischaemic stroke subtypes, including ESUS, where it could be helpful in suspecting the underlying cardioembolic or atherothrombotic origin and guiding the investigation of atherosclerosis in patients with ESUS and the Frank’s sign.

Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization – When “tissue clock” and “time clock” are desynchronized

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Jawed Nawabi ◽  
Fabian Flottmann ◽  
Andre Kemmling ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Water Uptake ◽  
Quantitative Imaging ◽  
Receiver Operating Curve ◽  
Imaging Biomarker ◽  
Poor Clinical Outcome ◽  
Similar Time ◽  
Poor Outcome ◽  
Malignant Infarction

Background Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction. Aims We hypothesized that early-elevated lesion water uptake indicates accelerated “tissue clock” desynchronized with “time clock” and therefore predicts poor clinical outcome despite successful recanalization. Methods Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0–4 and mRS 5–6. Results Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0–4 was lower compared to patients with mRS 5–6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72). Conclusions Quantitative NWU may serve as an indicator of “tissue clock” and pronounced early brain edema with elevated NWU might suggest a desynchronized “tissue clock” with real “time clock” and therefore predict futile recanalization with poor clinical outcome.

scholarly journals Susceptibility vessel sign as a predictor for recanalization and clinical outcome in acute ischaemic stroke: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Si Zhao Tang ◽  
Jon Sen
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Qualitative Synthesis ◽  
Poor Clinical Outcome ◽  
Significant Difference ◽  
Quantitative Synthesis

AbstractT2*-weighted MRI using GRE and SWI sequences can potentially prognosticate the recanalization rate and clinical outcomes in patients with acute ischaemic stroke, using susceptibility vessel sign (SVS) and prominent hypointense vessel sign (PHVS).A literature search on PubMed, EMBASE databases and other sources from inception up to 01 February 2020 was conducted. 15 studies which reported SVS and PHVS were included in qualitative synthesis. 9 studies on SVS were included in quantitative synthesis i.e. meta-analysis.Meta-analysis did not show any significant difference in the recanalization rate between SVS (+) group and SVS (-) group (RR = 0.95, 95% CI = 0.87–1.05, p = 0.33). Treatment subgroup analysis (intravenous thrombolysis, IVT- or mechanical thrombectomy, MT-only) does not show significant association between the SVS and IVT-only (RR = 0.73, 95% CI = 0.51-1.05, P=0.09); or MT-only groups (RR = 0.99, 95% CI = 0.90-1.09, P=0.90). No significant association between poor clinical outcome at 3 months and presence of SVS (RR = 1.42, 95% CI = 0.79–2.57, p = 0.24). Treatment subgroup analysis revealed significant association of the SVS and poor clinical outcome at 3 months in the MT-only (RR = 0.67, 95% CI = 0.55–0.82, p = 0.0001) or no thrombolytic treatment (RR = 2.83, 95% CI = 1.69-4.75, p < 0.0001).In conclusion, there is a significant association between the presence of SVS and poor clinical outcome in patients who underwent MT or without treatment, and no definitive association between the presence of SVS and recanalization rate for acute ischemic stroke.

scholarly journals Favorable revascularization therapy in patients with ASPECTS ≤ 5 on DWI in anterior circulation stroke

2017 ◽  
Vol 10 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Isabelle Mourand ◽  
Eitan Abergel ◽  
Daniel Mantilla ◽  
Xavier Ayrignac ◽  
Tzvika Sacagiu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Control Group ◽  
Anterior Circulation ◽  
Malignant Infarction ◽  
Baseline Characteristics ◽  
Revascularization Therapy ◽  
Favorable Clinical Outcome

BackgroundA low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke.ObjectiveTo evaluate the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct.MethodsWe retrospectively analyzed 108 consecutive patients presenting low ASPECTS on diffusion-weighted imaging. Sixty patients were treated by mechanical thrombectomy, including 34 patients who received simultaneously intravenous thrombolysis. A control group of 48 patients not eligible for reperfusion therapy gave us a perspective on the natural history. Clinical outcome was evaluated at 90 days using the modified Rankin Scale (mRS) score. Hemicraniectomy after malignant infarction, mortality, and symptomatic intracranial haemorrhage (sICH) were also reported.ResultsThrombolysis in Cerebral Infarction 2b–3 was assessed in 75% of treated patients. Reperfusion therapy led to significantly reduced disability (mRS score 0–2) at 90 days compared with the control group (30% vs 2.1%, p<0.001), hemicraniectomy (3.3% vs 22.9%, p=0.002), and death at 90 days (25% vs 47.9%, p=0.01). The sICH level was similar in treated patients and in the control group (p=0.78). Patients aged ≤70 years in the thrombectomy group had a significantly better clinical outcome than older patients (37.5% vs 10%, p=0.02), regardless of baseline characteristics or recanalization rate.ConclusionsIn patients with acute stroke in the anterior circulation and ASPECTS ≤5 revascularization therapy contributes to a favorable clinical outcome at 90 days, especially in patients younger than 70 years.

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