scholarly journals GFAP and S100B Protein are Associated with Discharged NIHSS of Anterior Circulation Ischemic Stroke

2012 ◽  
Vol 4 (2) ◽  
pp. 112
Author(s):  
Yenny Surjawan ◽  
Suryani As'ad ◽  
Teguh A S Ranakusuma ◽  
Andi Wijaya
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Lesion Size ◽  
Brain Cell ◽  
S100b Protein ◽  
Size Measurement ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Stroke Diagnosis ◽  
Additional Approach

BACKGROUND: Patient with larger ischemic lesion will suffer more severe neurogical deficit. The utility of MRI for lesion size measurement is still limited, therefore additional approach was pursued through examination of markers released by damaged brain cell, GFAP and S100B protein. The aim of this study is to know whether both markers are associated with the neurological deficit of anterior circulation ischemic stroke. METHODS: This observational prospective study enrolled 74 patients with anterior circulation ischemic stroke diagnosis. GFAP and S100B protein were measured with ELISA using blood collected at 48 to 72 hours after onset. The neurological deficit was assessed with NIHSS ad discharged.RESULTS: There was a significant association between GFAP level and discharged NIHSS (p=0.008) with 100% sensitivity and 100% negative predictive value. S100B protein also showed a significant correlation with discharged NIHSS (r=0.488; p=0.000) and this correlation could be described with an equation (OR=1.009; 95% CI=1.0003-1.0188; p=0.044). S100B protein at 78.3215 ng/L would give true prediction as 73.9% (95% CI=62.7%-85.2%, p=0.001). CONCLUSIONS: GFAP and S100B protein that were measured at 48 to 72 hours after onset were significantly associated with NIHSS at discharge. KEYWORDS: GFAP, S100B protein, discharged NIHSS, ischemic stroke

Abstract W P17: Factors Associated With DWI Lesion Growth After Endovascular Therapy for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shumei Man ◽  
M. Shazam Hussain ◽  
Dolora Wisco ◽  
Esteban Cheng-ching ◽  
Toshiya Osanai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Cleveland Clinic ◽  
Antiplatelet Agents ◽  
Lesion Size ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Large Growth

Background: The factors impacting infarct evolution after intra-arterial(IA) intervention for acute ischemic stroke remain uncertain. We studied the infarct evolution on MRI DWI among acute stroke patients who underwent IA therapy. Methods: We reviewed the early ischemic stroke imaging database at Cleveland Clinic Cerebrovascular Center for those undergoing IA therapy in anterior circulation from 2009 to 2012. Patients with both pre-treatment and follow-up MRI were included. Infarct volume was measured on initial and follow-up DWI by region of interest demarcation. Patients were grouped into quartiles by infarct growth from initial to follow-up. Outcome were defined as modified Rankin Score 0-2 at 30 days. Results: Among the 76 patients, the median (range) infarct growth of four quartiles were 0.5 cc (-19.1-4.2), 13.8 cc (4.8-25.8), 38.8 cc (28.0-77.6), and 166.3 cc (78.0-314.5). Baseline characteristics of age, gender, race, diabetes, and hypertension were similar among groups except more smokers (p=0.017) and fewer patients on anticoagulation or antiplatelet agents in large-growth group (p=0.049). Compared to No-growth group (Quartile 1), large-growth group (Quartile 4) had more Hyperdense M1 MCA sign ( 26.3% vs 73.7%, p=0.004), larger initial ischemic lesion measured by CT ASPECT (p=0.002) and DWI volume (p=0.012), and absence of full collaterals on CTA ( 36.8% vs 0, p=0.004). There was a trend of lower recanalization rate in large-growth group (73.7% vs 47.4%, p=0.097). With the increment of infarct growth, there is a decrement in favorable outcomes (mRS 0-2) at 30 days: 42%, 37%, 26% and 10.5% (p=0.027). Conclusion: Infarct growth after IA therapy determines outcome. Initial ischemic lesion size, collaterals, and hyperdense vessel sign are associated with infarct growth.

scholarly journals Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis

2021 ◽  
pp. 174749302110483
Author(s):  
Ida Rangus ◽  
Lennart S Milles ◽  
Ivana Galinovic ◽  
Kersten Villringer ◽  
Heinrich J Audebert ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Circle Of Willis ◽  
Posterior Circulation ◽  
Correct Identification ◽  
Anterior Circulation ◽  
Ischemic Lesion

Background Variants of the Circle of Willis (vCoW) may impede correct identification of ischemic lesion patterns and stroke etiology. We assessed reclassifications of ischemic lesion patterns due to vCoW. Methods We analyzed vCoW in patients with acute ischemic stroke from the 1000+ study using time-of-flight magnetic resonance angiography (TOF MRA) of intracranial arteries. We assessed A1 segment agenesis or hypoplasia in the anterior circulation and fetal posterior cerebral artery in the posterior circulation. Stroke patterns were classified as one or more-than-one territory stroke pattern. We examined associations between vCoW and stroke patterns and the frequency of reclassifications of stroke patterns due to vCoW. Results Of 1000 patients, 991 had evaluable magnetic resonance angiography. At least one vCoW was present in 37.1%. VCoW were more common in the posterior than in the anterior circulation (33.3% vs. 6.7%). Of 238 patients initially thought to have a more-than-one territory stroke pattern, 20 (8.4%) had to be reclassified to a one territory stroke pattern after considering vCoW. All these patients had fetal posterior cerebral artery and six (30%) additionally had carotid artery disease. Of 753 patients initially presumed to have a one-territory stroke pattern, four (0.5%) were reclassified as having more-than-one territory pattern. Conclusions VCoW are present in about one in three stroke patients and more common in the posterior circulation. Reclassifications of stroke lesion patterns due to vCoW occurred predominantly in the posterior circulation with fetal posterior cerebral artery mimicking multiple territory stroke pattern. Considering vCoW in these cases may uncover symptomatic carotid disease.

Abstract W MP18: NCCT ASPECTS Underestimates Infarct Core in Early Presenters with Poor Collateral Status

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jun-Gyu Yang ◽  
Jeong-Ho Hong ◽  
Chang-Hyun Kim ◽  
Hyuk-Won Chang ◽  
Bijoy K Menon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
National Institutes Of Health ◽  
Multivariable Logistic Regression Analysis ◽  
Infarct Core ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Ischemic Change ◽  
Significant Difference ◽  
Noncontrast Ct ◽  
Occlusion Of Ica

Background and Purpose: Noncontrast CT (NCCT) identifies early ischemic change that can predict irreversible ischemic injury. However DWI is more sensitive than NCCT in detection of early ischemic lesion. Our aim was to investigate the factors that influence discrepancy in early ischemic change detection between CT and DWI among good NCCT scan. Methods: We collected consecutive 167 ischemic stroke patients with occlusion of ICA and/or MCA M1 diagnosed by CTA and DWI within 6h of onset (last seen normal, LNT) between August 2004 and February 2013. Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was used to evaluate discrepancy between lesions on NCCT and DWI MR. We identified 109 patients with a good NCCT scan defined as ASPECTS 6-10. Discrepancy between NCCT and DWI was when DWI ASPECTS was 0-5 and no discrepancy was when DWI ASPECTS was 6-10. Regional leptomeningeal collateral (rLMC) score by CTA was used to evaluate collateral status. Results: We reviewed 109 patients (mean age 67.5 ± 12.5 years) with median baseline National Institutes of Health Stroke Scale (NIHSS) 14 (interquartile range, 10-19). Discrepancy group (N=40, 36.7%) had shorter time from LNT to CT (median 98 vs 132 min, p=0.013), higher score of initial NIHSS (median 17 vs 13, p=0.013), lower rLMC score (median 10.5 vs 14, p<0.001). There was no significant difference from CT to DWI time (median 41 vs 40 min) between both groups. In a multivariable logistic regression analysis, time from LNT to CT (OR 0.99; 95% CI 0.99-1.00; P=0.05), rLMC score (OR 0.21; 95% CI 0.08-0.56; P=0.002) were independently associated with the discrepancy group. Conclusion: Discrepancy between CT and DWI is common in patients with acute anterior circulation ischemic stroke. This discrepancy is more apparent when patients present early and have poor collaterals.

Effect of Endovascular Therapy on Subsequent Decompressive Hemicraniectomy in Cardioembolic Ischemic Stroke with Proximal Intracranial Occlusion in the Anterior Circulation: Sub-Analysis of the RESCUE-Japan Registry 2

2019 ◽  
Vol 48 (1-2) ◽  
pp. 9-16 ◽  
Author(s):  
Hidetoshi Matsukawa ◽  
Yoshihiro Kiura ◽  
Nobuyuki Sakai ◽  
Hiroshi Yamagami ◽  
Kazutaka Uchida ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Endovascular Therapy ◽  
Functional Limitation ◽  
Severe Disabilities ◽  
Lesion Size ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ischemic Lesion ◽  
Decompressive Hemicraniectomy ◽  
Symptomatic Intracranial Hemorrhage

Background: Cardioembolic stroke is associated with a higher rate of functional limitation, which may be related to the larger ischemic lesion size. Endovascular therapy (EVT) for acute stroke caused by large vessel occlusion reduces severe disabilities. Objectives: We aimed to investigate the relationship between EVT and decompressive hemicraniectomy (DH) in patients with cardioembolic proximal intracranial occlusion in the anterior circulation (CPIOAC) using the data from the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Registry 2. Methods: Among 2,420 patients in the RESCUE-Japan Registry 2, 555 patients aged 20–80 years with acute cardioembolic occlusion of the internal carotid artery and/or the first segment of the middle cerebral artery were included. The primary outcome was DH. Secondary outcomes were any type of intracranial hemorrhage, symptomatic intracranial hemorrhage indicating neurological worsening of >4 points on the National Institutes of Health Stroke Scale within 72 h after the onset of stroke, and recurrence of stroke or transient ischemic attack (TIA) within 90 days. Results: The median age was 73 years (66–77 years), and 360 patients (65%) were male. DH was performed in 1 of 374 patients in the EVT group and 5 of 181 patients in the no-EVT group (p = 0.032). The incidence of any type of intracranial hemorrhage and symptomatic intracranial hemorrhage within 72 h and recurrence of stroke or TIA within 90 days were similar between both groups. Conclusions: EVT may reduce DH in patients with CPIOAC without increasing intracranial hemorrhage.

Abstract TP51: Decreased Internal Cerebral Vein Filling - A New Radiographic Sign of Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Evgenia Klourfeld ◽  
Apurva Patel ◽  
Karim Mohamed ◽  
Albert Y Jin
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Vein ◽  
Venous Outflow ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Internal Cerebral Vein ◽  
Radiology Reports ◽  
Radiographic Sign ◽  
Arterial Lesions

INTRODUCTION: CT signs of acute ischemic stroke focus on parenchymal and arterial lesions. Little is known about venous changes. The aim of this study was to determine the value of decreased deep venous outflow as a predictor of acute ischemic stroke. METHODS: Multimodal CT findings of 182 patients presenting for acute stroke evaluation within 4.5 hours of symptom onset were retrospectively reviewed for evidence of deep venous outflow changes. Interhemispheric symmetry of internal cerebral vein (ICV) opacification on CT angiogram was assessed by 3 raters. Discharge diagnosis, neurological assessment details, and radiographic data were extracted from electronic hospital records, and radiology reports. RESULTS: Of 182 patients included in the study, 46 showed diminished ICV opacification (dICV) on the side of the expected ischemic lesion. Anterior circulation stroke was diagnosed in 87% of dICV cases, but in only 31% of subjects with ICV symmetry (sICV), suggesting a strong correlation of dICV with ipsilateral anterior circulation infarction (P<0.0001). Patients with dICV presented with greater neurologic impairment (NIHSS 14±1.0 vs. 6±0.8, P<0.0001), proximal arterial lesions, and lower ASPECTS (8±0.3 vs. 9±0.2, P=0.0022). In 48 patients who had a CT perfusion scan at the time of initial evaluation (dICV N=20 vs. sICV N=28), dICV was associated with larger perfusion defects: mean transit time ASPECTS 3±0.7 vs. 8±0.3 (P<0.0001), cerebral blood flow ASPECTS 3±0.8 vs. 8±0.5 (P<0.0001), and cerebral blood volume ASPECTS 7±0.7 vs. 9±0.2 (P=0.006). The sensitivity, specificity, and positive predictive value of dICV for anterior circulation stroke were 48%, 94%, and 87% respectively. Inter-rater agreement was very good with a free marginal kappa of 0.75. CONCLUSION: Decreased ICV may be a useful radiographic sign of ipsilateral acute ischemic stroke and a marker of a large cerebral territory at risk of infarction. Prospective studies are needed to help validate this finding, and its role in predicting stroke outcomes.

Effect of age on outcome in patients with cerebral stroke

2020 ◽  
pp. 41-45
Author(s):  
G. R. Kuchava ◽  
E. V. Eliseev ◽  
B. V. Silaev ◽  
D. A. Doroshenko ◽  
Yu. N. Fedulaev
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Neurological Status ◽  
Statistical Correlation ◽  
Multiple Organ ◽  
The Body ◽  
Social Adaptation ◽  
Cerebral Stroke ◽  
Septic Complications ◽  
Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

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.

scholarly journals Outcome of endovascular treatment within and beyond 6 h without perfusion software

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhen Jing ◽  
Hao Li ◽  
Shengming Huang ◽  
Min Guan ◽  
Yongxin Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Group A ◽  
Group B

AbstractEndovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6–24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6–24 h from symptom onset to groin puncture in this real world study.

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