Influence of white matter lesions on the prognosis of acute cardioembolic stroke without reperfusion therapy

Abstract Background Few studies have investigated the influence of white matter lesions (WMLs) on the prognosis of acute cardioembolic stroke (CES). We aimed to explore the role of WMLs in predicting 3-month prognosis of CES without reperfusion therapy. Methods A number of 251 acute CES patients without reperfusion therapy at a single center were retrospectively recruited. The severity of WMLs was evaluated by Fazekas scale and patients were divided into mild WMLs group (188 cases, Fazekas ≤ 2 points) and moderate to severe WMLs group (63 cases, Fazekas ≥ 3 points) accordingly. General data and clinical features of the two groups were compared. Functional outcomes of patients were followed up for 3 months using the modified Rankin scale (mRS) and patients were divided into poor outcome group (mRS ≥ 3) and favorable outcome group (mRS ≤ 2). The effect of WMLs on the prognosis was identified by binary logistic regression. Results Patients in moderate to severe WMLs group were older (P < 0.001). Also, they had higher baseline NIHSS score (P < 0.001) and elevated incidence of asymptomatic cerebral hemorrhage (P = 0.040) and stroke associated pneumonia (P = 0.001) than those in mild WMLs group. At 3 months, there were 100 cases in the poor outcome group. Patients in poor outcome group had higher baseline NIHSS score, increased proportion of moderate to severe WMLs, and elevated incidence of stroke associated pneumonia than those in favorable outcome group (P < 0.001). Binary logistic regression analysis showed that moderate to severe WMLs (odds ratio [OR] = 4.105, 95% confidence interval [CI] = 1.447–11.646), baseline NIHSS score (OR = 1.368, 95% CI = 1.240–1.511), and stroke-associated pneumonia (OR = 4.840, 95%CI = 1.889–12.400) were independent risk factors for poor outcome. Conclusion Moderate to severe WMLs is an independent risk factor for prognosis of CES patients without reperfusion therapy.

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Influence of white matter lesions on the prognosis of acute cardioembolic stroke without reperfusion therapy

BMC Neurology ◽

10.1186/s12883-021-02372-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yikun Guo ◽

Zhuoyou Chen ◽

Qian Wang ◽

Min Zhang ◽

Guanzhong Dong ◽

...

Keyword(s):

Logistic Regression ◽

White Matter ◽

White Matter Lesions ◽

Binary Logistic Regression ◽

Reperfusion Therapy ◽

Favorable Outcome ◽

Nihss Score ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group

Abstract Background Few studies have investigated the influence of white matter lesions (WMLs) on the prognosis of acute cardioembolic stroke (CES). We aimed to explore the role of WMLs in predicting 3-month prognosis of CES without reperfusion therapy. Methods A number of 251 acute CES patients without reperfusion therapy at a single center were retrospectively recruited. The severity of WMLs was evaluated by Fazekas scale and patients were divided into mild WMLs group (188 cases, Fazekas ≤ 2 points) and moderate to severe WMLs group (63 cases, Fazekas ≥ 3 points) accordingly. General data and clinical features of the two groups were compared. Functional outcomes of patients were followed up for 3 months using the modified Rankin scale (mRS) and patients were divided into poor outcome group (mRS ≥ 3) and favorable outcome group (mRS ≤ 2). The effect of WMLs on the prognosis was identified by binary logistic regression. Results Patients in moderate to severe WMLs group were older (P < 0.001). Also, they had higher baseline National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001) and elevated incidence of asymptomatic cerebral hemorrhage (P = 0.040) and stroke associated pneumonia (P = 0.001) than those in mild WMLs group. At 3 months, there were 100 cases in the poor outcome group. Patients in poor outcome group had higher baseline NIHSS score, increased proportion of moderate to severe WMLs, and elevated incidence of stroke associated pneumonia than those in favorable outcome group (P < 0.001). Binary logistic regression analysis showed that moderate to severe WMLs (odds ratio [OR] = 4.105, 95 % confidence interval [CI] = 1.447–11.646), baseline NIHSS score (OR = 1.368, 95 % CI = 1.240–1.511), and stroke-associated pneumonia (OR = 4.840, 95 %CI = 1.889–12.400) were independent risk factors for poor outcome. Conclusions Moderate to severe WMLs is an independent risk factor for prognosis of CES patients without reperfusion therapy.

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Hyperoxemia during the hyperacute phase of aneurysmal subarachnoid hemorrhage is associated with delayed cerebral ischemia and poor outcome: a retrospective observational study

Journal of Neurosurgery ◽

10.3171/2019.9.jns19781 ◽

2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Shinya Fukuda ◽

Yasutaka Koga ◽

Motoki Fujita ◽

Eiichi Suehiro ◽

Kotaro Kaneda ◽

...

Keyword(s):

Logistic Regression ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Favorable Outcome ◽

Regression Analyses ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group

OBJECTIVEThe harmful effects of hyperoxemia have been reported in critically ill patients with various disorders, including those with brain injuries. However, the effect of hyperoxemia on aneurysmal subarachnoid hemorrhage (aSAH) patients is unclear. In this study the authors aimed to determine whether hyperoxemia during the hyperacute or acute phase in patients with aSAH is associated with delayed cerebral ischemia (DCI) and poor neurological outcome.METHODSIn this single-center retrospective study, data from patients with aSAH treated between January 2011 and June 2017 were reviewed. The patients were classified into groups according to whether they experienced DCI (DCI group and non-DCI group) and whether they had a poor outcome at discharge (poor outcome group and favorable outcome group). The background characteristics and time-weighted average (TWA) PaO2 during the first 24 hours after arrival at the treatment facility (TWA24h-PaO2) and between the first 24 hours after arrival and day 6 (TWA6d-PaO2), the hyperacute and acute phases, respectively, were compared between the groups. Factors related to DCI and poor outcome were evaluated with logistic regression analyses.RESULTSOf 197 patients with aSAH, 42 patients experienced DCI and 82 patients had a poor outcome at discharge. TWA24h-PaO2 was significantly higher in the DCI group than in the non-DCI group (186 [141–213] vs 161 [138–192] mm Hg, p = 0.029) and in the poor outcome group than in the favorable outcome group (176 [154–205] vs 156 [136–188] mm Hg, p = 0.004). TWA6d-PaO2 did not differ significantly between the groups. Logistic regression analyses revealed that higher TWA24h-PaO2 was an independent risk factor for DCI (OR 1.09, 95% CI 1.01–1.17, p = 0.037) and poor outcome (OR 1.17, 95% CI 1.06–1.29, p = 0.002).CONCLUSIONSHyperoxemia during the first 24 hours was associated with DCI and a poor outcome in patients with aSAH. Excessive oxygen therapy might have an adverse effect in the hyperacute phase of aSAH.

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Abstract P450: Serum Arachidonic Acid Levels in Relation With Outcome of Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p450 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Junichiro Takahashi ◽

Kenichiro Sakai ◽

Tomomichi Kitagawa ◽

Takeo Sato ◽

Hiroki Takatsu ◽

...

Keyword(s):

Arachidonic Acid ◽

Intracerebral Hemorrhage ◽

Multivariate Logistic Regression Analysis ◽

Favorable Outcome ◽

Nihss Score ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group ◽

Dihomogammalinolenic Acid ◽

Laboratory Examinations

Introduction: The correlation between serum polyunsaturated fatty acids (PUFAs) such as Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), Arachidonic Acid (AA) and Dihomogammalinolenic Acid (DHLA) levels and clinical outcomes of cardiovascular disease are previously reported. The aim was to investigate serum PUFAs including AA levels to clinical outcome in intracerebral hemorrhage (ICH) patients. Method: From Nov 2012 to Nov 2019, ICH patients within 24 hours from the onset were enrolled. All patients underwent radiological investigations and laboratory examinations including measurement of serum PUFAs levels on admission. We divided patients into two groups, favorable outcome group (mRS at 3 months 0-3) and poor outcome group (mRS at 3 months 4-6). We compared baseline variables including serum PUFAs levels between two groups. Result: We enrolled 142patients (87 male, median age 60 years old, median NIHSS score 8). Of them, 113 patients (80%) were favorable outcome group and 29 patients (20%) were poor outcome group. Higher NIHSS score and larger size of hematoma on admission were found in poor outcome group (median NIHSS score 6 of favorable outcome vs. 14 of poor outcome, p<0.001, and median hematoma size, 7.5ml vs. 13.5ml, p=0.048). In serum PUFAs levels, only serum AA levels was significantly lower in poor outcome group (median interval 213μg/ml vs. 179μg/ml, p=0.002) though there were no difference of DHLA, EPA and DHA levels between two groups. In multivariate logistic regression analysis, lower serum AA levels was independently associated with poor outcome (OR 0.987, 95%CI 0.978-0.996, p=0.007, Figure). Conclusion: Serum AA levels may play an important role in predicting the outcome in ICH.

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Cerebral white matter lesions in bipolar affective disorder: relationship to outcome

The British Journal of Psychiatry ◽

10.1192/bjp.178.2.172 ◽

2001 ◽

Vol 178 (2) ◽

pp. 172-176 ◽

Cited By ~ 95

Author(s):

P. Brian Moore ◽

Debra J. Shepherd ◽

Donald Eccleston ◽

Iain C. Macmillan ◽

Uptal Goswami ◽

...

Keyword(s):

Bipolar Disorder ◽

White Matter ◽

Affective Disorder ◽

Bipolar Affective Disorder ◽

White Matter Lesions ◽

Periventricular White Matter ◽

White Matter Abnormalities ◽

Good Outcome ◽

Poor Outcome ◽

Outcome Group

BackgroundTwenty per cent of patients with bipolar affective disorder suffer an illness that responds inadequately to treatment and has a poor outcome. Many patients, but not all, with bipolar disorder show white matter abnormalities on T2-weighted magnetic resonance imaging (MRI).AimsTo explore the hypothesis that white matter abnormalities on MRI are seen more frequently in subjects whose illness has a poor outcome compared with those with a good outcome or controls.MethodTwo groups of age- and gender-matched patients with bipolar disorder (14 with a good outcome and 15 with a poor outcome) and 15 controls, aged 20–65 years, were studied. Axial T2-weighted MRI scans were examined for the presence and severity of white matter abnormalities.ResultsSignificantly more poor outcome group members had deep subcortical punctate, but not periventricular, white matter hyperintensities than the good outcome group (P=0.035) or controls (P=0.003) and these abnormalities were of greater severity (P=0.030 and P < 0.014, respectively).ConclusionsSubcortical white matter lesions are associated with poor outcome bipolar disorder.

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Endovascular Treatment of Urgent Carotid Occlusion

Interventional Neuroradiology ◽

10.1177/15910199060120s143 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 233-240 ◽

Cited By ~ 2

Author(s):

K. Tsumura ◽

N. Kuwayama ◽

R. Iwai ◽

T. Kanbayashi ◽

H. Satoh ◽

...

Keyword(s):

Carotid Artery ◽

Arterial Occlusion ◽

Artery Occlusion ◽

Carotid Occlusion ◽

Simultaneous Treatment ◽

Nihss Score ◽

Good Outcome ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group

Emergency revascularization of acute carotid artery occlusion is still controversial. We treated 15 patients (13 men and two women, mean age of 67.3 years) with acute atherosclerotic carotid occlusion by endovascular procedures and evaluated the usefulness of this treatment. All of the patients were evaluated with emergency MRI and MRA before treatment. Intracranial tandem arterial occlusion due to distal embolism was observed in nine patients, and contralateral carotid stenosis (>70%) was observed in seven. The mean NIHSS score of the patients was 15.4±7.4 (mean±SD) before treatment. Treatment modality included local intraarterial fibrinolysis (LIF), percutaneous transluminal angioplasty (PTA), and carotid artery stenting (CAS). A protective balloon was successfully placed in the distal carotid artery through the plaque before recanalization in seven patients. Three patients were treated with LIF+PTA, five with PTA+CAS, six with LIF+PTA+CAS, and one with PTA only. Successful recanalization of the carotid artery was obtained in 14 of the 15 patients, and distal tandem middle cerebral artery occlusion was also successfully recanalized in eight of the nine patients. GOS was four or five in eight patients (good outcome group) and 1–3 in seven patients (poor outcome group). Mean NIHSS score of the 15 patients was (6.9 ± 7.4) after treatment. Preoperative NIHSS score (10.3 ± 7.4) in the good outcome group was significantly lower than that (21.3 ± 5.4) in the poor outcome group. The protective balloon technique, PTA with stenting, seems to be useful for acute revascularization of urgent carotid occlusion. Simultaneous treatment of the intracranial tandem occlusive lesion is essential to achieve good clini-cal results. Patients with acute carotid occlusion with NIHSS scores of less than 16 could be good candidates for this advanced treatment.

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Endovascular Treatment of Urgent Carotid Occlusion

Rivista di Neuroradiologia ◽

10.1177/197140099500800643 ◽

1995 ◽

Vol 8 (6) ◽

pp. 233-240

Author(s):

K. Tsumura ◽

N. Kuwayama ◽

R. Iwai ◽

T. Kanbayashi ◽

H. Satoh ◽

...

Keyword(s):

Carotid Artery ◽

Arterial Occlusion ◽

Artery Occlusion ◽

Carotid Occlusion ◽

Simultaneous Treatment ◽

Nihss Score ◽

Good Outcome ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group

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Dilated Optic Nerve Sheath Diameter Predicts Poor Outcome in Acute Spontaneous Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000518724 ◽

2021 ◽

pp. 1-8

Author(s):

Haoli Xu ◽

Yuting Li ◽

Jinjin Liu ◽

Zhonggang Chen ◽

Qian Chen ◽

...

Keyword(s):

Logistic Regression ◽

Optic Nerve ◽

Intracerebral Hemorrhage ◽

Optic Nerve Sheath Diameter ◽

Favorable Outcome ◽

Optic Nerve Sheath ◽

Poor Outcome ◽

Nerve Sheath ◽

Multivariable Logistic Regression ◽

Outcome Group

Background and Purpose: Optic nerve sheath diameter (ONSD) enlargement occurs in patients with intracerebral hemorrhage (ICH). However, the relationship between ONSD and prognosis of ICH is uncertain. This study aimed to investigate the predictive value of ONSD on poor outcome of patients with acute spontaneous ICH. Methods: We studied 529 consecutive patients with acute spontaneous ICH who underwent initial CT within 6 h of symptom onset between October 2016 and February 2019. The ONSDs were measured 3 mm behind the eyeball on initial CT images. Poor outcome was defined as having a Glasgow Outcome Scale (GOS) score of 1–3, and favorable outcome was defined as having a GOS score of 4–5 at discharge. Results: The ONSD of the poor outcome group was significantly greater than that of the favorable outcome group (5.87 ± 0.86 vs. 5.21 ± 0.69 mm, p < 0.001). ONSD was related to hematoma volume (r = 0.475, p < 0.001). Adjusting other meaningful predictors, ONSD (OR: 2.83; 95% CI: 1.94–4.15) was associated with poor functional outcome by multivariable logistic regression analysis. Receiver operating characteristic curve showed that the ONSD improved the accuracy of ultraearly hematoma growth in the prediction of poor outcome (AUC: 0.790 vs. 0.755, p = 0.016). The multivariable logistic regression model with all the meaningful predictors showed a better predictive performance than the model without ONSD (AUC: 0.862 vs. 0.831, p = 0.001). Conclusions: The dilated ONSD measured on initial CT indicated elevated intracranial pressure and poor outcome, so appropriate intervention should be taken in time.

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Comparison of Prognostic Performance between Neuron-Specific Enolase and S100 Calcium-Binding Protein B Obtained from the Cerebrospinal Fluid of Out-Of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Journal of Clinical Medicine ◽

10.3390/jcm10071531 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1531

Author(s):

Changshin Kang ◽

Wonjoon Jeong ◽

Jung Soo Park ◽

Yeonho You ◽

Jin Hong Min ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cardiac Arrest ◽

Calcium Binding ◽

Neuron Specific Enolase ◽

Poor Outcome ◽

The Poor ◽

S100 Calcium Binding Protein ◽

Poor Outcome Group ◽

Outcome Group ◽

Hospital Cardiac Arrest

We compared the prognostic performances of serum neuron-specific enolase (sNSE), cerebrospinal fluid (CSF) NSE (cNSE), and CSF S100 calcium-binding protein B (cS100B) in out-of-hospital cardiac arrest (OHCA) survivors. This prospective observational study enrolled 45 patients. All samples were obtained immediately and at 24 h intervals until 72 h after the return of spontaneous circulation. The inter- and intragroup differences in biomarker levels, categorized by 3 month neurological outcome, were analyzed. The prognostic performances were evaluated with receiver operating characteristic curves. Twenty-two patients (48.9%) showed poor outcome. At all-time points, sNSE, cNSE, and cS100B were significantly higher in the poor outcome group than in the good outcome group. cNSE and cS100B significantly increased over time (baseline vs. 24, 48, and 72 h) in the poor outcome group than in the good outcome group. sNSE at 24, 48, and 72 h showed significantly lower sensitivity than cNSE or cS100B. The sensitivities associated with 0 false-positive rate (FPR) for cNSE and cS100B were 66.6% vs. 45.5% at baseline, 80.0% vs. 80.0% at 24 h, 84.2% vs. 94.7% at 48 h, and 88.2% (FPR, 5.0%) vs. 94.1% at 72 h. High cNSE and cS100B are strong predictors of poor neurological outcome in OHCA survivors. Multicenter prospective studies may determine the generalizability of these results.

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White matter lesions and poor outcome after intracerebral hemorrhage: A nationwide cohort study

Neurology ◽

10.1212/wnl.0b013e3181dd425a ◽

2010 ◽

Vol 74 (19) ◽

pp. 1502-1510 ◽

Cited By ~ 43

Author(s):

S. H. Lee ◽

B. J. Kim ◽

W. S. Ryu ◽

C. K. Kim ◽

N. Kim ◽

...

Keyword(s):

Cohort Study ◽

White Matter ◽

Intracerebral Hemorrhage ◽

White Matter Lesions ◽

Poor Outcome

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Abstract TP195: Pre-Stroke Cognitive Impairment is Associated With Poor Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.tp195 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Takuya Kanamaru ◽

Satoshi Suda ◽

Junya Aoki ◽

Kentaro Suzuki ◽

Yuki Sakamoto ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Modified Rankin Scale ◽

Good Outcome ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group ◽

Significant Difference

Background: It is reported that pre-stroke cognitive impairment is associated with poor functional outcome after stroke associated with small vessel disease. However, it is not clear that pre-stroke cognitive impairment is associated with poor outcome in patients treated with mechanical thrombectomy. Method: We enrolled 127 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke from December 2016 to November 2018. Pre-stroke cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We retrospectively compared poor outcome (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=75) with good outcome (a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=52) and examined that IQCODE could be the predictor of PO. Result: IQCODE was significantly higher in poor outcome group than in good outcome group (89 vs. 82, P=0.0012). Moreover, age (77.2 years old vs. 71.6 years old, P= 0.0009), the percentage of female (42.7% vs. 17.3%, P= 0.0021), complication of hypertension (HT, 68.0% vs. 44.2%, P=0.0076), National Institutes of Health Stroke Scale (NIHSS) at admission (20 vs. 11, P<0.0001), the percentage of postoperative intracerebral hemorrhage (ICH, 33.3% vs. 15.4%, P=0.0233) were higher in poor outcome group than in good outcome group, too. However, there was no significant difference between poor outcome and good outcome groups in occlusion site (P= 0.1229), DWI-ASPECTS (P= 0.2839), the duration from onset to recanalization (P=0.4871) and other risk factors. Multivariable logistic regression analysis demonstrated that IQCODE, HT and NIHSS at admission were associated with poor outcome (P= 0.0128, P=0.0061 and P<0.0001, respectively). Conclusion: Cognitive impairment could be associated with poor outcome in patients treated with mechanical thrombectomy.

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