CORRECTION OF NEUROLOGICAL DEFICIENCY IN PATIENTS WITH ACUTE ISCHEMIC STROKE BY APPLICATION OF DIFFERENT QUALITATIVE COMPOSITION OF INFUSION SOLUTIONS

Introduction: Infusion therapy is an important component in the treatment of patients with acute ischemic stroke (AIS). The aim: Compare the dynamics of changes neurological deficiency in the application of solutions: 0.9% NaCl, HES 130, HAES-LX-5% and mannitol 15% in patients with AIS. Materials and methods: The study included 100 patients with AIS. As the investigated solutions were used: isosmolar 0.9% NaCl, hyperosmolar mannitol 15%, colloid-isoosmolar HES 130, colloid-hyperosmolar HAES-LX-5%. The control group received only 0.9% NaCl compared: 0.9% NaCl+HES 130, 0.9% NaCl+HAES-LX-5%, 0.9% NaCl+mannitol 15%. The evaluation of treatment efficacy (magnitude of neurological deficiency) was performed daily for 7 days using the Glasgow Coma Scale (GCS), Full Outline of UnResponsiveness (FOUR) Score, National Institutes of Health Stroke Scale (NIHSS) and BIS-index. Results: The conducted research showed that the application of 0.9% NaCl and mannitol did not have a significant effect on the dynamics of neurological deficits according to the GCS, FOUR and NIHSS scales for 7 days of observation (p>0.05). The use of HES 130 contributed to a statistically significant improvement in the parameters of the GCS (p<0,05), which is confirmed by significant changes in the BIS-index (p<0,05) during a seven-day infusion therapy. The most significant positive changes were observed in the group with HAES-LX-5%, which was marked by an improvement in the neurological state during 7 days treatment acoording to the GCS, FOUR and BIS index (p<0.05). Conclusions: The intergroup analysis of the neurological deficiency confirmed the worst result of treatment in the group with mannitol (p<0,05) and the best result with HAES-LX-5% (p<0,05).

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IM-12 activates the Wnt–β-catenin signaling pathway and attenuates rtPA-induced hemorrhagic transformation in rats after acute ischemic stroke

Biochemistry and Cell Biology ◽

10.1139/bcb-2018-0384 ◽

2019 ◽

Vol 97 (6) ◽

pp. 702-708 ◽

Cited By ~ 3

Author(s):

Ting Wang ◽

Yu-Mei Duan ◽

Qiao Fu ◽

Tao Liu ◽

Jin-Cheng Yu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Signaling Pathway ◽

Glycogen Synthase ◽

Hemorrhagic Transformation ◽

Neurological Deficits ◽

Control Group ◽

High Morbidity ◽

Sprague Dawley ◽

Gsk 3Β

Hemorrhagic transformation (HT) is a devastating complication for patients with acute ischemic stroke (AIS) who are treated with tissue plasminogen activator (tPA). HT is associated with high morbidity and mortality, but no effective treatments are currently available to reduce the risk of HT. Therefore, methods to prevent HT are urgently needed. In this study, we used IM-12, an inhibitor of glycogen synthase kinase 3β (GSK-3β), to evaluate the role of the Wnt–β-catenin signaling pathway in recombinant tPA (rtPA)-induced HT. Sprague–Dawley rats were subjected to a middle cerebral artery occlusion (MCAO) model of ischemic stroke, and then were either administered rtPA, rtPA combined with IM-12, or the vehicle at 4 h after stroke was induced. Our results indicate that rats subjected to HT had more severe neurological deficits, brain edema, and blood–brain barrier (BBB) breakdown, and had a greater infarction volume than the control group. Rats treated with IM-12 had improved outcomes compared with those of rats treated with rtPA alone. Moreover, IM-12 increased the protein expression of β-catenin and downstream proteins while suppressing the expression of GSK-3β. These results suggest that IM-12 reduces rtPA-induced HT and attenuates BBB disruption, possibly through activation of the Wnt–β-catenin signaling pathway, and provides a potential therapeutic strategy for preventing tPA-induced HT after AIS.

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Do initially non-dehydrated patients with acute ischemic stroke need fluid supplement?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000686 ◽

2020 ◽

pp. 1-6

Author(s):

Leng Chieh Lin ◽

Yen Yun Tsai ◽

Jen Tsung Yang ◽

Yi Chuan Chen ◽

Yi Fang Wu ◽

...

Keyword(s):

Ischemic Stroke ◽

Specific Gravity ◽

Acute Ischemic Stroke ◽

National Institutes Of Health ◽

Favorable Outcome ◽

Urine Specific Gravity ◽

Control Group ◽

Study Group ◽

Daily Urine ◽

Group A

Abstract. Background: We previously found that dehydration is an independent predictor of early deterioration after acute ischemic stroke and rehydration helps to improve outcomes. There is limited evidence of how to treat patients who are initially non-dehydrated. In this study, we tested the hypothesis that rehydration therapy, based on the daily urine specific gravity, will improve the outcome of ischemic stroke patients who are initially non-dehydrated. Methods: We conducted a single-arm prospective study of patients with acute ischemic stroke with historical controls. For the first 5 days of study group, a daily urine specific gravity of > 1.020 g/ml was taken as indication for rehydration and patients were advised to drink water via oral or tubal feeding with a dose of 5 ml/kg body weight right away and after dinner. Control group patients were rehydrated without reference to urine specific gravity. An increase in National Institutes of Health Stroke Scale score of ≥ 4 within three days was defined as having stroke-in-evolution. Scores of ≤ 1 on the modified Rankin scale at 3 months were considered to indicate a favorable outcome. Results: A total of 125 patients were analyzed, 46 in the study group and 79 in the control group. The groups did not significantly differ in the stroke-in-evolution rate (4.3% vs. 8.2%, P = 0.474). The rate of favorable outcome at 3 months was significantly higher in the study group than in the control group (56.5% vs. 27.8%, P = 0.001). Conclusions: Urine specific gravity-based hydration might be a useful method to improve functional outcomes of patients with acute ischemic stroke who were non-dehydrated at admission.

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Escitalopram improves neural functional prognosis and endothelial dysfunction in patients with acute cerebral infarction

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201041 ◽

2020 ◽

Vol 38 (5) ◽

pp. 385-393

Author(s):

Jin-Xia Cao ◽

Li Liu ◽

Yun-Tao Sun ◽

Qing-Hong Zeng ◽

Zhen-Dong Yang ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Endothelial Dysfunction ◽

Acute Ischemic Stroke ◽

Rating Scale ◽

Mmse Score ◽

Neurological Deficits ◽

Control Group ◽

Relative Safety ◽

The Mean

Background: Escitalopram is one of the most commonly used SSRIs at present, which has the characteristics of quick onset, less interactions with other drugs, and relative safety. Objective: This study aims to investigate the effects of escitalopram on neural functional prognoses and endothelial dysfunction after acute ischemic stroke. Methods: One hundred eligible patients afflicted with acute ischemic stroke were randomized into two groups: control and treatment groups. Patients in the treatment group received escitalopram in addition to the basic therapies in the control group over a period of 90 days. Neurological deficits were quantified using the National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) score, cognitive impairment was determined using the Mini-Mental State Examination (MMSE) score, depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAMD). Furthermore, post-stroke depression (PSD) was defined based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), with a HAMD score ≥17. Flow-mediated vascular dilatation (FMD) of the brachial artery was use as a surrogate indicator for endothelial dysfunction assessment with ultrasound. Results: The mean NIHSS and HAMD scores on day 90 after treatment were significantly lower in the treatment group than in the control group (2.17±0.36 vs. 4.24±0.85; 5.81±1.35 vs. 10.43±4.91; P < 0.01), while the mean BI score and FMD were significantly higher in the treatment group (93.08±6.23 vs. 79.64±7.56, P < 0.01; 8.71±2.35 vs. 5.83±1.21, P < 0.05) than in the control group. The improvement in MMSE score was not significantly different between the two groups. Conclusions: Treatment with escitalopram early after ischemic stroke can improve neural functional prognoses and endothelial dysfunction. Escitalopram had less side effects, which is worthy of clinical prophylactic application.

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Effects of Repetitive Hyperbaric Oxygen Treatment in Patients with Acute Cerebral Infarction: A Pilot Study

The Scientific World JOURNAL ◽

10.1100/2012/694703 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Cheng-Hsin Chen ◽

Shao-Yuan Chen ◽

Vinchi Wang ◽

Chao-Ching Chen ◽

Kaw-Chen Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hyperbaric Oxygen ◽

National Institutes Of Health ◽

Adjunctive Treatment ◽

Control Group ◽

Oxygen Treatment ◽

Conventional Medical Treatment ◽

Significant Difference

The role of hyperbaric oxygen therapy (HBOT) in the treatment of acute ischemic stroke is controversial. This prospective study assessed the efficacy and safety of HBOT as adjuvant treatment on 46 acute ischemic stroke in patients who did not receive thrombolytic therapy. The HBOT group (n=16) received conventional medical treatment with 10 sessions of adjunctive HBOT within 3–5 days after stroke onset, while the control group (n=30) received the same treatment but without HBOT. Early (around two weeks after onset) and late (one month after onset) outcomes (National Institutes of Health Stroke Scale, NIHSS scores) and efficacy (changes of NIHSS scores) of HBOT were evaluated. The baseline clinical characteristics were similar in both groups. Both early and late outcomes of the HBOT group showed significant difference (P≤0.001). In the control group, there was only significant difference in early outcome (P=0.004). For early efficacy, there was no difference when comparing changes of NIHSS scores between the two groups (P=0.140) but there was statistically significant difference when comparing changes of NIHSS scores at one month (P≤0.001). The HBOT used in this study may be effective for patients with acute ischemic stroke and is a safe and harmless adjunctive treatment.

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Correlation between atherogenic index of plasma and national institutes of health stroke scale score in acute ischemic stroke patients at Haji Adam Malik general hospital, Medan

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213932 ◽

2021 ◽

Vol 9 (10) ◽

pp. 3057

Author(s):

Muhammad Zulfikri ◽

Cut A. Arina ◽

Chairil A. Batubara

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

General Hospital ◽

National Institutes Of Health ◽

Atherogenic Index ◽

Neurological Deficits ◽

Stroke Patients ◽

Atherogenic Index Of Plasma ◽

Nihss Score ◽

The Mean

Background: Stroke is the leading cause of morbidity and mortality in Indonesia. Dyslipidemia is one of the main risk factors of ischemic stroke. Atherogenic index of plasma (AIP) is the logarithm of the triglyceride’s plasma ratio concentration to high density lipoprotein cholesterol (HDL-C) plasma concentration. Previous studies showed that the high AIP at hospital admission was associated with deterioration of neurological deficits in patients with acute ischemic stroke.Methods: This is a cross sectional study with 82 sample of acute ischemic stroke subjects that consecutively collected from the medical records of Haji Adam Malik general hospital Medan from January to December 2019, AIP assessment performed at the 1st day of hospitalization and then at the 7th -onset the national institutes of health stroke scale (NIHSS) score assessment was count. Data analysis is conducted with Spearman test.Results: Demographic characteristics showed that most subjects were female (51.2%), at age range between 60 -68 years (30.5%), had high school education level (48.8%), self-employed (35.4%) and Bataknese (68.3%). The mean of AIP was 0.15±0.26 and the mean NIHSS score was 6.70±3.6. There was a positive significant and mild power of correlation between AIP and the NIHSS score (p=0.017; r=0.262).Conclusions: There is a significant relationship between AIP and the NIHSS score. The higher the AIP of acute ischemic stroke patients was associated with the increase in the NIHHS scores.

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Theophylline as an Add-On to Thrombolytic Therapy in Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.027446 ◽

2020 ◽

Vol 51 (7) ◽

pp. 1983-1990

Author(s):

Boris Modrau ◽

Grethe Andersen ◽

Irene Klærke Mikkelsen ◽

Anne Nielsen ◽

Mikkel Bo Hansen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Scale Score ◽

National Institutes Of Health ◽

Control Group ◽

Proof Of Concept ◽

Resonance Imaging

Background and Purpose: Delayed recanalization increases the risk of infarct growth and poor clinical outcome in acute ischemic stroke. The vasoactive agent theophylline has shown neuroprotective effects in animal stroke models but inconclusive results in case series and randomized clinical trials. The primary objective of this study was to evaluate whether theophylline, as an add-on to thrombolytic therapy, is safe and effective in acute ischemic stroke patients. Methods: The TEA-Stroke trial (The Theophylline in Acute Ischemic Stroke) was an investigator-initiated 2-center, proof-of-concept, phase II clinical study with a randomized, double-blinded, placebo-controlled design. The main inclusion criteria were magnetic resonance imaging–verified acute ischemic stroke, moderate to severe neurological deficit (National Institutes of Health Stroke Scale score of ≥4), and treatment with thrombolysis within 4.5 hours of onset. Participants were randomly assigned in the ratio 1:1 to either 220 mg of intravenous theophylline or placebo. The co-primary outcomes were early clinical improvement on the National Institutes of Health Stroke Scale score and infarct growth on magnetic resonance imaging at 24-hour follow-up. Results: Theophylline as an add-on to thrombolytic therapy improved the National Institutes of Health Stroke Scale score at 24 hours by mean 4.7 points (SD, 5.6) compared with an improvement of 1.3 points (SD, 7.5) in the control group ( P =0.044). Mean infarct growth was 141.6% (SD, 126.5) and 104.1% (SD, 62.5) in the theophylline and control groups, respectively ( P =0.146). Functional independence at 90 days was 61% in the theophylline group and 58% in the control group ( P =0.802). Conclusions: This proof-of-concept trial investigated theophylline administration as an add-on to thrombolytic therapy in acute ischemic stroke. The co-primary end points early clinical improvement and infarct growth at 24-hour follow-up were not significantly different after post hoc correction for multiplicity (Bonferroni technique). The small study size precludes a conclusion as to whether theophylline has a neuroprotective effect but provides a promising clinical signal that may support a future clinical trial. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: EudraCT number 2013-001989-42.

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Effect of Simvastatin in Serum Interleukin-6 Level in Patients with Acute Ischemic Stroke

Folia Medica Indonesiana ◽

10.20473/fmi.v56i3.24508 ◽

2021 ◽

Vol 56 (3) ◽

pp. 165

Author(s):

Maria Lettisia Meo ◽

Abdulloh Machin ◽

Didik Hasmono

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

University Hospital ◽

Neurological Deficits ◽

Control Group ◽

Stroke Severity ◽

Stroke Patients ◽

Permanent Disability ◽

Significant Difference

Acute ischemic stroke is the leading cause of death and causing permanent disability in adults worldwide. In acute ischemic stroke, IL-6 levels positively correlated to more severe neurological deficits, more extensive brain damage and worse prognoses. The use of statin was associated with milder initial stroke severity, better functional outcome and lower mortality. This clinically randomized controlled trial study was aimed to analyze the serum levels of IL 6 in acute ischemic stroke patients who treated with Simvastatin 20 mg compare to placebo. Samples were taken using consecutive sampling method from hospitalized acute ischemic stroke patients in Neurology Department of Dr. Soetomo Teaching Hospital Surabaya and Airlangga University Hospital Surabayafrom August to November 2017. Total of 44 patients met the inclusion criteria, consisting of 22 patients in treatment group and 22 patients in control group.There were no significant difference in the characteristic of the patients in both groups (p>0.05). Averages of serum IL-6 in the control and the treatment group are 38.594±74.313 and 17.760±25.253(p=0,438) while averages of serum IL-6 post in the control group and the treatment are 46.586±103.484 and 15.275±17.183 (p=0,589). There were no significant level escalation in pre and post of control group (p = 0.205) and also no significant level reduction in pre and post of treatment group (p = 0.411), while the average difference in the control group (-7.992 + 78.912 pg/ml) and in the treatment group (2.485 + 23.738 pg/ml).

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Effect of Simvastatin in Serum Interleukin-6 Level in Patients with Acute Ischemic Stroke

Folia Medica Indonesiana ◽

10.20473/fmi.v56i3.22162 ◽

2020 ◽

Vol 56 (3) ◽

pp. 165

Author(s):

Maria Lettisia Meo ◽

Abdulloh Machin ◽

Didik Hasmono

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

University Hospital ◽

Neurological Deficits ◽

Control Group ◽

Stroke Severity ◽

Stroke Patients ◽

Permanent Disability ◽

Significant Difference

Acute ischemic stroke is the leading cause of death and causing permanent disability in adults worldwide. In acute ischemic stroke, IL-6 levels positively correlated to more severe neurological deficits, more extensive brain damage and worse prognoses. The use of statin was associated with milder initial stroke severity, better functional outcome and lower mortality. This clinically randomized controlled trial study was aimed to analyze the serum levels of IL 6 in acute ischemic stroke patients who treated with Simvastatin 20 mg compare to placebo. Samples were taken using consecutive sampling method from hospitalized acute ischemic stroke patients in Neurology Department of Dr. Soetomo Teaching Hospital Surabaya and Airlangga University Hospital Surabaya from August to November 2017. Total of 44 patients met the inclusion criteria, consisting of 22 patients in treatment group and 22 patients in control group. There were no significant difference in the characteristic of the patients in both groups (p>0.05). Averages of serum IL-6 in the control and the treatment group are 38.594±74.313 and 17.760±25.253 (p=0,438) while averages of serum IL-6 post in the control group and the treatment are 46.586±103.484 and 15.275±17.183 (p=0,589). There were no significant level escalation in pre and post of control group (p=0.205) and also no significant level reduction in pre and post of treatment group (p=0.411), while the average difference in the control group (-7.992 ± 78.912 pg/ml) and in the treatment group (2.485 ± 23.738 pg/ml).

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Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽

10.1024/0301-1526/a000328 ◽

2014 ◽

Vol 43 (1) ◽

pp. 55-61 ◽

Cited By ~ 10

Author(s):

Konstantinos Tziomalos ◽

Vasilios Giampatzis ◽

Stella Bouziana ◽

Athinodoros Pavlidis ◽

Marianna Spanou ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Ankle Brachial Index ◽

Arterial Disease ◽

National Institutes Of Health ◽

Limited Data ◽

Severe Stroke ◽

Hospital Outcome ◽

Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.9.peds18242 ◽

2019 ◽

Vol 23 (3) ◽

pp. 363-368 ◽

Cited By ~ 1

Author(s):

Bing Zhou ◽

Xiao-Chuan Wang ◽

Jun-Yi Xiang ◽

Ming-Zhao Zhang ◽

Bo Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Balloon Dilation ◽

Stent Retriever ◽

National Institutes Of Health ◽

Clinical Prognosis ◽

Nihss Score ◽

Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

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