Ischemic Lesion Water Uptake in Acute Stroke: Is Blood Glucose Related to Cause and Effect?

Background and ObjectivesIn acute stroke, early ischemic lesion hypodensity in computed tomography (CT) is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma is however challenged by rare cases of apparently reversed early lesion hypodensity following complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment.Methods184 acute ischemic anterior circulation stroke patients were included after consecutive screening. Ischemic brain edema was determined using quantitative lesion net water uptake (NWU) in admission-CT and follow-up CT based on CT-densitometry and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed using modified Ranking Scale (mRS) scores at day 90.Results27/184 patients (14.7%) showed edema arrest and 3 patients (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio (OR): 2.96, 95%CI: 1.46-6.01, p<0.01) and shorter time from imaging to recanalization (OR/hour: 0.32, 95%CI: 0.18-0.54, p<0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS 2 versus mRS 5, p=0.004).DiscussionAlbeit rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible following complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions where early revascularization may halt or even reverse vasogenic edema of ischemic tissue.

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Improving acute stroke assessment in non-enhanced CT: Automated tool for early ischemic lesion volume detection

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.119611 ◽

2021 ◽

Vol 429 ◽

pp. 119611

Author(s):

Giovanni Furlanis ◽

Mara Bernardi ◽

Alex Rodriguez ◽

Paola Caruso ◽

Marcello Naccarato ◽

...

Keyword(s):

Acute Stroke ◽

Lesion Volume ◽

Ischemic Lesion ◽

Enhanced Ct ◽

Automated Tool ◽

Stroke Assessment

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STROKE OUTCOMES IN NON-DIABETIC, DENOVO DIABETIC AND DIABETIC INDIAN PATIENTS MEASURED BY MODIFIED RANKIN SCALE: AN OBSERVATIONAL STUDY

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i8.18378 ◽

2017 ◽

Vol 9 (8) ◽

pp. 94

Author(s):

Syed Junaid Ahmed ◽

Abdur Rahman Mohd Masood ◽

Safiya Sumana ◽

Khadeer Ahmed Ghori ◽

Javed Akhtar Ansari ◽

...

Keyword(s):

Blood Glucose ◽

Observational Study ◽

Hospital Admission ◽

Acute Stroke ◽

Mean Difference ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Glucose Levels ◽

Blood Glucose Levels ◽

The Mean

Objective: Hyperglycemia is a known risk factor which adversely impacts the outcomes in stroke patients compared to patients with normal blood glucose levels. Patients suffering from an acute stroke who are previously nonhyperglycemic may show elevated blood glucose levels. The present study was designed to measure the outcomes in denovo diabetic and diabetic stroke patients compared to nondiabetics.Methods: A prospective observational study over a period of 6 mo, in which 103 patients were divided into three cohorts based on their blood glucose levels (nondiabetic, denovo diabetic and diabetics). The modified Rankin scale (mRS) score was calculated at in-hospital admission and discharge in these three cohorts. The initial and final scores were correlated and mean differences with respect to outcomes between all the three cohorts was calculated.Results: The mean mRS at the time of hospital admission in diabetics and nondiabetics was 3.6±0.81 and 3.3±0.78 which decreased to 2.8±0.95 and 2.9±0.83 respectively at the time of discharge. The mean mRS score in denovo diabetic stroke patients during in-hospital admission was 4±0.81 which was calculated as 3.7±0.85 at the time of discharge. The mean difference in mRS score in diabetics vs non-diabetics was found to be 0.73±0.8 (p =<0.001). The mean difference in mRS score of denovo diabetics vs non-diabetics and denovo diabetics vs diabetics was 0.30±0.63 and 0.38±0.61 respectively (p = 0.1).Conclusion: Results of these observational study in Indian patients, highlights the need for controlling hyperglycemia in stroke patients to improve outcomes and to prevent mortality arising out of acute stroke attacks.

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Admission blood glucose and in-hospital clinical outcome among patients with acute stroke in Inner Mongolia, China

Clinical & Investigative Medicine ◽

10.25011/cim.v32i2.6033 ◽

2009 ◽

Vol 32 (2) ◽

pp. 151 ◽

Cited By ~ 2

Author(s):

Ning Wang ◽

Dawei Qiao ◽

Weijun Tong ◽

Fengshan Zhang ◽

Zhong Ju ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Acute Stroke ◽

Inner Mongolia ◽

Odds Ratio ◽

Logistic Model ◽

Hemorrhagic Stroke ◽

Blood Glucose Concentration ◽

Hospital Death ◽

Stroke Patients

Purpose: There is still controversy about the association between admission blood glucose concentration and outcome of acute stroke. We studied the association between admission blood glucose and in-hospital death / dependency among acute stroke patients in Inner Mongolia, China. Methods: 2,178 acute ischemic and 1,760 hemorrhagic stroke patients in six hospitals were included in the study. Blood glucose and other study variables were collected within the first 24-hr of hospital admission. Clinical outcomes were evaluated by neurologists during hospitalization. The associations between admission blood glucose and the risk of in-hospital death/dependency were analyzed using a multiple logistic model. Results: There were associations between admission blood glucose and in-hospital death/dependency among patients with acute ischemic or hemorrhagic stroke. Compared with patients with blood glucose < 6.1mmol/L, multivariate-adjusted odds ratio (95% confidence interval) of death/dependency were 0.53 (0.23, 1.27), 2.22 (1.21, 4.11), 1.92 (1.12, 3.33) and 1.91 (1.00, 3.64) for ischemic stroke patients, and 0.93 (0.44, 1.96), 1.42 (0.65, 3.10), 1.98 (1.10, 3.55) and 2.93 (1.40, 6.11) for hemorrhagic stroke patients, with blood glucose 6.1-6.9, 7.0-7.7, 7.8-11.0 and ?11.1mmol/L, respectively. Conclusion: Increased admission blood glucose was associated with death/dependency among patients with acute hemorrhagic and ischemic stroke.

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A Prospective, Observational Study of the Management of Hyperglycaemia in Acute Stroke. What is the Optimum Level of Blood Glucose at which to Intervene?

The British Journal of Diabetes ◽

10.1177/1474651410390310 ◽

2010 ◽

Vol 10 (6) ◽

pp. 287-291 ◽

Cited By ~ 4

Author(s):

Paul S Grant ◽

Khalid Ali

Keyword(s):

Blood Glucose ◽

Observational Study ◽

Acute Stroke ◽

Prospective Observational Study ◽

Optimum Level

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Blood glucose increases early after stroke onset: a study on serial measurements of blood glucose in acute stroke

European Journal of Neurology ◽

10.1046/j.1468-1331.2002.00409.x ◽

2002 ◽

Vol 9 (3) ◽

pp. 297-301 ◽

Cited By ~ 55

Author(s):

H. Christensen ◽

G. Boysen

Keyword(s):

Blood Glucose ◽

Acute Stroke ◽

Stroke Onset ◽

Serial Measurements

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Correlation of blood glucose levels, HbA1c, hemoglobin and leukocytes with outcome on acute stroke

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191629 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1430

Author(s):

Meiriani . ◽

Yuneldi Anwar ◽

Puji Pinta Omas Sinurat

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Acute Stroke ◽

Hemorrhagic Stroke ◽

Cross Sectional Study ◽

P Value ◽

Stroke Patients ◽

Cross Sectional ◽

Glucose Levels ◽

Blood Glucose Levels

Background: Diabetes and higher HbA1c level have increased the incidence of stroke. Hemoglobin levels both high and low are associated with poor outcomes. Leukocytes play an important role in the initiation of the atherosclerosis process.Methods: This was a cross-sectional study with a sample size of 62 people selected by non-random sampling method on a consecutive basis, patients with acute stroke were taken blood to measure blood glucose levels, HbA1c, Hb and Leucocytes when entering the hospital room. Outcomes were assessed using NIHSS and MRS. The calculation of NIHSS and MRS scores was performed on the first day of admission and the fourteenth day. To analyze the correlation of blood sugar levels during HbA1c, Hb and leukocytes in acute stroke, this study used Spearman's correlation test. The p value <0.05 was considered statistically significant.Results: The study subjects of 62 acute stroke patients (acute ischemic stroke 31 people and 31 people hemorrhagic stroke). Acute stroke patients were consisted of 38 men (61.3%) and 24 women (38.7%). Of 31 people with hemorrhagic stroke, there were 16 men (51.6%) and 15 women (48.4%), ischemic stroke patients were consisted of 22 people (71, 0%) and women were 9 people. Spearrman repair test showed no symptoms between blood glucose levels, HbA1c, Hemoglobin and leukocytes with outcomes in acute stroke.Conclusions: There was no significant association between blood glucose levels, HbA1c, hemoglobin and leukocytes with outcomes in acute stroke.

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

International Journal of Stroke ◽

10.1177/1747493019884522 ◽

2019 ◽

pp. 174749301988452 ◽

Cited By ~ 2

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.

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Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake

Neurosurgery ◽

10.1093/neuros/nyaa438 ◽

2020 ◽

Author(s):

Gabriel Broocks ◽

Sarah Elsayed ◽

Helge Kniep ◽

Andre Kemmling ◽

Fabian Flottmann ◽

...

Keyword(s):

Water Uptake ◽

Roc Analysis ◽

Early Stage ◽

Area Under The Curve ◽

Posterior Circulation ◽

Receiver Operating Curve ◽

Imaging Biomarker ◽

Anterior Circulation ◽

Ischemic Lesion ◽

Posterior Circulation Stroke

Abstract BACKGROUND Malignant cerebellar edema (MCE) is a life-threatening complication of ischemic posterior circulation stroke that requires timely diagnosis and management. Yet, there is no established imaging biomarker that may serve as predictor of MCE. Early edematous water uptake can be determined using quantitative lesion water uptake, but this biomarker has only been applied in anterior circulation strokes. OBJECTIVE To test the hypothesis that lesion water uptake in early posterior circulation stroke predicts MCE. METHODS A total 179 patients with posterior circulation stroke and multimodal admission CT were included. A total of 35 (19.5%) patients developed MCE defined by using an established 10-point scale in follow-up CT, of which ≥4 points are considered malignant. Posterior circulation net water uptake (pcNWU) was quantified in admission CT based on CT densitometry and compared with posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) as predictor of MCE using receiver operating curve (ROC) analysis and logistic regression analysis. RESULTS Acute pcNWU within the early ischemic lesion was 24.6% (±8.4) for malignant and 7.2% (±7.4) for nonmalignant infarctions, respectively (P < .0001). Based on ROC analysis, pcNWU above 14.9% identified MCE with high discriminative power (area under the curve: 0.94; 95% CI: 0.89-0.97). Early pcNWU (odds ratio [OR]: 1.28; 95% CI: 1.15-1.42, P < .0001) and pc-ASPECTS (OR: 0.71, 95% CI: 0.53-0.95, P = .02) were associated with MCE, adjusted for age and recanalization status. CONCLUSION Quantitative pcNWU in early posterior circulation stroke is an important marker for MCE. Besides pc-ASPECTS, lesion water uptake measurements may further support identifying patients at risk for MCE at an early stage indicating stricter monitoring and consideration for further therapeutic measures.

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