Gradient-echo MRI assessment of microbleed in ischemic stroke patients

Cerebral microbleeds are considered evidence of [microangiopathy], thus, they are commonly found in patients with severe leukoaraiosis and lacunar infarction. The aim of the present study was to evaluate the possible risk factors or [determinants] of microbleeds in patients with ischemia stroke, especially highlighting the association of the presence of microbleeds with small vessel vasculopathy [leukoaraiosis and lacunar infarcts]. The study included 52 patients with ischemic stroke, divided into 3 groups according to MRI findings: Group [A] patients with microbleeds +/- leukoaraiosis, Group [B] patients with leukoaraiosis without microbleeds and Group [C] patients with neither leukoaraiosis nor microbleeds [considered as a control group]. Assessment was done through clinical examination, laboratory investigations, carotid duplex, MRA and MRI brain with gradient-echo T2-weighted technique. Among the patients with microbleeds, the commonest site of microbleeds was in the deep grey nuclei followed by the hemispheric subcortical region then the brain stem while the cerebellum was involved in only 4 patients. Both groups [A] and [B] differed significantly from group [C] as they were older, hypertension was more commonly encountered and was poorly controlled. Stroke recurrence was more common among groups [A] and [B]. Furthermore, group [A] differed from group [C] in having longer duration of hypertension and more history of previous antiplatelet therapy. Group [A] differed from group [B] only concerning control of hypertension [larger number of poorly controlled patients] and number of lacunar infarcts [larger number of lacunar infarcts]. Cerebral microbleeds are commonly associated with lacunar infarctions and leukoaraiosis. Lack of proper control of hypertension [not just its mere presence or its duration] is an important determinant factor for both microbleeds and lacunar infarction, which might be complicated in the future by intra-cerebral hemorrhage

Serum soluble vascular cell adhesion molecule-1 [sVCAM-1] in acute ischemic stroke

Neuroinflammatory mechanisms play an important role in ischemic injury and interruption of these processes can result in improved neurological outcomes. Firm adhesion of leukocytes to the endothelial cells as well as leukocyte activation and transmigration across the endothelium is mediated by adhesion molecules. We aimed to assess the levels of serum soluble vascular cell adhesion molecule-1 [sVCAM-1] in acute stroke and their correlation to the extent of neurological deficits and short term clinical outcome. Forty four patients with first ever acute ischemic stroke admitted within 72 hours of stroke onset were enrolled, in addition to eighteen normal controls and twelve patients with vascular risk factors matched with age and sex to the patients group. Blood samples were obtained from the patients at the third day of stroke onset and from the control groups and subjected to the measurement of the level of sVCAM-1 in the serum. There is a higher mean sVCAM-1 among patients with ischemic stroke compared to normal controls and the difference is highly significant statistically, P<0.01. There is a higher mean sVCAM among patients with large vessel disease compared to patients with small vessel disease and the difference is highly significant statistically, P<0.01. There is a highly significant positive correlation between sVCAM-1 and NIHSS score, P<0.01. Also we found a statistically significant negative correlation between Barthel Index Score and sVCAM-1, P<0.05. The results support the prior hypothesis of involvement of the adhesion molecules [VCAM-1] in the pathogenesis of acute cerebral ischemia and their impact on neuronal damage and neurological deficit. Therapeutic trials that attempt to interfere with the function of adhesion molecules could be of benefit in acute stroke management