Cognitive impairment after ischemic stroke: frequency and pattern

To focus on cognitive impairment as indicator of intellectual decline, three months after ischemic stroke, as regards its prevalence and the factors that may affect it. A total of 60 consecutive patients with first-ever ischemic stroke were enrolled. The cognitive function was assessed three months after stroke using a battery of neuropsychological tests. Beside global cognitive function, six major cognitive domains; visual memory, verbal memory, language, orientation, abstract reasoning and visuospatial ability were evaluated. The functional abilities were measured using Barthel Index [BI] for Activity of daily Living. The relationship between cognitive function and demographic data, CT findings and BI was examined. Cognitive impairment was found in 35% of the patients 3 months after ischemic stroke. In comparison to controls, patients had significant cognitive impairment. There was significant impairment of memory and abstract with advancing age. The performance of male patients was significantly better than female patients as regards visual and verbal memory. Patients with left hemispheric infarction had significant impairment in language while right hemispheric infarction was associated with visuospatial neglect. The larger the size of infarct, the more was the impairment of memory, orientation, language and reasoning. Multiinfarcts significantly affected memory, orientation and language. Posterior cerebral artery occlusion significantly affected visual and verbal memory. There was significant relationship between disability BI score and all cognitive domains but neglect. The first-ever ischemic stroke is associated with significant cognitive impairment which occurs in 35% of poststroke patients, three months after stroke. Age, sex, involved hemisphere, size of infarct, single or multiinfarcts, occluded cerebral artery and severity of functional disability may predict cognitive impairment, at least in one domain, after ischemic stroke

Aneurysmal subarachnoid hemorrhage: presentation and neuroradiological detection

To study the presentation and the results of the different radiological tools; computed tomography [CT] brain scan, magnetic resonance imaging [MRI], magnetic resonance angiography [MRA] and cerebral angiography [CA] in patients with subarachnoid hemorrhage [SAH] resulting from ruptured cerebral aneurysms. Consecutive patients with CT proved diagnosis of SAH were subjected to thorough history taking, general, neurological examination and laboratory investigation. After exclusion and deaths, 13 patients underwent MRA and CA beside CT and MRI. CA detected 11 aneurysms in 11 patients, arterio-venous malformation in one patient and in one patient there was no apparent cause. Among our 11 patients with aneurysmal SAH, females and age group of 31-50 years predominated. Smoking was present in 45.5%, hypertension in 27.3% and history of recurrent headache in 63.6%. With the onset of SAH, headache with neck stiffness was the most common presentation [63.6%]. Disturbed consciousness was found in 45.5%, seizures in 18.2% and focal signs in 9.1%. 36.4% of the patients had grade II and 27.3% had grade III in Hunt and Hess scale. Radiological assessment revealed that 7 patients had pure SAH, 3 patients had intracerebral hemorrhage [ICH] and one patient had intraventricular hemorrhage [IVH] in association with SAH. 63.6% of the aneurysms in our patients were small and no giant aneurysms were found. The most common site of aneurysms was middle cerebral artery [MCA] accounted for 36.4%. Anterior cerebral artery [ACA] and anterior communicating artery [ACoA] accounted for 18.2% each. Internal carotid artery [ICA] and posterior communicating artery [PCoA] accounted for 27.3%. In comparison to the CA, as the golden standard method, MRA detected 10 aneurysms out of 11, and missed one small aneurysm, with a sensitivity of 90.9% in detection of aneurysms. Ruptured intracranial aneurysms accounted for about 85% of causes of SAH. History of recurrent headache, smoking, hypertension and female gender may be predictors of aneurysmal rupture in the 4[th] and 5[th] decades. 36.4% of SAH may be associated with ICH or IVH. Headache is the most common presentation of rupture aneurysm while less than half of the patients presented with altered consciousness. About tow thirds of aneurysms are small sized. Intracranial aneurysms located in the anterior cerebral circulation mostly in MCA. MRA is a rapid, non invasive technique and can be used to detect intracranial aneurysms with high sensitivity of 90.9%, with excellent correlation with the gold standard, invasive, CA

Association between hypertension and C-reactive protein in acute phase of ischemic stroke

High-sensitivity C-reactive protein [hs-CRP], an acute phase reactant, is an indicator of underlying systemic inflammation and a novel marker for atherothrombotic disease. This study was designed to evaluate serum levels of hs-CRP in acute ischemia stroke and its relation to stroke severity in the first 24 hours. Also, this study aimed to asses the relationship between hs-CRP levels and blood pressure [BP] in the acute phase of ischemic stroke. Sixty patients were recruited in three groups. Twenty patients with first ever ischemic stroke and history of hypertension were selected to represent group I. Group II included 20 patients with the first ever stroke, with no history of hypertension, with normal BP on regular measurements prior to stroke and presented with acute rise of BP. Twenty hypertensive patients with no history of stroke or ischemic heart diseases represented group III. For comparison, 20 healthy volunteers were included as control group. All subjects were submitted to detailed history taking, thorough general and neurological examination with paying special attention to BP. Stroke severity was assessed using the Canadian Neurological Scale [CANS]. The infarcts size was evaluated in CT and/or MRI. Serum levels of hs-CRP were measured using end point CRP-turbidoemetric assay. Serum levels of hs-CRP were significantly higher among patients of group I [t = 6.01, p<0.001], group II [t = 6.39, p<0.001] and group III [t = 2.91, p<0.01] in comparison with controls. The highest significant elevation was observed among stroke patients with acute rise of BP while; the modest was among patients with isolated hypertension. CRP levels showed significant negative correlation with the CANS score [r = -0.72, p<0.001], and significant positive correlation with the size of brain infarcts [r = 0.68, p<0.001]. There was highly significant positive correlation between hs-CRP levels and BP components; systolic BP [SBP], diastolic BP [DBF], mean arterial pressure [MAP] and pulse pressure [PP] in all patient groups. However, when displaying the multivariate adjusted logistic regression model assessing the association between all BP components and odds of having elevated CRP levels, only 10 mmHg rise in SBP significantly persisted to increase the odds of having an elevated CRP by 76% [odds ratio, 3.76; 95% confidence interval, 1.97-5.35; P<0.001]. Ischemic stroke can trigger an acute phase response expressed by elevation of circulating hs-CRP serum levels which may correlate with the size of infarcts and the severity of stroke. In the acute phase of ischemic stroke, hypertension, more specifically acute rise of BP, is associated with increased levels of hs-CRP which may correlate with BP components most prominent with SBP

High versus standard dose prophylactic cranial irradiation for patients with limited sm allcell lung cancer incomplete remission

Small cell lung cancer [SCLC] accounts for approximately 20% of all patients with lung cancer. Limited-disease [LD] is considered potentially curable. The role of prophylactic cranial irradiation [PCI] in those patients who achieved a complete cure [CR] to induction therapy remains uncertain. Eligible patients were randomized to receive either high dose PCI [20 patients received 2.4 Gy once daily in 10 fractions for a total dose of 24 Gy] or a standard dose PCI [25 patients were treated with 2 Gy once daily in 18 fractions for a total dose of 36 Gy, while there was another group [15 patents] who refused PCI. Results: The results confirmed the observable reduction of brain metastases with the high dose PCI compared to the standard dose PCI and also for those who did not receive PCI [16%, 35%, and 53% respectively]. Also this result confirmed the loss of significant survival advantage between those who receive PI and those who did not. No evidence of consistent difference regarding neurological and cognitive impairment between patients given or not PCI