Correlation of Serum Total Bilirubin Levels and the Severity of Acute Ischemic Stroke / 대한뇌혈관외과학회지

OBJECTIVE: We evaluated whether serum total bilirubin levels were related to large artery atherosclerosis (LAA), classified by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and stroke severity at admission in acute ischemic stroke. METHODS: We analyzed clinical features, laboratory tests, and radiologic findings such as brain MRI and MR angiography of patients admitted to our hospital within 24 hours of the onset of ischemic stroke between January 2004 and June 2007. By TOAST classification, 237 patients [115 with LAA and 122 with small artery occlusion (SAO)] were selected. We divided serum total bilirubin levels into three groups: Low (15). RESULTS: Total bilirubin levels were significantly higher in the Mild group than other groups, and high-sensitivity C reactive protein (hsCRP) levels were significantly higher in the Severe group than other groups in LAA. There were no differences for these factors in SAO. We found a significant correlation between total bilirubin levels and stroke severity in LAA (p=0.005). CONCLUSION: Higher serum total bilirubin levels were associated with lower stroke severity at admission in LAA but not SAO.

Relations to Plasma Fibrinogen Concentration and Subtype, Prognostic Influence in Patients with Acute Ischemic Stroke / 대한뇌혈관외과학회지

OBJECTIVE: Previous epidemiological studies have suggested that hyperfibrinogenemia is an independent risk factor for cerebrovascular atherosclerosis. Fibrinogen is a key factor in the coagulation cascade, and it is suggested to play in a significant role in atherosclerosis. However, there have been relatively few studies regarding the relationship between the level of fibrinogen and prognostic influence in stroke subtypes. We prospectively evaluated that whether plasma fibrinogen levels in the acute stage were related to clinical outcome in each subtype of acute ischemic stroke. METHODS: Acute ischemic stroke was classified by the Trial of Org 10172 in the Acute Stroke Treatment (TOAST) classification. Large atrery atherosclerosis (LAA), and small vessel occlusion (SVO) were included in the classification; cardioembolic (CE) occlusion, and other causes and undetermined causes were excluded from the classficiation. The level of fibrinogen was determined within 24 hours after stroke. Stroke severity and outcome was assessed using the National Institutes of Health Stroke Scale (NIHSS) score at admission (baseline) and follow-up (4 weeks later). The NIHSS changes were compared from baseline to follow-up. Patients with NIHSS changes were divided into two groups: the good group (NIHSS had improved) and poor group (NIHSS had no change or had worsened). Patients were placed into two groups based on the plasma fibrinogen level: the normal group (plasma fibrinogen level of 200~400mg/dl) and high group (plasma fibrinogen level >400mg/dl). The level of plasma fibrinogen and changes of NIHSS were analyzed by the Chi-squared tests and multiple logistic regression. RESULTS: A total of 619 patients with acute ischemic stroke were studied. Among the 619 patients, there were 251 patients with LAA and 229 patients with SVO. Multiple logistic regression analysis indicated that a high level of plasma fibrinogen (p < 0.001), a high level of C-reactive protein (p < 0.001) and the presence of diabetes mellitus (p = 0.026) were related to poor prognosis with acute stage ischemic stroke. Partial correlation analysis showed that the plasma fibrinogen levels were related to LAA (p = 0.05) and NIHSS at admission (p = 0.007) in patients with a high plasma fibrinogen level. However, there was no statistical significance of ischemic stroke subtype and NIHSS in patients with a normal level of plasma fibrinogen. CONCLUSION: An elevated level of plasma fibrinogen seemed to be associated with LAA in acute ischemic stroke and with a poor clinical outcome.

Clinical Characteristics of Pediatric Cerebral Aneurysms / 대한뇌혈관외과학회지

BACKGROUND: Hypercholesterolemia is a major risk factor for ischemic stroke. It was reported that a low triglyceride (TG), not a low cholesterol concentration, was independently associated with the poor outcome of ischemic stroke. There are no reports on relationship between the serum TG level and the clinical outcome of acute stage of ischemic stroke. Moreover, the differences in clinical outcome of each subtype of ischemic stroke in relation to the serum TG level are unknown. This study examined relationship between the serum TG level upon admission and the clinical outcome at discharge in each subtype of acute ischemic stroke. METHODS: Four hundred and fifty consecutive patients with their first-ever ischemic stroke, who admitted between January 2004 and December 2006, were examined retrospectively. The serum TG level was measured within 24 hours after stroke onset. The subtypes of stroke were classified according to the Trial of ORG 10172 in the Acute Stroke Treatment (TOAST) classification. The severity and outcome of stroke were assessed using the National Institutes of Health Stroke Scale (NIHSS) score upon admission, at discharge, and 4 weeks after discharge. The population was divided into 3 groups according to the serum TG level (Normal TG group : serum TG level 150mg/dl, Borderline-high TG group : 150 degrees ¬ TG< 200mg/dl, High TG group : serum TG level 200mg/dl) and 2 groups by NIHSS score (Improved outcome group: NIHSS score decreased or unchanged, Worsened outcome group: NIHSS score increased). The relationship between the level of TG of each stroke subtype and the clinical outcome of those patients was analyzed. RESULTS: The study population was divided into three groups, according to the serum TG level. The Normal TG group consisted of 128 patients (mean serum TG level : 74.0 17.2mg/dl). The borderline-high TG group consisted of 230 patients (mean serum TG level : 168.9 20.4 mg/dl). The high TG group consisted of 92 patients (mean serum TG level : 474.5 197.0 mg/dl). Hypertension and diabetes are prevalent in the high TG group, which also had higher incidence of large artery disease in the TOAST classification. The normal TG group showed more severe stroke upon admission and a poor clinical outcome after 4 weeks than the other two groups (p<0.05). Each TOAST classification of TG group showed a similar clinical outcome. CONCLUSION: The normal TG group had a more severe the stroke and poorer clinical outcome than the other groups. TG may play a role as a protective factor in the acute stage of ischemic stroke.