Opalski syndrome: a case study (Case Report) / Síndrome de Opalski: um relato de caso (Relato de Caso)

Opalski Syndrome (OS) is an unusual presentation of Lateral Medullary Syndrome (LMS) with ipsilateral hemiparesis. We report the case of a 65-year-old woman with a background of unprovoked deep venous thrombosis and unintentional weight loss that presented after a one-week-long episode of sudden onset vertigo, frontotemporal headache, blurry vision, and weakness. A head magnetic resonance imaging (MRI) revealed subacute ischemic event, with flow-void loss in the right vertebral artery and absence of blood flow, suggesting OS secondary to likely right posterior inferior cerebellar artery (PICA) occlusion. An abdominal and thoracic computed tomography (CT) scan showed suggestive findings of stage IV pancreatic tail cancer. Because of its non-classical presentation, OS might be a diagnostic challenge to most physicians. As in this patient, the existence of concomitant cancer probably led to a hypercoagulable state, which could explain the ischemic stroke while on anticoagulation therapy.

A Síndrome de Opalski (OS) é uma apresentação incomum da Síndrome Medular Lateral (LMS) com hemiparesia ipsilateral. Relatamos o caso de uma mulher de 65 anos com história de trombose venosa profunda não provocada e perda de peso não intencional que se apresentou após um episódio de uma semana de vertigem de início súbito, cefaleia frontotemporal, visão turva e fraqueza. Uma ressonância magnética (RM) de crânio revelou evento isquêmico subagudo, com perda de fluxo vazio na artéria vertebral direita e ausência de fluxo sanguíneo, sugerindo OS secundária à provável oclusão da artéria cerebelar inferior posterior direita (PICA). Uma tomografia computadorizada (TC) de abdome e tórax evidenciou achados sugestivos de câncer de cauda pancreática em estágio IV. Devido à sua apresentação não clássica, a OS pode ser um desafio diagnóstico para a maioria dos médicos. No caso dessa paciente, a existência de neoplasia concomitante provavelmente induziu um estado de hipercoagulabilidade, o que poderia explicar o acidente vascular cerebral isquêmico em regime de anticoagulação.

Predictors of outcome after childhood ischemic stroke at a referral neuroscience hospital in Bangladesh

Background: Though stroke in the pediatric age group is not as common as in adults, it is now recognized as an important cause of morbidity and mortality in children. For proper management of childhood stroke, it is very important to know about the spectrum of clinical presentation, risk factors, and neuroimaging features that can affect the outcome following stroke. The aim of the study was to identify predictors of outcomes in children with ischemic stroke treated at a referral neuroscience hospital in Bangladesh. Methods: A one-year prospective cohort study was conducted at the department of pediatric neurology, national institute of neurosciences and hospital (NINS and H), Dhaka, from March 2021 to February 2022. It involved 42 consecutive pediatric ischemic stroke patients aged 1 month to 18 years. Post-operative outcomes were assessed clinically, biochemically, and with imaging at discharge, 1 month, and 6 months post-discharge using the PSOM scale. Statistical analysis was performed using SPSS version 23.0, with significance set at p<0.05. Results: In our pediatric ischemic stroke study (n=42), most patients (76.2%) were aged 1-5 years, with iron deficiency anemia (59.5%) as the predominant risk factor. Anterior circulation stroke was common (90.5%), and PSOM assessments showed 28.6% favorable outcomes at discharge, increasing to 76.2% at 6 months. Seizure, speech difficulty, altered consciousness, and CNS infection were linked to poorer outcomes (p<0.005). Conclusions: Childhood stroke poses significant morbidity, with variable neurological outcomes. Factors like seizure, speech difficulty, altered consciousness, and CNS infection predict poorer outcomes.

ACV isquémico debido a embolia paradojal a través de malformación arteriovenosa pulmonar en paciente joven / Ischemic stroke due to paradoxical embolism through pulmonary arteriovenous malformation in a young patient

Resumen La embolia paradojal debido a una malformación arteriovenosa pulmonar (MAVP) aislada es una causa in frecuente de accidente cerebrovascular (ACV) isquémico. Las MAVP son conductos anómalos de alta circulación entre arterias y venas pulmonares, desviando sangre desoxigenada hacia la circulación sistémica y represen tan una fuente menos común de embolias paradojales, especialmente en personas jóvenes. La embolización endovascular es el tratamiento preferido para MAVP clínicamente significativas. Presentamos el caso de una mujer de 34 años con ACV isquémico talámico izquierdo. Se detectó pasaje de burbujas "en cortina" en arterias cerebrales mediante Doppler transcraneal. En ecografía intracardíaca no se encontró foramen oval permeable, motivo por el cual se avanzó con realización de angiotomografía pulmonar, la cual confirmó la presencia de MAVP. La paciente recibió tratamiento endovascular exitoso. Es esencial considerar la MAVP en el diagnóstico etio lógico del ACV isquémico, especialmente en pacientes jóvenes con signos de comunicación anormal de derecha a izquierda. Se recomienda un seguimiento periódico mediante imágenes para evaluar la posible recurrencia o cambios en la MAVP, resaltando la importancia del manejo adecuado de estas malformaciones.

Abstract Paradoxical embolism due to an isolated pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke. PAVMs are abnormal high-flow connec tions between pulmonary arteries and veins, diverting deoxygenated blood into the systemic circulation and they represent a less common source of paradoxical embolisms, especially in young individuals. Endovascular embolization is the preferred treatment for clinically significant PAVMs. We present the case of a 34-year-old woman with a left thalamic ischemic stroke. Severe contrast passage was detected in cerebral arteries through transcranial Doppler. Intracardiac ultrasound did not reveal a patent foramen ovale, prompting further investigation with pulmonary CT angiography, confirming the presence of PAVM. The patient underwent successful endovascular treatment. It is essential to consider PAVM in the etiological di agnosis of ischemic stroke, especially in young patients with signs of abnormal right-to-left communication. Periodic follow-up imaging is recommended to assess potential recurrence or changes in PAVM, emphasizing the importance of appropriate management of these malformations.

Effective endovascular reconstruction using multiple leo stents and silk flow-diverting stents for asymptomatic extracranial internal carotid artery dissection: a case report

Extracranial carotid artery dissection (ECAD), although infrequent, represents the predominant form of artery dissection within the brain. It accounts for 25% of young-onset ischemic strokes in adults. Its atypical presentation and limited availability of high-quality evidence underscore the importance of precision medicine in its management. This study aimed to illustrate a combined approach utilizing multiple scaffolding Leo stents and Silk flow-diverting stents to manage asymptomatic ECAD a week after the onset of acute ischemic stroke. A 40-year old Indian male with uncontrolled hypertension was admitted due to acute vestibular syndrome. His brain computed tomography (CT) scan showed cerebellar infarct. However, his angiographic cervical CT scan showed asymptomatic ECAD, which was confirmed with digital subtraction angiography. He was therefore managed with optimal antihypertensive agents and dual antiplatelet. The endovascular reconstruction procedure initiated one week after the onset of stroke by employing one scaffolding Leo stent and one Silk flow-diverting stent at his right internal carotid artery. He was discharged three days following the endovascular procedure and presented no complications until three-month follow-up. This safe approach could be considered for individuals with ECAD to help prevent secondary strokes, particularly among those in the productive age group.

COVID-19 e a incidência de AVC isquêmico pós-infecção: uma revisão integrativa da literatura / COVID-19 and the incidence of post-infection ischemic stroke: an integrative literature review

O SARS-CoV-2 é um vírus que surgiu em 2019, sendo responsável por causar uma síndrome respiratória que foi denominada COVID-19. O vírus possui uma proteína, chamada proteína Spike, que interage com as ACE2, estando presente no trato respiratório e nas células endoteliais, causando inflamação, apoptose e efeitos pró-trombóticos que ativam a via de coagulação. Dessa maneira, presume-se que o estado de hipercoagulabilidade do vírus e a inflamação endotelial estejam relacionados à fisiopatologia do AVC isquêmico pós-infecção. O objetivo desta revisão foi analisar a fisiopatologia e a etiologia dos AVCs associados à infecção pelo vírus SARS-CoV-2 e seus fatores de risco. Foi realizada uma busca por trabalhos prévios nas plataformas PubMed e BVS, e um total de 26 artigos científicos foram incluídos após a aplicação de critérios de inclusão e exclusão. Através dos estudos analisados, observou-se a correlação do aumento da incidência do AVC pós-infecção pelo SARS-CoV-2, e os fatores de risco presentes principais foram hipertensão arterial, fibrilação atrial, diabetes mellitus, dislipidemia e insuficiência cardíaca. Em conclusão, a infecção por SARS-CoV-2 possui relação com o aumento da incidência de AVC, possivelmente por seu mecanismo trombótico e inflamatório dos endotélios.

SARS-CoV-2 is a virus that emerged in 2019, being responsible for causing a respiratory syndrome that was named COVID-19. The virus has a protein, called Spike protein, which interacts with ACE2, which are present in the respiratory tract and endothelial cells, causing inflammation, apoptosis and prothrombotic effects that activate the coagulation pathway. Thus, it is presumed that the hypercoagulable state of the virus and endothelial inflammation are related to the pathophysiology of postinfection ischemic stroke. The aim of this review was to analyze the pathophysiology and etiology of strokes associated with SARSCoV-2 virus infection and their risk factors. A search for previous works was carried out on PubMed and VHL platforms, and a total of 26 scientific articles were included after applying inclusion and exclusion criteria. Through the studies analyzed, a correlation was observed between the increased incidence of stroke after infection with SARS-CoV-2, and the main risk factors present were arterial hypertension, atrial fibrillation, diabetes mellitus, dyslipidemia and heart failure. In conclusion, SARS-CoV-2 infection is related to the increased incidence of stroke, possibly due to its thrombotic and endothelial inflammatory mechanism.

Costos médicos directos de los pacientes con ataque cerebrovascular isquémico en un hospital público de Bogotá, Colombia / Direct medical costs of ischemic stroke in a public hospital in Bogotá, Colombia

Resumen Introducción: El ataque cerebrovascular isquémico (ACVi) es la segunda causa de muerte en Colombia. Se estimó que los costos asociados al ACVi podrían alcanzar los COP 5000 millones durante el 2019. Objetivo: Describir los costos médicos directos de los pacientes que sufren de ACVi en una institución en Bogotá durante el 2020. Metodología: Estudio de corte transversal que analiza los costos médicos directos de la atención hospitalaria de adultos que sufrieron un ACVi durante el 2020. Se compararon los costos, la estancia y los desenlaces clínicos de pacientes que recibieron trombólisis frente aquellos que no la recibieron. Resultados: Los costos directos relacionados con 132 pacientes con ACVi fueron COP 1.218.970.831 en el año 2020 en nuestra institución. El costo promedio por paciente fue COP 7.845.073. Entre los eventos hospitalarios, las imágenes diagnósticas y otros métodos diagnósticos representaron la mayor proporción de costos (40 %), entre los que se destacó la angiotomografía de cabeza y cuello. La severidad del ACV influyó significativamente en los costos totales (p = 0,018), así como en los costos de los medicamentos (p < 0,001), procedimientos (p < 0,001) y la estancia hospitalaria (p < 0,029). Los pacientes sometidos a trombólisis resultaron 1,33 veces más costosos que aquellos con manejo médico (p < 0,001), sin que ello afectara de manera significativa la duración de la estancia ni la tasa de letalidad. Conclusión: La trombólisis intravenosa en el ACVi implica un aumento significativo en los costos directos, pero reduce la carga de discapacidad en los pacientes tratados. Los costos se incrementan con la severidad del ACVi y la realización de algunos procedimientos adicionales.

Abstract Introduction: Ischemic stroke (IS) is the second leading cause of death in Colombia. The costs associated with IS were estimated to reach COP 5 billion during 2019. Objective: To describe the direct medical costs of patients suffering from IS in an institution in Bogotá during 2020. Methodology: A cross-sectional study analyzing the direct medical costs of hospital care for adults who experienced IS during 2020. Costs, length of stay, and clinical outcomes of patients who received thrombolysis were compared to those who did not. Results: Direct costs related to 132 IS patients were COP 1,218,970,831 in 2020 at our institution. The average price per patient was COP 7,845,073. Among hospital events, diagnostic imaging and other diagnostic methods represented the highest proportion of costs (40 %), with head and neck angiography standing out. IS severity significantly influenced total costs (p = 0.018), as well as medication costs (p < 0.001), procedures (p < 0.001), and hospital stay (p < 0.029). Thrombolysis patients were 1.33 times more costly than those with medical management (p < 0.001), without significantly affecting the length of stay or mortality rate. Tracheitis (p < 0.001) and gastrostomy (p = 0.007) were associated complications that increased both costs and hospital stay. Conclusion: Intravenous thrombolysis in IS involves a significant increase in direct costs but reduces the burden of disability in treated patients. Costs increase with the severity of IS and the performance of specific additional procedures.

Combining metabolomics and network pharmacology to investigate the protective effect of Jiawei Xinglou Chengqi Granules in ischemic stroke

Jiawei Xinglou Chengqi Granule (JXCG) is an effective herbal medicine for the treatment of ischemic stroke (IS). JXCG has been shown to effectively ameliorate cerebral ischemic symptoms in clinical practice, but the underlying mechanisms are unclear. In this study, we investigated the mechanisms of action of JXCG in the treatment of IS by combining metabolomics with network pharmacology. The chemical composition of JXCG was analyzed using ultra-high performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS). Ultra-high performance liquid chromatography-tandem time-of-flight mass spectrometry (UHPLC-Q-TOF MS) untargeted metabolomics were used to identify differential metabolites within metabolic pathways. Network pharmacology was applied to mine potential targets of JXCG in the treatment of IS. The identified key targets were validated by constructing an integrated network of metabolomics and network pharmacology and by molecular docking using Cytoscape. The effect of JXCG on IS was evaluated in vivo, and the predicted targets and pathways of JXCG in IS therapy were assessed using immunoblotting. Combining metabolomics and network pharmacology, we identified the therapeutic targets of JXCG for IS. Notably, JXCG lessened neuronal damage and reduced cerebral infarct size in rats with IS. Western blot analysis showed that JXCG upregulated PRKCH and downregulated PRKCE and PRKCQ proteins. Our combined network pharmacology and metabolomics findings showed that JXCG may have therapeutic potential in the treatment of IS by targeting multiple factors and pathways.

Proteína-C reactiva de alta sensibilidad y homocisteína en pacientes con enfermedad cerebrovascular isquémica

Fundamento: la proteína C reactiva de alta sensibilidad (PCR-as) y la homocisteína (Hci) parecen relacionarse con la enfermedad cerebrovascular isquémica, pero sus hallazgos sobre el riesgo y pronóstico de esta enfermedad resultan controversiales y no concluyentes. Objetivo caracterizar la proteína C reactiva de alta sensibilidad y homocisteína en pacientes con enfermedad cerebrovascular isquémica. Métodos: se realizó un estudio descriptivo y retrospectivo de corte transversal en pacientes con enfermedad cerebrovascular isquémica, ingresados en el Servicio de Ictus del Instituto de Neurología y Neurocirugía entre 2016 y 2019. Se recogieron variables demográficas, manifestaciones clínicas, tiempo de evolución, etiología y localización del infarto y factores riesgo. Se cuantificaron la PCR-as (riesgo cardiovascular) y la Hci. Resultados las medias de PCR-as (7,0±8,3 mg/L) y Hci (17,1±7,3 µM) fueron elevadas. El riesgo cardiovascular moderado y alto se presentaron en igual proporción (46,8 %). Hubo diferencias estadísticas en la relación entre el riesgo cardiovascular y la edad (p=0,00); pero ni el tiempo de evolución ni los factores de riesgo de la enfermedad mostraron este comportamiento. Los pacientes con riesgo cardiovascular alto (PCR-as >3 mg/L) y elevada Hci (>15 (M) exhibieron mayores frecuencias de etiologías aterotrombótica o cardioembólica. Conclusiones el riesgo cardiovascular aumenta en la medida que se incrementa la edad de pacientes con enfermedad cerebrovascular isquémica. Las características demográficas, clínicas y neurológicas no mostraron relación con el alto riesgo cardiovascular y los valores elevados de Hci, aunque se encontró una tendencia asociativa de la etiología aterotrombótica con el incremento de PCR-as y Hci.

Foundation: High-sensitivity C-reactive protein and homocysteine seem to be related to ischemic cerebrovascular disease, but their findings on the risk and prognosis of this disease are controversial and inconclusive. Objective: to characterize high sensitivity C-reactive protein and homocysteine in patients with ischemic cerebrovascular disease. Methods: a descriptive and retrospective cross-sectional study was carried out in patients with ischemic cerebrovascular disease, admitted to the Stroke Service of the Neurology and Neurosurgery Institute between 2016 and 2019. Demographic variables, clinical manifestations, time of evolution, etiology and infarction location, risk factors. High-sensitivity C-reactive protein (cardiovascular risk) and homocysteine were quantified. Results: the means of C-reactive protein (7.0±8.3 mg/L) and homocysteine (17.1±7.3 µM) were high. Moderate and high cardiovascular risk occurred in equal proportions (46.8%). There were statistical differences in the relationship between cardiovascular risk and age (p=0.00); but neither the time of evolution nor the risk factors of the disease showed this behavior. Patients with high cardiovascular risk (hs-CRP >3 mg/L) and high homocysteine (>15 (M), exhibited higher frequencies of atherothrombotic or cardioembolic etiologies. Conclusions: cardiovascular risk increases as the age of patients with ischemic cerebrovascular disease increases. Demographic, clinical and neurological characteristics did not show a relationship with high cardiovascular risk and high homocysteine values, although an associative trend of atherothrombotic etiology was found with increased high-sensitivity C-reactive protein and homocysteine.

Cognitive behavioral stress management effectively facilitates neurologic recovery, alleviates mental distress, and elevates health status in acute ischemic stroke patients

Cognitive behavioral stress management (CBSM) relieves physical and psychological burdens in patients with some central nervous system diseases, while its utility in acute ischemic stroke (AIS) patients is unclear. This study aimed to explore the effect of CBSM on neurologic recovery and psychosomatic health in AIS patients. Totally, 176 naive AIS patients were randomized into routine care (RC) group (n=88) and CBSM group (n=88) to receive a 3-month corresponding intervention. Modified Rankin scale (mRS) scores at the first month after discharge (M1) (P=0.008) and the third month after discharge (M3) (P=0.016) were lower in the CBSM group than in the RC group. The proportion of AIS patients with mRS score >2 at M3 was reduced in CBSM group vs RC group (P=0.045). Hospital anxiety depression scale (HADS)-anxiety score at M3 (P=0.016), HADS-depression score at M3 (P=0.005), and depression rate at M3 (P=0.021) were decreased in the CBSM group vs the RC group. EuroQol-5 dimension scores at M1 (P=0.024) and M3 (P=0.012) were decreased, while EuroQol-visual analogue scale score at M3 (P=0.026) was increased in the CBSM group vs the RC group. By subgroup analyses, CBSM had favorable outcomes in AIS patients with age ≤65 years. CBSM was beneficial to neurologic recovery and distress relief in AIS patients with an education level of middle school or above, and to health status in those with an education level of primary school or uneducated. In conclusion, CBSM benefitted neurologic recovery and psychosomatic health in AIS patients with minor neurological deficits, however, further studies should verify these results with a larger sample size and longer follow-up.

LDL levels and ejection fraction in ischemic stroke patients: a hospital based cross-sectional study

Background: Ischemic stroke is a top contributor to mortality amongst non-infectious diseases. Atherosclerosis is a major risk factor. This study aims to assess LDL levels and ejection fraction in ischemic stroke patients. Methods: This descriptive cross-sectional study was conducted in Government Thoothukudi Medical College from November, 2022 to April, 2023. 35 patients admitted in the neuromedicine ward and diagnosed as acute ischemic stroke were included in the study after informed consent and ethical clearance. Patients with acute neurological deficit and evidence of infarct on diffusion-weighted MRI were included. Patients with no evidence of infarct on DWI, those already on lipid lowering therapy, patients with a history of cerebrovascular disease or transient ischemic attacks were excluded. Blood for lipid profile taken after 8 hours of overnight fasting. Echocardiography done for all patients. Results: Of the 35 patients, 26 (74.28%) were men, mean age was 62.4. 57.14% ischemic stroke patients had their LDL levels elevated, 28.57% had decreased HDL, 28.57% had total cholesterol levels elevated, and in 14.28% triglycerides was elevated. This study also observed the cardiac status of the patients which showed 29% patients had decreased ejection fraction. Conclusions: This study concluded that most patients had elevated LDL levels which is an independent risk factor of ischemic cerebrovascular disease. LDL levels were also associated with decreased ejection fraction in a significant number of patients. Thereby it can be concluded that elevated LDL cholesterol levels can add to the cardiac risk, potentially contributing to stroke morbidity and mortality.

Analysis on risk factors of clopidogrel resistance in patients with ischemic stroke / 药学实践与服务

Objective To investigate the risk factors of drug resistance in patients with ischemic stroke by clopidogrel therapy and provide references for promoting clinical individualized drug therapy. Methods A total of 202 inpatients diagnosed with ischemic stroke were admitted and given dual anti-treatment (aspirin+clopidogrel). CYP2C19 genotype was detected by microarray hybridization during hospitalization, and CYP2C19 gene polymorphisms were classified into fast metabolism group, medium metabolism group and slow metabolism group according to the type of drug metabolism. Patients were tested for platelet inhibition induced by adenosine diphosphate (ADP) according to thromboelastographic (TEG) on 7~14 d of drug administration. ADP <30% was classified as clopidogrel drug resistance group and ADP ≥30% as non-resistance group. Logistic regression analysis was used to study the risk factors for the development of clopidogrel resistance. Results Among 202 patients with ischemic stroke, 87 were in the resistant group and 115 in the non-resistant group. The proportion of patients with clopidogrel resistance combined with diabetes and the level of white blood cell count were higher than that in the non-resistant group, and the differences were statistically significant (P<0.05).The proportion of patients with clopidogrel resistance in the CYP2C19 intermediate metabolism group was significantly higher than that in the fast metabolism group, and the rate of platelet inhibition was also significantly lower than that in the fast metabolism group, all with statistically significant differences (P<0.05). Conclusion Combined diabetes mellitus, high white blood cell count levels and CYP2C19 mid-metabolic phenotype are independent risk factors for the development of clopidogrel resistance in patients with ischemic stroke.

Traditional Chinese Medicine Treats Ischemic Stroke by Regulating mTOR Signaling Pathway： A Review / 中国实验方剂学杂志

Ischemic stroke （IS） is a serious cerebrovascular disease common in clinical practice. Targeting the pathogenesis of IS， intravenous thrombolysis for restoring blood flow is still the most effective therapy. However， intravenous thrombolysis has shortcomings such as increased bleeding risk， narrow therapeutic window， and contraindications， which limited its clinical application. Protection of the ischemic brain tissue before full recovery of blood flow is associated with the prognosis of IS. Studies have identified multiple pathways in the alleviation of the brain injury caused by IS， such as the mammalian target of rapamycin （mTOR） signaling pathway. Traditional Chinese medicine （TCM） has abundant therapies and unique advantages in the treatment of IS， especially in alleviating symptoms and improving the quality of life of patients. After the onset of IS， TCM can be integrated with Western medicine to play a role in the whole process of treatment， rehabilitation， and recurrence prevention as soon as possible， thus maximizing patient benefits. TCM has clinical significance for the recovery of neurological and motor functions after IS. Studies have shown that TCM can reduce the cerebral injury caused by IS by regulating and activating the mTOR signaling pathway， thereby regulating autophagy， inhibiting apoptosis of nerve cells， and reducing oxidative stress and inflammation. TCM exerts a positive effect for achieving cerebral protection and improving the prognosis of IS and provides new ideas for the prevention and treatment of IS. This article introduces the role of the mTOR signaling pathway in the pathogenesis of IS and reviews the research progress in the TCM regulation of this pathway in the treatment of IS， aiming to provide new therapeutic ideas and systematic scientific reference for the treatment of IS with TCM.

Research progress of integrated stress response in central nervous system diseases / 中国药科大学学报

@#Abstract: Integrated stress response is an adaptive response produced by eukaryotic cells after intracellular and extracellular stimulation. The activation of integrated stress response inhibits the translation of most proteins, yet it can promote the translation of certain proteins to cope with complex cellular microenvironment changes. A large number of studies have found that in a variety of nervous system diseases, the integrated stress response can be activated by stress signals of disease-related cells and participates in the occurrence and progression of diseases through processes such as learning and memory consolidation, myelin regeneration and synaptic plasticity. This article summarizes the role, mechanism and possible drug targets of integrated stress response in central nervous system diseases and discusses the potential of pharmacological methods to regulate integrated stress response in the treatment of central nervous system diseases, in order to provide reference for pathological research on and drug development for central nervous system diseases.

Analysis on severity of cerebral edema and prognostic influencing factors after mechanical thrombectomy in patients with acute ischemic stroke due to anterior circulation large vessel occlusion / 重庆医学

Objective To observe the severity of cerebral edema after mechanical thrombectomy in the patients with acute ischemic stroke caused by large vessel occlusion,and to statistically analyze the related fac-tors affecting the prognosis quality of the patients,so as to guide the patients to conduct scientific interven-tion.Methods Ninety-one patients with acute ischemic stroke due to anterior circulation large vessel occlusion treated with mechanical thrombectomy in this hospital from October 2021 to October 2022 served as the ana-lytic subjects.According to the severity of brain edema,they were divided into the group Ⅰ(mild),group Ⅱ(moderate),and group Ⅲ(severe);after 12-week treatment,the improved Rankin scale was used to evaluate the prognosis.The patients with good prognosis were included in the excellent group,and the patients with poor prognosis were included in the poor group.Single factor and multifactor logistic analysis was used to ana-lyze the influencing factors and prognostic related factors of different degrees of brain edema.Results The univariate analysis showed that the percentage of patients with NIHSS score at admission ≥15,time from on-set to thrombolysis ≥6 h,history of hypertension,successful vascular recanalization and good collateral circu-lation were significantly different among the groups Ⅰ,Ⅱ and Ⅲ(P＜0.05);the multivariate logistic regres-sion analysis results showed that the NIHSS score at admission ≥15,time from onset to thrombolysis ≥6 h,and hypertension history were the risk factors leading to severe cerebral edema,while successful recanalization of blood vessels was a protective factor for cerebral edema(P＜0.05).The univariate analysis showed that in the good prognosis group the percentage of patients had good circulation of lateral branches,successful reca-nalization of blood vessels,severe cerebral edema,hypertension,time from onset to thrombolysis ≥6 h,and NIHSS score ≥15 at admission were significantly different from those in the poor prognosis group(P＜0.05).The multivariate logistic regression analysis results showed that severe cerebral edema,time from onset to thrombolysis ≥6 h and NIHSS score ≥15 at admission were the risk factors for poor prognosis,while good collateral circulation and successful recanalization of blood vessels were the positive factors for good prognosis(P＜0.05).Conclusion Mechanical thrombectomy patients with hypertension and time from onset to throm-bolysis ≥6 h and NIHSS score at admission ≥15 have more severe brain edema after treatment;severe brain edema,time from onset to thrombolysis ≥6 h,NIHSS score at admission ≥15 were the adverse factors affect-ing the prognosis of the patients with mechanical thrombectomy.

Associations of cardiac biomarkers with stroke severity and short-term outcome in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate associations between cardiac biomarkers with stroke severity and short-term outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Affiliated Hospital of Qingdao University from June 2018 to February 2024 whose etiological classification was large artery atherosclerosis (LAA), small vessel occlusion (SVO) or cardioembolism (CE) were included retrospectively. According to the National Institutes of Health Stroke Scale score at admission, patients were divided into mild stroke group (≤8) and moderate to severe stroke group (>8). According to the modified Rankin Scale score at discharge, patients were divided into good outcome group (≤2) and poor outcome group (>2). Multivariate logistic regression analysis was used to determine the independent correlation between cardiac biomarkers and short-term outcome. The predictive value of cardiac biomarkers for poor outcome in patients with AIS and different stroke etiology subtypes were evaluated using receiver operating characteristic (ROC) curves. Results:A total of 2 151 patients with AIS were enrolled, including 1 256 males (58.4%), aged 67.40±11.34 years. 1 079 patents were LAA type (50.2%), 679 were SVO type (31.6%), and 393 were CE type (18.3%); 1 223 were mild stroke (56.86%) and 928 (43.14%) were moderate to severe stroke; 1 357 patients (63.09%) had good short-term outcome, and 794 (36.91%) had poor short-term outcome. Multivariate logistic regression analysis showed that N-terminal pro-B type natriuretic peptide (NT-proBNP), NT-proBNP/creatine kinase (CK) isoenzyme MB (CK-MB) ratio, and CK-MB/CK ratio were independent risk factors for poor short-term outcome. ROC curve analysis shows that the CK-MB/CK ratio had a higher predictive value for short-term poor outcome in patients with AIS (the area under the curve, 0.859, 95% confidence interval 0.839-0.879). Various cardiac biomarkers had a higher predictive value for short-term outcome of CE type and LAA type, but the predictive value for short-term outcome of SVO type was lower. Conclusions:Cardiac biomarkers are associated with the severity and poor outcome of AIS. NT-proBNP/CK-MB and CK-MB/CK ratios have higher predictive value for short-term poor outcome of AIS, especially in patients with CE type.

Association of serum uric acid with outcome at one year in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the association of serum uric acid (SUA) with the outcome in patients with acute ischemic stroke (AIS) at one year after onset.Methods:Patients with AIS admitted to the Department of Neurology, Dagang Hospital, Tianjin Binhai New Area were included retrospectively. According to the modified Rankin Scale (mRS) score at 1 year after onset, patients were divided into a good outcome group (0-2) and a poor outcome group (>2). They were also divided into a survival group and a death group based on their survival status at 1 year after onset. The clinical baseline data and laboratory tests were compared. Multivariate logistic regression analysis was used to determine the associations of SUA with poor outcome and death in patients with AIS. Results:A total of 651 patients were enrolled, including 430 males (66.1%) aged 67.5±11.7 years. Four hundred and fourteen patients (63.6%) were in the good outcome group, and 237 (36.4%) were in the poor outcome group. There were 568 patients (87.3%) in the survival group and 43 (16.7%) in the death group. Univariate analysis showed that there were differences in age, atrial fibrillation, history of stroke or transient ischemic attack, baseline National Institutes of Health Stroke Scale (NIHSS) score, and pre-admission mRS score between the poor outcome group and the good outcome group. The homocysteine, SUA, white blood cell count, and creatinine in the poor outcome group were higher than those in the good outcome group, while the red blood cell count and hemoglobin were lower than those in the good outcome group (all P<0.05). There were differences in age, history of ischemic heart disease, atrial fibrillation, history of stroke or transient ischemic attack, baseline NIHSS score, pre-admission mRS score, and stroke etiology classification between the survival group and the death group. Hemoglobin and triglycerides in the survival group were higher than those in the death group, while the white blood cell count and creatinine were lower than those in the death group (all P<0.05). Multivariate logistic regression analysis showed that SUA was an independent risk factor for poor outcome in patients with AIS (odds ratio 1.004, 95% confidence interval 1.001-1.006; P<0.01), but there was no independent correlation with death. Conclusion:Higher SUA is an independent risk factor for poor outcome at one year after onset in patients with AIS.

Characteristics of the nocturnal melatonin secretion concentration and circadian rhythm in patients with wake-up stroke / 国际脑血管病杂志

Objective:To investigate the characteristics of the nocturnal melatonin secretion concentration and circadian rhythm in patients with wake-up stroke (WUS).Methods:Patients with acute ischemia stroke (AIS) admitted to the Department of Neurology, the Second Affiliated Hospital of Soochow University from October 2019 to August 2022 were enrolled. They were divided into WUS group and non-WUS group. Saliva samples within one week after admission were collected (at 19∶00, 20∶00, 21∶00, 22∶00, and 23∶00) and melatonin concentration was measured. Melatonin secretion curve graph was drawn, dim light melatonin onset (DLMO) was calculated, and circadian rhythms were evaluated. The differences in endogenous circadian rhythms between the WUS group and the non-WUS group were compared. The relevant factors of WUS were determined by multivariate logistic regression analysis. Results:A total of 116 patients with AIS were included, with 79 males (68.1%), aged 59.9±10.3 years; 35 patients (30.2%) were WUS. Univariate analysis showed that there was a statistically significant difference in the infarct site between the WUS group and the non-WUS group ( P=0.019). At 21:00 ( P=0.004) and the average ( P=0.038) nighttime melatonin concentration in the WUS group were significantly lower than those in the non-WUS group, and DLMO showed a significant delay compared to the non-WUS group (21:28:08 vs. 20:57:57; P=0.015). Multivariate logistic regression analysis showed a significant independent correlation between DLMO delay and WUS (odds ratio 1.792, 95% confidence interval 1.123-2.858; P=0.014). Conclusion:Patients with WUS may have endogenous circadian rhythm delay, which is an independent risk factor for WUS.

Gut microbiota and their metabolites and the outcome of ischemic stroke / 国际脑血管病杂志

An increasing number of studies have shown that gut microbiota and their metabolites play an important role in the occurrence, development, and outcome of ischemic stroke. This article reviews the associations of gut microbiota and their metabolites with the outcome of ischemic stroke, in order to provide new ideas for the prevention and treatment strategies of ischemic stroke.

Multimodal imaging predicts outcome after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

An increasing number of studies have shown that neuroimaging techniques, including CT- and MRI-related imaging biomarkers, are associated with the clinical outcome after intravenous thrombolysis in patients with acute ischemic stroke. Therefore, as a necessary diagnostic item for acute ischemic stroke, imaging examinations and related biomarkers have important value in predicting the outcome after intravenous thrombolysis in patients with acute ischemic stroke.

Neuroprotective therapy for acute ischemic stroke in the era of endovascular therapy / 国际脑血管病杂志

In recent years, endovascular therapy has become the most important progress in the field of the treatment of acute ischemic stroke caused by large vessel occlusion. However, the vascular recanalization shown by imaging after endovascular treatment cannot fully translate into effective tissue reperfusion and functional outcome, a phenomenon known as "futile recanalization". Combined neuroprotective therapy after vascular recanalization is expected to reduce the occurrence of futile recanalization and improve the outcome of patients. This article briefly summarizes the main application progress of commonly used neuroprotective therapies in clinical practice (edaravone dexborneol, glucocorticoids, hypothermia, and remote ischemic conditioning). It explores the trend and direction of combining endovascular therapy and neuroprotective therapy for patients with acute ischemic stroke caused by large vessel occlusion, and provides further reference and suggestions for intervention measures after endovascular therapy.