Analyzing the neuropsychological characteristics and changes in serum markers of patients with chronic cerebral circulation insufficiency

Summary Objective: To investigate the neuropsychological characteristics and changes in CRP, S100B, MBP, HSP-7, and NSE in serum. Method: Sixty-six (66) patients treated in our hospital as CCCI group were chosen for our study, and 90 patients with depression were selected as the depression group. The patients in both groups were examined with CT perfusion, depression, anxiety and cognition evaluation. Their serum CRP, S100B, MBP, HSP-70 and NSE levels were detected. Neuropsychological and serum markers characteristics were compared. Results: The CBF and CBV in bilateral basal ganglia, frontal lobes, greater oval center, brain stem, and left and right regions of occipital lobes of the patients in CCCI group were significantly lower than in the depression group. The HAMD and HAMA scores of CCCI group patients were significantly lower than in the depression group; CCCI group performed better regarding attention, memory, abstract terms and delayed recall. CCCI also had significantly higher total scores than the depression group. Serum CRP, S100B, MBP, HSP-70 and NSE levels in CCCI group were significantly higher than in the depression group. The differences reach statistical significance (p<0.05). Conclusion: CCCI patients who are accompanied by minor depressive disorder have different degrees of cognitive impairment and experience a significant rise in serum CRP, S100B, MBP, HSP-70 and NSE.

Adiponectin and infarction size in subject with and without cerebrovascular disease

To investigate whether hypo-adiponectinemia is present in ischemic stroke patients. This comparative study was carried out in the Biochemistry Department, Ziauddin University, Karachi, Pakistan in 2008. In this study, plasma adiponectin concentration was measured by an enzyme-linked immunosorbent assay in subjects with and without ischemic cerebrovascular disease [CVD]. A total of 80 subjects were studied [40 patients with CVD, and 40 without CVD as controls]. The mean plasma level of adiponectin of the 40 patients with ischemic CVD was significantly lower than that of the 40 subjects without CVD [4.36 +/- 0.21 ug/mL versus 6.97 +/- 0.241 ug/mL; p=0.000]. Decreasing concentrations of adiponectin were negatively correlated with infarction size in ischemic CVD patients. These data show that there are significantly lower levels of plasma adiponectin in patients with ischemic CVD. Moreover, adiponectin is negatively correlated with infarction size in these patients suggesting the possible role of adiponectin in cerebrovascular disease

Stent carotídeo: estado del arte / Carotid stenting: state of the art

El implante percutáneo del stent carotídeo es utilizado ampliamente en todo el mundo como una alternativa menos invasiva a la endarterectomía carotídea para la prevención del ataque cerebrovascular isquémico causada por una estemosis arterial carotídea extracraneana. La estenosis arterial carotídea que particularmente involucra el origen de la arteria carótidea interna, es un problema clínico frecuente. Esta estenosis de etiología invariablemente aterosclerótica, puede presentarse como un soplo carotídeo asintomático descubierto en el examen físico, o por ataques isquémicos transitorios relacionados con la embolización de trombos originados en el sitio de lesión, o menos comúnmente como un ataque isquémico cerebral. Recientes estudios observacionales y aleatorizados han demostrado que el riesgo de sufrir un accidente cerebrovascular o muerte relacionado con el implante de stent carotídeo es comparable a endarterectomía carotídea, cuando operadores entrenados realizan estas intervenciones en grupos de pacientes bien definidos.

Carotid artery stenting is now utilized worlwide as a less invasive alternative to carotid end arterectomy for the prevention of ischemic strokes caused by stenoses at the extracraneal bifurcation of carotid arteries. Carotid artery stenosis, particularly involving the origin of the internal carotid artery, is a frequently encountered clinical problem. Such stenoses, almost invariably atherosclerotic, can present as an asymptomatic bruit discovered on physical examination, asone or more transient ischemic attacks related to embolization from a stenotic lesion or less commonly, as an ischemic stroke. Recent observational and randomized studies have shown that the risk of procedure-related stroke and death is comparable with carotid endarterectomy when skilled operators perform these interventions in well-defined patient subsets.

Etiological profile of stroke and its relation with prothrombotic states.

OBJECTIVE: To study the etiological profile of childhood stroke and its relation with prothrombotic states. METHODS: Children with acute stroke with no evidence of CNS infection or head injury were studied. Stroke was confirmed by CT scan and further evaluated by MRI. Cardiac status was assessed with transthoracic echocardiography. Test for hypercoagulable state (antithrombin III, protein C, protein S, anticardiolipin antibody IgG and IgM and lupus anticoagulant) were done in all patients. RESULTS: A total of 66 children were enrolled--36 cases and 30 controls. Presenting symptoms were motor deficit (72%), seizure (66%), altered sensorium (36%), aphasia (27%). Causes identified were antiphospholipid antibody syndrome (25%), Moya Moya disease (16.6%), cardiac disease (11.1%), vasculitis (5.5%), ATIII deficiency (5.5%), Protein C deficiency (2.7%). Etiology remained unknown in 25% of cases with infarction. Hemorrhage was seen in 8.2% of cases and they had DIC or liver disease as the underlying cause. CONCLUSIONS: Magnetic Resonance Angiography and ELISA for antiphospholipid antibody should be done in all patients with stroke without an obvious cause.

Lipoprotein -- an independent risk factor for CVD.

A case control study done to evaluate the Lipoprotein(a) [LP(a)] as a risk factor for CVD (cerebrovascular disease). 150 non-smokers, non-alcoholic subjects free from DM, renal disease, thyroid disease and liver disease were included in the study. Among them 120 were CVD cases and 30 were age and sex matched healthy control. Subjects were grouped as group-I (30, healthy control), Group-II (60, Hemorrhagic CVD) and group-III (60, Ischemic CVD). Fasting (12 hr) blood samples were collected from all subjects and in CVD cases samples were collected after 24 hr of attack. Lipid profile and LP(a) conc. were measured in all samples. Mean serum LP(a) conc. in Group-I, Group-II and Group-III were found to be 17.6 7.4 mg/dl, 31.9 15.6 mg/dl and 44.8 24.0 mg/dl respectively. Both the groups of CVD cases showed significantly higher level of serum LP(a) conc. compared to healthy control. CVD cases did not differ statistically in respect of their lipid profile when compared with control. Moreover the serum LP (a) conc. of CVD cases found to show no correlation with their lipid profile, suggesting the serum LP(a) conc. a possible independent risk factor for CVD.

Lipoprotein-a: a laboratory tool for clinical categorization of CVD.

A case-control study was done to evaluate the association of Lipoprotein(a)[LP(a)] with CVD (Cerebrovascular disease) and also to assess the implication of serum LP(a) concentration as a differentiating marker between ICVD (Ischemic CVD) & HCVD (Hemorrhagic CVD). 150 non-smokers, non-alcoholic subjects free from DM, renal disease, thyroid disease and liver disease were studied. Among them 120 were CVD cases and 30 were age & sex matched healthy control. Fasting (12 hr.) blood samples were collected from all subjects and in CVD cases samples were collected after 24 hr. of attack. Serum LP(a) concentration were measured in all samples. Mean serum LP(a) concentration in control, HCVD & ICVD were found to be 17.6 +/- 7.4 mg/dl, 31.9 +/- 15.6 mg/dl and 44.8 +/- 24.0 mg/dl respectively. Both HCVD & ICVD cases showed significantly higher level of serum LP(a) concentration compared to control. Moreover ICVD cases showed significantly higher level of serum LP(a) concentration compared to HCVD cases. The exquisite athero-thrombo-embolic potential of LP(a) explain its involvement with CVD but more with ICVD in comparison to HCVD; This finding apparently suggest the prospect of serum LP(a) concentration to be used as a promising laboratory maker to differentiate clinically the ICVD from HCVD following determination of cut-off value between ICVD & HCVD by broad based comprehensive study.

Viscocidad sanguínea como factor de riesgo cardiovascular / Blood viscosity as a cardiovascular risk factor

El conocimiento de los factores de riesgo cardiovascular ha permitido identificar mejor a aquellos pacientes con mayor riesgo de infarto agudo del miocardio o accidentes vasculares cerebrales. Sin embargo existe un porcentaje de pacientes que , aun sufriendo estos eventos, al ser estudiados no se les encuentra ningún factor de riesgo conocido. Últimamente se le ha dado mayor importancia a la reología sanguínea, siendo la viscosidad sanguínea la principal. Se revisan conceptos fisiopatológicos, evidencia experimental, estudios clínicos y poblacionales que dan soporte para postitular que el estudio de la viscosidad sanguínea debiera hacerse en pacientes con alto riesgo.

Fibrogênio como fator de risco independente de doença vascular cerebral / Fibrinogen as independent risk factor for ischemic stroke

No protocolo de avaliaçäo clínico-laboratorial de pacientes com acidente vascular cerebral (AVC) aterotrombótico dosamos e analisamos níveis de fibrinogênio plasmático (técnica de Clauss automatizada), para determinar seu possível papel como fator de risco trombogênico em 29 pacientes (20 homens e 9 mulheres) com idades entre 25 a 79 anos (mediana=55); todos tinham tido AVC aterotrombótico. Eles foram classificados em 2 grupos segundo alteraçöes de fluxo nas carótidas: g1 - sem alteraçäo de fluxo (n=19) e g2 - com alteraçöes de fluxo (n=10). Resultados- A média das dosagens de fibrinogênio no g1 foi de 269 e no g2 de 353 mg/dl. Quarenta e sete por cento dos pacientes do g1 e 80 por cento do g2, apresentaram medidas >300 mg/dl. As diferenças obtidas entre os grupos neste estudo foram significante. Conclusäo- Considerando o nível de risco epidemiológico de 300 mg/dl, nossos resultados sugerem que o fibrinogênio é um fator de risco independente para AVC aterotrombótico, especialmente naqueles com alteraçäo de fluxo carotídeo.

Evaluation of serum lipids in patients of acute stroke.

Stroke, though considered a thromboembolic disorder, is known to be associated with hyperlipidaemia. In Western country, some workers have performed studies exploring the role of lipids in stroke in their country. Such a study is lacking in Indian population. This study was therefore conducted to observe the role of lipids in stroke by evaluating 13 parameters of lipids in 48 patients of non haemorrhagic cerebral stroke hospitalised in acute condition and compared with those of 70 age matched normal subjects. Results revealed that phospholipids and arachidonic acid were significantly altered in patients of acute stroke.

Clinical profile of stroke in relation to glycaemic status of patients.

Present study was undertaken in fifty consecutive patients of acute stroke to assess the role of glycemic status on clinical profile of stroke. Majority of patients (76%) were in age group of 41-70 years. The patients were classified into four groups: euglycemics (33), known diabetics (8), newly diagnosed diabetics (6) and stress hyperglycemics (3). Diabetics as well as stress hyperglycemics had higher prevalence of larger sized severe haemorrhagic stroke with poor outcome and there was positive correlation between them.

Clinical study on antithrombotic effects of ticlopidine in ischemic stroke.

The investigators conducted a clinical study on antithrombotic effectiveness in ischemic stroke at Siriraj Hospital Medical School, Mahidol University from May 1987 to May 1989. Twenty-nine patients, 16 males and 13 females were enrolled in the study. The ages of the patients ranged from 30-87 years with a mean age of 63 +/- 11 years. Ticlopidine (250 mg) could significantly inhibit platelet aggregation induced by ADP and collagen within 24 hours of drug administration. After 1 week to 6 months, only aggregation by ADP was still inhibited significantly without significant effects on fibrinolytic activity and prostacyclin. Hematocrit was significantly decreased at the 1st and 2nd month of treatment. Serious side effects were skin rash and severe headache while the other common ones were dizziness, and diarrhea but these effects disappeared without discontinuing the drug. Most patients who suffered from nausea, diarrhea and headache, had temporary elevated SGPT. It may be concluded that only half of the recommended dose of ticlopidine has inhibitory effects on both phases of ADP-induced aggregation without interfering with fibrinolytic activity and can maintain prostacyclin. However, it also possesses either serious or common side-effects. This drug, therefore, should be used with the awareness of the clinician.

Plasma fibrinogen levels in stroke.

Plasma fibrinogen levels were estimated in 56 patients of stroke, admitted in the hospital within 24 hours of symptoms. The levels were found to be raised significantly (531.73 +/- 74 mg%) compared to those of the age and sex matched control group (445.78 +/- 92.28 mg%). When the levels in stroke group with one risk factor were compared to those of individuals with comparable control group with same risk factor, a significant difference was observed in hypertensive, smokers, alcoholics and atherosclerotic stroke groups, which indicates that the observed rise is related to phenomenon of stroke rather than the associated risk factors. However, the rise observed in hypertensive stroke group (554.26 +/- 47.08 mg%) is significantly more (p. less than 0.01) than that occurring for nonhypertensive stroke group (497.82 +/- 93.12 mg%) indicating that the presence of hypertension does contribute to the rise.

Viscosidad sanguínea humana implementación de un método sencillo para sangre total y plasma valores normales / Human blood viscosity use of a simple method for total blood and plasma normal values

Se implementa una técnica sencilla para medir la viscosidad sanguínea y plasmática, midiendo el tiempo que demora una cantidad determinada de sangre o plasma en recorrer un segmento de tubo, a temperatura y presión constante. Se analizan 100 muestras de sujetos normales, de acuerdo a parámetros determinados al inicio del estudio. Se concluyen valores expresados en viscosidad relativa similares a los encontrados en viscosímetros por otros autores. Promedio 4,5 u de viscosidad sanguínea para hombres y mujeres, y 1,9 u de viscosidad plasmática en mujeres y hombres, respectivamente. De esto concluimos que no hay diferencias significativas entre viscosidad sanguínea y viscosidad plasmática según sexo, edad, hematocrito normal y el tiempo transcurrido entre la toma de muestra y la medición en laboratorio para el grupo en estudio. Se deja planteada la inquietud de continuar analizando la viscosidad sanguínea de acuerdo a otros parámetros, como diabetes descompensada, accidentes vasculares u otras patologías o cuadros clínicos en que se describen alteraciones de viscosidad sanguínea

Risk factors in extracranial carotid disease.

One hundred patients with ischaemic cerebro vascular disease (TIA/RIND--67% and completed stroke--33%) were evaluated for various clinical and biochemical risk factors. Evidence of extra-cranial carotid vascular disease (ECCVD) was looked for by using Doppler scan and carotid angiography. Of the 28 patients with abnormal Dop scan, 27 were confirmed to have ECCVD by angiography. Though the history of hypertension was elicited in 40%, only 28% had BP of 160/95 mm Hg or more during hospital stay. Hypertension was twice more common in ECCVD group compared to the group with normal carotid vessels. Obesity was seen in 15%, diabetes mellitus in 10% and 1% had hyperuricaemia. Total cholesterol was elevated in 29% and HDL cholesterol fraction was decreased (less than 35 mg%) in 43%. The reduction of HDL cholesterol was more frequent in ECCVD group (63%) and in hypertensive (73%) patients. Lipoproteins, triglycerides, free fatty acids and phospholipids were not significantly affected.