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Objective To observe the safety and efficacy ofintra-arterial thrombolysis guided by CT perfusion in patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h.Methods The clinical data of patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h (n=36) and shorter than or equal to 6 h (n=30),performed intra-arterial thrombolysis in our hospitals from July 2003 to December 2012,were retrospectively evaluated.Patients of the former group were evaluated the ischemic penumbra and core region of infarction and the mismatch between the two regions based on CT perfusion.The clinical features,clinical outcomes and complications were compared between the two groups.Results As compared with those in patients of symptoms shorter than or equal to 6 h,the early neurological improvement rate (13.3％ vs.22.2％) and long-term neurological improvement rate (86.7％ vs.77.7％),recanalization rate (80.0％ vs.88.9％) and 3-month mortality (6.7％ vs.16.7％) of patients of symptoms longer than were not significantly different (P=0.665,P=0.665,P=0.639 and P=0.607).Conclusions To patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h,the neurological function at 3-month significantly improves after intra-arterial thrombolysis guided by CT perfusion.Although the incidence of symptomatic intracranial hemorrhage increases,the mortality rate does not significantly increase.
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Objective To investigate the clinical features of serotonin syndrome (SS) and observe its curative effects. Methods Retrospective analysis was performed on the clinical features of 15 patients with SS admitted to our hospital from January 2006 to December 2011; 9 mild-ill cases,5 moderately-ill cases,and 1 severe-ill case were noted in these patients.After the serotonin drugs were removed and cyproheptadine and supportive treatment were given, curative effects were analyzed.Results The clinical manifestations of SS were highly variable: irritability was noted in 4 patients,tachyrhythmia in 12,hyperactive bowel sounds in 5,diarrhea in 4,diaphorisis in 12,febricity in 5,hypertension in 6,ocular ataxia in 4, mydfiasis in 4, musculature tremor in 6, hypermyotonia in 8,myoclonus in 4,tendon hyperreflexia in 8,ataxia in 2 and seizure attack in 2.The symptoms of 9 mild-ill cases were recovered within 72 h.The major of duration of symptoms was 126 h and the mean time of therapy was (86.9±21.7) h in 5 moderate-ill cases and 1 severe-ill case. Conclusion SS is characterized by mental status changes,autonomic instability,and neuromuscular hyperactivity.The key point of prevention and cure is early diagnosis,appropriate management and being early aware of the serotonergic drug side effect by clinicians.
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<p><b>BACKGROUND</b>The underlying mechanism of early neurobiological impairment after subarachnoid hemorrhage (SAH) is not well understood, but the system of reactive oxygen superoxide (ROS) might be involved. Edaravone (MCI-186), a potent free radical scavenger that prevents apoptosis of neurons, was thus used in this study to see its possible therapeutic effect in early brain injury due to SAH in a rat model.</p><p><b>METHODS</b>One hundred and twenty male Sprague-Dawley rats were randomly assigned to four groups: group 1, control rats receiving sham operation only; group 2, rats with SAH treated by saline; group 3, rats with SAH treated with 1 mg/kg MCI-186 injected intraperitoneally; and group 4, rats with SAH treated with 3 mg/kg MCI-186. Treated with either saline or MCI-186 twice daily for two consecutive days after SAH, the rats were sacrificed for measurements of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) and histological analysis of caspase-3 protein by Western blotting and immunohistochemical staining. In addition, mortality and neurological scores were statistically analyzed by the chi-square test and Dunn's procedure respectively for each group. One-way analysis of variance followed by the Tukey's procedure was also used in data analysis.</p><p><b>RESULTS</b>The rats in group 2 that received saline only showed neurological impairment as well as elevated mortality, and were found to have significantly increased levels of MDA and caspase-3, but reduced SOD activities in brain tissues (P < 0.05). When treated with MCI-186 at two different dosages, the rats in groups 3 and 4 had markedly decreased levels of MDA and caspase-3 but increased SOD activities in the brain tissue (P < 0.05), along with improved scores of neurological evaluation (P < 0.05).</p><p><b>CONCLUSIONS</b>This study sheds some lights on the therapy of SAH-induced early brain injury by providing the promising data indicating that MCI-186, a radical scavenger, can efficiently diminish apoptosis of neurons and thus prevent the function loss of the brain in rats with SAH.</p>