A study on mean platelet volume in ischemic cerebrovascular stroke

Background: Ischemic Cerebrovascular stroke is one of the largest cause of death and disability. It is usually caused by thrombosis or thromboembolic phenomena. Large platelets are more reactive, produce more prothrombotic factors and aggregate more easily, and can be a major risk factor/indicator for stroke. While the Mean Platelet Volume (MPV) has been studied in detail in cases of IHD, very few studies have been done in stroke, and none in India � prompting this study. We aim to determine whether an association exists between MPV and incidence/severity of stroke.Methods: The study was carried out among fifty patients with an acute ischemic stroke. Clinical severity was assessed using Modified Rankin憇 scale. MPV was measured using an automated analyzer. Fifty controls were recruited and analysed.Results: MPV has got a statistically significant correlation with Ischemic stroke with a p value of < 0.0001. Average MPV in cases was 9.78+1.25 fl vs. controls who average 8.30+1.14 fl. We did not find a statistically significant correlation between clinical severity of stroke and MPV (P = 0.550).Conclusions: This study has shown an elevation of MPV in acute phase of Ischemic stroke. Within this relationship and adjusting for other significant variables in multivariate regression analysis, it can be stated that an increase in MPV is independently associated with stroke. Further research is required into the role of platelet volume in stroke pathology, outcome, and, most importantly, in individuals at risk for stroke.

Wake Up and Non-Wake up stroke: A comparative Hospital Based Study.

Background: Almost 25% of all acute ischemic strokes occur during sleep with the patients or relatives become aware of the neurological deficits as they wake up. The present study was conducted with an aim to find out the prevalence of wakeup stroke along with clinical profile and outcome of wake up stroke as compared to non-wake up stroke. Methods: All patients of age group 18 years or more presenting with stroke during the 12-month study period were included. Data was compared with non-wakeup stroke by applying Chi square test, Fischer exact test and Yates corrections was used to evaluate the association between the variables defining the clinical profile and outcome. Results: Patients of non wake-up stroke were higher (63%) as compared to wake-up stroke (37%). Out of 37 wake-up stroke patients, ischemic stroke was found in 23(62.16%) and hemorrhagic stroke in 14(37.83%) patients. Out of 14(37.83%) wakeup strokes; in 8(57.14%) patients lesion was parenchymal and in 5(35.71%) multiple lesions were present. Higher incidence of diabetes mellitus in wake up strokes was found. Atherothrombotic and cardioembolic strokes contribute to majority of the cases of ischemic stroke. Conclusions: The incidence of stroke increases dramatically with advancing age irrespective of gender. .Diabetes mellitus emerged as the main risk factor in wake-up stroke. In wake up hemorrhagic stroke, the higher percentage of thalamic bleed was found. Improvement was appreciated more in non wake-up stroke as compared to wake-up stroke.

Low-Density-Lipoprotein Particle Size Predicts a Poor Outcome in Patients with Atherothrombotic Stroke

BACKGROUND AND PURPOSE: Low-density lipoprotein (LDL) particle size is considered to be one of the more important cardiovascular risk factors, and small LDL particles are known to have atherogenic potential. The aim of this study was to determine whether LDL particle size is associated with stroke severity and functional outcome in patients with atherothrombotic stroke. METHODS: Between January 2009 and May 2011, 248 patients with first-episode cerebral infarction who were admitted to our hospital within 7 days after symptom onset were prospectively enrolled. LDL particle size was measured using the nondenaturing polyacrylamide gradient gel electrophoresis assay. Stroke severity was assessed by applying the National Institutes of Health Stroke Scale (NIHSS) at admission. Functional outcome was investigated at 3 months after the index stroke using the modified Rankin Scale (mRS), and poor functional outcome was defined as an mRS score of > or =3. RESULTS: The LDL particle size in the 248 patients was 25.9+/-0.9 nm (mean+/-SD). LDL particle size was inversely correlated with the degree of cerebral artery stenosis (p=0.010). Multinomial multivariate logistic analysis revealed that after adjustment for age, sex, and variables with p or =5; reference, NIHSS score 0-2; odds ratio=0.38, p=0.028) and poor functional outcome (odds ratio=0.44, p=0.038). CONCLUSIONS: The results of this study demonstrate that small LDL particles are independently correlated with stroke outcomes. LDL particle size is thus a potential biomarker for the prognosis of atherothrombotic stroke.

Low Plasma Proportion of Omega 3-Polyunsaturated Fatty Acids Predicts Poor Outcome in Acute Non-Cardiogenic Ischemic Stroke Patients / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Alterations in blood fatty acid (FA) composition are associated with cardiovascular diseases. We investigated whether plasma FA composition was related to stroke severity and functional outcome in acute ischemic stroke patients. METHODS: We prospectively enrolled 156 patients with first-episode cerebral infarction, within 7 days of symptom onset. The proportion of FAs was analyzed using gas chromatography, and the summation of the omega-3 polyunsaturated fatty acids (omega3-PUFA), 18:3 omega3 alpha-linolenic acid, 20:3 omega3 eicosatrienoic acid, 20:5 omega3 eicosapentaenoic acid (EPA), and 22:6 omega3 docosahexaenoic acid (DHA) was reported as Sigmaomega3-PUFAs. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Poor functional outcome was defined by modified Rankin scale (mRS) > or =3 at three months after the index stroke. RESULTS: Lower proportions of EPA (beta=-0.751), DHA (beta=-0.610), and Sigmaomega3-PUFAs (beta=-0.462) were independently associated with higher NIHSS score, after adjusting for stroke subtype, hemoglobin, high density lipoprotein, high sensitivity C-reactive protein, fasting glucose, 16:0 palmitic acid, and Sigmasaturated fatty acids. Moreover, a lower proportion of DHA (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04-0.88), and Sigmaomega3-PUFAs (OR: 0.22, 95% CI: 0.05-0.84) showed an independent relationship with poor functional outcome after adjusting for age, sex, smoking status, NIHSS score, stroke subtype, and 16:0 palmitic acid. CONCLUSIONS: Our results demonstrate that omega3-PUFAs correlated with stroke severity on admission and functional outcomes at 3 months. omega3-PUFAs are potential blood biomarkers for prognosis of acute non-cardiogenic ischemic stroke patients.

The Long-term Incidence of Recurrent Stroke: Single Hospital-based Cohort Study

BACKGROUND: Recurrent stroke is a major cause of morbidity and mortality among stroke survivors. However, studies of the long-term prognosis after acute stroke are very rare, especially in Asia. This study aimed to provide estimates of recurrent stroke rates by age, gender, and subtype of stroke in an unselected cohort of patients hospitalized to a community-based general hospital due to acute stroke. METHODS: Based on a prospective stroke registry, acute stroke patients were enrolled within 7 days of symptom onset and followed retrospectively or prospectively for up to 3 years. Information was gathered about stroke recurrence and other vascular events. The cumulative risk of recurrent stroke was calculated using the Kaplan-Meier method. RESULTS: Two-thousand and sixty-eight patients were enrolled in this study. The cumulative risks of stroke recurrence were 2.3%, 5.5%, 8.6%, and 10.0% at 90 days and 1, 2, and 3 years, respectively. The prevalence of stroke recurrence increased with age and the presence of previous stroke history (p<0.001), but not with gender or stroke subtype. CONCLUSIONS: To the best of our knowledge, this is the first cohort study of stroke recurrence in Korea. Its limitation of being a single hospital-based study warrants community- or multicenter-based cohort studies to identify high-risk groups for stroke recurrence.

Intravenous rt-PA Fibrinolytic Therapy in Acute Carotid Territory Ischemic Stroke with Severe Neurologic Deficits: The Implication of Arterial Recanalization for Stroke Outcome

BACKGROUND: Our previous pilot study demonstrated that intravenous recombinant tissue plasminogen activator(rt-PA) fibrinolytic therapy was effective in treatment of effects of acute ischemic stroke within 3 hours of onset. We studied whether rt-PA was effective and safe in patients with acute carotid artery territory ischemic stroke with severe neurologic deficits (National Institute of Health Stroke Scale (NIHSS) score >14 points) and whether arterial recanalization after rt-PA infusion influenced the initial neurologic improvements within 24 hours and the stroke outcome at 3 months. METHODS: Twenty eligible patients had pre- and post-treatment computed tomogram and pre-treatment magnetic resonance angiogram. Fourteen patients had post-treatment magnetic resonance angiogram at 24 hours after stroke onset. Endpoints examined included initial neurological improvement at 2 and 24 hours by NIHSS and clinical stroke outcome at 3 months by a modified Rankin scale and the effect of recanalization on initial improvement and stroke outcome. RESULTS: Out of 20 patients, 9 patients (45%) showed initial improvement at 2 hours and 10 patients (50%) at 24 hours. Five patients (25%) had intracranial hemorrhages (symptomatic; 2). Twelve patients (60%) showed good clinical stroke outcome at 3 months. Complete or partial recanalization was observed in 11 patients (55%) at 24 hours after stroke onset. Recanalization correlated with good initial improvement and stroke outcome (p<0.05 and <0.05). CONCLUSIONS: Recanalization may have an association with good clinical outcome after rt-PA infusion within 3 hours of stroke onset in patients with acute carotid artery territory stroke with severe neurologic deficits.