Subject(s)
Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Ocular Motility Disorders/drug therapy , Stroke/drug therapy , Tissue Plasminogen Activator/therapeutic use , Acute Disease , Administration, Intravenous , Adult , Brain Ischemia/complications , Fibrinolytic Agents/administration & dosage , Humans , Male , Ocular Motility Disorders/etiology , Stroke/complications , Tissue Plasminogen Activator/administration & dosageABSTRACT
BACKGROUND: Leukocyte-mediated neuroinflammation may affect outcomes after ischemic stroke. AIMS: To explore temporal changes in levels of peripherally circulating leukocyte subtypes in the early hours after ischemic stroke in humans. METHODS: Retrospective analysis of a single-center database of consecutive thrombolysis cases for acute ischemic stroke (AIS). Multivariable regression analysis was used to explore temporal changes in the levels of peripherally circulating leukocyte subtypes in the hours immediately after ischemic stroke. A natural logarithm transformation was used to achieve normally distributed residuals, and adjustment was made for the severity of stroke, blood glucose concentration, sex, and age. RESULTS: Blood samples were taken a median time of approximately 2 hours after stroke symptom onset. Median peripheral neutrophil and lymphocyte counts on admission were 4.8 × 109cells per liter (interquartile range [IQR], 3.6-7.2 × 109 cells per liter) and 1.9 × 109cells per liter (IQR, 1.3-2.6 × 109cells per liter), respectively. Multivariable regression analysis revealed that after adjustment there was a linear increase in the natural logarithm of the peripheral neutrophil count (P < .01), with a linear decrease in the natural logarithm of the peripheral lymphocyte count (P < .01) in the hours immediately after stroke onset. No significant temporal associations were found between the levels of the other peripherally circulating leukocyte subtypes. CONCLUSIONS: Immediately after ischemic stroke, there is an exponential increase in the neutrophil count and an exponential decrease in the lymphocyte count.
Subject(s)
Brain Ischemia/immunology , Inflammation/immunology , Lymphocyte Subsets/immunology , Neutrophils/immunology , Stroke/immunology , Aged , Aged, 80 and over , Brain Ischemia/blood , Brain Ischemia/diagnosis , Brain Ischemia/therapy , Databases, Factual , Female , Humans , Inflammation/blood , Inflammation/diagnosis , Inflammation/therapy , Linear Models , London , Lymphocyte Count , Male , Middle Aged , Multivariate Analysis , Phenotype , Prognosis , Retrospective Studies , Stroke/blood , Stroke/diagnosis , Stroke/therapy , Time FactorsABSTRACT
BACKGROUND: Intravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis. METHODS: This study is a retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was undertaken to explore the relationship between different subtypes of HT with changes in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis, after adjusting for potential confounders. RESULTS: As compared to cases with no HT, occurrence of the parenchymal hematoma 2 (PH2) subtype of secondary ICH was independently associated with reduced improvement or worsening in the NIHSS score, with an average effect size of 7 points (95% confidence interval -10 to -4, P < .001). In the absence of PH2, thrombolysis for AIS was generally associated with an improvement in the neurological status at 24 hours. CONCLUSIONS: The PH2 subtype of HT is associated with reduced neurological improvement or deterioration 24 hours after thrombolysis for AIS.
Subject(s)
Cerebral Hemorrhage/chemically induced , Fibrinolytic Agents/adverse effects , Nervous System Diseases/etiology , Nervous System Diseases/prevention & control , Stroke/complications , Stroke/drug therapy , Tissue Plasminogen Activator/adverse effects , Aged , Aged, 80 and over , Blood Glucose/drug effects , Brain Ischemia/complications , Databases, Factual/statistics & numerical data , Female , Humans , Male , Middle Aged , Regression Analysis , Retrospective Studies , Stroke/etiologyABSTRACT
BACKGROUND: Outcomes are worse in patients who underwent thrombolysis for acute ischemic stroke (AIS) with persistent hypertension. The objective of this study is to investigate whether fall in systolic blood pressure (SBP) has any relationship with neurological outcome 24 hours after thrombolysis, after adjusting for potentially confounding factors. METHODS: Retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was used to explore the relationship between fall in SBP and reduction in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis. Other potentially confounding predictor variables used in the model were SBP on thrombolysis, blood glucose level on thrombolysis, NIHSS score on thrombolysis, administration of antihypertensive medications, and the time to thrombolysis after symptom onset. RESULTS: A fall in SBP 24 hours after thrombolysis is independently associated with greater improvement in NIHSS score 24 hours after thrombolysis (coefficient .051, 95% confidence interval .023-.078, P < .001). Thus, a reduction of 10 mmHg in SBP after 24 hours is associated with a .51 point reduction in the NIHSS score. CONCLUSIONS: Restoration of SBP toward normal limits after thrombolysis for AIS is associated with greater early neurological improvement.
Subject(s)
Blood Pressure , Brain Ischemia/drug therapy , Fibrinolytic Agents/administration & dosage , Hypertension/physiopathology , Stroke/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/administration & dosage , Aged , Aged, 80 and over , Brain Ischemia/diagnosis , Brain Ischemia/physiopathology , Databases, Factual , Disability Evaluation , Female , Fibrinolytic Agents/adverse effects , Humans , Hypertension/diagnosis , Infusions, Intravenous , London , Male , Middle Aged , Multivariate Analysis , Recovery of Function , Retrospective Studies , Risk Factors , Stroke/diagnosis , Stroke/physiopathology , Systole , Thrombolytic Therapy/adverse effects , Time Factors , Tissue Plasminogen Activator/adverse effects , Treatment OutcomeABSTRACT
Tachycardia induced cardiomyopathy (TIC) is a rare but potentially reversible cause of heart failure. The case of a patient with severe tachycardiomyopathy who had a favorable outcome following treatment of tachyarrythmia is presented here.
