Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations.

BACKGROUND: Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. METHODS: We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. RESULTS: Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28-42) years in patients receiving CoronaVac and 46 (33.5-60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16-960) min and 30 (8.8-750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). CONCLUSIONS: Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.

Within-Visit Blood Pressure Variability and All-Cause and Stroke Mortality: Thai Epidemiologic Stroke Study.

INTRODUCTION: The association between within-visit blood pressure variability (BPV) and all-cause and stroke mortality remains uncertain. The aim of our study was to assess the association of within-visit BPV with all-cause and stroke mortality. METHODS: The study was conducted among participants from Thai Epidemiologic Stroke Study, which is a prospective community-based cohort study that recruited participants from the general population from five regions of Thailand. This study included 19,614 participants aged 45-80 years, who were free of stroke and had three blood pressure (BP) measurements, taken 1 min apart, at baseline. Within-visit systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability were expressed as the maximum absolute difference (MAD) between any two readings among the three repeated sequential measurements of SBP and DBP, respectively. The participants were followed up for mortality. Cox regression analysis was used to identify the association of within-visit BPV with all-cause and stroke mortality. Hazard ratio (HR) and 95% confidence intervals were used to illustrate the associations. Sensitivity analysis restricted to participants with mean SBP above 130 mm Hg and mean DBP above 90 mm Hg (n = 1,895) was performed. RESULTS: During a median follow-up of 11.1 years, 305 participants died of stroke, and 3,173 participants died of nonstroke cause. In unadjusted analyses, high within-visit MAD of SBP was significantly associated with all-cause (HR, 1.19; 95% CI, 1.09-1.31; p < 0.001) and stroke mortality (HR, 1.87; 95% CI, 1.35-2.59; p < 0.001); high within-visit MAD of DBP was also significantly associated with all-cause mortality (HR, 1.19; 95% CI, 1.08-1.31; p < 0.001), in quartile 4 versus quartile 1. These associations did not persist after further adjustment for sex, age, and other potential confounders including mean BP. However, sensitivity analysis showed some inconsistent results regarding associations of within-visit MAD of SBP and DBP with all-cause and stroke mortality, respectively. CONCLUSION: In general population, within-visit systolic BPV and within-visit diastolic BPV do not have prognostic significance on stroke mortality and all-cause mortality, respectively.

Clinical Characteristics and Treatment Response of Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

Background: The incidence, prevalence, clinical phenotypes, and treatment response of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are varying in the world literature. There have been no epidemiologic studies of CIDP in Thai adult patients. Objective: To determine clinical characteristics, phenotypes, electrophysiological tests, and treatment response of CIDP in Thai adult patients and to find factors associated with disease outcome after treatment. Material and Method: Retrospective chart review of Prasat Neurological Institute patients diagnosed of CIDP between January 1, 2008 and December 31, 2014. Results: Sixty-three CIDP patients were identified. Patients were slightly male predominant (1.3:1), age at onset was 47.7 years, disease duration prior to first evaluation was 5.0 months, follow-up duration was 26.8 months, and 19% of patients had diabetes. Clinical phenotypes were classic CIDP (76.2%), 19% DADS, and 4.8% MADSAM. Fifteen point nine percent presented as AIDP and 12.7% as SIDP. Symmetrical, sensorimotor polyneuropathy with hyporeflexia were the common presentation. Autonomic symptoms, respiratory failure, bulbar involvement, ophthalmoparesis, ptosis, and muscle atrophy were rarely presented. The treatment response was generally favorable. Patients in disease relapsing group had shorter disease onset (2 vs. 6 months) and 40% had disease duration less than four weeks. Conclusion: Clinical characteristics, phenotypes, electrophysiological findings, and treatment response of CIPD in Thai patients were not different from previously published studies in western and oriental populations. Mode of disease onset may predict a response to immunosuppressive treatment in CIDP patients.

Trinucleotide repeat expansion of TATA-binding protein gene associated with Parkinson's disease: A Thai multicenter study.

INTRODUCTION: Spinocerebellar ataxia type 17 (SCA17) is an inherited cerebellar degeneration associated with trinucleotide repeat expansions in the TATA-binding protein gene (TBP). Low-range expansions of TBP have recently been described in association with Parkinson's disease (PD). However, these low-range expansion alleles were also observed in healthy individuals. Prior distinct findings may result from reduced penetrance or age-dependent susceptibility, which may influence phenotypic expression. METHODS: A case-control study of 456 PD patients and 374 control subjects was conducted. Data and blood samples were collected during 2008-2013. Control subjects were individuals over 65 years old without parkinsonism. Sizes of TBP trinucleotide repeats were analyzed. All available carriers of the TBP repeat of ≥40 repeats were re-examined. RESULTS: A high prevalence of carriers of TBP repeat expansion ≥41 developed PD, mainly at an advanced age. Half of these carriers had onset after 70 years of age (range 34-84). Seven participants carried expansion alleles of ≥42, and all had PD. Fourteen participants (six patients and eight controls) carried a heterozygous 41-repeat allele. At the current mean age of 79 years and mean follow-up period of 4 years, three out of the eight control carriers of the 41-repeat allele developed PD, while none of the thirteen asymptomatic carriers of the 40-repeat allele did. CONCLUSIONS: A high prevalence of PD was observed in carriers of low-range expansions of TBP (41-45 repeats), especially in elderly. This finding suggests that cut-off value for pathological TBP repeat expansion appear to be 41.

Association between Socioeconomic Status and Major Risk Factors of Stroke: Thai Epidemiologic Stroke (TES) Study.

OBJECTIVE: To investigate the association of socioeconomic status (SES) (education, personal income, and occupation) with four major risk factors of stroke, those are diabetes, hypertension, hypercholesterolemia, and current smoker MATERIAL AND METHOD: The Thai Epidemiologic Stroke Study is a community-based cohort study, which recruitedparticipants from the general population from five geographic regions around the country. Cross-sectional baseline data of 19,997 (6,803 men and 13,194 women) participants, aged 45 to 80 years were included in the present analysis. Multiple logistic regression analysis was used to estimate association ofsocioeconomic indicators with the major risk factors of stroke. RESULTS: SES was associated with a major risk factor of stroke. Among three indicators ofsocioeconomic status, education was more consistently associated with the risk factors than personal income and occupation, particularly in women. Education significantly inversely associated with diabetes (p = 0.015 in men and 0.002 in women, respectively), and current smoker in both sexes (p < 0.001), and with hypertension in women (p = 0.011). By contrast, education was significantly positively associated with hypercholesterolemia in women (p < 0.001). CONCLUSION: The differences in the prevalence of the major risk factors of stroke between SES groups were important, and should be considered in the development ofpolicies or tailored strategies for prevention of stroke.

Analysis of SCA8, SCA10, SCA12, SCA17 and SCA19 in patients with unknown spinocerebellar ataxia: a Thai multicentre study.

BACKGROUND: About 50 % of Thai patients with adult-onset spinocerebellar ataxia (SCA) was Machado-Joseph disease (MJD), SCA1, SCA2 and SCA6. The author investigated further on less common SCAs in the patients without any known mutations. METHODS: DNA samples of 82 index patients who were genetically excluded MJD, SCA1, SCA2, SCA6, SCA7 and dentatorubro-pallidoluysian atrophy (DRPLA) were examined. Analysis of SCA8, SCA10, SCA12, SCA17 and SCA19 genes were comprehensively performed. Normal range of trinucleotide repeat expansion sizes of TATA-box-binding protein gene (TBP) were also determined in 374 control subjects. RESULTS: Eight patients carried ≥42 CAG/CAA repeat allele in the TBP consistent with SCA17. The pathological repeat alleles ranged from 42 to 57 repeats. All patients had significant degree of cognitive dysfunction. Other non-ataxic phenotypes comprised of parkinsonism, chorea, dystonia and myoclonus. A sporadic patient carried a heterozygous 41-repeat allele developed chronic progressive cerebellar degeneration commenced at the age of 28 years. Whilst, 2 % of the control subjects (8/374) carried the 41-repeat allele. Five of the carriers were re-examined, and revealed that four of them had parkinsonism and/or cognitive impairment without cerebellar signs. Analysis of other types of SCAs was all negative. CONCLUSIONS: This is the first study of SCA8, SCA10, SCA12, SCA17 and SCA19 in Thais. SCA17 appears to be an important cause of ataxia in Thailand. Although, the pathological cut-off point of the TBP repeat allele remains unclear, the finding suggests that the 41-repeat may be a pathological allele resulting late-onset or mild phenotype. Apart from ataxia, cognitive impairment and parkinsonism may be clinical presentations in these carriers.

Confirmation of the association between LRRK2 R1628P variant and susceptibility to Parkinson's disease in the Thai population.

OBJECTIVE: LRRK2 p.R1628P (c.4883G > C) is associated with Parkinson's disease (PD) in Chinese and Thais. However, some studies in other East Asian ethnic groups did not observe this association. Carriers of p.R1628P are about 3-5% Chinese and Thais. In contrast, Japanese, Koreans and Malays are much less prevalent (0-<1%). The contradictory results may be caused by insufficient sample sizes especially studies in ethnic groups with low prevalence, which, theoretically need a much larger sample size. We conducted a case-control Thai PD study with appropriate size in order to support the role of p.R1628P related to susceptibility to PD. METHODS: Estimated total sample size of 958 Thai subjects was needed. 485 PD patients and 480 controls were recruited. The p.R1628P was screened by RFLP and confirmed by direct sequencing. Clinical characteristics were compared between PD patients with and without p.R1628P. RESULTS: 54 PD patients (11%) and 29 control subjects (6%) carried p.R1628P. Multiple logistic regression analysis showed that GC and CC genotypes were significantly higher in PD patients than in controls (OR = 1.81, 95%CI = 1.10-2.97). The PD patients carrying p.R1628P had earlier age at onset (56 ± 13 vs 60 ± 12; P = 0.021) and a more rapidly progressive course (P < 0.001) than the patients carrying wild-type nucleotide. CONCLUSIONS: We confirm the association between p.R1628P and risk of developing PD in the appropriated sample-sized cohort. Certain LRRK2 variants appear to be generally distributed among East Asians, however, in widely different frequencies. In order to study role of such variants in PD, it should be carefully estimated the appropriate sample size.

Glucocerebrosidase mutations in Thai patients with Parkinson's disease.

BACKGROUND: GBA mutations are an important risk factor in developing Parkinson's disease (PD) worldwide. The study aimed to determine the frequency and clinical characteristics of GBA mutations in a Thai PD cohort of 480 patients and 395 control subjects. METHODS: Direct sequencing of GBA was performed in all early-onset PD patients (EOPD: n = 108) and 100 PD patients with age at onset over 50 years (AAO > 50y-PD). The study subsequently screened all identified mutations in the remaining AAO > 50y-PD patients and all control subjects. Predictive factors associated with risk of developing PD were analyzed. Comparisons of clinical characteristics of PD patients with and without GBA mutations were also carried out. RESULTS: Heterozygous GBA mutations were identified in 24 patients (5%) and 2 controls (0.5%). Seven identified GBA point mutations comprised p.L444P, p.N386K, p.P428S, IVS2+1G > A, IVS9+3G > C, IVS10-9_10GT > AG and c.1309delG, of which five mutations were novel. Multiple logistic regression analysis revealed that GBA mutations were more frequent in EOPD than AAO > 50y-PD groups (OR = 4.64, P < 0.022). Patients with GBA mutations had mean age at onset (43.1 ± 10.2, mean ± standard deviation) earlier than patients without GBA mutations (54.4 ± 13.9, P = 0.002). The patients with GBA mutations also had a more rapid progressive course, in which they were more likely to have higher Hoehn and Yahr staging (OR = 4.20, P = 0.006) and slightly lower means of Schwab-England ADL score [74.1 ± 17.1 vs. 81.0 ± 18.08 (OR = 0.98, 95%CI = 0.96-1.01, P = 0.162)]. CONCLUSION: GBA mutations are an important risk of PD in the Thai population. Patients having the mutations are likely to have early onset and may exhibit more rapid motor progression.

Factors predicting high estimated 10-year stroke risk: thai epidemiologic stroke study.

BACKGROUND: The purpose of the study was to determine the factors predicting high estimated 10-year stroke risk based on a risk score, and among the risk factors comprising the risk score, which factors had a greater impact on the estimated risk. METHODS: Thai Epidemiologic Stroke study was a community-based cohort study, which recruited participants from the general population from 5 regions of Thailand. Cross-sectional baseline data of 16,611 participants aged 45-69 years who had no history of stroke were included in this analysis. Multiple logistic regression analysis was used to identify the predictors of high estimated 10-year stroke risk based on the risk score of the Japan Public Health Center Study, which estimated the projected 10-year risk of incident stroke. RESULTS: Educational level, low personal income, occupation, geographic area, alcohol consumption, and hypercholesterolemia were significantly associated with high estimated 10-year stroke risk. Among these factors, unemployed/house work class had the highest odds ratio (OR, 3.75; 95% confidence interval [CI], 2.47-5.69) followed by illiterate class (OR, 2.30; 95% CI, 1.44-3.66). Among risk factors comprising the risk score, the greatest impact as a stroke risk factor corresponded to age, followed by male sex, diabetes mellitus, systolic blood pressure, and current smoking. CONCLUSIONS: Socioeconomic status, in particular, unemployed/house work and illiterate class, might be good proxy to identify the individuals at higher risk of stroke. The most powerful risk factors were older age, male sex, diabetes mellitus, systolic blood pressure, and current smoking.

Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study.

BACKGROUND: Data concerning quality of acute stroke care and outcome are scarce in developing countries. OBJECTIVE: This study aimed to evaluate quality of acute stroke care and stroke outcomes in Thailand. METHODS: We performed a multicenter countrywide prospective cohort study. Consecutive patients with an acute ischemic stroke admitted to the participating institutions between June 2008 and November 2010 were included. Baseline characteristics, process measures including thrombolysis use, acute stroke unit admission, initiation of aspirin within 48 hours, and antithrombotic and/or anticoagulation medication at discharge were recorded. Main outcome measures were death and disability at discharge as well as in-hospital complications. RESULTS: A total of 1222 patients were included with a mean (±SD) age of 65.0 ± 13 years, and 55.0% were men. Median National Institutes of Health Stroke Scale score was 6.5. Patients were given aspirin within 48 hours, admitted to acute stroke unit, and given thrombolytic therapy in 71.1%, 24.6%, and 3.8%, respectively. Good recovery at discharge (modified Rankin scale score 0-1) was found in 26.1%, and 3.2% of patients died during hospitalization. The median length of stay was 4 days. Factors predicting poor outcome (modified Rankin scale score 5-6) at discharge included: age (by 10-year increments: adjusted odds ratio [OR] 1.23; 95% confidence interval [CI], 1.06-1.43), female sex (adjusted OR 1.52; 95% CI, 1.05-2.19), initial National Institutes of Health Stroke Scale score (adjusted OR 1.35; 95% CI, 1.27-1.43), and in-hospital complications (adjusted OR 3.16; 95% CI, 1.58-6.35). CONCLUSIONS: Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.

Risk of metabolic syndrome for stroke is not greater than the sum of its components: Thai Epidemiologic Stroke (TES) study.

Limited information is available on the association between the metabolic syndrome (MetS) and stroke. Whether or not MetS confers a risk greater than the sum of its components is controversial. This study aimed to assess the association of MetS with stroke, and to evaluate whether the risk of MetS is greater than the sum of its components. The Thai Epidemiologic Stroke (TES) study is a community-based cohort study with 19,997 participants, aged 45-80 years, recruited from the general population from 5 regions of Thailand. Baseline survey data were analyzed in cross-sectional analyses. MetS was defined according to criteria from the National Cholesterol Education Program (NCEP) Adult Treatment Panel III, the American Heart Association/National Heart, Lung, and Blood Institute (revised NCEP), and International Diabetes Federation (IDF). Logistic regression analysis was used to estimate association of MetS and its components with stroke. Using c statistics and the likelihood ratio test we compared the capability of discriminating participants with and without stroke of a logistic model containing all components of MetS and potential confounders and a model also including the MetS variable. We found that among the MetS components, high blood pressure and hypertriglyceridemia were independently and significantly related to stroke. MetS defined by the NCEP (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.32-2.04), revised NCEP (OR, 2.27; 95% CI, 1.80-2.87), and IDF definitions (OR, 1.70; 95% CI, 1.37-2.13) was significantly associated with stroke after adjustment for age, sex, geographical area, education level, occupation, smoking status, alcohol consumption, and low-density lipoprotein cholesterol. After additional adjustment for all MetS components, these associations were not significant. There were no statistically significant difference (P=.723-.901) in c statistics between the model containing all MetS components and potential confounders and the model also including the MetS variable. The likelihood ratio test also showed no statistically significant (P=.166-.718) difference between these 2 models. Our findings suggest that MetS is associated with stroke, but not to a greater degree than the sum of its components. Thus, the focus should be on identification and appropriate control of its individual components, particularly high blood pressure and hypertriglyceridemia, rather than of MetS itself.

Appropriate body mass index and waist circumference cutoffs for middle and older age group in Thailand: data of 19,621 participants from Thai epidemiologic stroke (TES) study.

OBJECTIVE: To determine the appropriate body mass index (BMI) and waist circumference (WC) cutoff point for identification of at least one cardiovascular risk factor (hypertension, dyslipidemia, and type 2 diabetes) in Thailand, and to compare the discrimination ability of BMI with that of WC for discrimination of at least one cardiovascular risk factor. MATERIAL AND METHOD: Baseline health survey data of participants of Thai Epidemiologic Stroke (TES) Study, who were free from stroke, enrolled from five geographic regions around the country, were studied as cross-sectional analysis. Receiver operating characteristics curve (ROC) analysis was performed to determine the appropriate cutoff points of BMI and WC in identifying those with presence of at least one cardiovascular risk factors. The BMI or WC value with the shortest distance on the ROC curve was considered to be appropriate cutoffs. Comparing the ability of BMI in discrimination of at least one cardiovascular risk factor with that of WC was performed by comparing ROC area under curve (AUC). RESULTS: Among 19,621 (6,608 men and 13,013 women) participants with age range of 45 to 80 years, the average age was 59.8 years for men and 58.5 years for women. The appropriate cutoff point of BMI was 23 kg/m2 in men and 24 kg/m2 in women. The cutoffs of WC were 80 cm and 78 cm in men and women, respectively. In both gender, waist circumference (WC) (AUC in men = 0.684; 95% CI, 0.672-0.695, AUC in women = 0.673; 95% CI, 0.665-0.681) was significantly (p < 0.001) better than BMI (AUC in men = 0.667; 95% CI, 0.656-0.679, AUC in women = 0.636; 95% CI, 0.628-0.644) in discrimination of at least one cardiovascular risk factor. CONCLUSION: In Thai adults aged 45 to 80 years, the cutoff points of BMI should be 23 kg/m2 in men and 24 kg/m2 in women. For WC, 80 cm and 78 cm should be considered to be appropriate cutoffs for men and women, respectively. Waist circumference (WC) as a simple obesity index should be advocated for public health screening.

The usage of proton magnetic resonance spectroscopy in Parkinson's disease.

BACKGROUND: Parkinson's disease is a degenerative disorder of the central nervous system resulting from neuronal loss in the substantia nigra (a region of the mid brain) and BSG. Proton magnetic resonance spectroscopy (1H-MRS) has been previously performed in Parkinson's disease (PD) to evaluate in vivo concentration of basal ganglia (BSG) and cerebral cortex metabolites. However this technique has never been used to evaluate the substantia nigra (SN) in PD patients. In this preliminary report, single voxel MRS of BSG and SN was performed in PD and normal control (non-PD) to evaluate the usage of MRS in PD patients. MATERIAL AND METHOD: Seventeen PD patients including 12 men and five women with a mean age 60.5 years (SD 9.4) and a mean duration of the disease 5.9 years (SD 4.2) based on Hoehn & Yahr stage I to III, and 14 healthy age-matched controls including eight men and six women with a mean age 55.5 years (SD 5.8) were enrolled. Patients with evidence of brain atrophy and cognitive impairment were excluded. RESULTS: A significant reduction in the NAA/Cr ratio was observed in the SN ofPD compared with controls (p < 0.05). BSG spectra did not allow any evaluation due to the presence of artifacts related to inorganic paramagnetic substances. CONCLUSION: 1H-MRS could be used as a sensitive tool for studying neuronal dysfunction in SN of PD patients and may be a useful technique to monitor the disease. The SN reduction of NAA/Cr ratio in PD patients may be the marker of neuronal loss in SN of patients with PD.

Prevalence of stroke and stroke risk factors in Thailand: Thai Epidemiologic Stroke (TES) Study.

OBJECTIVE: To assess stroke prevalence and stroke risk factors in Thailand. MATERIAL AND METHOD: Thai Epidemiologic Stroke (TES) Study is an ongoing, community based cohort study that has been conducted in five geographic regions of Thailand. Baseline health status survey was started in 2004 and enrollment continued until the end of 2006. All participants who were suspicious of being stroke victims were verified. In this analysis, baseline data of 19,997 participants aged 45 to 80 years were identified and analyzed as a cross-sectional analysis. RESULTS: Three hundred and seventy six subjects were proved to have a stroke thus resulting the crude prevalence of stroke to be 1.88% (95% CI, 1.69 to 2.07). Age standardization to Segi world standard population was 1.81% (95% CI, 1.62 to 1.99). Crude prevalence among adults aged > or = 65 years was 2.70% (95% CI, 2.28 to 3.11). Stroke prevalence differed among five geographic regions of the country (Bangkok 3.34%, Central region 2.41%, Southern 2.29%, Northern 1.46% and Northeastern 1.09%). Using multiple logistic regression analysis, factors associated with higher stroke prevalence were male gender (p < 0.001), occupational class (p < 0.001), geographic region (p < 0.001), hypertension (p < 0.001), diabetes mellitus (p = 0.002) and hypercholesterolemia (p = 0.026). CONCLUSION: Stroke prevalence in Thailand from TES study is higher than previous studies, but it is lower than developed countries, probably due to high case fatality rate in Thai population. Geographic variation in stroke prevalence is found more in Bangkok, Central and Southern regions. Longitudinal follow-up of TES cohort study will provide further information on risk factors and incidence of stroke.

Body temperature and mortality in acute cerebral infarction.

BACKGROUND AND OBJECTIVE: In animal models, a rise in body temperature after cerebral ischemia consistently produces more extensive brain damage. In humans, however the relationship between body temperature and stroke outcome has been far less extensively investigated, providing conflicting results. The objective of the present study is to determine whether body temperature recorded during the first 72 hours after admission is an independent predictor of mortality in acute cerebral infarction. MATERIAL AND METHOD: The medical records of patients admitted within 48 hours of onset of symptoms to Prasat Neurological Institute between 1 January 2002 and 31 December 2003, with a diagnosis of cerebral infarction, confirmed by CT or MRI of the brain were retrospectively studied. The relationship between the highest temperature recorded during the first 72 hours after admission and mortality during hospital stay was evaluated. Multiple logistic regression analysis included relevant confounders and potential predictors such as gender, age, hypertension, diabetes, smoking, previous stroke, ischemic heart disease, atrial fibrillation, consciousness and infections was performed. RESULTS: There were 332 patients included in the present study. During the first 72 hours after admission, 88 (26.5%) patients had fever (> 37.5 degrees C). The highest temperature recorded during the first 72 hours after admission was a significant predictor of in hospital mortality in the final multivariate logistic regression model. For each 1 degree C increase in body temperature the odd ratio of mortality rose by 3.95 (OR, 3.95; 95%CI, 1.84 - 8.45). CONCLUSION: In the present study, the highest body temperature recorded during the first 72 hours after admission was shown to be a significant predictor of mortality in acute cerebral infarct patients.

Risk factors for early infection after an acute cerebral infarction.

BACKGROUND AND OBJECTIVE: Infection is a common complication after an acute stroke. This is important because it may cause death or delayed successful rehabilitation. Investigation of the risk factors for infection after an acute stroke is limited The objective of this study was to determine the risk factors for early infection after an acute cerebral infarction. DESIGN: Retrospective analystical study. MATERIAL AND METHOD: The medical records of patients admitted within 48 hours of onset of symptoms to Prasat Neurological Institute from 1 January 2002 to 31 December 2003, with a diagnosis of cerebral infarction, confirmed with CT or MRI of the brain were retrospectively studied. Collected data included clinical features, risk factors for stroke, comorbid conditions, infection, and results of diagnosis tests. Univariate and multiple logistic regression analyses were used to determine factors that were associated with the risk of early infection. RESULTS: During the 24-month study period, 332 cerebral infarct patients were identified. Early infection occurred in 7.6%. The most common infection was pneumonia (4.3%). In the final multiple logistic model, independent risk factors for early infections were atrial fibrillation (OR, 9.31; 95% CI, 2.18-39.75), thromboembolic infarction (large vessel disease) (OR, 6.04; 95% CI, 1.97-18.54), admission conscious level (subconscious or unconscious/coma) (OR, 4.82; 95% CI, 1.60-14.55) and previous stroke (OR, 3.20; 95% CI, 1.21-8.47) respectively. CONCLUSION: Atrial fibrillation, thromboembolic infarction (large vessel disease), admission conscious level (subconscious or unconscious/coma), and previous stroke were independent risk factors for development of early infection.