Fibrinogen concentrations in ischaemic stroke patients with metabolic disorders.

BACKGROUND: Hyperfibrinogenemia plays a crucial role in the coagulation cascade leading to the formation of clots. It is involved in the process of platelet aggregation, primary haemostasis, and leukocyte-endothelial cell interactions. The aim of our study was to assess the correlations between fibrinogen concentration and particular risk factors for vascular diseases and atherosclerotic changes in stroke patients. METHODS: The study group consisted with 94 patients with acute ischaemic stroke with normo- or hyperglycaemia and normoor hyperlipidemia. 21 healthy subjects served as a control group. Fibrinogen level, HbA1c, and lipid profile were measured in all patients. Using a flow cytometer, we assessed CD61 positive microparticles which were defined as platelet-derived microparticles (PDMPs). The level of sP-selectin in serum was measured using the ELISA method. RESULTS: A significant positive correlation was observed between fibrinogen concentration and sP-selectin (p = 0.001), HbA1c (p < 0.05) level, and percentage of PDMPs (p < 0.05) in the study patients. Furthermore, we noticed a significant negative correlation between fibrinogen concentration and the level of HDL (p < 0.05). No correlation was observed between fibrinogen and TC, LDL and TG levels. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our findings suggest that an elevated fibrinogen level may represent a marker of prothrombotic condition exacerbated in the state of hyperglycaemia and activation of platelets and endothelial cells. This suggests an important role played by fibrinogen in the process of thrombogenesis.

sP- and sE-selectin in stroke patients with metabolic disorders.

BACKGROUND: Activation of platelets and endothelial cells plays an important role in the pathogenesis of atherosclerosis and thrombotic disorders. The aim of our study was to assess the relationship between the metabolic disorders and markers of platelet activity and vascular injury in patient with acute ischemic stroke. MATERIAL AND METHODS: The study group consisted of 84 patients with acute non-lacunar ischemic stroke divided into four subgroups with: (1) normolipidemia and normoglycemia, (2) normolipidemia and hyperglycemia, (3) hyperlipidemia and normoglycemia, (4) hyperlipidemia and hyperglycemia. 21 healthy subjects served as controls. We analyzed the concentration of adhesion molecules sP-selectin and sE-selectin in serum collected from all studied groups using ELISA method. RESULTS: We observed significantly higher sE- and sP-selectin concentration in patients with hyperglycemia and hyperlipidemia compared to both control subjects and patients with normolipidemia and normoglycemia. We did not observe additional effect of comorbid hyperlipidemia and hyperglycemia on studied markers. Soluble E- and P-selectin concentration correlated positively with LDL, TC and HbA1c level in all stroke patients. CONCLUSION: Soluble E- and P-selectin, blood markers of vascular injury and platelet activation, could be useful in the assessment of atherothrombotic properties of hyperglycemia and hyperlipidemia in stroke patients.

[Von Hippel-Lindau syndrome - a case report]. / Von Hippel-Lindau syndrome ­ a case report.

Von Hippel-Lindau disease (vHL, familial cerebello-retinal angiomatosis) is a rare genetic autosomal dominant disorder associated with predisposition to vascular tumors. Mutations of VHL tumor suppressor gene, located on chromosome 3p25-26, are responsible for clinical manifestation of the disease. The VHL gene product encodes VHL protein, which is responsible for HIF-1 (hypoxia-inducible factor-1) dependent cell cycle regulation and cellular pathways mediated by VEGF, PDGF, TGF-α, EPO. The mechanism substantiates the hypoxia dependent vascular tumor growth caused by loss of wild-type VHL protein. The clinical spectrum of vHL syndrome includes multiple tumors of various localization and low histologic grade, often bilateral. The most typical for the syndrome are: hemangioblastoma of central nervous system (typically posterior fossa or medulla), retinal hemangioblastoma, renal cell carcinoma and pheochromocytoma. The aim of the case report is to remind the typical clinical manifestation of von Hippel- Lindau syndrome, update the diagnostic criteria, recommended diagnostic and follow up methods.

The impact of hyperglycemia and hyperlipidemia on plasma P-selectin and platelet markers after ischemic stroke.

INTRODUCTION: Platelet activation plays a key role in the pathogenesis of ischemic cerebrovascular diseases. Thus, it is very important to identify novel pharmacological targets for platelet inhibition to improve ischemic stroke treatment. The aim of the study was to assess the relationship between metabolic disorders and platelet activity markers in patients with acute ischemic stroke. MATERIAL AND METHODS: Ninety-four patients with acute ischemic stroke were divided into four groups with: normolipidemia and normoglycemia (NL/NG), n = 25; normolipidemia and hyperglycemia (NL/HG), n = 21; hyperlipidemia and normoglycemia (HL/NG), n = 27; hyperlipidemia and hyperglycemia (NL/NG), n = 21. Twenty-one healthy subjects served as controls. We assessed the CD62P expression on resting and thrombin-activated blood platelets using the flow cytometer and anti-CD61 and anti-CD62P monoclonal antibodies. CD61-positive microparticles were defined as platelet-derived microparticles. The level of sP-selectin in serum was measured by the ELISA method. RESULTS: We observed a significant influence of hyperlipidemia and hyperglycemia on sP-selectin concentration. A strong correlation between higher sP-selectin concentration and enhanced LDL (p = 0.001), total cholesterol (p = 0.02), HbA1c level (p < 0.001) was noticed. The level of sP-selectin and PDMPs (p < 0.001) were significantly higher in all groups of stroke patients compared with the controls. CD62P expression on resting and thrombin activated platelets were significantly lower in groups of patients with stroke. CONCLUSIONS: Hyperlipidemia and hyperglycemia exert an equal stimulatory effect on tested platelet markers but with no synergistic action in stroke patients with both of the metabolic comorbidities. sP-selectin concentration in stroke patients best reflects the impact of hyperglycemia and hyperlipidemia on vascular lesions and platelet activation.

[The difficulties with the diagnosis of cerebral sinus thrombosis of a young woman - a case report]. / Trudnosci diagnostyczne zakrzepicy zatok mózgowych u mlodej kobiety - opis przypadku.

UNLABELLED: Cerebral venous stroke is disfunction of brain cause by thrombosis of cerebral veins or thrombosis of sinus of the dura mater. This disease represents about 0,5-1% of all strokes. Women are ill more often. There are over 100 factors which cause this disease. The most often symptoms are headache, epileptic fit, oedema of optic nerve, loss of visual acuity, speech defects. Magnetic resonance proves the diagnosis. MRI with contrast is recommended. A CASE REPORT: We show the case of a young woman taking the oral contraceptive pill whose only symptom of venous thrombosis for a few days was a strong headache. When the woman was admitted to hospital, she didn't have any other symptoms ( in neurology examine, tomography and blood tests). The severity of headache after lumbar puncture (because of suspected subarachnoid bleeding) suggested presented of post-dural-puncture headache, which delayed the correct diagnosis. It was not until after the symptoms of the focal brain damage appeared on the fifth day that we finally made the correct diagnosis confirmed by some additional tests/examinations. Thus we started causal and symptomatic treatment. The difficulties we had with making the correct diagnosis indicate that the recognition of cerebral thrombosis should be taken into account when treating every young woman taking contraceptive pills and suffering from strong headaches. Headaches can be the only symptom of venous stroke in 90% of cases.

[New orally anticoagulants and brain stroke]. / Nowe doustne antykoagulanty a udar mózgu.

Brain stroke is a grave society problem. About 20% ischemic strokes are cardiac related problems. Atrial fibrillation (AF) is the most common cause of ischemic strokes. Decision to deploy anticoagulant treatment with AF patient depends on bleeding and thrombo-embolic risk which summerise scale CHA(2)DS(2)VASc and HAS-BLED. Past recent years in AF treatment anticoagulants from the group of vitamin K antagonist were used. At present in brain stroke prevention and systemic emboilment, new oral anticoagulants (NOA) which weren't worst than vitamin K antagonists, and they are recomendet in most cases of AF unrelated with heart valve defets. Useing NOA causes lower risk of bleeding, including intracranial heamorrhage. It is believed that this is related to the selective inhibition of specific coagulation factors, and respect other hemostatic mechanisms. Results from clinical studies NOA are encouraging, but still lacks clear answers regarding, among other things: long-term safety of treatment and economically viable in everyday clinical practice. In addition, to date there is no specific antidote for this group of drugs.

Platelet Reactivity in Patients With Stroke and Hyperlipidemia, GPIbα Assessment.

The aim of this study was to assess platelet reactivity in patients after ischemic stroke and to investigate the influence of hyperlipidemia (HL) on platelet activity markers. A total of 41 patients after ischemic stroke were divided into the following 2 groups: patients with HL and patients with normolipidemia. Expression of CD42b on resting, thrombin-activated blood platelets, and fibrinogen level was assessed. The CD42b-positive platelets were analyzed using the flow cytometer, anti-CD61, and anti-CD42b monoclonal antibodies. The results confirmed increased platelet reactivity to thrombin in all patients after ischemic stroke manifested by significantly lower CD42b expression and percentage of CD42b(+) platelets after activation by thrombin. The influence of HL on the expression of CD42b on resting and thrombin-activated platelets was not found. However, increased level of fibrinogen but no influence of HL on fibrinogen concentration was observed in patients after ischemic stroke. Increased susceptibility to platelet agonists was found in patients after ischemic stroke in the convalescent phase.

The influence of statin therapy on platelet activity markers in hyperlipidemic patients after ischemic stroke.

INTRODUCTION: Low-density lipoprotein cholesterol (LDL-C) has been reported to increase platelet activation. Reducing the level of LDL-C with statins induces important pleiotropic effects such as platelet inhibition. This association between platelet activity and statin therapy may be clinically important in reducing the risk of ischemic stroke. We investigated the effect of simvastatin therapy on platelet activation markers (platelet CD62P, sP-selectin, and platelet-derived microparticles (PDMPs)) in hyperlipidemic patients after ischemic stroke. MATERIAL AND METHODS: The study group consisted of 21 hyperlipidemic patients after ischemic stroke confirmed by CT, and 20 healthy subjects served as controls. We assessed the CD62P expression on resting and thrombin-activated blood platelets. CD62P and PDMPs were analyzed by the use of monoclonal antibodies anti-CD61 and anti-CD62 on a flow cytometer. The level of sP-selectin in serum was measured by the ELISA (enzyme-linked immunosorbent assay) method. All markers were re-analyzed after 6 months of treatment with simvastatin (20 mg/day). RESULTS: Hyperlipidemic patients presented a significantly higher percentage of CD62+ platelets and higher reactivity to thrombin compared to control subjects. After simvastatin therapy hyperlipidemic patients showed a reduction of the percentage of resting CD62P(+) platelets (p = 0.005) and a reduction of expression and percentage of CD62P(+) platelets after activation by thrombin (median p < 0.05; percentage: p = 0.001). A decrease of sP-selectin levels (p = 0.001) and percentage of PDMPs (p < 0.05) in this group was also observed. CONCLUSIONS: HMG-CoA reductase inhibitor therapy in stroke patients with hyperlipidemia may be useful not only due to the lipid-lowering effect but also because of a significant role in reduction of platelet activation and reactivity.

The influence of hyperlipidemia on platelet activity markers in patients after ischemic stroke.

BACKGROUND: To investigate the relationship between hyperlipidemia and platelet activation markers--platelet and soluble P-selectin (sP-selectin), and platelet-derived microparticles (PDMPs)--in patients after ischemic stroke. METHODS: 41 patients after ischemic stroke (>3 months) confirmed by CT were divided into 2 groups: with hyperlipidemia (HL, n = 21) and normolipidemia (NL, n = 20). Twenty healthy subjects served as controls. CD62P-positive platelets and PDMPs in whole blood were analyzed by the use of a flow cytometer and anti-CD61 and anti-CD62P monoclonal antibodies. Platelets were activated by thrombin (0.08 units). The level of sP-selectin in serum was measured by ELISA. RESULTS: We observed a significantly higher CD62P expression and percentage of CD62P-positive resting and thrombin-activated platelets in the HL as compared to the NL group. The sP-selectin concentration was also significantly higher in HL than NL subjects (p < 0.05). Moreover, we observed a significantly higher percentage of PDMPs in patients after stroke (NL: p < 0.05; HL: p = 0.005) in comparison with the control group. CONCLUSIONS: Patients after stroke present symptoms of platelet hyperreactivity. HL in the patients may be a risk factor for vascular events due to the increase in platelet activation.

[The usefulness of P300 potential in hepatic encephalopathy diagnostics of alcoholic etiology]. / Przydatnosc potencjalu P300 w diagnostyce encefalopatii watrobowej o etiologii alkoholowej.

UNLABELLED: The consequence of consuming excessive amount of alcohol is the damage of internal organs, particularly liver. In the liver there comes in turn to its fatty degeneration, hepatitis, fibrosis and finally to its cirrhosis. The aim of the study was the analysis of P300 potential in subjects chronically abusing alcohol with alcohol-related toxic liver damage and the assessment of the usefulness of this potential in the diagnosis of hepatic encephalopathy. MATERIAL AND METHODS: Group I--consisted of 30 men meeting the criteria of alcohol dependency syndrome, with diagnosed alcohol-related toxic liver damage. Comparative group--consisted of 30 physically and mentally healthy men, with no alcohol dependency syndrome. The following were carried out in all the examined: examination of auditory endogenic P300 potential. RESULTS: In subjects chronically abusing alcohol, with diagnosed toxic liver damage statistically significant prolonged latency and also reduced amplitude (p < 0.001) were found in comparison with the control group. CONCLUSIONS: 1. Changes in P300 parameters (latency elongation and amplitude reduction) in alcohol-dependent subjects with alcohol-related liver damage were confirmed. 2. P300 potential may be a complementary method in the diagnosis of hepatic encephalopathy.

[The case of multiple brain abscesses conservatively treated]. / Przypadek mnogich ropni mózgu leczonych zachowawczo.

We report the case of patient with rheumatoid arthritis treated by sulfasalazin. He was hospitalized because of general erythrodermia and diarrhoea with dysproteinemia. The consciousness disturbances and the meningitis syndrome occured in the course of disease. The findings of cerebrospinal fluid suggested viral meningitis and encephalitis. The treatment was started. After short-term improvement, the focal neurological deficits and the consciousness disturbances appeared again. The examinations of the computed tomography and the magnetic resonance image suggested inflammatory or neoplasmatic process. The inflammatory process seemed to be more probable and antibiotic treatment was administered. The following CT and MRI findings confirmed inflammatory changes of brain tissue and abscess formation tendency. After the neurosurgeon consultation the conservatively treatment was continued. The 2 month therapy achieved a successful outcome. We report this case because of the difficulties of diagnostic and treatment choices and the 50% mortality connected with the multiple brain abscesses. It seems that in our case the bacterial infection was secondary to the viral encephalomeningitis. We couldn't find the primary focus of bacterial infection, although the infection cause was undoubtedly hematogenous (abscesses location on the boundaries of cerebral cortex and white matter). There is no evident therapeutic standards and the choice of the best treatment is still under discussion. However, neuroimagining techniques are very useful in the correct diagnosis and optimal treatment.

[Diabetic neuropathy]. / Neuropatia cukrzycowa.

Diabetic neuropathy is most common chronic complication of diabetes mellitus. It is responsible for substantial morbidity, increased mortality and impaired quality of life. Patogenesis of diabetic neuropathy is complex. Chronic hyperglycemia is a major factor induces nerve fibers injury. High level of glucose stimulate the polyol pathway causing osmotic stress and enhance reactive oxygen species generation, as well as it play an important role in diabetic angiopathy development. Distal symmetric polineuropathy is most common type of diabetic neuropathy. Many patient may develop combinations of neuropathies concerning somatic and autonomic system. Early diagnosis and administered suitable treatment are necessary to reduce severe complication of diabetic neuropathy as well as strict glycemic control and risk factor increased.

[Central pontine myelinolysis--case report]. / Centralna mielinoliza mostu--opis przypadku.

Central pontine myelinolysis (CPM) is a neurologic disorder, consists of demyelinisation without inflammation in the base of pons, with a relative sparing of the axons and the nerve cells. Clinical symptoms have various manifestations. They include pseudobalbular paralysis, tetraparesis, locked-in syndrome, coma. Rapid correction of persistence hyponatremia is a well recognized factor predisposing to CPM and nutritional deficiency is a commonly evoked cause of CMP as well. In more than half the cases it appeared in the late stages of chronic alcoholism. Among other medical conditions conjoined with CMP are liver failure and transplantation, electrolyte disturbances, cachexia from various causes, carcinoma, and severe bacterial infections. The autors report the cases of 31 year old patient with 4 year history of alkohol abuse in whom CPM developed with mild tetraparesis.

[Statins and stroke]. / Statyny a udar mózgu.

The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nevertheless, large, long-term statin trials in patients with established CHD or et high risk for CHD (diabetes, hypertension) have shown that statins decrease stroke incidence in these populations even with a normal baseline cholesterol concentration. In patients with previous stroke statins reduce the incidence of coronary events, but whether they actually reduce the incidence of recurrent strokes in secondary prevention is unproved. In this review we discuss the potential reason for the effects of statins on stroke and the mechanisms of action. Statins probably reduce stroke by a variety of mechanisms. Several studies indicate that statins have multiple effects beyond lowering the cholesterol level. There is evidence that statins have neuroprotective properties for the acute ischaemic brain. Statins interfere with platelet aggregation and have anti-inflammatory and antioxidative properties. Also statins promote stabilisation of atherosclerotic plaques and improve blood flow to the ischaemic brain. The protective effects of statins might be due to their direct effect on endothelial cells leading to improved nitric oxide (NO) bioavailability. However further studies are needed to understand the full role of statins in the prevention of stroke in patients without established cardiovascular disease, representative of the typical stroke population.

[Potential P300 in diagnostics of cognitive functions]. / Potencjal P300 w diagnostyce zaburzen poznawczych.

On the base of accessible literature and own experience general information concerning potential P300, the methodology of its research as well as the influence of different factors on each its components were reviewed. The possibilities of the clinical use of potential P300 in the diagnostics of cognitive disturbances were presented. It emerges that P300 potential can have practical use in the diagnostics of dementias, but because of its physiological and individual changeability it cannot be treated as a fully objective diagnostic method.

[Post-traumatic unilateral atlanto-axial rotatory subluxation in an adult]. / Urazowe zwichniecie stawu szczytowo-obrotowego bocznego u osoby doroslej.

This retrospective single-patient case report deals with a rare form of spinal trauma, i.e. atlantoaxial rotatory subluxation. The authors present a review of the literature including a classification of rotatory atlantoaxial subluxation types proposed by Fielding, and describe their own experience with treatment of this condition. A case is reported of a 29-year-old woman with a history of head contusion in a car accident. Immediately after the trauma she had the following symptoms: torticollis and neck pain with decreased cervical motion. Atlantoaxial rotatory subluxation of the right C1-C2 articulation was diagnosed by plain radiographs and CT. The patient was treated surgically by an open reduction, unilateral screw fixation of the right CI-C2 articulation (according to Magerl) and posterior C1-C2 wiring with graft. The normal atlantoaxial relation was restored with disappearance of torticollis. At follow-up certain limitation of neck movements due to C1-C2 stabilization persisted. No complications were noted. The patient remains neurologically intact and has radiographic documentation of fusion.