Clinical Profile and Outcomes of Early Seizures in Asian Patients With Acute Intracerebral Hemorrhage.

BACKGROUND: Seizures are one of the most common complications of stroke. We aimed to establish the incidence and clinical profile of post-stroke early seizure (ES) in patients with intracerebral hemorrhage (ICH). METHODS: Patients with ICH within 10 days of onset who were admitted to Landseed International Hospital were recruited consecutively between January 1, 2006, and December 31, 2009. The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale were used to access patients initial stroke severity and functional outcome at discharge, respectively. The occurrence of epileptic seizures within 30 days after onset of the index ICH was recorded. Early post-ICH seizure was defined by the occurrence of clinically identifid seizure episodes or non-epileptic seizure within 7 days after the stroke onset. RESULTS: A total of 297 ICH patients were included. The mean age of the participants was 62 ± 16 years, and 72% of them were male. A total of 9 (3%) participants had seizures during acute hospitalization. Patients with seizures had higher median NIHSS scores at baseline (34 vs. 16, p = 0.004). No difference was noted in the cortical involvement of ICH (22% for patients with seizures and 14% for those without, p = 0.156). Patients with seizures had higher in-hospital mortality ( 56% vs. 23%, p = 0.024). The multivariate Cox regression model showed the factors significantly associated with ES were higher initial NIHSS scores on admission (adjusted odds ratio [aOR] = 1.1 per 1 point increased, 95% confidence interval [CI] = 1.0-1.2) and coronary artery disease (aOR = 7.0, 95% CI = 1.3-36.4). CONCLUSIONS: The NIHSS scores and coronary heart disease were associated with ES in ICH, whereas cortical involvement was not. These findings may reflect difference in post-stroke seizure and primary ICH between Asian and Western populations.

Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry.

The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160-200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41-2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11-1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76-8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.

Distinct expression of Mas1-related G-protein-coupled receptor B4 in dorsal root and trigeminal ganglia--implications for altered behaviors in acid-sensing ion channel 3-deficient mice.

Mas1-related G-protein-coupled receptors (Mrgprs), comprising more than 50 distinct members, are specifically expressed in primary sensory neurons. Reflecting the diversity and specificity of stimuli they detect, Mrgprs are involved in pain, touch, and itch-related behaviors. Sensory-neuron-specific acid-sensing ion channel 3 (ASIC3) is essential for touch and inflammatory pain, but mice lacking ASIC3 have complex behavioral alterations in various modalities of pain and touch. To understand whether Mrgprs are involved in complex behavioral alterations found in ASIC3-deficient mice, we examined Mrgpr gene expression in ASIC3(-/-) mice. Only MrgprB4 expression has shown significant change. MrgprB4 expression was increased in ASIC3(-/-) dorsal root ganglia (DRG) but decreased in ASIC3(-/-) trigeminal ganglia. The distinct alterations in DRG and trigeminal ganglia imply that MrgprB4 could have multiple functions. Given that MrgprB4 is expressed in neurons that may detect gentle touch and that ASIC3(-/-) mice have altered sensitivity of mechanoreceptors for light touch, the expression change of MrgprB4 is more likely related to the altered touch behaviors of ASIC3(-/-) mice.

Risk factors of in-hospital mortality of intracerebral hemorrhage and comparison of ICH scores in a Taiwanese population.

BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality. This study aimed to explore the risk factors associated with mortality and unfavorable outcome of ICH in Taiwan and to compare the predictive power with the existing ICH scores. METHODS: Medical records of the ICH patients consecutively admitted to a regional hospital between January 2003 and December 2006 were reviewed retrospectively. The demographics, outcome, clinical and radiological characteristics were also analyzed. RESULTS: A total of 61 among 285 (21.4%) ICH patients died during hospitalization. Diabetes mellitus, lower scores of initial Glasgow Coma Scale, initial ICH volume >30 ml, and intraventricular hematoma were identified as major independent risk factors associated with in-hospital mortality in the logistic regression model. In comparison to the predictive power for mortality and unfavorable outcome, Barthel Index <40 at discharge, the results showed no significant difference among the scores derived from our study, the ICH score by Hemphill and the modified ICH score developed in Taiwan. CONCLUSIONS: Although these ICH scores developed with various measurements, no significant difference in predicting mortality and unfavorable functional outcomes was found. The results supporting the ICH score by Hemphill may provide a good prediction in acute outcome across ethnic groups.