RESUMO
OBJECTIVE: To assess the implication of tumor necrosis factor alpha (TNF-alpha) and interleukine-6 (IL-6) in acute ischemic stroke and to correlate this with lesion size, vascular risk factors, and neurological impairment. METHODS: We included 70 patients consecutively admitted to the Department of 1st Neurology, Haydarpasa Numune Educational and Research Hospital, Istanbul, Turkey, between September 2001 and April 2002, with first-ever ischemic cerebral infarction within the first 24 hours from onset. The TNF-alpha, IL-6, fibrinogen, C-reactive protein, erythrocyte sedimentation rate (ESR) and leukocytes were determined in plasma on admission. Neurological impairment was evaluated with the modified Rankin Scale. RESULTS: We found higher baseline levels of TNF-alpha and IL-6 in the plasma of patients with acute ischemic stroke and neurological impairment in comparison to control subjects. In the large infarct group, TNF-alpha, IL-6, low-density lipoprotein-cholesterol and fibrinogen were found significantly higher compared to the small infarct group. While an association between TNF-alpha and IL-6 values and lesion size were determined, no relation was found between localization and etiology. The TNF-alpha level was found to be in positive correlation with IL-6, fibrinogen, and ESR. The IL-6 level was found to be in positive correlation with ESR fibrinogen, and leukocytes. CONCLUSION: Inflammatory findings are associated with the early stage of ischemic stroke. The TNF-alpha and IL-6 were also higher in patients with clinical worsening. The release of proinflammatory cytokines after focal cerebral ischemia indicates a step leading to tissue necrosis or reflects the amount of ischemic brain injury, since the higher concentrations of TNF-alpha and IL-6 are found in patients with large infarctions.
RESUMO
OBJECTIVE: To investigate and determine the clinical findings, lesions, risk factors, and variety of etiology in Turkish patients suffering from vertebrobasilar ischemia. METHODS: The clinical, radiological, and prognostic features of patients with ischemic stroke in the vertebrobasilar system (VBS) are not homogeneous. The mechanism, localization, and severity of the vascular lesions and the presence of coexisting vascular risk factors influence the prognosis. The study included 134 patients with ischemic strokes in the VBS that were evaluated according to age, gender, clinical findings, risk factors, lesion localization, echocardiography, Doppler sonography, and cervical magnetic resonance angiography at Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey between 1998-2002. RESULTS: Hypertension, heart disease, smoking, diabetes mellitus, and hyperlipidemia were the most commonly observed risk factors. While infratentorial involvement was seen at a higher ratio (75.4%), acute multi-infarcts appearing simultaneously were mostly localized in the thalamus and the brain stem (18.7%). Large and small vessel disease incidences have been found in 32.8% and 20.1% of the patients. Cardioembolism with an incidence rate of 41.8% was the most frequent etiological cause in VBS ischemia. No significant meaning has been developed with age and gender as compared to the relationship between localization and etiological subgroups. CONCLUSION: The most common risk factors were hypertension and cardiac diseases, and the most common localization of the infarcts was the infratentorial region. The cerebellum was seen as the most coexisting localization with all multiple infarcts. Cardioembolism accounted for the largest etiological group in all localizations and in multiple infarcts.
