The importance of selected markers of inflammation and blood-brain barrier damage for short-term ischemic stroke prognosis.

Acute cerebral ischemia triggers local and systemic immune response. The aims of this project was to assess the blood serum concentration of the markers of inflammation and markers of the blood brain barrier damage on the first day of ischemic stroke, and the mutual correlations between these marker levels. Patients with first-in-life stroke were analysed according to: plasma concentration of the following markers on the first day of stroke: interleukin 2 (IL-2) and interleuki 6 (IL-6), S100B, tumor necrosis factor-α (TNF-α), progranulin (GRN), neuron specific enolase (NSE), urokinase-type plasminogen activator (uPA), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), C-reactive protein (CRP), leucocyte and thrombocyte counts; their neurological status on the first day of stroke (NIHSS) and their functional status at 30 days following stroke (mRS). The study included 138 patients with mean age: 73.11 ± 11.48. Patients with a higher score on the NIHSS showed significantly higher concentrations of TNF-α, white blood cells (WBC), CRP, NSE, IL-6 and S100B. Patients with a higher score on the modified Rankin Score (mRS) showed significantly higher concentrations of WBC, CRP, GRN, IL-6, S100B. Factors with an independent influence on the neurological status on the first day of stroke were: sex, WBC, total blood platelet (PLT) count, CRP, S100B and IL-6 levels. Atrial fibrillation, leukocyte count, CRP, NSA, uPA, IL-6 and S100B showed an independent impact on the functional status on the 30th day of stroke. Patients with symptomatic atherosclerosis, as compared to others, were older (P = 0.003) and had higher levels of CRP, IL-6, and S100B. In each case, the differences were statistically significant. We conclude that the concentration of Il-6 and S100B on the first day of stroke are important for both the neurological status and the functional status in the acute period of the disease. Increased CRP and leukocyte count are associated with a worse prognosis regarding the course of acute stroke. The expression of pro-inflammatory agents and markers of blood-brain barrier damage in the acute phase of stroke seem to be more prominent in patients with symptomatic atherosclerosis than in patients with no clinical features of atherosclerosis. The expression of inflammatory parameters may indicate the importance of the inflammatory process starting during the early days of ischemic stroke, for the post-stroke neurological deficit.

Transcranial sonography of subcortical structures in patients with multiple sclerosis.

BACKGROUND: Transcranial sonography may be applied to assess the basal ganglia nuclei and brain atrophy by the measurement of the width of the third ventricle. The aim of this study was to assess usefulness of transcranial sonography (TCS) in patients with multiple sclerosis (MS) by examining the echogenicity of subcortical structures and the width of the third ventricle. METHOD: Transcranial sonography evaluation of substantia nigra, brain stem raphe nuclei, diameter of the third ventricle, width of the anterior horn of the lateral ventricle, thalamus, lenticular nucleus, and head of the caudate nucleus in 41 patients with relapsing-remitting MS (RRMS), 23 with secondary progressive MS (SPMS), and 20 healthy controls was compared. A potential link between the patients' age, sex, Expanded Disability Status Scale (EDSS) score, relapse index, and ultrasound parameters was assessed. RESULTS: The following were found in patients with MS, as compared to the control group: a greater area of the substantia nigra, a longer diameter of the third ventricle and wider frontal horns of the lateral ventricles, hypo-echogenicity of the brain stem raphe, and hyperechogenicity of the lenticular nucleus. The study group was found to have a significant correlation between the area of the substantia nigra, and the age of patients, the duration of the illness, EDSS score, and the number of relapses. There was a significant correlation between the diameter of the third ventricle and the age of patients and EDSS score. CONCLUSIONS: Patients with MS reveal ultrasound features of subcortical structure atrophy. Selected TCS findings show a correlation with disease progression and activity.

The presence of Tau protein in blood as a potential prognostic factor in stroke patients.

Tau protein is found in the blood of 40 - 50% of patients in the acute phase of a stroke, as a result of the degradation of neurons and damage to the blood-brain barrier. The aim of the study was to assess the incidence of tau protein in the blood of stroke patients, as well as to evaluate the potential impact of tau protein presence in the blood of patients on their neurological state during the first 24 hours, and their functional condition three months after the stroke. Eighty-seven patients aged 39 - 99 (42 females and 45 males) diagnosed with stroke were enrolled in the prospective study (August 2014 - April 2015). The following parameters were analyzed in enrolled participants: the age at which first ischemic stroke occurred, neurological state during the first 24 hours (National Institutes of Health Stroke Scale - NIHSS), blood tau protein and brain derived neurotrophic factor (BDNF) concentrations on day 2 of stroke, the functional condition on day 90 after stroke onset (mRankin). A multifactorial analysis was carried out to establish independent factors for the presence of serum tau protein and to identify independent factors for poor prognosis. Eighty-seven patients of the mean age of 71.7 ± 11.8 years (median 74; min. 39 max. 99 years) took part in the study. The tau protein was found in the serum of 42 (48.27%) patients in the concentrations between 29.56 and 19 023.50 ng/ml. The female sex was the only independent factor for the presence of tau protein in blood (RR 4.49 (1.68 - 11.97), P = 0.003). The mean BDNF concentration in the evaluated group was: 9.96 ± 5.21; median 10.39. Three independent factors for poor functional condition of patients on day 90 after the stroke were identified: the presence of tau protein in blood (RR 3.90 (1.45 - 10.49), P = 0.007), BDNF concentration below the mean value for the study (RR 14.49 (4.60 - 45.45); P = 0.000) and NIHSS score > 4 during the first 24 hours of stroke (RR 1.14; 95% CI: 1.00 - 1.31; P = 0.027). The presence of the tau protein, low BDNF concentrations, and moderate/serious neurological state during the first 24 hours of stroke can be considered as negative prognosis for the patient's functional condition. The coincidence of high BDNF concentrations and absence of tau in blood during the acute phase of an ischemic stroke is a predictor of patient's good state in 3 months after stroke.

Analysis of the efficacy and safety of new oral anticoagulant drugs in the secondary stroke prevention in patients with AF: single center experience based on 311 patients.

AIM: According to the performed trials, an introduction of the new oral anticoagulant drugs (NOAC) in the chronic anticoagulation in patients with non-valvular AF (NVAF) is an interesting treatment option. In addition to the encouraging results of the randomized controlled trials the efficacy of this treatment modality in the real-world clinical settings should also be confirmed. In the article, the two-year single center experience with NOACs in the secondary prevention of cerebral stroke in patients with NVAF and previous ischemic stroke was presented. The objective of the study was to evaluate the efficacy, safety and tolerability of the NOACs in the secondary stroke prevention in patients with NVAF. METHODS: Three hundred eleven patients (M/F 98/213) with NVAF (mean age 62.22 years [41-85]) on NOAC in secondary prevention of cardiogenic stroke, were enrolled into a prospective study. All of them started the therapy during the acute period of cerebral ischemia from III to IX day after the stroke onset. The estimated risk of stroke was based on the CHA2DS2VASc and the risk of hemorrhage on the basis of HAS-BLED scale. Patients underwent a long-term follow-up within the period from 12 to 24 months after initiation of NOAC therapy (mean follow up 18.6 months). 230 patients were treated by the means of rivaroxaban, in 78 patients dabigatran was administered and 1 patient received apixaban. The rate of stroke recurrence, bleeding as well as the drug intolerance were evaluated. RESULTS: Ischemic stroke during NOAC treatment was diagnosed in 6 patients (1.92%); TIA was observed in 3 cases (0.96%). Hemorrhagic complications during follow-up were recorded in 29 patients (9.32%), of which 3 patients had major bleedings (0,96%): intracranial bleeding (1), bleeding from the genital tract (1) and from the urinary tract (1). There were no deaths caused by bleeding associated with the use of medications, 1 patient died after ischemic stroke when taking NOACs. In 59 patients (18.97%) NOAC therapy was discontinued in the course of follow-up, mostly because of bleeding (29 patients) or renal function worsening (10 patients). There were no significant differences in the efficacy and safety between the groups on selective factor II inhibitor (dabigatran) or factor Xa inhibitor (rivaroxaban). CONCLUSION: Clinical application of NOAC in a real-world clinical setting results in the treatment profile of high efficacy and acceptable safety for patients with non-valvular AF and stroke.