RESUMO
BACKGROUND: Ischemic stroke is the most common cause of disability in North America and in addition to the generally accepted risk factors, there is increasing evidence for the potential pathophysiological role of genes. One of these genes, the endothelial nitric oxide synthase gene (NOS3) has been reported as a genetic risk factor for ischemic stroke. To independently confirm and extend the results of these previous reports, we investigated this gene as a risk factor for stroke in an ethnically diverse study population. METHODS: Using the TOAST classification, we characterized and studied 377 patients with ischemic stroke. We genotyped two common variants in the NOS3 gene, the intron 4 insertion/deletion and an exonic single nucleotide polymorphism (SNP), G894T, in these patients and compared them with 502 controls. Chi-square or Fisher's exact tests were used to examine allele effects on stroke and stroke subtypes. Logistic regression analysis was used to adjust for confounding covariate effects. RESULTS: All genotypes are in Hardy-Weinberg equilibrium except for intron 4c, which is overrepresented in ischemic stroke patients. In pooled analysis of all patients, intron 4c, but not intron 4a, intron 4b or G894T alleles are associated with stroke (p < 0.01). In subgroup analysis by race, the intron 4c allele is most strongly associated with large artery ischemic stroke in African Americans (p < 0.01). CONCLUSION: We are unable to confirm previous reports of an association of the intron 4a or the G894T alleles with ischemic stroke. However, although limited by a relatively small sample size, our study suggests a potentially important role of the intron 4c allele as a genetic marker of ischemic stroke in African Americans.
Assuntos
Negro ou Afro-Americano , Isquemia Encefálica/genética , Predisposição Genética para Doença , Óxido Nítrico Sintase Tipo III/genética , Acidente Vascular Cerebral/genética , Idoso , Idoso de 80 Anos ou mais , Alelos , Isquemia Encefálica/etnologia , Feminino , Frequência do Gene , Marcadores Genéticos , Genótipo , Humanos , Íntrons , Masculino , Pessoa de Meia-Idade , Razão de Chances , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/etnologiaRESUMO
The authors assessed the effect of IV abciximab on early neurologic improvement and ischemic lesion growth in 29 patients with supratentorial stroke and NIH stroke scale score (NIHSSS) > or = 4 (11.1 +/- 5.9), treated within 3 to 24 (13.6 +/- 5.5) hours of onset. The 48 to 72-hour NIHSSS improvement was 4.4 +/- 3.2 and the 24-hour lesion growth on DWI was +23% (-50%, +103%); 7/26 (27%) patients experienced lesion size decrease. Treatment of sub-24-hour stroke with abciximab improves early post-treatment neurologic status and often attenuates ischemic lesion growth.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Anticoagulantes/administração & dosagem , Isquemia Encefálica/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Fragmentos Fab das Imunoglobulinas/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Abciximab , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/efeitos adversos , Anticoagulantes/efeitos adversos , Encéfalo/patologia , Encéfalo/fisiopatologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Artérias Cerebrais/efeitos dos fármacos , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Feminino , Humanos , Fragmentos Fab das Imunoglobulinas/efeitos adversos , Infusões Intravenosas , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/patologia , Hemorragias Intracranianas/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do TratamentoAssuntos
Aceleração/efeitos adversos , Lesões do Pescoço/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/etiologia , Adulto , Infarto Encefálico/diagnóstico por imagem , Angiografia Cerebral , Humanos , Angiografia por Ressonância Magnética , Masculino , Lobo Occipital/irrigação sanguínea , Postura , Recreação , Acidente Vascular Cerebral/tratamento farmacológico , Dissecação da Artéria Vertebral/diagnósticoRESUMO
We present a case of acute angioedema after administration of recombinant tissue plasminogen activator (t-PA) for acute ischemic stroke. Our patient was treated with t-PA in accordance with the National Institute of Neurological Disorders and Stroke (NINDS) protocol, and subsequently developed angioedema of the lower lip that subsided within 2 hours. Five patients who required upper airway control after the use of t-PA for ischemic stroke have been reported in the literature. Although the outcome in our case was excellent, development of angioedema after t-PA administration is a potential complication of which treating physicians need to be aware.
