Association of Proinflammatory Cytokine Levels with Stroke Severity, Infarct Size, and Muscle Strength in the Acute Phase of Stroke.

OBJECTIVE: Patterns of cytokine levels and their association with stroke severity, infarct size, and muscle strength are obscure. We aimed to analyze the immune mediators linked to T helper (Th)1, Th2, Th17, and regulatory T cell patterns and their association with stroke severity, infarct size, and muscle strength. MATERIALS AND METHODS: We included patients with acute stroke (n = 15) and healthy non-disabled individuals (n = 20) aged > 18 years. The dependent variables were stroke severity according to the National Institute of Health Stroke Scale (NIHSS), infarct size on computed tomography, handgrip strength by dynamometry, and global muscle strength according to the Medical Research Council (MRC) scale. The independent variables were the circulating cytokine levels. The cytokine levels were compared between the groups, and correlations between the clinical data were verified. RESULTS: The stroke group had higher interleukin (IL)-6 (p < 0.0001) and IL-10 (p < 0.0001) levels, but lower tumor necrosis factor (TNF)-α (p = 0.036) levels than the control group. IL-10 and soluble tumor necrosis factor receptor (sTNF-RII) levels were correlated with each other (r = 0.533; p = 0.042) and infarct size (r = 0.653; p = 0.033 and r = 0.689; p = 0.018, respectively). MRC scores were positively and negatively correlated with handgrip strength of the affected side (r = 0.78; p = 0.001) and NIHSS scores (r = -0.87; p < 0.0001), respectively. CONCLUSIONS: Plasma levels of some cytokines were associated with changes in the acute phase of stroke, and IL-10 and sTNF-RII levels are potential biomarkers of infarct size.

Optimization of cranial computed tomography in patients with AIDS and clinical suspicion of a neural opportunistic pathology.

Cranial computed tomography (CT) remains valuable for the identification of opportunistic pathologies in AIDS patients in low-income countries. Delayed iodinated contrast medium CT images have the potential to better demonstrate inflammatory-infectious or neoplastic opportunistic pathologies. The main objective of this study was to optimize the protocol for cranial CT in patients with AIDS and clinical signs of opportunistic pathologies at the authors' institution. It was hypothesized that 20-min delayed contrast-enhanced CT images would be sufficient to optimize the detection of brain pathologies and that no additional delayed images would be necessary. Twenty-six adult patients with AIDS and brain pathologies were enrolled and had their cranial CT images analyzed by three evaluators. The numbers of lesions identified at two predetermined delayed time-points were compared. There was no variation in the number of lesions depicted by each evaluator, between the 20-min delayed contrast-enhanced CT image and the image obtained at the other predetermined delayed time-point.