Third ventricle midline shift due to spontaneous supratentorial intracerebral hemorrhage evaluated by transcranial color-coded sonography.

OBJECTIVE: We aimed to assess the clinical usefulness of the third ventricle midline shift (MLS) evaluated by transcranial color-coded sonography (TCCS) in acute spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS: Consecutive patients with acute (<24 hours after symptom onset) ICH were recruited for this TCCS study. Sonographic measurement of MLS and the pulsatility index (PI) of the middle cerebral arteries were compared with head computed tomographic (CT) data, including MLS, and hematoma volume. Poor functional outcome at 30 days after stroke onset was defined as modified Rankin scale greater than 2. RESULTS: There were 51 patients with spontaneous supratentorial ICH who received CT and TCCS studies within a 12-hour window. Correlation between MLS by TCCS (mean +/- SD, 3.2 +/- 2.6 mm) and CT (3.0 +/- 2.4 mm) was high (gamma = 0.91; P < .01). There was also a good linear correlation between hematoma volume and MLS by TCCS (gamma = 0.81; P < .01). Compared with ICH volume less than 25 mL, those with greater volume had more severe MLS and a higher PI of the ipsilateral middle cerebral artery (P < .001). Midline shift by TCCS was more sensitive and specific than the PI in detecting large ICH (accuracy = 0.82 if MLS > or = 2.5 mm), and it was also a significant predictor of poor outcome (odds ratio, 2.09 by 1-mm increase; 95% confidence interval, 1.06-4.13). CONCLUSIONS: Midline shift may be measured reliably by TCCS in spontaneous supratentorial ICH. Our study also showed that MLS on TCCS is a useful and convenient method to identify patients with large ICH and hematoma expansion and to predict short-term functional outcome.     

Headache in cerebral hemorrhage is associated with inflammatory markers and higher residual cavity

BACKGROUND AND PURPOSE: The mechanisms responsible for headache in patients with intracerebral hemorrhage (ICH) are not completely understood. The present study was undertaken to analyze the headache-associated factors, the possible related biochemical mechanisms, and the headache potential predictors of outcome in spontaneous ICH. METHODS: We prospectively studied 189 patients from a large cohort of 266 consecutive patients with supratentorial ICH admitted within the first 12 hours of symptoms onset. The presence of headache at stroke onset was evaluated in these patients. The volumes of the initial ICH, peripheral edema at 48 hours, and the residual cavity at 3 months were measured on CT scan. Glutamate, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha levels were measured in blood samples obtained on admission. The Canadian Stroke Scale (CSS) and the modified Rankin Scale were used to evaluate stroke severity and neurological outcome, respectively. RESULTS: Headache at onset of stroke was observed in 65 patients (34.4%). Patients who experienced headache had a significantly higher frequency of history of infection (P= .009) or inflammation (P= .045), as well as higher body temperature (P= .021), leukocyte count (P= .038), ESR (P= .011), and mass effect (P= .017) on admission. Plasma concentrations of IL-6 and TNF-alpha were significantly higher in patients with headache than in those without. Headache was an independent predictor of the residual cavity volume in patients with spontaneous ICH (odds ratio 6.49; 95% CI 2.51 to 16.78; P= .0001). CONCLUSIONS: Headache at ICH onset is associated with clinical and biochemical markers of inflammation and is an independent predictor of higher residual cavity volume after spontaneous ICH.     

高血糖对急性缺血性脑卒中亚型预后的影响

目的探讨入院时高血糖对腔隙性脑梗死和非腔隙性脑梗死预后的影响是否一致。方法采用前瞻性队列研究方法,共有248例缺血性卒中患者纳入试验,研究卒中发作8小时内血糖浓度与神经功能预后的关系。有益的终点定义为3个月后改良Rankin量表评分≤2分;根据牛津郡社区卒中计划（OSCP）进行临床分型,并经头颅CT证实为腔隙性脑梗死（n=62）和非腔隙性脑梗死（n=186）;高血糖定义为血糖≥8mmol／L。结果非腔隙性脑梗死组入院时血糖水平、高血压史和意识改变高于腔隙性脑梗死组,差异有统计学意义（P〈0．01或〈0．05）。单因素分析显示,在腔隙性脑梗死组中,与良好预后比较,不良预后与高龄有关,差异有统计学意义（P〈0．05）;在非腔隙性脑梗死组中,与良好预后比较,不良预后与高血糖、高龄、意识改变有关,差异有统计学意义（P〈0．01或〈0．05）。多变量分析显示高血糖与非腔隙性脑梗死预后不良有关（0R=0．71,P=0．008）,但能改善腔隙性脑梗死的预后（0R=2．76,P=0．052）。随着血糖上升,在非腔隙性脑梗死中,有益预后的优势比逐渐下降;而在腔隙性脑梗死中,有益预后与血糖≥8mmol／L有关,但当血糖〉10mmol／L,这种趋势消失。结论高血糖与非腔隙性脑梗死的预后不良有关,但适度高血糖可改善腔隙性脑梗死的预后。     

Significant aortic stenosis associated with poorer functional outcomes in patients with acute ischaemic stroke undergoing endovascular therapy

Background and aimBi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke.MethodsConsecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area <1.5 cm²) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months.ResultsWe identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68–84) vs. 67 (interquartile range 56–75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1–7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation.ConclusionIn acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further.     

Relationship between usual physical, cognitive and social activities and functional recovery at hospital discharge after acute stroke.

OBJECTIVE: To assess the relationship between lifestyle prior to the event and functional recovery at hospital discharge after acute stroke. DESIGN: Cohort study. PATIENTS: A sample of 191 patients with first stroke episode (87.4% ischaemic). METHODS: Severity of the event at admission was measured by the Modified National Institutes of Health Stroke Scale. The Frenchay Activity Index was used to evaluate the patients' previous lifestyles. Functional recovery was assessed using the Modified Rankin scale on discharge from hospital. A Rankin score < or = 2 was the main outcome. RESULTS: At discharge, 37.2% of the patients were functionally independent. A receiver operating characteristic curve analysis established a value of > or = 18 on the Frenchay Activity Index scale as the best cut-off point to predict favourable outcome (specificity 62%; 95% confidence interval (CI) 54-69% and a sensibility of 60%; 95% CI 49-69%) with an area under the curve of 0.65 (95% CI 0.57-0.71). There was a positive association between Frenchay Activity Index > or = 18 and a Rankin score < or = 2, after controlling for potential confounders (odds ratio 2.62; 95% CI 1.21-5.66; p = 0.001). CONCLUSION: This result emphasizes the protective effect of mental, physical and social activity for the prevention of functional damage after an acute cerebrovascular event.     

颈动脉超声与脑循环动力学检测对高血压病合并缺血性脑卒中的早期诊断

目的：探讨颈动脉超声和脑循环动力学（CVA）检测对高血压病合并缺血性脑卒中的早期临床诊断价值。方法：采用彩色多普勒超声和CVA检测仪检测分析120例高血压病合并缺血性脑卒中超早期和急性期患者的颈动脉内膜中层厚度（IMT）、IMT／D比率及CVA各项指标并与60例健康成人对照。结果：病例组患者颈动脉IMT及IMT／D比率均明显大于对照组；缺血性脑卒中超早期组Vimean,Qmean比急性期组明显降低，而R、DR明显增高，超早期组CVA检测阳性率明显高于急性期组。颈动脉IMT及IMT／D比率与Vmean,Qmean呈直线负相关，与R、Zc呈显著直线正相关。结论：颈动脉超声及CVA检没对高血压病合并急性缺血性脑卒中的早期诊断具有重要临床意义。     

Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients

OBJECTIVE: To analyze survival, mortality, and long-term functional disability outcome and to determine predictors of unfavorable outcome in critically ill patients admitted to a neurologic intensive care unit (neuro-ICU). DESIGN: Retrospective cohort study with post-neuro-ICU health-related evaluation of functional long-term outcome. SETTING: Ten-bed neuro-ICU in a tertiary care university hospital. PATIENTS: A consecutive cohort of 1,155 patients admitted to a neuro-ICU during a 36-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1,155 consecutive patients, of whom 41% were women, were enrolled in the study. The predominant reasons for neuro-ICU care were cerebrovascular diseases, such as intracerebral hemorrhage (20%), subarachnoid hemorrhage (16%), and complicated, malignant ischemic stroke (15%). A total of 213 patients (18%) died in the neuro-ICU. The Glasgow Outcome Scale and modified Rankin scale were dichotomized into two groups determining unfavorable vs. favorable outcome (Glasgow Outcome Scale scores 1-3 vs. 4-5 and modified Rankin scale scores 2-6 vs. 0-1). Factors associated with unfavorable outcome in the unselected cohort according to logistic regression analysis were admission diagnosis, age (p < .01), and a higher score in the simplified Therapeutic Intervention Scoring System (TISS-28) at time of admission (p < .01). Functional long-term outcome was evaluated by telephone interview for 662 patients after a median follow-up of approximately 2.5 yrs by evaluating modified Rankin scale and Glasgow Outcome Scale scores. Factors associated with unfavorable functional long-term outcome were admission diagnosis, sex, age of >70 yrs (odds ratio, 8.45; 95% confidence interval, 4.52-15.83; p < .01), TISS-28 of >40 points at admission (odds ratio, 4.05; 95% confidence interval, 2.54-6.44; p < .01), TISS-28 of >40 points at discharge from the neuro-ICU (odds ratio, 3.50; 95% confidence interval, 1.51-8.09; p < .01), and length of stay (odds ratio, 1.01; 95% confidence interval, 1.00-1.03; p = .02). CONCLUSION: We found admission diagnosis, age, length of stay, and TISS-28 scores at admission and discharge to be independent predictors of unfavorable long-term outcome in an unselected neurocritical care population.     

Brain arrest neurological outcome scale (BrANOS): predicting mortality and severe disability following cardiac arrest

BACKGROUND: To create a predictive scale of neurological outcome following cardiac arrest (CA) that incorporates radiological and clinical markers of brain injury. METHODS AND RESULTS: Brain arrest neurologic outcome scale (BrANOS) is a prospective 16-point scale. It consisted of three variables: (1) duration of arrest (DAR), (2) reversed Glasgow coma scale (GCS), and (3) Hounsfield unit (HU) ratio on non-contrast CT scan of the head. Reversed GCS score was defined as 15-GCS (best GCS in the first 24 h). HU ratio was defined as the density ratio of the caudate nucleus over the posterior limb of the internal capsule measured on unenhanced CT scan of the brain. We identified 32 comatose patients who had: (1) CT scan performed within 48 h of event; (2) no previous history of either coma, severe head trauma, cardiac arrest or stroke. Primary outcome was defined as alive or dead. Secondary outcome was the Glasgow outcome score recorded on discharge. Patient demographics were collated from retrospective chart review. Patients' mean age was 63 +/- 3 years (mean +/- S.E.M.); 44% were females. Mortality rate was 81%. Mean DAR was 21 +/- 2 min. Survivors had a significantly lower BrANOS score (8 +/- 2 points) compared to non-survivors (13 +/- 1) (P = 0.006). BrANOS was a strong predictor of mortality alone (ROC = 0.86) and mortality with severe disability combined (ROC = 0.9). The scale had a 100% specificity and positive predictive value. CONCLUSIONS: BrANOS is a reliable predictor of neurological outcome following CA. It is the first scale to incorporate clinical and radiological markers of brain injury.     

缺血性卒中早期复发的危险因素分析

目的 观察急性脑梗死患者大脑中动脉微栓子信号(MES)的发生率及其危险因素,并探讨MES与缺血性卒中早期复发的相关性.方法 共纳入209例发病72 h内的前循环惠性脑梗死患者,均排除具有潜在心源性栓子.自动在线监测大脑中动脉内的MES,计算MES的发生率并评估其危险因素.所有患者均前瞻性随访到卒中复发或6个月研究结束时,分析MES与脑梗死复发间的关系.结果 共有77例(36.8%)检测到MES.MES与年龄(每10岁OR 1.71,95% CI 1.22～2.40,P=0.002)和颈动脉斑块(OR 2.67,95% CI 1.39～5.13,P=0.003)相关.在6个月的随访中,有22例(10.5%)发生前循环再次卒中,Kaplan-Meier生存分析显示,MES与脑梗死复发问存在显著相关(log rank 25.24,P=0.000).Cox回归分析显示MES与颈动脉斑块预测脑梗死复发,OR分别为9.42(95% CI 2.75～32.31,P=0.00)和3.39(95% CI1.36～8.48,P=0.01).结论 颈动脉斑块和年龄是MES的危险因素,脑梗死急性期检出MES和颈动脉斑块可以预测脑梗死早期复发.Embo-Dop自动微栓子检测适用于筛选脑梗死复发的高危人群.     

Prognostic use of circulating plasma nucleic acid concentrations in patients with acute stroke

BACKGROUND: At present there is no simple, accurate blood test that may be used to determine the severity of stroke or to predict mortality and morbidity in stroke patients presenting to emergency departments. METHODS: Patients with stroke-like symptoms who presented to an emergency department of a university hospital in Hong Kong were recruited for the study. DNA extracted from patients' plasma was analyzed for the beta-globin gene with a fluorescent-based PCR test. The primary outcome measures were in-hospital and 6-month mortality and morbidity using the post-stroke modified Rankin Score. RESULTS: Among the 88 consecutive patients recruited to the study, 70 (80%) had ischemic stroke, 11 (13%) had intracerebral hemorrhage, and 7 (8%) had transient ischemic attacks. Median plasma DNA concentrations taken within 3 h of symptom onset were higher in patients who died compared with those who survived at discharge (6205 vs 1334 kilogenome-equivalents/L; P = 0.03). Among patients with NIH Stroke Scale scores >8, median plasma DNA concentrations were higher in patients who died compared with those who survived to 6 months (2273 vs 968 kilogenome-equivalents/L; P = 0.002). Plasma DNA concentrations correlated with the volume of cerebral hematoma (r = 0.66; P = 0.03). Plasma DNA concentrations >1400 kilogenome-equivalents/L had a sensitivity of 100% and a specificity of 74.4% for predicting hospital mortality after stroke, and the area under the ROC curve was 0.89 (95% confidence interval, 0.80-0.94). The adjusted odds ratio for plasma DNA concentrations predicting 6-month mortality was 1.6 (1.1-2.4; P = 0.03) and for predicting 6-month post-Rankin Score >2 was 1.8 (1.0-3.3; P = 0.05). CONCLUSION: Plasma DNA concentrations correlate with stroke severity and may be used to predict mortality and morbidity in the emergency room.     

Early findings on brain computed tomography and the prognosis of post-cardiac arrest syndrome: application of the score for stroke patients

Aim

To examine whether early findings of the brain computed tomography (CT) evaluated by the modified Alberta stroke programme early CT (m-ASPECT) score is useful for determining the prognosis of post-cardiac arrest syndrome (PCAS) patients or not.

Materials

From 2003 through 2010, 149 consecutive PCAS patients: (1) with various aetiologies but neither from haemorrhagic stroke nor trauma, (2) who were 15 years old or older and (3) whose brain CT was available were admitted to our intensive care unit. Early findings on all of their CT images were rated with the m-ASPECT scoring system by three raters, and an inter-rater comparison was conducted. Next, the images within 24 h from arrest were collected from 133 patients (89 males, age 60.2 ± 17.6 years), and a relation of the scores with outcome at day 30 of the patients was analysed.

Results

According to the inter-rater comparison based on a linear regression analysis, agreement between the raters was good (correlation coefficient 0.76–0.88). A receiver operating curve analysis revealed that the m-ASPECT scores within 24 h were a good predictor of poor outcome (dead or vegetative state) with an area under the curve of 0.905. An m-ASPECT score ≤13 was 100% predictive of a poor outcome, with a negative predictive value of 0.57. The m-ASPECT score was the best predictor of poor outcome (odds ratio 45.62) among various factors including cause or duration of arrest.

Conclusion

The m-APSECT score evaluated within 24 h from arrest was found to be the most predictive factor for outcome at day 30.     

Low high-density lipoprotein cholesterol predicts cardiovascular events after carotid stenting: a long-term survey

BACKGROUND: Apart from advanced age, little is known about predictors of the long-term outcome after carotid artery stenting (CAS). OBJECTIVE: We sought to determine whether atherosclerotic risk factors predict the long-term outcome after CAS. PATIENTS AND METHODS: We enrolled 532 patients assigned for CAS. The primary composite end-point, including stroke, myocardial infarction and all-cause mortality, was observed in 100 patients (19%) during the long-term follow-up (median 28 months, interquartile range 14-49 months). RESULTS: Cumulative event rates at 1, 3 and 5 years were 4.4%, 17.1% and 33.4%, respectively. High-density lipoprotein (HDL) cholesterol was an independent predictor of event-free survival. The adjusted hazard ratio for the primary end-point was 0.97 per increase of 1 mg dL(-1) HDL cholesterol [95% confidence interval (CI) 0.95-0.99, P = 0.002) and 2.7 (95% CI 1.6-4.4, P < 0.001) for low HDL cholesterol (< 40 mg dL(-1) in men and < 50 mg dL(-1) in women). Inflammatory activation (leukocyte count > 10,000 mL(-1) or fibrinogen > 450 mg dL(-1) or erythrocyte sedimentation rate > 20 mm h(-1)) was the only other independent atherosclerotic risk factor (P = 0.001). Patients with low HDL cholesterol and elevated inflammatory activation were at very high risk, with a 5-year event rate of 59.4% (95% CI 43.6-75.2%) as compared to 15.1% (95% CI 8.2-22.0%) in those without both risk factors (log rank, P < 0.001). Age, occlusion of the contralateral carotid artery and heart failure were further independent risk predictors (P < 0.01 for all). CONCLUSIONS: Low HDL cholesterol is an independent predictor of the long-term outcome after CAS. The combination of low HDL cholesterol and elevated inflammatory markers identified high-risk patients.     

全脑血管造影未见血管阻塞的急性脑梗死患者的临床预后

目的:探讨起病1周内全脑血管造影(DSA)未见血管阻塞的急性脑梗死患者的临床预后。方法:急性脑梗死患者260例,在发病1周内完成全脑血管DSA和头颅CT、MRI检查,采用NI HSS量表评估入院时病情,改良Rankin量表(mRS)评估患者3个月时的预后,mRS≤2分视为预后良好,并对影响患者预后的危险因素进行多因素logistic回归分析。结果:260例患者中,发病1周内全脑血管DSA正常者96例(37%),其中头颅MRI显示有相应梗死灶93例(97%),发病1周内脑血管自然再通率为18%(46/260)。脑血管DSA未见血管阻塞的患者3个月时预后良好者67例(70%)。多因素logistic回归分析显示,入院时NI HSS评分[OR=0.231(0.080～0.811),P=0.013]、是否为大面积脑梗死[OR=0.171(0.062～0.725),P=0.006]显著影响患者3个月时的预后。结论:起病1周内急性脑梗死患者血管的再通率为18%,DSA检查显示无血管阻塞的患者为37%,其中70%的患者预后良好,入院时的病情及脑梗死面积是影响患者3个月预后的主要因素。     

急性缺血性卒中动脉溶栓后造影剂渗出的临床分析

目的 研究急性缺血性卒中动脉溶栓后造影剂渗出的相关因素和其对预后的影响.方法 采用前瞻性、开放性临床病例研究,对北京世纪坛医院神经内科2008年4月至2012年6月收治的78例发病6h内行动脉溶栓治疗的颈内动脉系统急性缺血性卒中患者的临床和影像学资料进行研究,比较基线和动脉溶栓治疗后头颅CT结果,观察造影剂渗出的发生情况.结果 血管造影显示颈内动脉闭塞30例,大脑中动脉闭塞48例.动脉溶栓后血管再通率为78.2％ （61/78）.动脉溶栓术后即刻头颅CT扫描显示,造影剂渗出共16例（占20.5％）,其中4例为颈内动脉起始部闭塞的患者,12例为大脑中动脉闭塞的患者,所有患者均为溶栓后获得部分或完全再通者.无造影剂渗出者3个月时预后良好率（modified Rankin Score,mRS 0 ～2）的比例（74.2％）明显高于发生造影剂渗出者（43.8％）,差异有统计学意义（P=0.020）.发生造影剂渗出者溶栓后症状性颅内出血的发生率（25％）明显高于无造影剂渗出者（3.2％）,差异有统计学意义（P =0.017）.单因素X2检验分析显示基线美国国立卫生研究院卒中量表（The National Institutes of Health Stroke Scale,NIHSS）评分＞16分（且＜22分）、动脉溶栓过程中收缩压高于160 mmHg、溶栓后血管获得再通、使用微导管和微导丝机械碎栓、经微导管造影和发病至溶栓后血管再通时间＞6h可能与发生造影剂渗出相关（P＜0.05）.多因素Logistic回归分析显示基线NIHSS评分＞16分（且＜22分）、动脉溶栓过程中收缩压高于160 mm Hg和发病至溶栓后血管再通时间＞6h可能是造影剂渗出的独立危险因素.结论 基线NIHSS评分＞16分（且＜22分）的急性缺血性卒中重症患者、动脉溶栓过程中收缩压高于160 mm Hg和发病至溶栓后血管再通时间＞6h者易于发生造影剂渗出.造影剂渗出与溶栓后症状性颅内出血的发生相关,而且预后不良.     

Prediction of cerebrovascular and cardiovascular events in patients with subclinical carotid atherosclerosis: the role of C-reactive protein.

BACKGROUND: Several studies have suggested that inflammation and infection may be important for accelerated progression of atherosclerosis, but few data are available on subjects with early stages of atherosclerosis. METHODS AND RESULTS: We included, in a prospective 5-year follow-up study, 150 patients with subclinical carotid atherosclerosis, evaluating at baseline all established traditional cardiovascular risk factors (eg, older age, male sex, obesity, hypertension, diabetes, smoking, family history of coronary artery disease, and dyslipidemia); 2 markers of inflammation, fibrinogen, and high-sensitivity C-reactive protein (CRP); and the seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus. After follow-up, cardiovascular and cerebrovascular events were registered in the 19% of patients, and the increment in CRP levels (in quintiles) was significantly associated with ischemic stroke (P = 0.0253), acute myocardial infarction (P = 0.0055), cardiovascular or cerebrovascular death (P = 0.0145), and the presence of any event (P = 0.0064). Most traditional cardiovascular risk factors (eg, older age, hypertension, diabetes, and dyslipidemia) were significantly associated with the events but only in the unadjusted analysis; in fact, at logistic regression analysis, among all baseline variables, only elevated CRP levels showed a predictive role (odds ratio, 7.0; 95% confidence interval, 2.2-18.4; P = 0.0247). CONCLUSIONS: Our findings suggest that elevated CRP concentrations may significantly influence the occurrence of cerebrovascular and cardiovascular events in patients with baseline subclinical carotid atherosclerosis. Notably, null findings were obtained by viral and bacteria titers, suggesting a greater role of inflammation (and not of infection) in the progression of atherosclerosis in our cohort. However, further studies are needed to evaluate the therapeutic implications in this category of patients.     

颞浅动脉-大脑中动脉搭桥术治疗大脑中动脉狭窄或闭塞16例疗效分析

目的:探讨颞浅动脉-大脑中动脉(STA-MCA)搭桥术治疗伴大脑中动脉狭窄或闭塞的缺血性卒中患者的效果。方法:伴大脑中动脉狭窄或闭塞的缺血性卒中患者16例,行STA-MCA搭桥术或STA-MCA搭桥术联合脑-硬脑膜-动脉贴敷(EDAS);术中采用脑血管吲哚菁绿荧光造影、术后行血管超声以确定吻合血管通畅情况;术前、术后1周及出院3个月后采用改良Rankin量表(mRS)对患者进行神经功能评分,随访3个月。结果:所有病例手术均顺利完成;吻合口处血流通畅者15例(93.75%),血流缓慢者1例(6.25%);无患者再发缺血性卒中;术前1周、术后1周及3个月mRS评分良好的患者分别为6例(37.50%)、7例(43.75%)、14例(87.50%);3月时mRS评分良好的患者例数高于术前和术后1周者(P=0.0091,P=0.0233)。结论:STA-MCA搭桥术或联合EDAS治疗大脑中动脉狭窄或闭塞所致脑组织的低灌注效果满意。     

Blood levels of glutamate oxaloacetate transaminase are more strongly associated with good outcome in acute ischaemic stroke than glutamate pyruvate transaminase levels

Ischaemic stroke is associated with an excessive release of glutamate in brain. GOT (glutamate-oxaloacetate transaminase) and GPT (glutamate-pyruvate transaminase) are two enzymes that are able to metabolize blood glutamate facilitating the lowering of extracellular levels of brain glutamate. Our aim was to study the association between blood levels of both enzymes and stroke outcome in patients with acute ischaemic stroke. We prospectively studied 365 patients with first ischaemic stroke<12 h. Glutamate, GOT and GPT levels were determined in blood samples obtained at admission. We considered functional outcome at 3 months [good outcome: mRS (modified Rankin Scale)≤2; poor outcome mRS >2], END (early neurological deterioration) in the first 72 h [increment ≥4 points in NIHSS (National Institutes of Health Stroke Scale)] and infarct volume [CT (computed tomography) at 36-72 h] as end points. We have found an inverse correlation between GOT and GPT levels and blood glutamate levels. Patients with poor outcome showed lower levels of GOT (11.9±8.2 compared with 22.7±10.2 m-units/ml, P<0.0001) and GPT (19.5±14.3 compared with 24.7±20.3 m-units/ml; P=0.004). A negative correlation has been found between GOT (Pearson coefficient=-0.477, P<0.0001) and GPT (Pearson coefficient=-0.116; P=0.027) levels and infarct volume. Patients with END showed higher levels of blood glutamate (381.7±97.9 compared with 237.6±114.0 μmol/l, P<0.0001) and lower levels of GOT (10.8±6.7 compared with 18.1±10.8 m-units/ml; P<0.0001). This clinical study shows an association between high blood GOT and GPT levels and good outcome in ischaemic stroke patients, this association being stronger for GOT than GPT levels.     

Are serum lipids measured on stroke admission prognostic?

BACKGROUND: It has been hypothesized that serum lipids measured in the early period of stroke are predictive of stroke severity and outcome. The optimal time for lipid measurement is not established. We explored whether lipid profile assessed within the first 24 h after stroke onset: (i) differs from that in stroke-free individuals; (ii) differs between stroke subtypes; and (iii) is predictive of stroke severity and outcome. METHODS: We prospectively enrolled 70 acute ischemic stroke patients who presented to the Stroke Unit within 24 h of the onset of stroke symptoms, and 68 stroke-free control subjects. RESULTS: Triglycerides (p<0.001) and high-density lipoprotein (HDL) cholesterol (p<0.001) were significantly lower in patients than in controls. HDL cholesterol was different across stroke subtypes classified according to the Trial of ORG 10172 in Acute Stroke Treatment scale (p=0.035). Patients with more severe stroke had higher serum triglycerides (odds ratio 2.755; p=0.030). CONCLUSIONS: Serum triglycerides might serve as a prognostic marker in acute stroke patients.