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1.
Joel Neves Briard Rahel T. Zewude Mahesh P. Kate Brian H. Rowe Brian Buck Ken Butcher Laura C. Gioia 《Journal of stroke and cerebrovascular diseases》2018,27(10):2738-2745
Background
Despite the use of validated prehospital stroke scales, stroke mimics are frequent among patients transported by Emergency Medical Services to the Emergency Department. We aimed to describe the frequency and characteristics of neurological and non-neurological mimics transported to a comprehensive stroke center for acute stroke evaluation.Methods
This was a retrospective analysis of a database consisting of all consecutive patients with suspected stroke transported to the Emergency Department of a comprehensive stroke center during an 18-month period. Hospital charts and neuroimaging were utilized to adjudicate the final diagnosis (acute stroke, stroke mimic, and specific underlying diagnoses).Results
Nine hundred fifty patients were transported with suspected stroke, among whom 405 (42.6%) were stroke mimics (age 66.9 ± 17.1 years; 54% male). Neurological mimics were diagnosed in 223 (55.1%) patients and mimics were non-neurological in 182. The most common neurological diagnoses were seizures (19.7%), migraines (18.8%), and peripheral neuropathies (11.2%). Cardiovascular (14.6%) and psychiatric (11.9%) diagnoses were common non-neurological mimics. Patients with neurological mimics were younger (64.1 ± 17.3 years versus 70.5 ± 16.1 years, P < .001) and had less vascular risk factors than non-neurological mimics. The proportion of non-neurological mimics remained high (38%) despite the use of a prehospital stroke identification scale.Conclusions
Stroke mimics are common among patients transported by Emergency Medical Services to a comprehensive stroke center for suspected stroke, with a considerable proportion being non-neurological in origin. Studies refining triage and transport of suspected acute stroke may be warranted to minimize the number of mimics transported by to a comprehensive stroke center for acute stroke evaluation. 相似文献2.
Hannah Pressler Arno Reich Jörg Bernhard Schulz Omid Nikoubashman Klaus Willmes Pardes Habib Jan-Philipp Bach 《Journal of stroke and cerebrovascular diseases》2018,27(10):2669-2676
Background
Access to reperfusion therapies in patients with large vessel occluding acute ischemic stroke demands process reorganization and optimization. Neurovascular networks are being built up to provide 24/7 endovascular stroke therapy service. In times of an increasingly complex stroke rescue chain little is known about patients’ and their relatives’ treatment awareness.Methods
All patients, who received any kind of acute reperfusion treatment between January and August 2017 in the university hospital Aachen, and their proxies, were included in the survey. Patients were either primarily or secondarily transferred.Results
For all questions regarding stroke treatment patients and their caregivers provided concurring answers. 40% of both patients and caregivers did not understand the treatment that was performed. Finally, patients who perceived on their own that stroke detection was delayed had significantly longer onset to door times than patients who did not have this impression.Conclusions
This study showed that patients’ and proxies’ answers correlated significantly. In case of patients’ unavailability extrapolation of treatment satisfaction from answers by proxies might be permitted. High percentages of patients and caregivers do not understand relevant information, possibly due to limits of communication in an emergency setting or deficits in communication during the hospital stay. More emphasis should be laid on providing further information during the hospital stay. 相似文献3.
Cyrielle Tomich Sabrina Debruxelles Yahsou Delmas Sharmila Sagnier Mathilde Poli Stéphane Olindo Pauline Renou François Rouanet Igor Sibon 《Journal of stroke and cerebrovascular diseases》2018,27(11):3163-3171
Introduction
Immune thrombotic thrombocytopenic purpura (i-TTP), related to acquired ADAMTS-13 dysfunction, can lead to various neurological symptoms including ischemic stroke. To date the clinical, radiological, and biological characteristics of patients having a stroke as the inaugural manifestation of i-TTP are largely unknown.Methods
Probable immune-TTP was defined by a low ADAMTS-13 activity associated with the presence of ADAMTS-13 inhibitors and/or favorable clinicobiological response under immunological treatments. The clinical, radiological, biological data and outcome under treatment are described in a cohort of 17 patients coming from 3 local cases and a literature review.Results
Fourteen of the 17 patients were female and the mean age was 41 years. None of the patients had the classical pentad of TTP. Only 41% had a combination of thrombocythemia and hemolysis. Stroke was multifocal in 35% and included large artery strokes. No adverse event was observed following intravenous thrombolysis. Refractory and relapsing forms were observed in 47%.Discussion
The clinical, radiological, and biological presentation of patients with stroke as the inaugural presentation of i-TTP is heterogeneous. This diagnosis should be discussed in every young adult with ischemic stroke of undetermined source. 相似文献4.
Jianfeng Qu Yangkun Chen Genpei Luo Huohua Zhong Weimin Xiao Hanpeng Yin 《Journal of stroke and cerebrovascular diseases》2018,27(10):2641-2647
Objective
The aim of this prospective cohort study was to assess the incidence and risk factors of delirium following acute ischemic stroke, as well as its effects on functional outcome.Methods
Two hundred and sixty-one patients with acute ischemic stroke were screened for delirium during the first week after admission. Delirium was diagnosed according to the Confusion Assessment Method. If delirium was present, delirium rating scale-revised-98 was used to assess its severity. Neurologic deficits were assessed with the National Institutes of Health Stroke Scale (NIHSS). Brain magnetic resonance imaging assessment quantified the infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome assessment included the modified Rankin Scale and Lawton Instrumental Activities of Daily Living scale at 3 and 6 months after the index stroke.Results
Thirty-eight (14.6%) patients with acute ischemic stroke developed delirium during the first week of admission. Patients with poststroke delirium (PSD) were older, had higher NIHSS scores on admission, and were more likely to have a previous stroke, an infection, and a left cortical infarct. Furthermore, left cortical infarction, older age, severer neurological deficit and having a previous stroke increased the risk of PSD. PSD was associated with a worse functional outcome.Conclusion
The incidence of delirium was 14.8% in the first week after admission with acute ischemic stroke. Age, having a previous stroke, stroke severity, and left-cortical infarction were independently predictors of PSD. PSD may result in a significantly worse functional outcome. 相似文献5.
Edgar A. Samaniego Jorge A Roa Kaustubh Limaye Harold P. Adams 《Journal of stroke and cerebrovascular diseases》2018,27(10):2555-2571
Background
The treatment of acute ischemic stroke due to large vessel occlusion (LVO) has revolutionized in the last decade. We sought to compile the most relevant literature published about the evolution in treating this disabling and fatal disease.Methods
A literature review of recent studies describing early treatment options like intravenous tissue plasminogen activator to the latest mechanical thrombectomy (MT) techniques was performed. We described in a chronological order the evolution of LVO treatment.Results
Recanalization rates with newer techniques and MT devices approach a 90% of effectiveness. Timely interventions have also resulted in better clinical outcomes with approximately 50% of patient achieving functional independence at 90 days. At least 14 new third generation thrombectomy devices are currently being evaluated in in vitro and clinical studies.Conclusions
The treatment of LVO with MT is feasible and safe. MT is standard of care in treating acute ischemic stroke due to LVO. 相似文献6.
Background
Several studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden.Methods
Articles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor.Results
Of predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers’ predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes.Conclusions
The most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice. 相似文献7.
Bin Qin Ming-Jun Zhao Hong Chen Huixun Qin Libo Zhao Lin Fu Cheng Qin Mingxiu Yang Wen Gao 《Journal of stroke and cerebrovascular diseases》2018,27(12):3542-3548
Background
Evidence from outside the typical clinical research setting, such as the real-world setting, complements evidence coming from randomized controlled trials. The purpose of this study was to evaluate all available evidence from the real-world observational trials about long-term outcomes of treatment with intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) compared with not treated with IV rt-PA (non-rt-PA) in patients with acute ischemic stroke.Methods
We searched PubMed and Embase until March 1, 2018 for observational studies reporting matched or adjusted results comparing IV rt-PA versus non-rt-PA in patients with acute ischemic stroke. Outcomes assessed included all-cause mortality, hospital readmission rates, and independence rates. Hazard ratios with 95% confidence intervals were used as a measure of comparing between patients treated with IV rt-PA and non-rt-PA.Results
Six observational trials with 16,399 participants were identified. The use of IV rt-PA in acute ischemic stroke patients was associated with a lower risk of mortality (hazard ratio .61; 95% confidence interval, .52-.70; P < .00001), and there was no heterogeneity across trials. There was no evidence of an effect on hospital readmission rates and independence rates.Conclusions
IV rt-PA is associated with reduced long-term mortality in acute ischemic stroke patients. 相似文献8.
Xiaopeng Chu Yongxin Yang Fushan Zhang Ruidiong Ye Wenzheng Chu 《Journal of stroke and cerebrovascular diseases》2018,27(11):3261-3265
Background
To validate iScore and PLAN score in acute anterior circulation large vessel occlusion stroke patients undergoing thrombectomy.Methods
iScore and PLAN score were calculated for consecutive acute ischemic stroke undergoing thrombectomy were included and death at 1 month and death at 3 months were recorded. The area under the receiver operating characteristic curve was used to assess the discrimination ability of the scales for death.Results
Two hundred and twenty-nine patients were included, 25.3% (58 of 229) of patient died at 1 month after thrombectomy and 25.8% (59 of 229) of them died at 3 months after thrombectomy. The receiver operator curve analysis found that iScore (area under the curve [AUC] = .76, 95% confidence interval [CI] .69-.83) was numerically better than PLAN score (AUC?=?.73, 95% CI .66-.81) for predicting death at day 90. The cut-off for iScore is 193, with sensitivity 64%, specificity 79%, positive predictive value 75% and negative predictive value 69%.Conclusions
The iScore scale is a valid predictive tool for death in anterior circulation large vessel occlusions undergoing thrombectomy. 相似文献9.
Carlos de la Cruz-Cosme Marc Stefan Dawid-Milner Guillermo Ojeda-Burgos Alejandro Gallardo-Tur Tomás Segura 《Journal of stroke and cerebrovascular diseases》2018,27(12):3425-3435
Introduction and Goal
Lacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke.Material and Methods
We prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period.Results
The study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI?=?.96/RI?=?.58 for screening (sensitivity, 96%) and PI?=?1.46/RI?=?.83 for confirmation (specificity, 89%).Conclusions
Doppler ultrasound is a useful technique for determining the LO of acute stroke. 相似文献10.
Rajan Gadhia David McCane Jason Lee Ken Chyuan Ling Kevin Jiang David Chiu 《Journal of stroke and cerebrovascular diseases》2018,27(11):2973-2976
Background
We present a single institution registry with the novel feature of 90-day outcome assessments on all hospitalized acute stroke patients, inclusive of every patient with a primary discharge diagnosis of transient ischemic attack (TIA), acute ischemic stroke (AIS), nontraumatic subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH).Methods
Patient data obtained in the HOPES registry include demographics, comorbid diagnoses, medications, health behaviors, laboratory values, imaging studies, vital signs, and outcome measures, most notably the modified Rankin Scale (mRS) at 90days.Results
From May 2016 to December 31, 2017, 1607 patients were enrolled in the HOPES registry. 90-day outcome assessments were captured on 1555 patients (97%): 1096 AIS, 230 ICH, 110 SAH, and 119 TIA patients. Mortality rates and 90-day outcomes were most favorable for TIA patients. Mortality and 90-day disability scores were poorest for patients in the ICH group.Conclusions
The inclusion of 90-day outcomes data will allow HOPES to stand apart among stroke registries as a new standard for stroke outcomes research. The registry will provide the necessary comprehensive data that the field needs as we transition our focus of stroke research to poststroke recovery. 相似文献11.
Takahiro Ota Keigo Shigeta Tatsuo Amano Masayuki Ueda Teruyuki Hirano Yuji Matsumaru Yoshiaki Shiokawa 《Journal of stroke and cerebrovascular diseases》2018,27(11):3350-3355
Background and Purpose
To improve results of acute thrombectomy, the time from stroke onset to efficient recanalization must be minimized. Studies have confirmed the importance of rapid treatment, workflow, and efficient team-based care for acute thrombectomy in large vessel occlusion. This study examined the challenges facing mechanical thrombectomy in the Tama area (population, 4.3 million), a densely populated urban area of Tokyo, Japan, and analyzed retrospective data from the Tama-REgistry of Acute endovascular Thrombectomy.Methods
This study was a retrospective observational study using data from Tama-REgistry of Acute endovascular Thrombectomy, a multicenter registry of mechanical thrombectomy for acute ischemic stroke in the Tama area of Tokyo. The survey covered 396 patients with large vessel occlusion who underwent acute thrombectomy between January 2015 and March 2017. Participating facilities are 12 of the 13 recanalization therapy-capable stroke centers.Results
We analyzed 326 cases for which modified Rankin Scale score at 90days was available, of which 264 cases were directly admitted, and 62 cases were transferred from other stroke centers. Median time from stroke onset to hospital arrival was 111 minutes, and from arrival to efficient recanalization was 135 minutes. Efficient recanalization was achieved in 257 cases (78.8%), symptomatic hemorrhage developed in 19 cases (5.8%), and modified Rankin Scale 0-2 at 90days was seen in 129 cases (39.6%). The vast majority of patients (n?=?299, 94.3%) were transferred within 10km to the enrolling hospital.Conclusions
These results provide useful information about the emergent transfer system for patients with large vessel occlusion in a densely populated urban area. 相似文献12.
Yongwoo Kim Mohammad Faysel Clotilde Balucani Daohai Yu Nadege Gilles Steven R Levine 《Journal of stroke and cerebrovascular diseases》2018,27(12):3419-3424
Objects
To identify predictors of acute ischemic stroke (AIS) among patients presenting to the Emergency Department (ED) with dizziness, imbalance, or vertigo (DIV) based on demographic and clinical characteristics.Methods
We identified patients admitted to the hospital after presenting to the ED with DIV from the Statewide Planning and Research Cooperative System database of New York from 2010 to 2014. Demographic and clinical characteristics were systematically collected. Multivariable logistic regression was used to determine predictors of a discharge diagnosis of AIS.Results
Among 77,993 patients with DIV, 3857 (4.9%) had a discharge diagnosis of AIS. Admission presentation of imbalance, African-American race, history of hypertension, diabetes mellitus, hypercholesterolemia, tobacco use, atrial fibrillation, and prior AIS due to extracranial artery atherosclerosis were each positively associated with an AIS diagnosis independently. Factors negatively associated with an AIS discharge diagnosis included: admission presentation of vertigo, female sex, age > 81, history of anemia, coronary artery disease, asthma, depressive disorders, and anxiety disorders.Conclusions
Multiple potential positive and negative predictive AIS risk factors were identified. Combining with currently available centrally-caused dizziness prediction tools, these newly identified factors could provide more accurate AIS risk stratifying method for DIV patients. 相似文献13.
Grace Vincent-Onabajo Hadiza Y. Musa Emmanuel Joseph 《Journal of stroke and cerebrovascular diseases》2018,27(12):3487-3492
Background
Poststroke balance impairment adversely affects stroke outcomes and addressing the impairment is expected to constitute an important focus of neurorehabilitation.Aims
To examine the prevalence and factors associated with balance impairment after stroke.Methods
Ninety-five stroke survivors undergoing neurorehabilitation at 2 government hospitals in Northern Nigeria participated in this cross-sectional study. Berg Balance Scale (BBS) was used to assess the presence of balance impairment (BBS score of 0-20). Prevalence of balance impairment was presented as frequency and percentage while demographic and stroke-related determinants of balance impairments were identified using logistic regression analysis.Results
Thirty-five (36.8%) stroke survivors had balance impairment, and age, gender, and poststroke duration were statistically significant determinants. Stroke survivors aged less than 40 years (odds ratio [OR]?=?.14 [confidence interval [CI]?=?.20-.94]) and 40-59 years (OR?=?.23 [CI?=?.06-.81]) had a lower likelihood of having balance impairment compared to stroke survivors aged 60 years and above. Similarly, males had a lower likelihood of having balance impairment (OR?=?1.60 [CI?=?.05-.55]) compared to females while those in the acute/subacute phase of stroke had a 7-fold likelihood of having balance impairment (OR?=?7.74 [CI?=?2.63-22.79]) compared to those with chronic stroke.Conclusions
Poststroke balance impairment appears to be significantly influenced by stroke survivors’ age, gender, and poststroke duration. Hence, these variables should be considered when planning rehabilitation strategies for improving balance after stroke. 相似文献14.
Charlotte Lützhøft Rath Niklas Rye Jørgensen Troels Wienecke 《Journal of stroke and cerebrovascular diseases》2018,27(10):2683-2690
Background
Antiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS.Methods
We performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period.Results
A total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis.Conclusions
Clopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients. 相似文献15.
Naoto Kinoshita Naohisa Hosomi Hayato Matsushima Masahiro Nakamori Yoshiki Yagita Takemori Yamawaki Tsuyoshi Torii Takeshi Kitamura Yoshimasa Sueda Ryo Shimomura Mutsuko Araki Tomohisa Nezu Shiro Aoki Satoshi Ishii Hiroki Maruyama Masayasu Matsumoto Hirofumi Maruyama 《Journal of stroke and cerebrovascular diseases》2018,27(12):3563-3569
Background
Fabry disease is an X-linked lysosomal storage disorder caused by mutations in GLA, which encodes the enzyme α-galactosidase A (α-Gal A). Although the prevalence of Fabry disease in patients with stroke has been reported to range from 0% to 4%, few cohort studies have examined Japanese stroke patients. We aimed to clarify the prevalence of Fabry disease and the frequency of GLA mutations among patients with young-onset stroke in Japan.Methods
From April 2015 to December 2016, we enrolled patients with young-onset (≤60 years old) ischemic stroke or intracerebral hemorrhage. We measured α-Gal A activity and the concentration of globotriaosylsphingosine in plasma. Genetic evaluations were performed in patients with low α-Gal A activity or high concentrations of globotriaosylsphingosine.Results
Overall, 516 patients (median age of onset, 52 years old; 120 women) were consecutively enrolled in this study. Five patients (4 men and 1 woman) had low α-Gal A activity, and no patients were detected with the screen for plasma globotriaosylsphingosine levels. The genetic analysis did not identify a causative mutation responsible for classic Fabry disease in any of the patients, but 2 patients (.4%) carried the p.E66Q in GLA.Conclusions
No patient with Fabry disease was detected in our young-onset stroke cohort. 相似文献16.
Amélie Gabet Christine de Peretti France Woimant Maurice Giroud Yannick Béjot Alexis Schnitzler Valérie Olié 《Journal of stroke and cerebrovascular diseases》2018,27(12):3443-3450
Goal
We studied time trends of admission in neurological rehabilitation units (NRU) among patients hospitalised for stroke from 2010 to 2014 and compared prognostic factors of functional gain, home return and inpatient survival.Methods
Patients hospitalized for Stroke from 2010 to 2014 were selected from the French national hospital databases. Admission in rehabilitation was searched till 3 months. Predictive factors of functional gain, home return, in-patient survival, and the corresponding trends were studied using logistic regression.Results
In 2014, global rehabilitation rate was 36.3% with 15.8 discharged in a NRU. The rate of patients managed in NRU rose between 2010 and 2014. An increase in the proportion of home return (+4%) and inpatient survival rate (+7%) were observed between 2010 and 2014. Almost 40% of patients with severe functional deficits benefited of a partial or complete recovery after their rehabilitation stay. NRU admission was associated with higher probability of functional gain (OR [odds ratio] =1.76 [confidence interval {CI} 95% 1.67-1.85]), home return (OR?=?1.38 [CI 95% 1.29-1.47]) and inpatient survival (OR?=?3.15 [CI 95% 2.83-3.52]).Conclusions
A greater proportion of patients were admitted in NRU along with an increase of home return and in-patient survival, but too many patients remained excluded. 相似文献17.
Chakri Gavva Mark Johnson Nicole De Simone Ravi Sarode 《Journal of stroke and cerebrovascular diseases》2018,27(11):3301-3305
Objectives
Many patients admitted with an ischemic stroke or transient ischemic attack (TIA) undergo thrombophilia testing. There is limited evidence to support this practice. We examined the effect of thrombophilia testing on management of patients admitted with an ischemic stroke or TIA.Materials and Methods
In this retrospective observational single-center study, we identified patients who were admitted with stroke or TIA and underwent thrombophilia testing over a 45-month period. We reviewed their electronic medical records to assess whether testing affected clinical management, defined as anticoagulation treatment by the time of discharge due to a positive test result. Secondary endpoints included potential misdiagnosis due to false positive results and cost of testing.Results
Testing was performed in 143 patients with a stroke or TIA. Forty-four patients (31%) had at least 1 positive test result. The most common positive tests were an elevated factor VIII activity (18% of patients tested) and decreased protein S activity (11% of patients tested). Both of these tests are subject to acute phase effects. Testing altered clinical management in only 1 patient (1% of total patients tested). Thirty-three patients (75%) have the potential for carrying a misdiagnosis due to a positive test that was never repeated for confirmation or repeated too soon after the initial positive test. The annual cost of testing was approximately $62,000.Conclusions
Thrombophilia testing in the acute inpatient setting rarely impacted the clinical management of patients admitted with a stroke or TIA. By avoiding thrombophilia testing, both the potential for misdiagnosis and health care costs can be reduced. Therefore, we have discontinued thrombophilia testing in in-patients with a diagnosis of stroke. 相似文献18.
Dannielle Zierath Theresa Olmstead Astiana Stults Angela Shen Allison Kunze Kyra J. Becker 《Journal of stroke and cerebrovascular diseases》2018,27(11):3177-3186
Background
A robust adrenergic response following stroke impairs lymphocyte function, which may prevent the development of autoimmune responses to brain antigens. We tested whether inhibition of the sympathetic response after stroke would increase the propensity for developing autoimmune responses to brain antigens.Methods
Male Lewis rats were treated with 6-hydroxydopamine (OHDA) prior to middle cerebral artery occlusion (MCAO), labetalol after MCAO, or appropriate controls. Behavior was assessed weekly and animals survived to 1 month at which time ELISPOT assays were done on lymphocytes from spleen and brain to determine the Th1 and Th17 responses to myelin basic protein (MBP), ovalbumin (OVA), and concanavalin A. A subset of animals was sacrificed 72 hours after MCAO for evaluation of infarct volume and lymphocyte responsiveness. Plasma C-reactive protein (CRP) was measured as a biomarker of systemic inflammation.Results
Despite similar initial stroke severity and infarct volumes, 6-OHDA-treated animals lost less weight and experienced less hyperthermia after stroke. 6-OHDA-treated animals also had decreased CRP in circulation early after stroke and experienced better neurological outcomes at 1 month. The Th1 and Th17 responses to MBP did not differ among treatment groups at 1 month, but the Th1 response to OVA in spleen was more robust in labetalol and less robust in 6-OHDA-treated animals.Conclusions
Chemical sympathectomy with 6-OHDA, but not treatment with labetalol, decreased systemic markers of inflammation early after stroke and improved long-term outcome. An increase in Th1 and Th17 responses to MBP was not seen with inhibition of the sympathetic response. 相似文献19.
Monica S. Badve Zien Zhou Craig S. Anderson Maree L. Hackett 《Journal of stroke and cerebrovascular diseases》2018,27(11):3137-3147
Background
Pneumonia is a common complication after stroke which increases morbidity and mortality. This systematic review was conducted to evaluate the efficacy and safety of antibiotics for the prevention of pneumonia after acute stroke.Methods
Medline, EMBASE, and Cochrane databases were searched for randomized controlled trials comparing preventive antibiotics to placebo or no antibiotics after acute stroke. The primary outcome was poststroke pneumonia. Secondary outcomes were all infections, urinary tract infections, death, dependency, length of hospital stay, and adverse events. Treatment effects were summarized using random effects metaanalysis.Results
Six trials (4111 patients) were eligible for inclusion. The median National Institute of Health Stroke Scale score in included trials ranged from 5 to 16.5. The proportion of dysphagia ranged from 26% to 100%. Preventive antibiotics were commenced within 48hours after acute stroke. Compared to control, preventive antibiotics reduced the risk of poststroke pneumonia (RR .75, 95%CI ·.57-.99), and all infections (RR .58, 95%CI .48-.69). There was no significant difference in the risks of dependency (RR 0.99, 95%CI 0·80-1·11), or mortality (RR .96, 95%CI .78-1.19) between the preventive antibiotics and control groups. Preventive antibiotics did not increase the risk of elevated liver enzymes (RR 1.20, 95% CI .97-1.49). Preventive antibiotics had uncertain effects on the risks of other adverse events.Conclusion
Preventive antibiotics reduced the risk of post-stroke pneumonia. However, there is insufficient evidence to currently recommend routine use of preventive antibiotics after acute stroke. 相似文献20.
Wen-Yi Huang Wei-Chieh Weng Feng-Chieh Su Shun-Wen Lin 《Journal of stroke and cerebrovascular diseases》2018,27(11):3365-3372