Nutrition and stroke prevention

Nutrition is much more important in prevention of stroke than is appreciated by most physicians. The powerful effects of statin drugs in lowering the levels of fasting cholesterol, combined with an unbalanced focus on fasting lipids (as opposed to postprandial fat and oxidative stress), have led many physicians and patients to believe that diet is relatively unimportant. Because the statins can lower fasting lipids by &50% to 60%, and a low-fat diet only lowers fasting cholesterol by &5% to 10%, this error is perhaps understandable. However, a Cretan Mediterranean diet, which is high in beneficial oils, whole grains, fruits, and vegetables and low in cholesterol and animal fat, has been shown to reduce stroke and myocardial infarction by 60% in 4 years compared with the American Heart Association diet. This effect is twice that of simvastatin in the Scandinavian Simvastatin Survival Study: a reduction of myocardial infarction by 40% in 6 years. Vitamins for lowering of homocysteine may yet be shown to be beneficial for reduction of stroke; a key issue is the high prevalence of unrecognized deficiency of vitamin B(12), requiring higher doses of vitamin B(12) than have been used in clinical trials to date. Efforts to duplicate with supplementation the evidence of benefit for vitamins E, C, and beta carotene have been largely fruitless. This may be related to the broad combination of antioxidants included in a healthy diet. A Cretan Mediterranean diet is probably more effective because it provides a wide range of antioxidants from fruits and vegetables of all colors.     

Hypertriglyceridemia and ischemic stroke

There are no conclusive data regarding the association between dyslipidemia and the risk of ischemic stroke (IS). Clinical investigations have primarily focused on the association between elevated levels of low-density lipoprotein cholesterol and low levels of high-density lipoprotein cholesterol as stroke risk factors. Much less scientific attention has been aimed at elevated levels of triglycerides. Consequently the potential role of hypertriglyceridemia as an independent risk factor for IS remains controversial. However, accumulating evidence has shown that hypertriglyceridemia is associated with pathophysiological processes such as endothelial dysfunction, atherosclerosis and the production of a prothrombotic state, which could contribute to IS risk. The aim of this review is to critically analyze the contribution of hypertriglyceridemia to the occurrence of IS.     

同型半胱氨酸与缺血性卒中

同型半胱氨酸(Hcy)即2-氨酸-4-巯基丁酸,又名高半胱氨酸,是蛋氨酸(Met)代谢的重要中间产物。1964年,Gibson等率先报告高同型半胱氨酸血症与血管性疾病和血栓形成有关。自1969年McCully提出高同型半胱氨酸血症是导致动脉粥样硬化的主要因素以来,已有大量研究证实高同型半胱氨酸血症是缺血性卒中的独立危险因子,但近年又有临床试验得出不同结论。笔者拟就同型半胱氨酸与缺血性卒中之间的关系作如下综述。一、同型半胱氨酸代谢特点     

炎症与缺血性脑卒中

缺血性脑卒中(IS)是复杂多因素疾病,除传统的高血压、高脂血症、糖尿病和吸烟之外,炎症亦是重要的相关因素.临床上常见IS急性期患者在无明确感染条件下有短时发热或血白细胞升高,提示伴随了炎症过程.     

P-选择素与缺血性脑卒中

血小板活化在缺血性脑卒中的发生、发展过程中起着重要作用,P-选择素（CD62p）的表达是血小板活化的标志。抗CD62p治疗可以减轻缺血性脑损伤症状。因此,研究CD62p在缺血性脑卒中的发生和卒中后再损伤过程中的作用,对缺血性脑卒中的防治具有重要意义。     

Pediatric ischemic stroke

Journal of Neurology -     

Valvular strands and ischemic stroke

We report the case of a previously healthy 47-year-old woman suffering an acute embolic stroke in the left middle cerebral artery distribution. A filiform structure along the line of the aortic valve was first identified by transesophageal echocardiography, leading to the diagnosis of a valvular strand. These masses are thought to represent giant Lambl's excrescences, although differential diagnoses include several benign cardiac tumors, e.g. papillary fibroelastoma. Valvular strands have previously been associated with embolic events including stroke, although exact pathogenetic mechanisms and further patient management have not yet been fully established. This case report additionally provides a short overview of the currently existing literature. As a conclusion, standard recommendations for patient management and treatment cannot be derived from currently available evidence.     

Chagas' disease and ischemic stroke

American trypanosomiasis, known as Chagas' disease (CD) is a major Public Health problem in South America. Chronic cardiomyopathy is the most common clinical form of CD. Chagasic cardiomyopathy affects about 30 % of CD patients, and its manifestations begin on average 10-40 years after the initial infection. Chagas' cardiomyopathy is characterized by congestive heart failure, sudden cardiac death, intraventricular conduction defects, arrhythmias and thromboembolism. The relationship between Chagas' cardiomyopathy and ischemic stroke was reviewed. Significant variables that predict ischemic stroke in chagasic patients have been identified: apical aneurysm, cardiac insufficiency and cardiac arrhythmia. Prevalence of apical aneurysm in CD stroke patients has been estimated in 37%. The diagnosis of CD may be established after stroke presentation in at least 40% of patients. Chagasic cardiomyopathy should be included in the differential diagnosis of the etiology of stroke, being a potential source of cardioembolic stroke.     

脑血管反应性与缺血性卒中

目的观察缺血性卒中患者脑血管反应性（CVR）变化,确定两者之间的相关性。方法采用经颅多普勒超声（TCD）结合屏气试验检测76例缺血性卒中患者及62例对照病例的屏气指数（BHI）。结果缺血性卒中患者组的BHI明显低于对照组（P〈0.001）,Logistic 回归显示,由BHI所表示的CVR是缺血性卒中的独立影响因素（P=0.000）。结论降低的CVR是缺血性脑卒中的独立危险因素,应该重视CVR在脑缺血发生、发展过程中的独立影响作用。     

Arterial ischemic stroke in an adolescent with presumed perinatal ischemic stroke

The risk of recurrent ischemic stroke after presumed perinatal stroke and the risk factors for such recurrence are rarely reported. Here, we present an adolescent with a history of presumed perinatal stroke who presented with arterial ischemic stroke recurrence at the age of 15 years. Hereditary thrombophilia screening performed at the time of his stroke recurrence demonstrated protein S deficiency. No evidence-based consensus guidelines on thrombophilia screening in children with presumed perinatal stroke exist, nor has the role of secondary prophylaxis been addressed. There is a risk of stroke recurrence after presumed perinatal stroke, and routine thrombophilia screening may identify those children who are at higher risk for recurrence and who might therefore benefit from secondary prophylaxis. Clear guidelines should be developed to standardize investigations and management of children with presumed perinatal ischemic stroke.     

Nutrition and the risk of stroke

Poor nutrition in the first year of a mother's life and undernutrition in utero, infancy, childhood, and adulthood predispose individuals to stroke in later life, but the mechanism of increased stroke risk is unclear. Overnutrition also increases the risk of stroke, probably by accelerating the development of obesity, hypertension, hyperlipidaemia, and diabetes. Reliable evidence suggests that dietary supplementation with antioxidant vitamins, B vitamins, and calcium does not reduce the risk of stroke. Less reliable evidence suggests that stroke can be prevented by diets that are prudent, aligned to the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets, low in salt and added sugars, high in potassium, and meet, but do not exceed, energy requirements. Trials in progress are examining the effects of vitamin D and marine omega-3 fatty acid supplementation on incidence of stroke. Future challenges include the need to improve the quality of evidence linking many nutrients, foods, and dietary patterns to the risk of stroke.     

Acute ischemic stroke management

The use of thrombolytic therapy represents one of many recent developments in the management of acute ischemic stroke. The development of stroke teams and protocols has been driven by these new demands for an urgent response to ischemic stroke. The short time window of 3 hours for therapy with intravenous recombinant tissue plasminogen activator requires efficient evaluation and treatment of stroke patients and also necessitates a rigorous approach to blood pressure management, electrolytes, fluids, and temperature. Anticoagulation has not been proven to safely prevent progression or early recurrence of stroke, but antiplatelet therapy is worthwhile.     

Genetics of ischemic stroke

Stroke is the third leading cause of death and a major cause of disability worldwide. Most cases of ischemic stroke are attributable to hypertension and other risk factors, but in over 20% of cases, the cause is unknown. Recent research has implicated some novel genes in the etiology of ischemic stroke, including genes for soluble epoxide hydrolase (sHE), 5-lipoxygenase activating protein (FLAP) and phosphodiesterase 4D (PDE4D). Moreover, thrombophilic states such as prothrombin G20210A mutation and factor V Leiden are now known to cause arterial stroke as well as venous thrombosis. Meanwhile, the recent availability of enzyme replacement therapy for Fabry disease and the proven benefits of regular blood transfusion in certain patients with sickle cell disease have greatly altered the outlook of these devastating inherited disorders. Thus, our understanding of the role of genetic factors in stroke raises the prospects for accurate assessment of future stroke risk among susceptible individuals, in whom early preventive measures may be life-saving. Further research into the genetics of stroke will clearly compliment ongoing national and international efforts to reduce the global burden of stroke.     

Acute ischemic stroke therapy

Acute ischemic stroke is a medical emergency that requires rapid evaluation and treatment. Prehospital and emergency department care can be streamlined to meet those goals. Intravenous rt-PA therapy improves outcome in selected patients with ischemic stroke if given within 3 hours of stroke onset, but offers no benefit beyond that time window. Intra-arterial thrombolytic therapy and intravenous defibrogenating agents may also be beneficial in selected patients. Newer thrombolytic agents such as aspirin and heparin in acute ischemic stroke treatment have been clarified by recent trials.     

Acute ischemic stroke]

Therapeutic nihilism has been overcome by the results of phase III trials of intravenous t-PA with 3-hours time window. The integrated team approach can increase the number of patients treated rapidly, permit closer monitoring of patients, potentially increase the safety of thrombolysis, and streamline diagnosis and therapy. The results of randomized clinical trials and meta-analyses demonstrated that stroke unit treatment made mortality lower, hospitalization shorter, good outcome and discharge to the home greater as compared to treatment in general medical units. In a nation-wide survey in Japan, only 3% of hospitals had a stroke care unit, a specialized unit for acute stroke patients. In-hospital mortality was significantly lower in SCU than in ICU or general medical wards. In patients with moderate to severe neurological deficits at admission (NIHSS score 7 or more), good outcome (mRS score 0 to 2) was also more frequently observed in SCU than in other wards. We have to reestablish the systems of acute stroke management. It will be achieved by obtaining the approval of the use of t-PA, organizing stroke care units in major hospitals, and assessing their effects not only on patients' outcome but also on the quality and costs of care by their families, medical personnels and our public societies.     

超急性期缺血性卒中

<正>图1男性患者,面扩散加权成像(56岁。主因突发言语不清、右侧肢体活动不利4 h就诊。临床诊断:缺血性卒中。头部MRI检查所见1a横断扩DWI)显示左侧额颞岛叶交界区、左侧颞枕叶交界区斑片状异常高信号(箭头所示),提示超急性期缺血灶横断面表观散系数(ADC)图显示上述区域异常低信号(箭头所示)1c横断面Td 2横断面WI显示左侧侧裂、颞枕叶交界区脑沟变浅(1箭b头所示)1FLAIR成像显示左侧侧裂内线样慢血流征(箭头所示)1e左侧大脑中动脉供血区及后分水岭区血流平均MTT1f TTP