Ischemic Stroke

The relationship between smoking and the risk of ischemic stroke has been known about for quite some time. Traditionally, studies have only been able to explore correlations and not causality, due to the limitations of observational analysis. In this study, we used a new method called Mendelian randomization to explore a potential causal relationship between smoking and the risk of stroke. First, we looked for changes in a person ’ s genome, called single nucleotide polymorphisms (SNPs), which were correlated with smoking. Because a person cannot alter their genotypes, this helps us avoid problems like reverse causation which can confound traditional analyses. We then explored whether presence of these smoking-related SNPs had any relationship to the risk of ischemic stroke by looking for the presence of these SNPs in a large stroke database. We found that for certain subtypes of ischemic stroke, there was a positive relationship between smoking-related SNPs and the risk Correspondence: Yingying Mao

In this category of patients, the risk of ischemic stroke was substantially increased by the use of oral contraceptives (OR, 13.9), for which a dose-effect relationship between risk of stroke and dose of estrogen was found (for pills contain- ing 50 µg estrogen: OR, 4.8; for pills with 30–40 µg: OR, 2.7; pills with 20 µg: OR, 1.7; pills with progesterone; OR, 1) [7]; the risk of ischemic stroke was also elevated in heavy smok- ers ( ≥ 20 cigarettes per day: OR, 10.2). In migrainous women, coexistent use of oral contraceptives, history of high blood pressure and smoking habit had greater than multiplicative effects on the odds ratio for ischemic stroke (OR, 34.4; 95% CI, 3.27–3.61). However, this dramatic increase was based on only nine cases and two controls [9]. Other conditions predisposing to stroke, namely minor cardiac abnormalities like patent foramen ovale [12] and mitral valve prolapse [13] or the presence of anti-cardiolipin antibodies [14], may cause a stroke when combined with migraine, but this has not been definitely established [11].

Results: Among 1511 patients with ischemic stroke and TIA (mean age 63 years, 33.1% women), 305 (20.2%) had either previously known (196, 13.0%) or AF newly-detected by electrocardiography (53, 3.5%) or by 6-day Holter monitoring (56/1262, 4.4%). A history of heart failure (OR = 4.70, 95%CI, 1.64 – 13.5), advanced age (OR = 1.06, 95%CI, 1.04 – 1.09), NIHSS at admission (OR = 1.06, 95%CI, 1.02 – 1.10), blood high density lipoprotein (HDL) (OR = 1.52, 95%CI, 1.09 – 2.13), together with blood triglycerides (OR = 0.64, 95%CI, 0.45 – 0.91) were independently associated with newly-detected AF. Conclusions: Contrary to previous reports, AF-associated stroke is frequent (20%) in China if systemically sought. Prolonged noninvasive cardiac rhythm monitoring importantly increases AF detection in patients with recent ischemic stroke and TIA in China. Advanced age, history of heart failure, and higher admission NIHSS and higher level of HDL were independent indicators of newly-detected AF.

Although we provide evidence of an independent associ- ation of FKN dynamics with stroke outcome, and therefore present FKN as a putative future biomarker in stroke, the interpretation of the data must be done cautiously. Consid- ering the multifactorial pathology of ischemic stroke, the patient cohort is relatively small. For that reason, we also could not evaluate a probable effect of any treatment, such as, for example, thrombolysis. Furthermore, despite strict exclusion criteria, an overlap of pre-ischemic inflammation processes that might distort the results cannot be ruled out completely. Due to strict exclusion criteria concerning in- fectious diseases, we could include relatively fewer patients with severe strokes. Finally, as this is a retrospective study, measurements of CX3CR1 expression on vital leucocytes could not be done.

A major problem in previous studies was the lack of carotid Doppler ultrasound in the investigation of stroke cases. 57, 183 This was not an issue in our study, given that almost all patients had carotid ultrasound. This helped differentiate large artery atherosclerosis from strokes/TIAs caused by dissection or other vascular diseases and avoid misclassification bias due to incomplete diagnostic assessment. Moreover, the availability of services from a tertiary teaching hospital allowed additional diagnostic testing for cardiac evaluation or other imaging and laboratory technologies, which might not be available in rural areas. This might have contributed to the lower rate of cases with “undetermined” cause of stroke/TIA, compared to previous studies. 156, 178 Furthermore, the majority of previous studies used TOAST for classifying ischemic stroke subtypes with an increased number of “undetermined” cases. The use of CCS managed to considerably eliminate that restriction, without being able to completely differentiate large artery atherosclerosis from “undetermined” causes of stroke, a limitation mentioned in another study that used CCS. 157 The introduction of SPARKLE resolved this problem and enriched our study with criteria to classify stroke/TIA subtypes, which can be used elsewhere and reflect real clinical practice. Moreover, SPARKLE, as CCS, was able to classify patients with more than one cause of stroke into the most “probable” or most “possible” stroke/TIA subtype. This reduced the number of “undetermined” causes of stroke/TIA and is probably responsible for inconsistent results in studies in the U.S.A. and Europe, where different classification systems have been used over time.

approved by the Ethics Committee of all participating hospitals. The planned enrollment is 10,000 patients with AIS as defined in the current (2014) Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke [27]. A total of 5 visits within a 1-year follow-up period will be carried out. Demographic data at baseline, the therapeutic effect, cost-utility, adverse events and complications with different treatments will be analyzed. The influence of TOAST classification on the specific therapy regimens in AIS will be also evalu- ated. All study conducts will follow the provisions of the ICH GCP and the Declaration of Helsinki. The study is registered with ClinicalTrials.gov (NCT02470624).

recommended treatment within three hours of onset of ischemic stroke. The benefit from the use of intravenous rtPA for acute ischemic stroke beyond three hours from onset of [r]

In our study on comparing mean values of interleukin-6 among patients with and without recurrence (after exclu- sion of patients non-compliant on their medications), it was found that there is statistically significant higher mean values of IL-6 in patients with recurrence than mean values of IL-6 in patients without recurrence. It also showed strong test specificity and sensitivity of interleukin-6 in predicting recurrence. The cutoff IL-6 value above which recurrence is anticipated was 7.75 pg/ ml. This demonstrates the clinical potential of using IL-6 as an early predictor for recurrence of acute ischemic stroke and suggests a clear cut point for patients at a high risk who may benefit from closer clinical observation.

The prevalence of MetS in China has been steadily rising in recent decades and reached 58.1 % in elderly Chinese population [11]. A longitudinal study from Beijing Tongren Hospital showed that the 5-year cumulative incidence of MetS was 10.82 % in 2007 to 2012 [12]. In the United States, the prevalence of MetS was 38.5 % in adults [13] and it is 21.1 % in the French population [14]. As a potential risk factor, MetS has been associated with an increased risk of prevalent stroke [6]. The data from a meta-analysis about 13 cohort studies showed that subjects with MetS were 1.6-fold more likely to have stroke than the ones without MetS [15] The occurrence of MetS among the patients with acute ischemic stroke in our study is 58.3 %. In the other two acute ischemic stroke studies of Chinese, the occurrence of MetS was 51.4 and 57.29 %, respectively [8, 16]. There were more female (70.3 %) than male (49.7 %) stroke patients with MetS, which is consistent with the results from the other study [4], and there were less stroke patients with smoking or drinking in MetS + group. However, the previous studies tend to exhibit causal correlation between MetS and

Given the high risk and considerable consequences, prevention of VTE is crucially important following a stroke. However, it is essential to rule out hemorrhagic stroke and identify patients at increased risk of bleeding complications before prescribing pharmacological prophylaxis. Current guidelines from the American College of Chest Physicians recommend that patients with acute ischemic stroke and restricted mobility receive prophylactic low-dose subcutaneous unfractionated heparin or LMWH (Grade 1A). 5 For patients

A third group of potential collateral circulation channels consist of connections between the external and internal carotid arteries (e.g., external maxillary–ophthalmic-internal carotid). These potential channels are rarely significant as a sole source of collateral circulation in persons with acute stroke but helpful in a very gradual and probably staggered carotid and vertebral occlusion . In such patients, arteriograms reveal large collateral channels from the external carotid system that anastomose with the intracranial arterial systems through the orbit and/or foramen magnum.Almost 50% of persons who suffer a complete ischemic stroke have stenotic or occlusive disease in the cervical vessels.

Conclusion: A decrease in the incidence of ischemic stroke is associated with miR-196a2 TT genotype and T allele and increases in the likelihood risk of ischemic stroke are associated wi[r]

This prospective study was carried out between January 2008 and December 2013 at Yashoda Hospital, in Hyderabad, in the state of Telangana in South India. The study population comprised of 10 consecutive patients with acute ischemic stroke. All the patients were recruited within 6.5 hours of the onset of stroke. The World Health Organization defined stroke as rapidly developing clinical signs of focal/global disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin. 9

All the patients were divided in to Group 1 (n=10, 9 males and 1 female, age <40 years) and Group 2 (n=54, 39 male and 15 female, age >40 years). There were 9 thrombotic and 1 embolic cases in Group 1 whereas there were 51 thrombotic and 3 embolic cases in Group 2. The diagnosis of ischemic stroke was made on the basis of history, clinical examination i.e. acute onset neurologic deficit and CT scan and MRI of the central nervous system. A detailed history along with peripheral vessels examination, examination for hyperlipidemia and history of angina was recorded.

associated with a poor prognosis in acute myocardial infarction and peripheral artery disease. RDW has also been evaluated as a predictor of mortality in patients with cardiovascular disease, cancer, chronic lung disease, symptomatic chronic congestive cardiac insufficiency and acute cardiac insufficiency (7, 8). Utility of RDW in predicting stroke severity, is still being evaluated. In this study, we tried to correlate RDW with the severity of acute ischemic stroke and also tried to find out whether RDW can be used as a predictor of mortality in acute ischemic stroke.

Patients who had acute ischemic stroke were evaluated with physical examination, neurologic examination, Glasgow coma scale, and Canadian neurological scale. The Glasgow coma scale was determined for patients in the control group, but the more detailed Canadian neurological scale was not determined for control patients. Severity of impaired level of consciousness was rated with the Glasgow coma scale score as mild (15), moderate (8 to 14), or severe (3 to 7). Severity of impaired neurologic status was rated by Canadian neuro- logical scale score as mild (8.5 to 10), moderate (2.5 to 8), or severe (0 to 2). In addition to routine laboratory tests such as biochemistry tests and complete blood count, the stroke and control patients were tested for hs-CRP level, Lp-PLA 2 activ- ity and underwent a 12-lead electrocardiogram.

Thus, we predict that balance of IL-1β and IL-1Ra might be good predictor for patient outcome following ischemic stroke. However, few clinical studies have made use of their level as stroke biomarkers. IL-1 β levels mostly were associated with poor long-term functional outcome in study, [106] while IL-1Ra levels

Depending on the severity of reduced blood supply, acute and delayed cell death, i.e., necrosis and apoptosis, occurs in the core region and penumbra region of the ischemic territory, respectively [27]. Necrosis occurs within minutes after stroke, which cannot be rescued. However, apoptosis and impaired synaptic function in the penumbra could be salvageable by proper interventions, suggesting that pre- venting apoptosis and recovering synaptic function in the penumbra region may be an effective approach to improve post-stroke recovery. Ischemia/reperfusion injury-induced apoptosis and synaptic impairment in the penumbra are mediated by a number of mechanisms, including excito- toxicity, oxidative stress, inflammatory response, and endo- plasmic reticulum (ER) stress [28–30]. For example, the dysregulation of synaptic proteins, e.g., subunits of N-methyl- D -aspartic acid (NMDA) receptors, was observed in ischemic stroke, which not only led to synaptic dysfunc- tion but also contributed to excitotoxic cell death [30]. It suggests that suppressing detrimental pathways may have therapeutic potential for ischemic stroke by protecting the penumbra from neuronal death and synaptic impairment.

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Because we synthe- sized data from previously published publications, the meta- analysis was exempt from ethics approval. We searched ISI Web of Science (http://www.webofknowledge.com), Embase (http://www.embase.com), PubMed (http://www.pubmed. com), and China National Knowledge Infrastructure (CNKI) (http://www.cnki.net) databases to identify case–control studies containing data on the relationship of rs679620 and rs3025058 with risk of ischemic stroke using the following keywords: stroke, ischemic stroke, cerebral infarction, poly- morphism, matrix metalloproteinase-3, rs3025058, rs679620, gene, and risk. Search dates ranged from January 1995 to September 2017. Additional studies were searched through screening reference lists of retrieved studies, but no additional articles were identified using this strategy. A search of the gray area literature was not performed.

model. Likewise, mice that were administered anti-Nogo-A immediately following MCAO had a similar increase in mortality as knock-out mice. Therefore, Nogo-A must play a necessary role in healing immediately following a stroke. However, immunotherapy against Nogo-A that was administered 7-9 days after an ischemic stroke proved beneficial. The administration of anti- Nogo-A a week after MCAO in mice showed increased sprouting, increased neuroplasticity, increased midline crossing of corticorubral axons to the red nucleus of the cerebellum, and new efferent cortical projections [11]. Another study evaluated the importance of antibodies directed against Nogo-A and discovered that forepaw function drastically improved [29]. Purified monoclonal anti-Nogo-A antibody (7B12) was administered to rats exactly 24 hours after MCAO induction. Forepaw function of rats that had MCAO without 7B12 improved to 40-50% of prelesion levels from weeks 4 to 12 after MCAO. In contrast, the 7B12 group had improved to 40% of prelesion levels at week 4 with 60-70% when evaluated at weeks 7-12 [29].