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Pohlmann JE, Kim ISY, Brush B, Sambhu KM, Conti L, Saglam H, Milos K, Yu L, Cronin MFM, Balogun O, Chatzidakis S, Zhang Y, Trinquart L, Huang Q, Smirnakis SM, Benjamin EJ, Dupuis J, Greer DM, Ong CJ. Association of large core middle cerebral artery stroke and hemorrhagic transformation with hospitalization outcomes. Sci Rep 2024; 14:10008. [PMID: 38693282 PMCID: PMC11063151 DOI: 10.1038/s41598-024-60635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
Historically, investigators have not differentiated between patients with and without hemorrhagic transformation (HT) in large core ischemic stroke at risk for life-threatening mass effect (LTME) from cerebral edema. Our objective was to determine whether LTME occurs faster in those with HT compared to those without. We conducted a two-center retrospective study of patients with ≥ 1/2 MCA territory infarct between 2006 and 2021. We tested the association of time-to-LTME and HT subtype (parenchymal, petechial) using Cox regression, controlling for age, mean arterial pressure, glucose, tissue plasminogen activator, mechanical thrombectomy, National Institute of Health Stroke Scale, antiplatelets, anticoagulation, temperature, and stroke side. Secondary and exploratory outcomes included mass effect-related death, all-cause death, disposition, and decompressive hemicraniectomy. Of 840 patients, 358 (42.6%) had no HT, 403 (48.0%) patients had petechial HT, and 79 (9.4%) patients had parenchymal HT. LTME occurred in 317 (37.7%) and 100 (11.9%) had mass effect-related deaths. Parenchymal (HR 8.24, 95% CI 5.46-12.42, p < 0.01) and petechial HT (HR 2.47, 95% CI 1.92-3.17, p < 0.01) were significantly associated with time-to-LTME and mass effect-related death. Understanding different risk factors and sequelae of mass effect with and without HT is critical for informed clinical decisions.
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Affiliation(s)
- Jack E Pohlmann
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Ivy So Yeon Kim
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Benjamin Brush
- Department of Neurology, NYU Langone Medical Center, 550 1st Ave, New York, NY, 10016, USA
| | - Krishna M Sambhu
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Lucas Conti
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Hanife Saglam
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Katie Milos
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Lillian Yu
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Michael F M Cronin
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Oluwafemi Balogun
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Stefanos Chatzidakis
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Yihan Zhang
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
| | - Ludovic Trinquart
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
- Tufts Clinical and Translational Science Institute, Tufts University, 419 Boston, Ave, Medford, MA, 02155, USA
| | - Qiuxi Huang
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
| | - Stelios M Smirnakis
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
- Department of Neurology, Jamaica Plain Veterans Administration Medical Center, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Emelia J Benjamin
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
- Department of Cardiology, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, 85 E Concord St, Boston, MA, 02118, USA
| | - Josée Dupuis
- Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College, Montreal, QC, Canada
| | - David M Greer
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA
| | - Charlene J Ong
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.
- Department of Neurology, Boston University School of Medicine, Chobanian and Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA.
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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Wu N, Wang X, Jia S, Cui X, Wang Y, Li J, Zhang X, Wang Y. Clinical features of ischemic stroke in patients with nonvalvular atrial fibrillation combined with intracranial atherosclerotic stenosis. Brain Behav 2023; 13:e3036. [PMID: 37128146 PMCID: PMC10275557 DOI: 10.1002/brb3.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Nonvalvular atrial fibrillation (NVAF) and intracranial atherosclerotic stenosis (ICAS) are major causes of ischemic stroke. Relatively few studies have focused on the risk factors and clinical features of ischemic stroke caused by NVAF combined with ICAS. METHOD We retrospectively evaluated NVAF and/or ICAS in patients with acute ischemic stroke admitted within 72 h after stroke. All patients with acute ischemic stroke underwent diffusion-weighted magnetic resonance imaging (DWI), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and/or digital subtraction angiography (DSA). NVAF was detected by routine electrocardiogram or 24-h Holter examination, Doppler echocardiography, and contrast echocardiography of the right heart. RESULTS Among the 635 enrolled patients, NVAF, ICAS, and NVAF+ICAS were diagnosed in 170 (26.77%), 255 (40.16%), and 210 (33.07%) patients, respectively. Patients in the NVAF+ICAS group were older (p < .001), specifically aged ≥75 years (p < .001). The admission time of the NVAF+ICAS group was shorter (p < .001) than that of the ICAS group. The admission NIHSS score of the NVAF group was higher than that of the NVAF+ICAS group (p < .001). HsCRP, NTpro-BNP, and LEVF levels were significantly different among the three groups (p < .001). NVAF+ICAS ischemic stroke occurred mainly in the right hemisphere (52.4%). CONCLUSION NVAF with ICAS ischemic stroke is more likely to occur in older patients. Infarctions occurred mainly in the right cerebral hemisphere. Neurological deficits in NVAF are more severe than those in NVAF combined with ICAS and in simple ICAS ischemic strokes. HsCRP, LEVF, andNTpro-BNP seem to be closely associated with NVAF+ICAS ischemic stroke.
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Affiliation(s)
- Ning Wu
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Xinli Wang
- Department of NeurorehabilitationYidu Central Hospital of WeifangWeifangShandongChina
| | - Shuai Jia
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Xiaomei Cui
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Yaozhen Wang
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Jian Li
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Xiaojun Zhang
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Yanqiang Wang
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
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Arca G, Núñez C, Stephan-Otto C, Arnaez J, Agut T, Cordeiro M, Boronat N, Lubián-López S, Benavente-Fernández I, Valverde E, Garcia-Alix A. Massive Neonatal Arterial Ischemic Stroke. Pediatr Neurol 2023; 144:5-10. [PMID: 37087915 DOI: 10.1016/j.pediatrneurol.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Massive infarction in adults is a devastating entity characterized by signs of extreme swelling of the brain's parenchyma. We explored whether a similar entity exists in neonates, which we call massive neonatal arterial ischemic stroke (M-NAIS), and assess its potential clinical implications. METHODS Prospective multicenter cohort study comprising 48 neonates with gestational age ≥35 weeks with middle cerebral artery (MCA) NAIS was performed. Diagnosis with magnetic resonance imaging (MRI) was performed within the first three days after symptom onset. The presence of signs of a space-occupying mass, such as brain midline shift and/or ventricular and/or extra-axial space collapse, was recorded. The volume of the infarct and brain midline shift were determined with semiautomatic procedures. Neurodevelopment was assessed at age 24 months. RESULTS Fifteen (31%) neonates presented MRI signs of a space-occupying mass effect and were considered to have an M-NAIS. The relative volume (infarct volume/total brain volume) of the infarct was on average significantly greater in the M-NAIS subgroup (29% vs 4.9%, P < 0.001). Patients with M-NAIS consistently presented lesions involving the M1 arterial territory of the MCA and showed more apneic and tonic seizures, which had an earlier onset and lasted longer. Moderate to severe adverse neurodevelopmental outcomes were present in most M-NAIS cases (79% vs 6%, P < 0.001). CONCLUSIONS M-NAIS appears to be a distinctive subtype of neonatal infarction, defined by characteristic neuroimaging signs. Neonates with M-NAIS frequently present a moderate to severe adverse outcome. Early M-NAIS identification would allow for prompt, specific rehabilitation interventions and would provide more accurate prognostic information to families.
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Affiliation(s)
- Gemma Arca
- Department of Neonatology, Hospital Clínic, IDIBAPS, Barcelona, Spain; Nene Foundation, Madrid, Spain.
| | - Christian Núñez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Mental Health Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Pediatric Computational Imaging Group (PeCIC), Hospital Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Juan Arnaez
- Nene Foundation, Madrid, Spain; Department of Neonatology, Hospital Universitario de Burgos, Burgos, Spain
| | - Thais Agut
- Nene Foundation, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Department of Neonatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Malaika Cordeiro
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Nuria Boronat
- Department of Neonatology, University and Politechnic Hospital La Fe, Health Research Institute La Fe, Valencia, Spain
| | - Simón Lubián-López
- Nene Foundation, Madrid, Spain; Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain; Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Isabel Benavente-Fernández
- Nene Foundation, Madrid, Spain; Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain; Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Eva Valverde
- Nene Foundation, Madrid, Spain; Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Alfredo Garcia-Alix
- Nene Foundation, Madrid, Spain; Professor in Iberoamerican Society of Neonatology (SIBEN), Buenos Aires, Argentina
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He Y, Zuo M, Huang J, Jiang Y, Zhou L, Li G, Chen L, Liu Q, Liang D, Wang Y, Wang L, Zhou Z. A Novel Nomogram for Predicting Malignant Cerebral Edema After Endovascular Thrombectomy in Acute Ischemic Stroke: A Retrospective Cohort Study. World Neurosurg 2023; 173:e548-e558. [PMID: 36842531 DOI: 10.1016/j.wneu.2023.02.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Malignant cerebral edema (MCE) is a common and feared complication after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). This study aimed to establish a nomogram to predict MCE in anterior circulation large vessel occlusion stroke (LVOS) patients receiving EVT in order to guide the postoperative medical care in the acute phase. METHODS In this retrospective cohort study, 381 patients with anterior circulation LVOS receiving EVT were screened from 636 hospitalized patients with LVOS at 2 stroke medical centers. Clinical baseline data and imaging data were collected within 2-5 days of admission to the hospital. The patients were divided into 2 groups based on whether MCE occurred after EVT. Multivariate logistic regression analysis was used to evaluate the independent risk factors for MCE and to establish a nomogram. RESULTS Sixty-six patients out of 381 (17.32%) developed MCE. The independent risk factors for MCE included admission National Institutes of Health Stroke Scale (NIHSS) ≥16 (odds ratio [OR] 1.851; 95% CI 1.029-3.329; P = 0.038), ASPECT score (OR 0.621; 95% CI 0.519-0.744; P < 0.001), right hemisphere (OR 1.636; 95% CI 0.941-2.843; P = 0.079), collateral circulation (OR 0.155; 95% CI 0.074-0.324; P < 0.001), recanalization (OR 0.223; 95% CI 0.109-0.457; P < 0.001), hematocrit (OR, 0.937; 95% CI: 0.892-0.985; P =0.010), and glucose (OR 1.118; 95% CI 1.023-1.223; P = 0.036), which were adopted as parameters of the nomogram. The receiver operating characteristic curve analysis showed that the area under the curve of the nomogram in predicting MCE was 0.901(95% CI 0.848-0.940; P < 0.001). The Hosmer-Lemeshow test results were not significant (P = 0.685), demonstrating a good calibration of the nomogram. CONCLUSIONS The novel nomogram composed of admission NIHSS, ASPECT scores, right hemisphere, collateral circulation, recanalization, hematocrit, and serum glucose provide a potential predictor for MCE in patients with AIS after EVT.
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Affiliation(s)
- Yuxuan He
- Department of Neurology, School of Medicine, Chongqing University, Chongqing, China; Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Meng Zuo
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jialu Huang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Jiang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Linke Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Guangjian Li
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lin Chen
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Qu Liu
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dingwen Liang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yu Wang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Li Wang
- Department of Neurology, Zigong Third People's Hospital, Zigong, Sichuang, China
| | - Zhenhua Zhou
- Department of Neurology, School of Medicine, Chongqing University, Chongqing, China; Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
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Enlarged left atrium may be associated with laterality of anterior circulation cardioembolic stroke. J Stroke Cerebrovasc Dis 2023; 32:106999. [PMID: 36689795 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Propensity for lesion lateralization in atrial fibrillation-related cardiac embolic stroke (AF-stroke) remains controversial. In this study, we compared the hemispheric differences among patients with AF-stroke and identified factors associated with lesion laterality. METHODS We retrospectively reviewed patients with acute AF-stroke admitted from January, 2017 to March, 2022. Patients were grouped based on whether lesions were right or left hemispheric in the anterior circulation territory, based on diffusion-weighted imaging. Factors associated with right-side propensity were analyzed. RESULTS Among 385 patients, the mean age was 74±11 years and 52.5 % were male. Right and left hemispheric lesions were observed in 189 (49.1 %) and 196 (50.9%) patients, respectively. In the multivariate analysis, enlarged left atrium (LA) (adjusted odds ratio [aOR]=1.03, 95% confidential interval [CI], 1.007-1.061; p=0.013) and single confluent lesion pattern (aOR= 1.55, 95% CI, 1.012-2.381; p=0.044) were associated with right hemispheric lesions. CONCLUSIONS Enlarged LA and single confluent lesion pattern were strongly related to right-sided propensity in patients with AF-stroke.
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Li J, Zhang P, Liu Y, Chen W, Yi X, Wang C. Stroke Lateralization in Large Hemisphere Infarctions: Characteristics, Stroke-Related Complications, and Outcomes. Front Neurol 2021; 12:774247. [PMID: 34956055 PMCID: PMC8702425 DOI: 10.3389/fneur.2021.774247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives: To assess the hemispheric differences in characteristics, stroke-related complications, and outcomes of patients with large hemisphere infarctions (LHI). Methods: We enrolled consecutive patients admitted within 24 h after the diagnosis of LHI (defined as an ischemic stroke involving more than 50% of the territory of the middle cerebral artery in computed tomography and/or magnetic resonance imaging). Univariate and multivariate analysis were performed to explore the association between lateralization and stroke-related complications and clinical outcomes. Results: A total of 314 patients with LHI were enrolled, with 171 (54.5%) having right hemispheric involvement. Right-sided patients with LHI had lower baseline National Institutes of Health Stroke Scale (NIHSS) score (18 vs. 22, p < 0.001), higher frequency of atrial fibrillation (69.0 vs. 52.4%, p = 0.003), and higher proportion of cardio-embolism (73.1 vs. 56.6%, p = 0.013) than the left. Right-sided LHI had higher incidence rates of malignant brain edema (MBE) (48.5 vs. 30.8%, p = 0.001) and a composite of cardiovascular events (29.8 vs. 17.5%, p = 0.011) during hospitalization. The incidence rate of 1-month mortality (34.5 vs. 23.8%, p = 0.036) was higher in right-sided patients with LHI, but there were no hemispheric differences in the incidence rates of 3-month mortality and unfavorable outcome (both p > 0.05). Multivariate analyses suggested right hemisphere involvement was independently associated with increased risk of MBE (adjusted OR 2.37, 95% CI 1.26–4.43, p = 0.007) and composite of cardiovascular events (adjusted OR 2.04, 95% CI 1.12–3.72, p = 0.020). However, it was not independently associated with 1-month death, 3-month mortality, and 3-month unfavorable outcome (all p > 0.05). Conclusions: Right-sided patients with LHI had higher frequency of atrial fibrillation and cardio-embolism than the left-sided patients. Right hemisphere involvement was independently associated with increased risk of MBE and composite of cardiovascular events during hospitalization, whereas stroke lateralization was not an independent predictor of mortality and unfavorable outcome in patients with LHI.
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Affiliation(s)
- Jie Li
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Yingying Liu
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Wanli Chen
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang, Deyang, China
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MicroRNA Analysis of Human Stroke Brain Tissue Resected during Decompressive Craniectomy/Stroke-Ectomy Surgery. Genes (Basel) 2021; 12:genes12121860. [PMID: 34946809 PMCID: PMC8702168 DOI: 10.3390/genes12121860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Signaling pathways mediated by microRNAs (miRNAs) have been identified as one of the mechanisms that regulate stroke progression and recovery. Recent investigations using stroke patient blood and cerebrospinal fluid (CSF) demonstrated disease-specific alterations in miRNA expression. In this study, for the first time, we investigated miRNA expression signatures in freshly removed human stroke brain tissue. METHODS Human brain samples were obtained during craniectomy and brain tissue resection in severe stroke patients with life-threatening brain swelling. The tissue samples were subjected to histopathological and immunofluorescence microscopy evaluation, next generation miRNA sequencing (NGS), and bioinformatic analysis. RESULTS miRNA NGS analysis detected 34 miRNAs with significantly aberrant expression in stroke tissue, as compared to non-stroke samples. Of these miRNAs, 19 were previously identified in stroke patient blood and CSF, while dysregulation of 15 miRNAs was newly detected in this study. miRNA direct target gene analysis and bioinformatics approach demonstrated a strong association of the identified miRNAs with stroke-related biological processes and signaling pathways. CONCLUSIONS Dysregulated miRNAs detected in our study could be regarded as potential candidates for biomarkers and/or targets for therapeutic intervention. The results described herein further our understanding of the molecular basis of stroke and provide valuable information for the future functional studies in the experimental models of stroke.
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Räty S, Georgiopoulos G, Aarnio K, Martinez-Majander N, Uhl E, Ntaios G, Strbian D. Hemicraniectomy for Dominant vs Nondominant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 30:106102. [PMID: 34536811 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Decompressive hemicraniectomy decreases mortality and severe disability from space-occupying middle cerebral artery infarction in selected patients. However, attitudes towards hemicraniectomy for dominant-hemispheric stroke have been hesitant. This systematic review and meta-analysis examines the association of stroke laterality with outcome after hemicraniectomy. MATERIALS AND METHODS We performed a systematic literature search up to 6th February 2020 to retrieve original articles about hemicraniectomy for space-occupying middle cerebral artery infarction that reported outcome in relation to laterality. The primary outcome was severe disability (modified Rankin Scale 4‒6 or 5‒6 or Glasgow Outcome Scale 1‒3) or death. A two-stage combined individual patient and aggregate data meta-analysis evaluated the association between dominant-lateralized stroke and (a) short-term (≤ 3 months) and (b) long-term (> 3 months) outcome. We performed sensitivity analyses excluding studies with sheer mortality outcome, second-look strokectomy, low quality, or small sample size, and comparing populations from North America/Europe vs Asia/South America. RESULTS The analysis included 51 studies (46 observational studies, one nonrandomized trial, and four randomized controlled trials) comprising 2361 patients. We found no association between dominant laterality and unfavorable short-term (OR 1.00, 95% CI 0.69‒1.45) or long-term (OR 1.01, 95% CI 0.76‒1.33) outcome. The results were unchanged in all sensitivity analyses. The grade of evidence was very low for short-term and low for long-term outcome. CONCLUSIONS This meta-analysis suggests that patients with dominant-hemispheric stroke have equal outcome after hemicraniectomy compared to patients with nondominant stroke. Despite the shortcomings of the available evidence, our results do not support withholding hemicraniectomy based on stroke laterality.
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Affiliation(s)
- Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00290, Finland.
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Karoliina Aarnio
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00290, Finland
| | - Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00290, Finland
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00290, Finland
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Zhu T, Wang L, Tian F, Zhao X, Pu XP, Sun GB, Sun XB. Anti-ischemia/reperfusion injury effects of notoginsenoside R1 on small molecule metabolism in rat brain after ischemic stroke as visualized by MALDI-MS imaging. Biomed Pharmacother 2020; 129:110470. [PMID: 32768957 DOI: 10.1016/j.biopha.2020.110470] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 02/09/2023] Open
Abstract
Ischemic stroke is a syndrome of severe neurological responses that cause neuronal death, damage to the neurovascular unit and inflammation. Notoginsenoside R1 (NG-R1) is a neuroprotective drug that is commonly used to treat neurodegenerative and cerebrovascular diseases. However, its potential mechanisms on the regulation of small molecule metabolism in ischemic stroke are largely unknown. The aim of this study was to explore the potential mechanisms of NG-R1 on the regulation of small molecule metabolism after ischemic stroke. Here, we found that NG-R1 reduced infarct size and improved neurological deficits by ameliorating neuronal damage and inhibiting glial activation in MCAO/R rats. Furthermore, using matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI), we clarified that NG-R1 regulated ATP metabolism, the tricarboxylic acid (TCA) cycle, the malate-aspartate shuttle, antioxidant activity, and the homeostasis of iron and phospholipids in the striatum and hippocampus of middle cerebral artery occlusion/reperfusion (MCAO/R) rats. In general, NG-R1 is a promising compound for brain protection from ischemic/reperfusion injury, possibly through the regulation of brain small molecule metabolism.
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Affiliation(s)
- Ting Zhu
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100193, China; Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Ministry of Education, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100193, China; Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing, 100193, China.
| | - Lei Wang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100193, China; Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Ministry of Education, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100193, China; Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing, 100193, China; Harbin University of Commerce, Harbin, Heilongjiang, 150000, China.
| | - Fang Tian
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China.
| | - Xin Zhao
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China.
| | - Xiao-Ping Pu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China.
| | - Gui-Bo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100193, China; Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Ministry of Education, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100193, China; Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing, 100193, China.
| | - Xiao-Bo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100193, China; Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Ministry of Education, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100193, China; Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing, 100193, China.
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10
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Long-term outcome changes after mechanical thrombectomy for anterior circulation acute ischemic stroke. J Neurol 2019; 267:1026-1034. [DOI: 10.1007/s00415-019-09670-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
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11
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Fodor DM, Mutter I, Stănescu IC, Fodor M, Bulboaca A, Perju Dumbravă L. Is segmental muscle strength recovery different in patients with dominant versus non-dominant hemispheric ischemic stroke? BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction & objectives: Starting from the well-known functional hemispheric asymmetry and concomitantly, from the clinical findings of practitioners involved in the post-stroke rehabilitation process, the aim of this study was to evaluate whether ischemic stroke in the dominant hemisphere results in more severe initial motor deficit and if its motor recovery is decreased compared to that of the non-dominant hemisphere.
Material and method: This was a retrospective study, comprising 39 patients with ischemic stroke in the middle cerebral artery territory, divided into two groups depending on the hemispheric location of the lesion (left/right). They were evaluated for their segmental muscle strength using the Medical Research Council Muscle Strength Grading Scale, both in terms of initial value and evolution between two successive admissions.
Results and conclusions: No significant difference was found for motor deficit evaluated on the occasion of the first admission between patients with left-side stroke and those with right-side stroke. Motor recovery was more obvious proximally in the paretic limbs, but without statistical significance.
Key words: hemispheric dominance, functional laterality, stroke, motor rehabilitation,
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Affiliation(s)
- Dana Marieta Fodor
- Neuroscience Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ingrid Mutter
- Neuroscience Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ioana Cristina Stănescu
- Neuroscience Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Marius Fodor
- Vascular Surgery Department, Emergency County Hospital, Cluj-Napoca, Romania
| | - Angelo Bulboaca
- Neuroscience Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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12
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Relationship between normalized distributional pattern and functional outcome in patients with acute cardiogenic cerebral embolism. PLoS One 2019; 14:e0210709. [PMID: 30645646 PMCID: PMC6333406 DOI: 10.1371/journal.pone.0210709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022] Open
Abstract
This study aimed to elucidate spatial characteristics for magnetic resonance imaging (MRI) of cardiogenic cerebral embolism, to determine imaging biomarkers predicting patient outcome and cerebral herniation in cardioembolic stroke. This retrospective study assessed 90 patients with cardiogenic cerebral embolism. All images from MRI were normalized using a voxel-based symptom lesion mapping technique. Patients were categorized into two subgroups based on the outcome and presence of cerebral herniation. Each subgroup was assessed individually. The distribution map of all analyzed patients revealed accumulated ischemic lesions in bilateral middle cerebral artery areas. Ischemic lesions for the poor outcome group accumulated at the corona radiata on the right side and throughout the entire left hemisphere. Receiver operating characteristic (ROC) analysis suggested that a normalized ischemic volume of 62.8 mL allowed optimal differentiation between good and poor outcomes (sensitivity, 0.923; specificity, 0.923; area under the curve (AUC), 0.91) for left-side-dominant infarction. The distribution map for the cerebral herniation group revealed large ischemic areas in the left hemisphere. The analysis of differential involvement map with random permutation analysis showed that left anterior circulation infarcts were associated with midline shift. Receiver operating characteristic analysis revealed that a normalized infarction volume of 192.9 mL was highly predictive of cerebral herniation (sensitivity, 0.929; specificity, 0.750; AUC, 0.895). The medial frontal and occipital lobes, caudate head and basal ganglia were significantly involved in those patients who developed cerebral herniation. Ischemic volume contributed to outcomes and cerebral herniation. Ischemic lesions of the anterior and posterior cerebral arteries and basal ganglia in addition to middle cerebral artery area were identified as differences on MRI images between with and without cerebral herniation patients.
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13
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Laterality is an Independent Predictor of Endovascular Thrombectomy in Patients With Low National Institute of Health Stroke Scale. J Stroke Cerebrovasc Dis 2018; 27:3172-3176. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/18/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
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14
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Li W, Liu H, Jiang H, Wang C, Guo Y, Sun Y, Zhao X, Xiong X, Zhang X, Zhang K, Nie Z, Pu X. (S)-Oxiracetam is the Active Ingredient in Oxiracetam that Alleviates the Cognitive Impairment Induced by Chronic Cerebral Hypoperfusion in Rats. Sci Rep 2017; 7:10052. [PMID: 28855592 PMCID: PMC5577264 DOI: 10.1038/s41598-017-10283-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022] Open
Abstract
Chronic cerebral hypoperfusion is a pathological state that is associated with the cognitive impairments in vascular dementia. Oxiracetam is a nootropic drug that is commonly used to treat cognitive deficits of cerebrovascular origins. However, oxiracetam is currently used as a racemic mixture whose effective ingredient has not been identified to date. In this study, we first identified that (S)-oxiracetam, but not (R)-oxiracetam, was the effective ingredient that alleviated the impairments of spatial learning and memory by ameliorating neuron damage and white matter lesions, increasing the cerebral blood flow, and inhibiting astrocyte activation in chronic cerebral hypoperfused rats. Furthermore, using MALDI-MSI and LC-MS/MS, we demonstrated that (S)-oxiracetam regulated ATP metabolism, glutamine-glutamate and anti-oxidants in the cortex region of hypoperfused rats. Altogether, our results strongly suggest that (S)-oxiracetam alone could be a nootropic drug for the treatment of cognitive impairments caused by cerebral hypoperfusion.
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Affiliation(s)
- Wan Li
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Huihui Liu
- Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Hanjie Jiang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Chen Wang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Yongfei Guo
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Yi Sun
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Xin Zhao
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Xin Xiong
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, P. R. China
| | - Xianhua Zhang
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, P. R. China
| | - Ke Zhang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China.,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China
| | - Zongxiu Nie
- Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China.
| | - Xiaoping Pu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, P. R. China. .,Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P. R. China.
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15
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Outcome following surgical treatment of chronic subdural hematoma in the oldest-old population. Neurosurg Rev 2016; 40:461-468. [DOI: 10.1007/s10143-016-0803-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/16/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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