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Fang H, Zhao L, Pei L, Song B, Gao Y, Liu K, Xu Y, Li Y, Wu J, Xu Y. Severity of White Matter Lesions Correlates with Subcortical Diffusion-Weighted Imaging Abnormalities and Predicts Stroke Risk. J Stroke Cerebrovasc Dis 2017; 26:2964-2970. [PMID: 28867524 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/14/2017] [Accepted: 07/23/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND AND PURPOSE The severity of white matter lesions (WMLs) has been strongly linked to small-vessel diseases or lacunar infarction. The present study aimed to investigate the correlation between severity of WMLs and distribution of diffusion-weighted imaging (DWI) hyperintensities, and to explore whether the severity of WMLs is an independent neuroimaging predictor of stroke risk after transient symptoms with infarction (TSI). METHODS We evaluated the presence and severity of WMLs on fluid-attenuated inversion recovery sequences using the age-related white matter changes scale and the location and size of hyperintensities on DWI sequences, respectively, in a prospective cohort study of TSI patients. The primary end point was recurrent stroke within 90 days. RESULTS A total of 191 consecutive TSI patients were eligible for inclusion in the present analysis. The average age of the patients was 57.3 ± 12.8 years. DWI abnormalities occurred more often in the deep white matter with increasing severity of WMLs (P < .001). During 90-day follow-up, Kaplan-Meier analysis showed that recurrent stroke was correlated to the severity of WMLs (P = .01). The Cox proportional hazards model revealed that WMLs were predictive of recurrent stroke (hazard ratio, 1.748; 95% confidence interval, 1.16-2.634; P = .008). CONCLUSIONS Severe WMLs were correlated with DWI hyperintensities in the deep white matter in TSI patients and contributed to an increased risk of recurrent stroke.
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Affiliation(s)
- Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafang Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yusheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Ng FC, Coote S, Frost T, Bladin C, Choi PM. CT perfusion predicts tissue injury in TIA and minor stroke. J Neurol 2017; 264:802-803. [DOI: 10.1007/s00415-017-8423-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
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Kvistad CE, Oygarden H, Logallo N, Thomassen L, Waje-Andreassen U, Moen G, Naess H. A stress-related explanation to the increased blood pressure and its course following ischemic stroke. Vasc Health Risk Manag 2016; 12:435-442. [PMID: 27956837 PMCID: PMC5113932 DOI: 10.2147/vhrm.s109032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke. Methods Ischemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3–6 h, 6–12 h and 12–24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h. Results A reduction in systolic BP and diastolic BP from baseline to 12–24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12–24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings. Conclusion We found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke.
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Affiliation(s)
| | - Halvor Oygarden
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Nicola Logallo
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Gunnar Moen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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Liu D, Scalzo F, Starkman S, Rao NM, Hinman JD, Kim D, Ali LK, Saver JL, Noorian AR, Ng K, Liang C, Sheth SA, Yoo B, Liu X, Liebeskind DS. DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis. Cerebrovasc Dis 2015; 40:279-285. [PMID: 26513397 DOI: 10.1159/000441153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/14/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lesion patterns may predict prognosis after acute ischemic stroke within the middle cerebral artery (MCA) territory; yet it remains unclear whether such imaging prognostic factors are related to patient outcome after intravenous thrombolysis. AIMS The aim of this study is to investigate the clinical outcome after intravenous thrombolysis in acute MCA ischemic strokes with respect to diffusion-weighted imaging (DWI) lesion patterns. METHODS Consecutive acute ischemic stroke cases of the MCA territory treated over a 7-year period were retrospectively analyzed. All acute MCA stroke patients underwent a MRI scan before intravenous thrombolytic therapy was included. DWI lesions were divided into 6 patterns (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts). Lesion volumes were measured by dedicated imaging processing software. Favorable outcome was defined as modified Rankin scale (mRS) of 0-2 at 90 days. RESULTS Among the 172 patients included in our study, 75 (43.6%) were observed to have territorial infarct patterns or other deep infarct patterns. These patients also had higher baseline NIHSS score (p < 0.001), a higher proportion of large cerebral artery occlusions (p < 0.001) and larger infarct volume (p < 0.001). Favorable outcome (mRS 0-2) was achieved in 89 patients (51.7%). After multivariable analysis, groups with specific lesion patterns, including territorial infarct and other deep infarct pattern, were independently associated with favorable outcome (OR 0.40; 95% CI 0.16-0.99; p = 0.047). CONCLUSIONS Specific lesion patterns predict differential outcome after intravenous thrombolysis therapy in acute MCA stroke patients.
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Affiliation(s)
- Dezhi Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, Calif., USA.,UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Fabien Scalzo
- Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, Calif., USA.,UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Sidney Starkman
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Neal M Rao
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Jason D Hinman
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Doojin Kim
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Latisha K Ali
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Jeffrey L Saver
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Ali Reza Noorian
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Kwan Ng
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Conrad Liang
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Sunil A Sheth
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Bryan Yoo
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, Calif., USA.,UCLA Stroke Center, University of California Los Angeles, Los Angeles, Calif., USA
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Ejaz S, Emmrich JV, Sawiak SJ, Williamson DJ, Baron JC. Cortical selective neuronal loss, impaired behavior, and normal magnetic resonance imaging in a new rat model of true transient ischemic attacks. Stroke 2015; 46:1084-92. [PMID: 25669312 DOI: 10.1161/strokeaha.114.007581] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE New-definition transient ischemic attacks (TIAs) are frequent but difficult to diagnose because magnetic resonance imaging (MRI)-negative by definition. However, hidden underlying cell damage might be present and account for the reported long-lasting cognitive impairment after TIAs. Most prior rodent models of true TIA targeted the striatum or have not been fully characterized. Here we present the MRI, behavioral, and quantitative cell changes characterizing a new rodent model of true TIA targeting the more behaviorally relevant cerebral cortex. METHODS Fifteen-minute distal middle cerebral artery occlusion was performed in 29 spontaneously hypertensive rats allowed to survive for 7 to 60 days. Behavior was assessed serially using both global neurological and fine sensorimotor tests. Diffusion- and T2-weighted MRI was obtained 20 min postreperfusion and again 7 to 60 days later, and then changes in neurons and microglia were quantified across the middle cerebral artery territory using immunohistochemistry. RESULTS No MRI changes or pan-necrosis were observed at any time point, but patchy cortical selective neuronal loss affected 28/29 rats, regardless of survival interval, together with topographically congruent microglial activation that gradually declined over time. The Neuroscore was unchanged, but there was marked contralateral sensorimotor impairment, still recovering by day 28. CONCLUSIONS Our new rodent model mimicking true cortical TIA is characterized by normal MRI, but consistent cortical selective neuronal loss and microglial activation and long-lasting sensorimotor deficits. By causing selective neuronal loss, TIAs and silent microemboli might affect neuronal reserve, thereby increasing long-term cognitive impairment risk. Selective neuronal loss and microglial activation might represent novel therapeutic targets that could be detectable in vivo after TIAs using appropriate imaging tracers.
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Affiliation(s)
- Sohail Ejaz
- From the Stroke Research Group, Department of Clinical Neurosciences (S.E., J.V.E., J.-C.B.), and Wolfson Brain Imaging Centre, Department of Clinical Neurosciences (S.J.S., D.J.W.), University of Cambridge; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (J.V.E.); and INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Julius V Emmrich
- From the Stroke Research Group, Department of Clinical Neurosciences (S.E., J.V.E., J.-C.B.), and Wolfson Brain Imaging Centre, Department of Clinical Neurosciences (S.J.S., D.J.W.), University of Cambridge; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (J.V.E.); and INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Stephen J Sawiak
- From the Stroke Research Group, Department of Clinical Neurosciences (S.E., J.V.E., J.-C.B.), and Wolfson Brain Imaging Centre, Department of Clinical Neurosciences (S.J.S., D.J.W.), University of Cambridge; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (J.V.E.); and INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - David J Williamson
- From the Stroke Research Group, Department of Clinical Neurosciences (S.E., J.V.E., J.-C.B.), and Wolfson Brain Imaging Centre, Department of Clinical Neurosciences (S.J.S., D.J.W.), University of Cambridge; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (J.V.E.); and INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Jean-Claude Baron
- From the Stroke Research Group, Department of Clinical Neurosciences (S.E., J.V.E., J.-C.B.), and Wolfson Brain Imaging Centre, Department of Clinical Neurosciences (S.J.S., D.J.W.), University of Cambridge; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (J.V.E.); and INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.).
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