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Brown AA, Ferguson BJ, Jones V, Green BE, Pearre JD, Anunoby IA, Beversdorf DQ, Barohn RJ, Cirstea CM. Pilot Study of Real-World Monitoring of the Heart Rate Variability in Amyotrophic Lateral Sclerosis. Front Artif Intell 2022; 5:910049. [PMID: 35875194 PMCID: PMC9301244 DOI: 10.3389/frai.2022.910049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
Aims Cardiovascular dysautonomia may impact the quality of life and survival in amyotrophic lateral sclerosis (ALS). Such dysfunction is not systematically assessed in these patients. Wearable devices could help. The feasibility of a wearable biosensor to detect heart rate variability (HRV), a physiological marker of sympathovagal balance, was studied for the first time in real-world settings in ALS. Methods Five ALS patients (two early/three late; one bulbar-onset; mildly-to-moderately disabled) and five age/sex/BMI/comorbidities-matched controls underwent assessment of 3-day HRV via VitalConnect biosensor (worn on the left thorax). De-identified data captured by the biosensor were transferred to a secure cloud server via a relay Bluetooth device. Baseline ALS severity/anxiety and physical activity during testing were documented/quantified. Time-domain HRV measures (i.e., pNN50) were analyzed. Results An overall 3-day abnormal HRV (pNN50 < 3%), was found in three out of five patients (mean ± SD for the group, 2.49 ± 1.51). Similar changes were reported in controls (12.32 ± 21.14%). There were no statistically significant relationships between pNN50 values and baseline anxiety or physical activity during the tested days (p > 0.05 for both groups). A negative correlation was found between pNN50 values and age in patients (p = 0.01) and controls (p = 0.09), which is similar with what is found in the general population. In line with prior studies, pNN50 values were independent of disease stage (p = 0.6) and disability (p = 0.4). Conclusions These preliminary results suggest that remote HRV measures using the VitalConnect is feasible and may constitute an improved strategy to provide insights into sympathovagal balance in ALS. Further work with larger sample sizes is warranted.
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Affiliation(s)
- Alexander A. Brown
- Department of Psychological Sciences, College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - Bradley J. Ferguson
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Vovanti Jones
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Bruce E. Green
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Justin D. Pearre
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Ifeoma A. Anunoby
- College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - David Q. Beversdorf
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Richard J. Barohn
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Carmen M. Cirstea
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States
- *Correspondence: Carmen M. Cirstea
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Wang X, Zhou C, Wang Y, Wang L. Microstructural changes of white matter fiber tracts induced by insular glioma revealed by tract-based spatial statistics and automatic fiber quantification. Sci Rep 2022; 12:2685. [PMID: 35177685 PMCID: PMC8854665 DOI: 10.1038/s41598-022-06634-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Gliomas typically grow along white matter fiber tracts, yet their invasion patterns remain unclear. This study assessed the effect of insular glioma on large white matter fiber tracts and the microstructural subcortical changes associated with clinical outcomes in patients with insular glioma. Twenty-five patients with insular glioma were enrolled and divided into left and right groups according to tumor lateralization. The control group comprised 14 healthy volunteers. Subjects in both the glioma and control groups underwent diffusion tensor magnetic resonance imaging at 3.0 T. The characteristics of white matter fiber bundles were analyzed using tract-based spatial statistics and automatic fiber quantification. Both Automatic Fiber Quantification and Tract-Based Spatial Statistics revealed that patients with insular glioma had significantly lower fractional anisotropy (FA) values in the inferior frontal-occipital fasciculus and uncinate fasciculus ipsilateral to the tumor, than the controls. Fractional anisotropy associated with mean diffusivity values several large fiber tracts showed potential on tumor-grade distinguishing. Diffusion metrics can sensitively detect microstructural changes in tumor progression. Insular glioma significantly affects the microstructure of white matter fibers proximal to the tumor. The range of white matter fiber bundles affected differs according to the grade of the glioma. These changes are mainly associated with early-stage tumor invasion.
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Affiliation(s)
- Xiangdong Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 West South Fourth Ring Road, Beijing, 100070, China.,Department of Neurosurgery, Heji Hospital, Changzhi Medical College, Changzhi City, Shanxi province, China
| | - Chunyao Zhou
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yinyan Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 West South Fourth Ring Road, Beijing, 100070, China
| | - Lei Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 West South Fourth Ring Road, Beijing, 100070, China.
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3
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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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4
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Wittstock M, Meyer K, Klinke J, Grossmann A, Walter U, Storch A. Effects of insular involvement on functional outcome after intracerebral hemorrhage. Acta Neurol Scand 2021; 144:559-565. [PMID: 34224142 DOI: 10.1111/ane.13496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/31/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ischemic stroke, as well as intracerebral hemorrhage (ICH), involving the insular cortex tends to be more severe. The impact of insular involvement on outcome of ICH remains enigmatic. METHODS We analyzed 159 patients with supratentorial ICH. Depending on insular involvement the patients were classified into two groups (ICHnon-insular vs. ICHinsular ). Volume and symptom severity of ICH were assessed. Electrocardiography, chest X-ray, and laboratory examinations including myocardial enzymes and inflammatory markers were made. In-hospital death and outcome at discharge from hospital were assessed on the modified Rankin scale (mRS). RESULTS The main finding was an association of insular involvement of ICH with worse short-term outcome as measured by mRS (common odds ratio: 4.08 (95% CI: 2.09-7.92); p < .001). This association survived adjustment to relevant covariates such as age, sex, ICH volume, intraventricular hemorrhage, pneumonia, and length of stay (adjusted common odds ratio: 2.51 (95% CI: 1.21-5.21); p = .014) but had no predictive value for side of ICH or rate of atrial fibrillation. There was no association of ICH localization with in-hospital death rate. CONCLUSION Insular localization of ICH lesions predicts worse short-term functional outcome independent of side of bleeding or cardiac dysfunction such as new AF. These findings need clarification in larger prospective cohorts assessed by detailed autonomic/cardiac testing, as well as neuroimaging sub-localization of ICH within the insular region.
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Affiliation(s)
| | - Kezia Meyer
- Department of Neurology University of Rostock Rostock Germany
| | - Jan Klinke
- Department of Neurology University of Rostock Rostock Germany
| | - Annette Grossmann
- Institute of Diagnostic and Interventional Radiology Pediatric Radiology and Neuroradiology University of Rostock Rostock Germany
| | - Uwe Walter
- Department of Neurology University of Rostock Rostock Germany
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Lin HB, Li FX, Zhang JY, You ZJ, Xu SY, Liang WB, Zhang HF. Cerebral-Cardiac Syndrome and Diabetes: Cardiac Damage After Ischemic Stroke in Diabetic State. Front Immunol 2021; 12:737170. [PMID: 34512671 PMCID: PMC8430028 DOI: 10.3389/fimmu.2021.737170] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/06/2021] [Indexed: 12/24/2022] Open
Abstract
Cerebral-cardiac syndrome (CCS) refers to cardiac dysfunction following varying brain injuries. Ischemic stroke is strongly evidenced to induce CCS characterizing as arrhythmia, myocardial damage, and heart failure. CCS is attributed to be the second leading cause of death in the post-stroke stage; however, the responsible mechanisms are obscure. Studies indicated the possible mechanisms including insular cortex injury, autonomic imbalance, catecholamine surge, immune response, and systemic inflammation. Of note, the characteristics of the stroke population reveal a common comorbidity with diabetes. The close and causative correlation of diabetes and stroke directs the involvement of diabetes in CCS. Nevertheless, the role of diabetes and its corresponding molecular mechanisms in CCS have not been clarified. Here we conclude the features of CCS and the potential role of diabetes in CCS. Diabetes drives establish a “primed” inflammatory microenvironment and further induces severe systemic inflammation after stroke. The boosted inflammation is suspected to provoke cardiac pathological changes and hence exacerbate CCS. Importantly, as the key element of inflammation, NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasome is indicated to play an important role in diabetes, stroke, and the sequential CCS. Overall, we characterize the corresponding role of diabetes in CCS and speculate a link of NLRP3 inflammasome between them.
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Affiliation(s)
- Hong-Bin Lin
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Jin-Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Jian You
- Guangxi Health Commission Key Laboratory of Clinical Biotechnology, Liuzhou People's Hospital, Liuzhou, China
| | - Shi-Yuan Xu
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wen-Bin Liang
- University of Ottawa Heart Institute and Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Hong-Fei Zhang
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Li X, Wang F, Zhao Z, Sun C, Liao J, Li X, Huang C, Nyame L, Zhao Z, Zheng X, Zhou J, Li M, Zou J. A SCANO Nomogram for Individualized Prediction of the Probability of 1-Year Unfavorable Outcomes in Chinese Acute Ischemic Stroke Patients. Front Neurol 2020; 11:531. [PMID: 32695060 PMCID: PMC7338753 DOI: 10.3389/fneur.2020.00531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose: Accurate prediction of functional outcomes after stroke would provide evidence for reasonable poststroke management. This study aimed to develop and validate a nomogram for individualized prediction of 1-year unfavorable outcomes in Chinese acute ischemic stroke (AIS) patients. Methods: We gathered AIS patients at the National Advanced Stroke Center of Nanjing First Hospital (China) between August 2014 and May 2017 within 12 h of symptom onset. The outcome measure was 1-year unfavorable outcomes (modified Rankin Scale 3–6). The patients were randomly stratified into the training (66.7%) and testing (33.3%) sets. With the training data, pre-established predictors were entered into a logistic regression model to generate the nomogram. Predictive performance of the nomogram model was evaluated in the testing data by calculating the area under the receiver operating characteristic curve (AUC-ROC), Brier score, and a calibration plot. Results: A total of 807 patients were included into this study, and 262 (32.5%) of them had unfavorable outcomes. Systolic blood pressure, Creatinine, Age, National Institutes of Health Stroke Scale (NIHSS) score on admission, and fasting blood glucose were significantly associated with unfavorable outcomes and entered into the SCANO nomogram. The AUC-ROC of the SCANO nomogram in the testing set was 0.781 (Brier score: 0.166; calibration slope: 0.936; calibration intercept: 0.060). Conclusions: The SCANO nomogram is developed and validated in Chinese AIS patients to firstly predict 1-year unfavorable outcomes, which is simple and convenient for the management of stroke patients.
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Affiliation(s)
- Xiang Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fusang Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Chao Sun
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Liao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xuemei Li
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Chaoping Huang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Linda Nyame
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zheng Zhao
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaohan Zheng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ming Li
- College of Life Science and Technology, China Pharmaceutical University, Nanjing, China
- *Correspondence: Jianjun Zou
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Ming Li
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Sposato LA, Lam M, Allen B, Richard L, Shariff SZ, Saposnik G. First-ever ischemic stroke and increased risk of incident heart disease in older adults. Neurology 2020; 94:e1559-e1570. [DOI: 10.1212/wnl.0000000000009234] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/15/2019] [Indexed: 12/28/2022] Open
Abstract
ObjectivePoststroke cardiac complications are common. It is unknown whether the reason is shared risk factors and preexisting heart disease or stroke-associated myocardial and coronary injury. We tested the hypothesis that first-ever ischemic stroke is associated with increased risk of incident cardiovascular complications in patients without known preexisting cardiac comorbid conditions.MethodsThis population-based cohort study included residents in Ontario between 2002 and 2012 who were ≥66 years of age without known cardiovascular disease. We compared the incident risk of major adverse cardiovascular events (MACE), defined as myocardial infarction, unstable angina, congestive heart failure, coronary artery disease, coronary artery revascularization, or cardiovascular death, at 1 year in patients with first-ever ischemic stroke vs propensity-matched individuals without stroke (4:1 matching using 31 variables). To estimate cause-specific hazard ratios (HRs), we used Cox regression models adjusted for variables with weighted standardized differences >0.10 or known to influence the risk of MACE.ResultsWe included 21,931 patients with first-ever ischemic stroke and 71,696 propensity-matched individuals, well balanced on all variables used for propensity matching. First-ever ischemic stroke was associated with increased unadjusted incident MACE risk (HR 4.5, 95% confidence interval [CI] 4.3–4.8). MACE adjusted risk was highest in the first 30 days (HR 25.0, 95% CI 20.5–30.5) and declined both at 31 to 90 days (HR 4.8, 95% CI 4.1–5.7) and at 91 to 365 days (HR 2.2, 95% CI 2.0–2.4).ConclusionsIn this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE. Whether this association is explained by stroke-associated cardiac injury, preexisting subclinical cardiovascular comorbid conditions, or both remains unknown.
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Méloux A, Béjot Y, Rochette L, Cottin Y, Vergely C. Brain-Heart Interactions During Ischemic Processes: Clinical and Experimental Evidences. Stroke 2019; 51:679-686. [PMID: 31856693 DOI: 10.1161/strokeaha.119.027732] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Alexandre Méloux
- From the Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2, EA 7460), Université de Bourgogne-Franche-Comté, Dijon, France (A.M., L.R., C.V.).,Department of Cardiology (A.M., Y.C.), University Hospital of Dijon, France
| | - Yannick Béjot
- Department of Neurology (Y.B.), University Hospital of Dijon, France
| | - Luc Rochette
- From the Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2, EA 7460), Université de Bourgogne-Franche-Comté, Dijon, France (A.M., L.R., C.V.)
| | - Yves Cottin
- Department of Cardiology (A.M., Y.C.), University Hospital of Dijon, France
| | - Catherine Vergely
- From the Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2, EA 7460), Université de Bourgogne-Franche-Comté, Dijon, France (A.M., L.R., C.V.)
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Lateralization of Insular Ischemic Stroke is Not Associated With Any Stroke Clinical Outcomes: The Athens Stroke Registry. J Stroke Cerebrovasc Dis 2019; 29:104529. [PMID: 31806455 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Controversial evidence suggests that right insular stroke may be associated with worse outcomes compared to the left insular ischemic lesion. OBJECTIVES We investigated whether lateralization of insular stroke is associated with early and late outcome in terms of in-hospital complications, stroke recurrence, cardiovascular events, and death. METHODS Data were prospectively collected from the Athens Stroke Registry. Insular cortex involvement was identified based on brain CT scans or MRI images. Patients were followed up prospectively at 1, 3, 6 months after hospital discharge and yearly thereafter up to 5-years or until death. The assessed outcomes were in-hospital complications, functional outcome assessed by the modified Rankin Scale, stroke recurrence, cardiovascular events, and death. Cox-regression analysis was performed to estimate the cumulative probability of each outcome according to the lateralization of insular strokes. RESULTS Among the 1212 patients, 650 had left insular stroke involvement and 562 had right. New onset of in-hospital atrial fibrillation was similar between right and left insular strokes (11.6% versus 12.9%, P = .484). During the 5-year follow-up sudden death occurred in 21 (3.7%) patients with right insular compared to 30 (4.6%) with left insular stroke (P = .476). There was no difference between left and right insular strokes regarding mortality (adjusted odds ratio [OR]: .92, 95% confidence interval [CI]: .80-1.06), stroke recurrence (4.3% versus 4.9%; adjusted OR: .81 95% CI: .58-1.13), cardiovascular events, and sudden death (adjusted OR: .99, 95% CI: .76-1.29) and on death and dependency (adjusted OR: .88, 95% CI: .75-1.02) during a 5-year follow up. CONCLUSIONS Lateralization of insular ischemic stroke involvement is not associated with stroke outcomes.
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Shim R, Wen SW, Wanrooy BJ, Rank M, Thirugnanachandran T, Ho L, Sepehrizadeh T, de Veer M, Srikanth VK, Ma H, Phan TG, Sobey CG, Wong CHY. Stroke Severity, and Not Cerebral Infarct Location, Increases the Risk of Infection. Transl Stroke Res 2019; 11:387-401. [PMID: 31709500 DOI: 10.1007/s12975-019-00738-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
Abstract
Infection is a leading cause of death in patients with stroke; however, the impact of cerebral infarct size or location on infectious outcome is unclear. To examine the effect of infarct size on post-stroke infection, we utilised the intraluminal middle-cerebral artery occlusion (MCAO) mouse model of ischemic stroke and adjusted the duration of arterial occlusion. At 1 day following stroke onset, the proportion of mice with infection was significantly greater in mice that had larger infarct sizes. Additionally, the presence of lung infection in these mice with severe strokes extended past 2 days, suggestive of long-term immune impairment. At the acute phase, our data demonstrated an inverse relationship between infarct volume and the number of circulating leukocytes, indicating the elevated risk of infection in more severe stroke is associated with reduced cellularity in peripheral blood, owing predominately to markedly decreased lymphocyte numbers. In addition, the stroke-induced reduction of lymphocyte-to-neutrophil ratio was also evident in the lung of all post-stroke animals. To investigate the effect of infarct location on post-stroke infection, we additionally performed a photothrombotic (PT) model of stroke and using an innovative systematic approach of analysis, we found the location of cerebral infarct does not impact on the susceptibility of post-stroke infection, confirming the greater role of infarct volume over infarct location in the susceptibility to infection. Our experimental findings were validated in a clinical setting and reinforced that stroke severity, and not infarct location, influences the risk of infection after stroke.
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Affiliation(s)
- Raymond Shim
- Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia
| | - Shu Wen Wen
- Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia
| | - Brooke J Wanrooy
- Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia
| | - Michelle Rank
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Parkville, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Tharani Thirugnanachandran
- Stroke and Ageing Research Group, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Luke Ho
- Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia
- Department of Medicine (Academic Unit), Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Tara Sepehrizadeh
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Michael de Veer
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Velandai K Srikanth
- Department of Medicine (Academic Unit), Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Henry Ma
- Stroke and Ageing Research Group, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Thanh G Phan
- Stroke and Ageing Research Group, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Christopher G Sobey
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Connie H Y Wong
- Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia.
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Does aneurysm side influence the infarction side and patients´ outcome after subarachnoid hemorrhage? PLoS One 2019; 14:e0224013. [PMID: 31697715 PMCID: PMC6837438 DOI: 10.1371/journal.pone.0224013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background The prognostic factors and outcome of aneurysms appear to be dependent on its locations. Therefore, we compared left- and right- sided aneurysms in patients with aneurysmal subarachnoid hemorrhage (SAH) in terms of differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. A total of 509 patients with aneurysmal subarachnoid hemorrhage were retrospectively selected and stratified in two groups depending on side of ruptured aneurysm (right n = 284 vs. left n = 225). Midline aneurysms of the basilar and anterior communicating arteries were excluded from the analysis. Outcomes were assessed using the modified Rankin Scale (mRS; favorable (mRS 0–2) vs. unfavorable (mRS 3–6)) six months after SAH. Results We did not identify any differences in outcome depending on left- and right-sided ruptured aneurysms. In both groups, the significant negative predictive factors included clinical admission status (WFNS IV+V), Fisher 3- bleeding pattern in CT, the occurrence of delayed cerebral ischemia (DCI), early hydrocephalus and later shunt-dependence. The side of the ruptured aneurysm does not seem to influence patients´ outcome. Interestingly, the aneurysm side predicts the side of infarction, with a significant influence on patients´ outcome in case of left-sided infarctions. In addition, the in multivariate analysis side of aneurysm was an independent predictor for the side of cerebral infarctions. Conclusion The side of the ruptured aneurysms (right or left) did not influence patients’ outcome. However, the aneurysm-side predicts the side of delayed infarctions and outcome appear to be worse in patients with left-sided infarctions.
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12
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Balint B, Jaremek V, Thorburn V, Whitehead SN, Sposato LA. Left atrial microvascular endothelial dysfunction, myocardial inflammation and fibrosis after selective insular cortex ischemic stroke. Int J Cardiol 2019; 292:148-155. [DOI: 10.1016/j.ijcard.2019.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/15/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023]
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13
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Raghu ALB, Parker T, van Wyk A, Green AL. Insula stroke: the weird and the worrisome. Postgrad Med J 2019; 95:497-504. [PMID: 31296791 DOI: 10.1136/postgradmedj-2019-136732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 01/10/2023]
Abstract
Infarction of the insula is a common scenario with large tissue-volume strokes in the middle cerebral artery territory. Considered to be part of the central autonomic network, infarction of this region is associated with autonomic disturbances, in particular cardiovascular dysregulation. Risk of aspiration following stroke is also associated with involvement of the insula, consistent with its purported participation in complex functions of the mouth and pharynx. Strokes restricted to the insula are rare and present with a broad range of symptoms that offer a window of insight into the diverse functionality of the insular cortex. Chemosensory, autonomic, vestibular, auditory, somatosensory, language and oropharyngeal functional deficits are all recognised, among others. Long-term sequelae are unknown but profound symptoms, such as hemiparesis, are usually transient. Understanding the patterns of dysfunction highlighted provides the basis for future strategies to optimise stroke management on the discovery of insula involvement.
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Affiliation(s)
| | - Tariq Parker
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - André van Wyk
- Acute Stroke Unit, Royal Berkshire Hospital, Reading, UK
| | - Alexander Laurence Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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14
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Horie N, Morofuji Y, Iki Y, Sadakata E, Kanamoto T, Tateishi Y, Izumo T, Anda T, Morikawa M, Tsujino A, Matsuo T. Impact of basal ganglia damage after successful endovascular recanalization for acute ischemic stroke involving lenticulostriate arteries. J Neurosurg 2019; 132:1880-1888. [PMID: 31151109 DOI: 10.3171/2019.3.jns182909] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Regional ischemic vulnerability of the brain reportedly differs between the cortex and basal ganglia and has been poorly assessed in the setting of endovascular mechanical thrombectomy. This study was conducted to determine the fate of an ischemic basal ganglia and its contribution to the clinical outcome after successful endovascular recanalization for acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries. METHODS Clinical and radiological findings were retrospectively analyzed in consecutive patients with acute ischemic stroke characterized by large vessel occlusion involving the lenticulostriate arteries. Mechanical thrombectomy was performed in all patients using a stent retriever. The fate of ischemic basal ganglia based on location (lentiform nucleus, caudate nucleus, and internal capsule) and insular cortex was assessed according to the Alberta Stroke Programme Early CT Score (ASPECTS). RESULTS Of 170 patients with large intracranial vessel occlusion who achieved successful endovascular recanalization, defined as a thrombolysis in cerebral infarction grade of ≥ 2B, involvement of the lenticulostriate arteries was seen in 55 patients (internal carotid artery, n = 35; proximal middle cerebral artery, n = 20). Preoperative infarction was detected in the lentiform nucleus (66.7%), internal capsule (11.1%), and caudate nucleus (33.3%), all of which showed secondary advancement despite successful recanalization (85.4%, 27.3%, and 54.5%, respectively; p < 0.05). Lenticulostriate arteries with a lateral proximal and/or medial proximal origin significantly affected the development of mature infarction in the lentiform nucleus. Postoperative hemorrhagic transformation was detected in 25 of 55 patients, mostly in the lentiform nucleus. Involvement of insular ribbon infarction was significantly high in patients with hemorrhagic transformation in the basal ganglia. Age, initial National Institutes of Health Stroke Scale (NIHSS) score, initial ASPECTS, postoperative ASPECTS, postoperative infarction in the insular ribbon, and lesions in the middle cerebral artery area (M1-M6) were significantly different between patients with good and poor modified Rankin Scale scores. Interestingly, no differences were detected in postoperative infarction or hemorrhagic transformation in the basal ganglia. Multivariate analysis showed that only age (p = 0.02, OR 0.88) and the initial NIHSS score (p = 0.01, OR 0.86) independently affected favorable clinical outcomes. CONCLUSIONS The basal ganglia are vulnerable and readily develop secondary infarction and hemorrhagic transformation despite successful recanalization. However, this does not have a significant impact on the clinical outcome of acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Minoru Morikawa
- 3Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
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15
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Lv Y, Han X, Song Y, Han Y, Zhou C, Zhou D, Zhang F, Xue Q, Liu J, Zhao L, Zhang C, Li L, Wang J. Toward neuroimaging-based network biomarkers for transient ischemic attack. Hum Brain Mapp 2019; 40:3347-3361. [PMID: 31004388 DOI: 10.1002/hbm.24602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022] Open
Abstract
Stroke is associated with topological disruptions of large-scale functional brain networks. However, whether these disruptions occur in transient ischemic attack (TIA), an important risk factor for stroke, remains largely unknown. Combining multimodal MRI techniques, we systematically examined TIA-related topological alterations of functional brain networks, and tested their reproducibility, structural, and metabolic substrates, associations with clinical risk factors and abilities as diagnostic and prognostic biomarkers. We found that functional networks in patients with TIA exhibited decreased whole-brain network efficiency, reduced nodal centralities in the bilateral insula and basal ganglia, and impaired connectivity of inter-hemispheric communication. These alterations remained largely unchanged when using different brain parcellation schemes or correcting for micro head motion or for regional gray matter volume, cerebral blood flow or hemodynamic lag of BOLD signals in the patients. Moreover, some alterations correlated with the levels of high-density lipoprotein cholesterol (an index related to ischemic attacks via modulation of atherosclerosis) in the patients, distinguished the patients from healthy individuals, and predicted future ischemic attacks in the patients. Collectively, these findings highlight the emergence of characteristic network dysfunctions in TIA, which may aid in elucidating pathological mechanisms and establishing diagnostic and prognostic biomarkers for the disease.
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Affiliation(s)
- Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yu Han
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China
| | - Chengshu Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Dan Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Fuding Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Qiming Xue
- Department of Image, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinling Liu
- Department of Ultrasonics, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lijuan Zhao
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Cairong Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lingyu Li
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
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16
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Jakimovski D, Topolski M, Kimura K, Marr K, Gandhi S, Ramasamy DP, Bergsland N, Hagemeier J, Weinstock-Guttman B, Zivadinov R. Abnormal venous postural control: multiple sclerosis-specific change related to gray matter pathology or age-related neurodegenerative phenomena? Clin Auton Res 2018; 29:329-338. [PMID: 30120624 DOI: 10.1007/s10286-018-0555-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Autonomic nervous system dysfunction has been previously observed in multiple sclerosis (MS) patients. OBJECTIVE To assess associations between magnetic resonance imaging-detected neuroinflammatory and neurodegenerative pathology and postural venous flow changes indicative of autonomic nervous system function. METHODS We used a standardized 3T magnetic resonance imaging protocol to scan 138 patients with MS and 49 healthy controls. Lesion volume and brain volumes were assessed. The cerebral venous flow (CVF) was examined by color-Doppler sonography in supine and upright positions and the difference was calculated as ΔCVF. Based on ΔCVF, subjects were split into absolute or quartile groups. Student's t test, χ2-test, and analysis of covariance adjusted for age and sex were used accordingly. Benjamini-Hochberg procedure corrected the p-values for multiple comparisons. RESULTS No differences were found between healthy controls and patients with MS in both supine and upright Doppler-derived CVF, nor in prevalence of abnormal postural venous control. Patients with absolute negative ΔCVF had higher disability scores (p = 0.013), lower gray matter (p = 0.039) and cortical (p = 0.044) volumes. The negative ΔCVF MS group also showed numerically worse bladder/bowel function when compared to the positive ΔCVF (2.3 vs. 1.5, p = 0.052). Similarly, the lowest quartile ΔCVF MS group had higher T1-lesion volumes (p = 0.033), T2-lesion volumes (p = 0.032), and lower deep gray matter (p = 0.043) and thalamus (p = 0.033) volumes when compared to those with higher ΔCVF quartiles. CONCLUSION No difference in postural venous outflow between patients with MS and healthy controls was found. However, when the abnormal ΔCVF is present within the MS population, it may be associated with more inflammatory and neurodegenerative pathology. Further studies should explore whether the orthostatic venous changes are an aging or an MS-related phenomenon and if the etiology is due to impaired autonomic nervous system functioning.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Matthew Topolski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Kana Kimura
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Karen Marr
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Sirin Gandhi
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Deepa P Ramasamy
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Jesper Hagemeier
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs MS Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA. .,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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17
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Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke. Sci Rep 2018; 8:9498. [PMID: 29934530 PMCID: PMC6015086 DOI: 10.1038/s41598-018-27883-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/30/2018] [Indexed: 12/02/2022] Open
Abstract
The prognostic relevance of strokes in different locations is debated. For example, insular strokes have been associated with increased mortality, but this association could reflect their greater severity. In two independent cohorts of patients with supratentorial ischemic stroke (n = 90 and 105), we studied the prognostic consequences of lesion size and location using voxel-based lesion-symptom mapping before and after volume control, which better accounts for total lesion volume. Strokes affecting the insula were larger than non-insular strokes (28 vs 2cc and 25 vs 3cc, p < 0.001 in both cohorts). A number of supratentorial areas (mainly in the left hemisphere), including the insula, were associated with poor functional outcome in both cohorts before (4014 voxels) and after volume control (1378 voxels), while the associations with death were greatly reduced after volume control (from 8716 to 325 voxels). Exploratory analyses suggested that the method of lesion volume quantification, the National Institutes of Health Stroke Scale hemispheric bias and patient selection can result in false associations between specific brain lesions and outcomes. In conclusion, death in the first months after stroke is mainly explained by large infarct volumes, whereas lesions of specific supratentorial structures, mostly in the left hemisphere, also contribute to poor functional outcomes.
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18
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Mai LM, Sposato LA. Insular damage, death and newly diagnosed atrial fibrillation in intracerebral hemorrhage: stroke‐induced heart injury as the potential missing link. Eur J Neurol 2018; 25:423-424. [DOI: 10.1111/ene.13558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. M. Mai
- Department of Medicine (Division of Neurology) McMaster University Hamilton ON
| | - L. A. Sposato
- Department of Clinical Neurological Sciences Western University London ON
- Stroke Dementia and Heart Disease Laboratory Western University London ON
- Department of Epidemiology and Biostatistics Western University London ON
- Department of Anatomy and Cell Biology Western University London ON Canada
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19
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Prats‐Sánchez L, Guisado‐Alonso D, Painous C, Fayos F, Pascual‐Goñi E, Delgado‐Mederos R, Martínez‐Domeño A, Camps‐Renom P, Martí‐Fàbregas J. Insular damage, new‐onset atrial fibrillation and outcome after acute intracerebral hemorrhage. Eur J Neurol 2017; 25:491-496. [DOI: 10.1111/ene.13522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022]
Affiliation(s)
- L. Prats‐Sánchez
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - D. Guisado‐Alonso
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - C. Painous
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - F. Fayos
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - E. Pascual‐Goñi
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - R. Delgado‐Mederos
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - A. Martínez‐Domeño
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - P. Camps‐Renom
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - J. Martí‐Fàbregas
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau) Department of Neurology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
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20
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Kijpaisalratana N, Chutinet A, Suwanwela NC. Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First? Front Neurol 2017; 8:664. [PMID: 29270151 PMCID: PMC5725403 DOI: 10.3389/fneur.2017.00664] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/23/2017] [Indexed: 11/26/2022] Open
Abstract
Concurrent acute ischemic stroke and acute myocardial infarction is an uncommon medical emergency condition. The challenge for the physicians regarding the management of this situation is paramount since early management of one condition will inevitably delay the other. We present two illustrative cases of “hyperacute simultaneous cardiocerebral infarction” who presented with simultaneous cardiocerebral infarction and arrived at the hospital within the thrombolytic therapeutic window for acute ischemic stroke of 4.5 h. We propose an algorithm for managing the patient with hyperacute simultaneous cardiocerebral infarction based on hemodynamic status and suggest close cardiac monitoring based on the site of cerebral infarction.
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Affiliation(s)
| | - Aurauma Chutinet
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, Bangkok, Thailand
| | - Nijasri C Suwanwela
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, Bangkok, Thailand
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21
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Alves JN, Pinho J, Ferreira C. Letter by Alves et al Regarding Article, "Effect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial)". Stroke 2017; 48:e91. [PMID: 28174329 DOI: 10.1161/strokeaha.116.016373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - João Pinho
- Neurology Department, Hospital de Braga, Portugal
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22
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Sposato LA, Wardlaw JM, Hachinski V. Response by Sposato et al to Letter Regarding Article, "Effect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial)". Stroke 2017; 48:e92. [PMID: 28174325 DOI: 10.1161/strokeaha.116.016387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada, Stroke, Dementia and Heart Disease Laboratory, Western University, London, Ontario, Canada
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
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23
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Sposato LA, Hachinski V. Right insular cortex involvement is consistently associated with death after ischaemic stroke. Eur J Neurol 2016; 24:1-2. [PMID: 27797138 DOI: 10.1111/ene.13174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L A Sposato
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - V Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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