Frontiers in stroke最新文献

{"title":"Safety and efficacy of tirofiban after early neurological deterioration in patients with branch atheromatous disease receiving alteplase","authors":"Xuemin Zhong, Meng Zhao, Ronghua Xu, Jian Wang, J. Du","doi":"10.3389/fstro.2022.968510","DOIUrl":"https://doi.org/10.3389/fstro.2022.968510","url":null,"abstract":"Objectives No standard treatment exists for branch atheromatous disease (BAD), and patients' conditions often worsen after thrombolytic therapy. We evaluated the safety and effectiveness of tirofiban after early neurological deterioration (END) development in patients receiving intravenous alteplase. Materials and methods Bleeding incidence, National Institute of Health Stroke Scale (NIHSS) score, and modified Rankin scale (mRS) score were assessed for patients with BAD receiving alteplase within 4.5 h of stroke onset. Results Among 193 patients, 119 (61.64%) did not experience exacerbation after thrombolytic treatment, 74 (38.34%) had END, 34 were treated with tirofiban after END, and 40 received standard treatment. On day 7 or at discharge, no cases of symptomatic cerebral hemorrhage were noted, and no patient died during the 90-day follow-up. Fifty-two of 74 patients (70.27%) had a good mRS score at 90 days. Among patients with END who received tirofiban, 27 (79.41%) had a good mRS score at 90 days, which was significantly better than that of the 18 cases that did not receive tirofiban after exacerbation (45%; P < 0.001). NIHSS scores were significantly lower 24 h, 48 h, and 7 days after tirofiban treatment in patients with exacerbation after thrombolytic therapy than in those without tirofiban treatment. Conclusions Patients with BAD have elevated risks of END after thrombolytic therapy. Compared with conventional oral antiplatelet aggregation drugs, tirofiban rescue therapy resulted in significantly better NIHSS and mRS scores without increased symptomatic cerebral hemorrhage rates.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89636035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive Sleep Apnea (OSA) and Patent Foramen Ovale (PFO), the “Perfect Storm” for a Cryptogenic Stroke? Case Series of Four Patients","authors":"A. Schwarz, Albert Lee, Nancy E Gadallah, Jessalyn Wong, Divya Gupta","doi":"10.3389/fstro.2022.916154","DOIUrl":"https://doi.org/10.3389/fstro.2022.916154","url":null,"abstract":"We were intrigued by the finding of severe obstructive sleep apnea (OSA) in patients referred to our Sleep Clinic with a history of stroke at a relatively young age, in the setting of a patent foramen ovale (PFO). This prompted us to do a literature search to see the association of OSA with stroke in such a patient population. The correlation of PFOs with cryptogenic strokes is well established, as is that of OSA with stroke. However, not many studies have looked at the correlation between OSA and PFO in patients with cryptogenic strokes.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87689350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grand challenges in stroke genomics","authors":"M. Fornage","doi":"10.3389/fstro.2022.984176","DOIUrl":"https://doi.org/10.3389/fstro.2022.984176","url":null,"abstract":"COPYRIGHT © 2022 Fornage. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Grand challenges in stroke genomics","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88528071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitivity and specificity of vessel wall MRI sequences to diagnose central nervous system angiitis","authors":"Lorenzo Ferlini, N. Ligot, Arab Rana, L. Jodaitis, N. Sadeghi, V. Destrebecq, G. Naeije","doi":"10.3389/fstro.2022.973517","DOIUrl":"https://doi.org/10.3389/fstro.2022.973517","url":null,"abstract":"Magnetic resonance imaging (MRI) with intracranial vessel wall (IVW) sequences is able to directly characterize disease processes affecting the VW increasing the accuracy of intracranial vasculopathies differential diagnosis. Nevertheless, data concerning the specificity and sensitivity of this technic for diagnosis of angiitis of the central nervous system (ACNS) are scant. We aimed at quantifying the IVW abnormalities in a cohort of primary and secondary ACNS and assessing the specificity of ACNS-associated IVW MRI abnormalities. We retrospectively included 36 patients with a diagnosis of ACNS with IVW imaging and we compared IVW MRI abnormalities with those of fifty successive patients admitted at the stroke unit for acute neurological deficit (stroke-unit-group). Since an ACNS was retained as cause of the acute neurological deficit in two patients in the stroke-unit-group, they were finally included in the ACNS group. In our cohort, headache and cognitive disorders were present in 29 and 55% of cases respectively, seizure were rare (n = 5, 13%). CSF analysis were abnormal in 29 patients (76%). MRI showed lesion with restricted diffusion in 82% of patients (n = 31). In 71% of our ACNS population (n = 27) multifocal vessel abnormalities were described in angiographic MRI sequences. Digital subtraction angiography (DSA) was performed in 14 patients and it was suggestive of an ACNS in 11 (79%). Brain-meningeal biopsy was performed in two cases (5%). The typical ACNS-associated IVW abnormalities, i.e., the multifocal concentric VW enhancement with wall thickening, was found in the 95% of ACNS patients (n = 36) whereas it was reported in 4% (n = 2) of the stroke-unit-group (specificity and sensitivity of concentric VW enhancement for ACNS diagnosis of 95% and 94%, respectively). IVW enhancement co-localized with multifocal angiographic stenosis in ACNS patients. The clinical, laboratory and imaging findings were comparable to those of previously described ACNS cohorts in the literature, and particularly to those of DSA-diagnosed patients. Our results suggest that concentric VW enhancement could efficaciously identify patients affected by medium-sized vessels CNS vasculitis with a specificity of 95% and sensitivity of 94%. Further studies with larger samples are necessary to confirm our findings.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91208984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandarin Stroke Social Network Scale and Item Response Theory","authors":"Chun Feng, Qing-Ling Lai, A. Ferland, Feng Lin","doi":"10.3389/fstro.2022.903289","DOIUrl":"https://doi.org/10.3389/fstro.2022.903289","url":null,"abstract":"Background Stroke survivors may have difficulty in social integration due to physical or mental disorders across the entire continuum of disease. Higher perceived social support can promote social participation for persons following a stroke. However, no scale is available to investigate the perceived social support among the Chinese post-stroke population. Objectives The current study addresses this gap by developing the Mandarin version of the Stroke Social Network Scale (M-SSNS) and examining the reliability and validity of this scale. This study also utilizes the Item Response Theory (IRT) model as a bridge between social ability and functional status. Methods The convenience sampling method was followed to recruit 71 inpatient post-stroke individuals. All participants were evaluated by the modified Barthel Index (MBI), M-SSNS, and the Extended International Classification of Functioning, Disability, and Health (ICF) Core Set for Stroke. The reliability of M-SSNS was explored based on the IRT model. The validity of the scale was further confirmed by assessing the correlation between estimated personal social competence and the final score of the 19-item M-SSNS, and the correlation between estimated personal social competence and functional status based on the ICF. Results A total of 71 patients with stroke (53 males and 18 females) were included in this research. Fourteen items of M-SSNS were selected to represent personal social ability according to the unidimensional 3-parameter logistic (3PL) IRT model. The Cronbach's α of the 14-item scale was 0.7192, with the Guttman's λ2 = 0.7567, Molenaar Sijtsma ρ = 0.7491, and latent class reliability coefficient = 0.8657, indicating that the M-SSNS had great internal consistency. The estimated individual social competence by the 14-item 3PL model was highly related to the final score of the 19-item M-SSNA (p < 0.001, r = 0.79). The correlation between the personal functional status and social ability was 0.23 (p = 0.049, r = 0.23). Conclusion The 14-item M-SSNS manifests great reliability and acceptable validity. Based on the IRT, the 14-item M-SSNS is also a promising tool to assess the social structure and provide customized relationship consulting, education, and advice among the Chinese stroke population.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81843051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Stent Retriever Thrombectomy Combined With Local Urokinase Thrombolysis for Deep Cerebral Vein Thrombosis: A Case Report","authors":"Qunli Xu, Yigang Chen, Xu Zheng, X. Jin, Jinhua Zhang","doi":"10.3389/fstro.2022.901694","DOIUrl":"https://doi.org/10.3389/fstro.2022.901694","url":null,"abstract":"Background Deep cerebral vein (DCV) thrombosis is a rare type of cerebrovascular disorder and usually has an unfavorable prognosis. Although endovascular treatment measures for venous sinus thrombosis are well-described and evidenced, relevant reports on DCV thrombosis are presently lacking. Case Report In this report, we present the first case of the successful use of stent retriever thrombectomy combined with local urokinase thrombolysis for DCV thrombosis and have described the detailed procedure. Conclusion The use of stent retriever thrombectomy combined with local thrombolysis was technically feasible and effective for DCV thrombosis. The key to the successful restoration of DCV outflow was to recanalize the occluded vein of Galen.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76464645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-Spinal Direct Current Stimulation in Spasticity: A Literature Mini-Review","authors":"M. A. Estudillo-Guerra, I. Mesia-Toledo, Noga Rogel, N. Yaghoubi, Z. Ahmed, R. Black-Schaffer, L. Morales-Quezada","doi":"10.3389/fstro.2022.921450","DOIUrl":"https://doi.org/10.3389/fstro.2022.921450","url":null,"abstract":"Spasticity is common after a stroke and has a negative impact on functional and quality-of-life measures. There is an unmet medical need to provide safe and effective treatment using non-pharmacological approaches. Trans-spinal direct current stimulation (tsDCS) is an emerging modality for non-invasive neuromodulation that induces reduction of spinal excitability leading to a decrease in spasticity. We describe current treatment options for spasticity, including a literature review about the use of tsDCS in patients with spasticity. We found four clinical studies that used tsDCS to treat spasticity for different neurological conditions including hereditary spastic paraplegia, upper extremity spasticity following stroke, multiple sclerosis, and incomplete chronic spinal cord injury. Spasticity was the primary outcome in three of the studies and a secondary outcome in the final study. The three studies that addressed spasticity as the primary outcome found that active tsDCS decreased spasticity compared to sham. These studies suggest that tsDCS can modulate spinal motor and sensory spinal pathways through the use of specific electrode montages and stimulation parameters. This therapy can improve motor functions and may represent a viable treatment option for spasticity.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"195 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79582801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The profile of inflammatory extracellular vesicles in intracerebral hemorrhage patients.","authors":"Harshal Sawant, Trevor Bihl, Doan Nguyen, Ifeanyi Iwuchukwu, Ji Bihl","doi":"10.3389/fstro.2022.988081","DOIUrl":"10.3389/fstro.2022.988081","url":null,"abstract":"<p><strong>Background: </strong>Intracerebral hemorrhage (ICH) is one of the leading life-threatening types of strokes with high mortality. A prominent feature of ICH is neuroinflammation involving leukocytes, such as neutrophils and macrophages. Large extracellular vesicles (lEV) and small extracellular vesicles (sEV) released from various cells are used as biomarkers for different diseases. Here, we aimed to determine the concentration/population of lEV and sEV from different leukocytes in ICH patients and analyze the correlation of these lEV/sEV with clinical parameters.</p><p><strong>Methods: </strong>lEV and sEV were isolated from the plasma of ICH patients (n = 39) by using the serial centrifuge methods. Nanoparticle tracking analysis (NTA, NS300) was used to determine the type and concentration of different leukocytes-released lEV/sEV. Specific antibodies, CD66b, P2RY12, and CD80 were used for different leukocyte types.</p><p><strong>Results: </strong>A predictive relationship between both hospital length of stay (<i>R</i> ² = 0.83) and Intensive care units (ICU) length of stay (<i>R</i> ² = 0.88) was found with lEV and sEV and patient data [including low-density lipoprotein (LDL), ICH volume, etc.]. Further predictive-multiple linear regression relationship was seen between lEV and sEV concentrations and MRSV3 (Modified Rankin Scale at 90 days) (<i>R</i> ² = 0.46) and MRSV5 (modified Rankin Scale at 180 days) (<i>R</i> ² = 0.51). Additionally, a slight, but statistically significant (<i>p</i> = 0.0151), multiple linear regression relationship was seen between lEV and sEV concentrations and ICU length of stay (<i>R</i> ² = 0.26).</p><p><strong>Conclusion: </strong>This study found predictive relationships between patient outcomes and lEV and sEV. When combined with generally collected patient data (LDL, etc.), measurements of lEV and sEV are strongly predictive of overall patient outcome. Further, larger studies should investigate these effects.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"320 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77784578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbial dysbiosis correlates with stroke severity markers in aged rats.","authors":"Tyler C Hammond, Sarah Messmer, Jacqueline A Frank, Doug Lukins, Rita Colwell, Ai-Ling Lin, Keith R Pennypacker","doi":"10.3389/fstro.2022.1026066","DOIUrl":"10.3389/fstro.2022.1026066","url":null,"abstract":"<p><strong>Background: </strong>An imbalanced gut microbial community, or dysbiosis, has been shown to occur following stroke. It is possible that this dysbiosis negatively impacts stroke recovery and rehabilitation. Species level resolution measurements of the gut microbiome following stroke are needed to develop and test precision interventions such as probiotic or fecal microbiota transplant therapies that target the gut microbiome. Previous studies have used 16S rRNA amplicon sequencing in young male mice to obtain broad profiling of the gut microbiome at the genus level following stroke, but further investigations will be needed with whole genome shotgun sequencing in aged rats of both sexes to obtain species level resolution in a model which will better translate to the demographics of human stroke patients.</p><p><strong>Methods: </strong>Thirty-nine aged male and female rats underwent middle cerebral artery occlusion. Fecal samples were collected before stroke and 3 days post stroke to measure gut microbiome. Machine learning was used to identify the top ranked bacteria which were changed following stroke. MRI imaging was used to obtain infarct and edema size and cerebral blood flow (CBF). ELISA was used to obtain inflammatory markers.</p><p><strong>Results: </strong>Dysbiosis was demonstrated by an increase in pathogenic bacteria such as <i>Butyricimonas virosa</i> (15.52 fold change, <i>p</i> < 0.0001), <i>Bacteroides vulgatus</i> (7.36 fold change, <i>p</i> < 0.0001), and <i>Escherichia coli</i> (47.67 fold change, <i>p</i> < 0.0001). These bacteria were positively associated with infarct and edema size and with the inflammatory markers Ccl19, Ccl24, IL17a, IL3, and complement C5; they were negatively correlated with CBF. Conversely, beneficial bacteria such as <i>Ruminococcus flavefaciens</i> (0.14 fold change, <i>p</i> < 0.0001), <i>Akkermansia muciniphila</i> (0.78 fold change, <i>p</i> < 0.0001), and <i>Lactobacillus murinus</i> (0.40 fold change, <i>p</i> < 0.0001) were decreased following stroke and associated with all the previous parameters in the opposite direction of the pathogenic species. There were not significant microbiome differences between the sexes.</p><p><strong>Conclusion: </strong>The species level resolution measurements found here can be used as a foundation to develop and test precision interventions targeting the gut microbiome following stroke. Probiotics that include <i>Ruminococcus flavefaciens, Akkermansia muciniphila, and Lactobacillus murinus</i> should be developed to target the deficit following stroke to measure the impact on stroke severity.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9945937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10800047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}