Journal of neurological disorders & stroke最新文献

{"title":"Racial Differences in Small Vessel Disease Measured in MRI of Ischemic Stroke/TIA Patients.","authors":"Chylee Martin, Karly Pikel, Stefanie Wood, Makenzie Logue, Rachel Mascari, Nishanth Kodumuri, Souvik Sen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>White matter hyperintensities (WMH) and cerebral microbleeds (CMB) are manifestations of cerebral small vessel disease (SVD). We investigated the racial differences in SVD among African American (AA) and white patients with stroke/TIA.</p><p><strong>Methods: </strong>Magnetic resonance imaging (MRI) of brain in consecutive patients were assessed in four years as part of a study. Deep and periventricular WMHs (DWMHs and PVWMHs, respectively) were rated visually on axial fluid-attenuated inversion recovery (FLAIR) sequence using the 3-point Fazekas scale and categorized into none/mild (grades 0 and 1) or moderate/severe (grades 2 and 3). Gradient echo imaging was used to categorize CMBs for number, location, and topography. Patient demographics were collected including vascular risk factors, periodontal disease (PD), and index event (TIA, stroke, and stroke subtype). Univariate (t-tests for continuous variables, and X2 test for categorical variables) and multivariable analyses (multiple logistic regression) were conducted to assess the association between race and SVD.</p><p><strong>Results: </strong>A total of 861 patients, 469 AA and 360 white, were compared for moderate/severe PVWMH, DWMH, and CMB ≥5. White patients were older (67±11 vs. 60±13, p <0.001) and more likely to be male (60% vs. 52%, p = 0.02). AA patients were more likely to be hypertensive (91% vs. 85%, p = 0.006), diabetic (49% vs. 40%, p = 0.009), and have moderately severe gum disease (55% vs. 36%, p <0.001). AA race was associated with PVWMH (Adjusted OR 1.83, 95% 1.32-2.55) adjusted for age, gender, hypertension, diabetes, and PD. AA race was associated with DWMH (Adjusted OR 1.5, 95% 1.08-2.1) adjusted for age, hypertension, diabetes, and PD. AA race was associated with CMB ≥5 (Adjusted OR 3.93, 95% 1.08-14.36) adjusted for age and hypertension.</p><p><strong>Conclusion: </strong>We report an independent association between AA race and various manifestations of SVD including moderate/severe DWMH, PVWMH, and CMB ≥5 in stroke/TIA patients.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438325","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":"Autoregulation of White Matter Cerebral Blood Flow to Arterial Pressure Changes in Normal Subjects.","authors":"William Powers,&nbsp;Hongyu An,&nbsp;Jonathan Oakes,&nbsp;Joseph Eron,&nbsp;Kevin Robertson,&nbsp;Souvik Sen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endothelial dysfunction causing impaired cerebrovascular vasodilatory capacity in response to reduced blood pressure has been proposed as a mechanism of white matter (WM) disease development. This study investigated autoregulation of CBF to blood pressure reduction in WM and gray matter (GM) in normal subjects recruited as controls for a study of cerebrovascular function in human immunodeficiency virus positive subjects. They underwent baseline CBF and oxygen extraction fraction measurement by MRI before and after mean arterial pressure (MAP) reduction. Autoregulatory Index (AI) was computed as CBF AI = -%CBF change/% MAP change. Thirty of 44 subjects achieved target MAP reduction. MAP was reduced -13.65 ± 2.35 (range 10 to 20) %. WM AI of -0.61 ± 1.23 was significantly more negative than GM AI of 0.02 ± 0.44 (paired t test, p= 0.016). WM CBF fell (paired Wilcoxon, p= 0.03) whereas GM CBF did not change (paired Wilcoxon, p=0.92). WM AI was different from 0 (p=0.011, one-sample t-test vs 0), whereas GM AI was not (p=0.913, one-sample t-test vs 0). These data demonstrate that maintenance of CBF to 10-20% reductions in MAP is less effective in WM than in GM. This may put WM at higher risk for ischemic damage.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9447844/pdf/nihms-1783797.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40360721","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":"Neuroendocrine Targeting of Tissue Plasminogen Activator (t-PA).","authors":"Robert J Parmer,&nbsp;Yun Gong,&nbsp;Seung Hyun Yoo,&nbsp;Lindsey A Miles","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>t-PA has a widespread neuroendocrine distribution including prominent expression in chromaffin cells of the sympathoadrenal system. Chromaffin cell t-PA is sorted into catecholamine storage vesicles and co-released with catecholamines in response to sympathoadrenal activation, suggesting that catecholamine storage vesicles may serve as a reservoir for the rapid release of t-PA. Chromogranin A (CgA), a major core protein in secretory vesicles throughout the neuroendocrine system, may play a crucial role in targeting proteins into the regulated secretory pathway, by forming aggregated \"granin\" complexes to which other proteins destined for the regulated secretory vesicle bind and become separated from constitutively secreted proteins in the trans-Golgi network (TGN). Formation of such complexes is facilitated by conditions of the TGN (low pH, high Ca⁺²). We tested the hypothesis that t-PA interacts specifically with CgA and that this interaction is enhanced under conditions of the TGN. Immobilized t-PA was incubated with ¹²⁵I-CgA. t-PA interacted specifically and saturably with CgA and the interaction was domain-specific, mediated by the EGF/finger and kringle 1 domains of t-PA and by a specific internal hydrophilic domain within CgA (KERTHQQKKHSSYEDELSEVL) as assessed by antibody and peptide competition studies. The interaction of t-PA with aggregated CgA complexes may play a role in the targeting of t-PA and its release from neurosecretory cells. These results may have broad implications for the regulation of local neurosecretory cell plasminogen activation under both normal physiological conditions and pathological conditions including cerebral ischemia.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297194/pdf/nihms-1583138.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38058418","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":"Disparity among neural injury models and the unfolded protein response.","authors":"Aric Flint Logsdon,&nbsp;Brandon Peter Lucke-Wold,&nbsp;Charles Lee Rosen,&nbsp;Jason Delwyn Huber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endoplasmic reticulum stress is activated following both stroke and traumatic brain injury producing reactive oxgygen species, increasing intracellular calcium levels, and inducing inflammation; however, the timing and duration of activation varies between injuries. Preventing the immediate effects of ischemic/reperfusion injury or traumatic brain injury is challenging due to short onset of injury, but mitigating the secondary effects is a therapeutically targetable option. Preventative therapies using pharmacological agents have been utilized in pre-clinical models of neural injury to ameliorate secondary effects such as apoptosis and neurodegeneration. The connection between ER stress activation, apoptosis, and subsequent neurodegeneration has been proposed, but not yet causally linked. Researchers are now pursuing effective treatment strategies to suppress the secondary effects of neural injury in order to mitigate the development of chronic deficits. Secondary effects such as endoplasimic reticulum stress and neuroinflammation can be prevented in pre-clinical models, but the results have yet to translate to meaningful treatment options for patients. Evidence suggests that targeting the right transcription factors, at the right time, will aid in the prevention of apoptosis and neurodegenerative disease development following neural injury. In this review, we examine therapeutic approaches that target secondary injury and how these may correlate to better treatment options for patients.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896636/pdf/nihms789405.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34456940","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":"The NIHSS Score and its Components can Predict Cortical Stroke.","authors":"E Alton Sartor, Karen Albright, Amelia K Boehme, Miriam M Morales, Amir Shaban, James C Grotta, Sean I Savitz, Sheryl Martin-Schild","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Neuroprotective agents have the potential to reduce ischemia to penumbra of the cortex, but are time-sensitive. To quickly determine whether a cortical stroke is present without imaging, we created a scoring system based on the NIH stroke scale (NIHSS) that can accurately predict cortical damage in an acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>Patients treated with tPA for AIS were retrospectively assessed through prospectively acquired databases at two stroke centers. Stroke was classified as cortical vs. non-cortical stroke. The total NIHSS score, cortical components (gaze, visual fields, language, and neglect) and cortical score (sum of cortical components) were analyzed for site 1 and then validated for site 2 for sensitivity and positive predictive value (PPV) for a cortical stroke.</p><p><strong>Results: </strong>An acute infarct was detected in 194/239 (81%) patients at site 1 and 122/174 (70%) at site 2 on diffusion-weighted MRI. Cortical involvement was found in 71% (site 1) and 75% (site 2). The median cortical score was 25% of the total NIHSS score at both sites. NIHSS ≥ 4 had the highest sensitivity; PPV was 90% for any cortical sign with ≥ 2 points. The best combination of sensitivity and PPV was cortical score/NIHSS score ≥10%.</p><p><strong>Discussion: </strong>If a trial targeting cortical stroke required that the cortical score represent at least 10% of the total NIHSS score with no imaging, less than 10% of patients with cortical stroke would be missed and less than 18% of patients would be misclassified as having a cortical stroke.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"2 1","pages":"1026"},"PeriodicalIF":0.0,"publicationDate":"2013-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904284/pdf/nihms539857.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32079651","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":"The Potential Impact of Maintaining a 3-Hour IV Thrombolysis Window: How Many More Patients can we Safely Treat?","authors":"Michael J Lyerly, Karen C Albright, Amelia K Boehme, Reza Bavarsad Shahripour, James T Houston, Pawan V Rawal, Niren Kapoor, Muhammad Alvi, April Sisson, Anne W Alexandrov, Andrei V Alexandrov","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In 2008, the European Cooperative Acute Stroke Study-3 (ECASS-3) demonstrated that intravenous-tissue plasminogen activator could be safely administered for acute stroke patients presenting between 3 and 4.5 hours from symptom onset. Recently, the Food and Drug Administration rejected expansion of this time window in the United States. We sought to determine how many fewer patients would be treated by maintaining this restricted time window.</p><p><strong>Methods: </strong>We reviewed charts from patients who received intravenous thrombolysis at the University of Alabama at Birmingham between January 2009 and December 2011. Patients were divided into two groups (treated within 3 hours of onset, treated between 3 and 4.5 hours from onset). Demographics, stroke severity and protocol deviations according to the ECASS-3 trial were collected. Our safety measures were any hemorrhagic transformation, symptomatic intracerebral hemorrhage and systemic hemorrhage.</p><p><strong>Results: </strong>Two hundred and twelve patients were identified, of whom 192 were included in our analysis. A total of 36 patients (19%) were treated between 3 and 4.5 hours. No statistical differences were seen between age (p=0.633), gender (p=0.677), race (p=0.207) or admission stroke severity (p=0.737). Protocol deviations from the ECASS-3 criteria were found in 20 patients (56%). These were primarily age > 80 and aggressive blood pressure management. Despite these deviations, we did not see significant increases in the rates of adverse events in patients treated in the extended time window.</p><p><strong>Conclusions: </strong>Our data are consistent with previously reported international data that IV thrombolysis can safely be used up to 4.5 hours from symptom onset. Restricting the time window to 3 hours would have resulted in almost one-fifth fewer patients treated at our center.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"1 2","pages":"1015"},"PeriodicalIF":0.0,"publicationDate":"2013-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901990/pdf/nihms539863.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32068356","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":"Elevated Plasma Factor VIII in Patients with Ischemic Stroke: Does it have any Association with Hypertensive Heart Disease?","authors":"Joseph Tarsia, Tiffany R Chang, Aimee Aysenne, Amelia K Boehme, Alton E Sartor, Karen C Albright, Ethan Arda Yalvac, Rebecca Kruse-Jarres, Cindy Leissinger, Sheryl Martin-Schild","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Elevated factor VIII (FVIII) has been linked with higher risk of vascular events. We aimed to determine the relationship between FVIII and hypertension in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>FVIII levels and transthoracic echocardiogram reports were reviewed in patients with acute ischemic stroke who presented to our stroke center between July 2008 and September 2011. Presenting systolic and diastolic blood pressure, history of hypertention, left ventricular hypertrophy, diastolic dysfunction, and depressed left ventricular function (ejection fraction <50%) were compared in patients with normal and elevated FVIII levels.</p><p><strong>Results: </strong>No differences in presenting blood pressure or frequency of hypertension history were found based on FVIII level. Patients with elevated FVIII had demonstrated a statistically significant higher frequency of diastolic dysfunction (64.8 vs. 43.6%, p=0.042) and a trend towards higher frequency of left ventricular hypertrophy (18.5 vs 5.1%, p=0.073). Median FVIII was significantly higher in patients with left ventricular hypertrophy (194.4 vs 152.9%, p=0.042) and diastolic dysfunction (180.5 vs 149.3%, p=0.031) than patients without these findings.</p><p><strong>Conclusions: </strong>Among patients with acute ischemic stroke, FVIII levels were higher when there was evidence of hypertensive heart disease. Synthesis of FVIII may be augmented by the ongoing presence of shear stress and could contribute to the higher risk of vaso-occlusive events in patients with elevated FVIII.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"1 3","pages":"1027"},"PeriodicalIF":0.0,"publicationDate":"2013-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350327/pdf/nihms539860.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32994430","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":"Feasibility and Findings from a Novel Working Memory fMRI Paradigm in Multiple Sclerosis.","authors":"F Nelson,&nbsp;J Steinberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Functional MRI (fMRI) basic cognitive paradigms such as the n-back have been shown to detect cognitive impairment (CI) in Multiple Sclerosis (MS). The immediate memory task/delayed memory task (IMT/DMT) detects varying degrees of working memory (WM) by alternating three levels of complexity and two levels of WM delay. This paradigm has not been evaluated in MS nor validated against standard neuropsychological (NP) testing.</p><p><strong>Objective: </strong>To evaluate the correlation between WM function and blood oxygen level dependent (BOLD) activation on fMRI in MS patients undergoing the IMT/DMT. To compare IMT/DMT behavioral scores to NP scores.</p><p><strong>Methods: </strong>10 MS patients with no history of CI underwent the Minimal Assessment of Cognitive Function in MS (MACFIMS) and an fMRI session where they performed the IMT/DMT. Working-memory (\"wmem\") activation was defined as the BOLD signal during DMT blocks for a particular condition (3, 5, or 7 digits per stimuli) minus the BOLD signal during IMT blocks for that condition. Areas of statistically significant Family Wise Error (FWE) -corrected cluster-level BOLD activation were identified using SPM8 Random Effects t-test. IMT/DMT behavioral data and MACFIMS scores were compared.</p><p><strong>Results: </strong>The 3-digit as well as the 5-digit wmem showed significant fMRI BOLD activation. The 3-digit wmem, activation was found in portions of the bilateral superior and mid frontal cortex, supplementary motor area, pre and post central gyrus, bilateral superior and inferior parietal lobule, inferolateral pre-frontal cortex, cuneus, insula and cingulate regions. The 5 digit wmen activation was seen in the inferior medial frontal and medial orbitofrontal cortex. IMT/DMT behavioral scores were within normal range and consistent with MACFIMS.</p><p><strong>Conclusion: </strong>IMT/DMT, a novel fMRI working memory paradigm, is associated with BOLD activation in areas of the brain related to cognitive function in patients with MS. Both MACFIMS and IMT/DMT scores were in agreement and supported intact cognitive function.</p>","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"1 2","pages":"1011"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996842/pdf/nihms558333.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32296631","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":"Cerebellar Ataxia and <i>CoQ10</i> Deficiency.","authors":"Catarina M Quinzii,&nbsp;Michio Hirano,&nbsp;Ali Naini","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89984,"journal":{"name":"Journal of neurological disorders & stroke","volume":"1 1","pages":"1004"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130390/pdf/nihms585450.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32588386","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}