Austin journal of cerebrovascular disease & stroke最新文献

{"title":"Bioinformatic Identification of Differentially Expressed Genes and Pathways in Intracranial Aneurysm","authors":"Q. Tian, S. Han, W. Zhang, P. Gong, Z. Xu, Q. Chen, M. Li","doi":"10.26420/AUSTINJCEREBROVASCDISSTROKE.2021.1087","DOIUrl":"https://doi.org/10.26420/AUSTINJCEREBROVASCDISSTROKE.2021.1087","url":null,"abstract":"Background: Intracranial Aneurysm (IA) is a serious disease with high mortality and high morbidity rates, but the pathophysiological mechanisms of IA remain unclear. This study aimed to identify the Differentially Expressed Genes (DEGs) between IA tissues and Superficial Temporal Artery (STA) tissues using bioinformatic analysis. Methods: To investigate the key genes that are important for IAs, we analyzed microarray datasets (GSE75436) from the Gene Expression Omnibus (GEO) database, including 15 IA samples and 15 normal STA samples. First, we used the GEO2R tool to screen for DEGs (P-value<0.01 and |log2 FC| ≥2) between IA and STA tissues. Subsequently, the Database for Annotation, Visualization, and Integrated Discover software was used to perform function and pathway enrichment analyses. Finally, protein-protein interaction network analysis was performed using the Search Tool for Retrieval of Interacting Genes and Cytoscape software. Real-Time Quantitative Polymerase Chain Reaction (RT-QPCR) was performed to prove our assumption. Results: A total of 829 DEGs, of which 399 were upregulated and 430 were downregulated, were identified. The upregulated genes were mostly associated with Staphylococcus aureus infection, amoebiasis, rheumatoid arthritis, phagocytosis, and tuberculosis. The downregulated genes were mainly involved in vascular smooth muscle contraction, calcium signaling, histidine metabolism, cGMP-PKG signaling, and cAMP signaling. From the DEGs, five genes were selected as hub genes on the basis of the connection degree, which is one of 12 calculation methods from a plugin of Cytoscape called cytoHubba. The PCR results demonstrated that the expression levels of the top five hub genes, namely, Tumor Necrosis Factor (TNF), interleukin 8 (IL-8), Protein Tyrosine Phosphatase Receptor Type C (PTPRC), interleukin 1β (IL-1β), and Toll-like receptor 4 (TLR 4), were significantly higher in the IA samples than in the STA samples. Conclusion: TNF showed higher expression in the IA samples than in the STA samples. Thus, this gene may be involved in the occurrence and development of IA. The immune response and inflammation play important roles in the progression of IA. However, the specific pathophysiological mechanism needs further study.","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48264103","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":"Elevated Plasma Factor VIII in Non-Pyogenic Cerebral Venous Thrombosis after Head Trauma without Skull Fracture","authors":"Kipyoung Jeon, J. .. Kim, Kijeong Lee, Kyu-Nam Park, B. Kim, Y. Shin, J. Koo","doi":"10.26420/austinjcerebrovascdisstroke.2019.1082","DOIUrl":"https://doi.org/10.26420/austinjcerebrovascdisstroke.2019.1082","url":null,"abstract":"Cerebral Venous Thrombosis (CVT) is a relatively uncommon but important cause of stroke that tends to affect young adults, especially women. Head trauma with or without skull fracture was reported to be triggering factors for CVT, but the underlying pathophysiology was not well elucidated. Endothelial injury and coexistent hypercoagulability were supposed to contribute to CVT after head trauma without skull fracture. We report a 49-year-old female patient who presented with headache with vomiting after head trauma and was initially diagnosed as post-traumatic Intracerebral Hemorrhage (ICH), but subsequently, progressed to CVT that resulted in cerebral venous infarction with hemorrhagic transformation. Magnetic Resonance brain Venography (MRV) confirmed CVT in superior sagittal sinus as well as right transverse and sigmoid sinuses. She was treated with endovascular mechanical thrombectomy followed by anticoagulation. The coagulopathy panel was checked both in hospital and in outpatient clinic for evaluating the etiology underlying post-traumatic nonpyogenic CVT. Persistently elevated level of plasma Factor VIII was identified. We should consider that patients with recent head trauma history without skull fracture and coexistent hypercoagulability could develop CVT resulting in cerebral venous infarction with hemorrhagic transformation even when the patient showed no definite focal neurologic deficit or the patient’s initial CT scan revealed no intracranial hemorrhage.","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47049082","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":"Elevated Lipocalin-2 Can Indicate the Vascular Inflammation in Patients with Ischemic Stroke","authors":"Rajnics P, K. A, N. F., Alföldi V, C. C, Gángó A, M. M, Egyed M","doi":"10.26420/austinjcerebrovascdisstroke.2019.1081","DOIUrl":"https://doi.org/10.26420/austinjcerebrovascdisstroke.2019.1081","url":null,"abstract":"Purpose: Elevated level of Lipocalin-2 (LCN2), a new acute phase adipokine, was described after ischemic stroke. A number of researchers feel as though that LCN2 originated from the infiltrating neutrophils and other cells in brain after stroke. Others measured elevated LCN2 expression in arteriosclerotic plaque. Therefore we have investigated LCN2 relative gene expression level of blood neutrophil granulocytes in patients with ischemic stroke to assess if elevated LCN2 is the cause or consequence of ischemic stroke. Methods: Laboratory and anamnestic data were collected, which could have a role in development of thrombo-embolic events in patients with ischemic stroke. RNA based method was used to evaluate the relative gene expression level of LCN2. We calculated Odds Ratio (OR) and Confidence Interval (CI) for the association between LCN2 and ischemic stroke. Results: 34 samples were available for evaluation. The LCN 2 relative gene expression level was decreased in 12 cases. In this group, 91% of patients have Atrial Fibrillation (AF) at the time of hospitalisation. The mean LCN2 relative gene expression value was 64.25% (ranges: 34%-115%) in patients with AF. It was significantly lower than in patients with normal sinus rhythm (409.2%; ranges: 127%-1127%; p=0.0003). The elevated LCN2 relative gene expression level significantly (p=0.012) increases the risk of stroke (OR: 12.6) independently from other factors. Conclusions: High LCN2 expression level seems to have strong positive predictive value on ischemic stroke, and may be useful in thrombotic risk stratification of plaque vulnerability in these patients.","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43780749","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 Effect of Neutrophil-Lymphocyte Ratio on Prognosis in Acute Hemorrhagic Stroke: A Retrospective Study","authors":"S. Tokgoz","doi":"10.26420/austinjcerebrovascdisstroke.2019.1080","DOIUrl":"https://doi.org/10.26420/austinjcerebrovascdisstroke.2019.1080","url":null,"abstract":"Objective: The study aim is to evaluate the relationship of short-term mortality with the neutrophil to lymphocyte ratio (NLR) in acute hemorrhagic stroke. Method: The retrospective study included 106 patients who admitted within 24 hours of AHS. A hemogram (peripheral venous blood sample) was taken at admission. The ratio of neutrophils to lymphocytes was calculated. Thirty days was defined as duration of follow-up. A mortality and survival groups were detected within 30 days. Results: During the follow-up period, twenty-eight of 106 patients died. The median NLR was significantly higher in the mortality group compared then the survival group (8.87; IQR 10.8 vs . 5.12; IQR 5.3, respectively; p=0.021) as well as a blood glucose level and hematoma volume. In the Cox regression model, NLR was not an independent variable as short-term mortality predictors. The specificity for short-term mortality when the NLR (>7.54) was 71.8%, and the sensitivity was 60.7%. The positive predictive value of a NLR (>7.5) was 43.6%, negative predictive value was 83.6% [Area under the ROC curve, 0.647; 95% CI, 0.548-0.738]. A weak linear positive correlations were found between NLR and National Institutes of Health Stroke Scale (NIHSS), and negative correlation between NLR and Glaskow Coma Score (GCS) (r=0.281; p=0.004, r=-0.283; p=0.002, respectively). Conclusions: The NLR at admission is significantly higher in mortality group than survival group, but it has lower sensitivity and specificity for short-term mortality than acute ischemic stroke. NLR may be important to follow short-term mortality, but it can be affected by dependents variables such as hematoma volume.","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47022196","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":"Factors Influencing Acute Stroke Thrombolytic Treatments in Hispanics In the San Diego Region.","authors":"P M Chen,&nbsp;D T Nguyen,&nbsp;J P Ho,&nbsp;M Pirastehfar,&nbsp;R Narula,&nbsp;K Rapp,&nbsp;K Agrawal,&nbsp;B Huisa,&nbsp;R Modir,&nbsp;D Meyer,&nbsp;T Hemmen,&nbsp;C Kidwell,&nbsp;B C Meyer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Since the introduction of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, rt-PA rate and number of stroke centers have increased. Despite this, studies have shown racial and ethnic disparities in stroke care especially in Black and Hispanic populations. What factors are related to the administration of rt-PA within the Hispanic population has to date been unclear.</p><p><strong>Methods: </strong>We performed a retrospective review of IRB approved, prospectively collected data from the UC San Diego Stroke Registry from 7/2004-7/2016. Patients were included based on the primary diagnosis of Transient Ischemic Attack or Ischemic Stroke. Hispanic vs non-Hispanic patients were compared to assess for overall rt-PA treatment rates and process of care intervals. For the Hispanic cohort itself, demographics and NIHSS scores were assessed to determine why some Hispanics received rt-PA while others were not.</p><p><strong>Results: </strong>Overall, 1489 patients (300 Hispanic vs. 1189 non-Hispanic) were included. Comparing Hispanics to non-Hispanics, there was no difference in rt-PA rate (35.3% vs. 33.1%; p=0.49). In rt-PA treated patients, \"onset to arrival\" interval was higher in Hispanics (1.03 vs. 0.88 hours; p=0.04), while the \"arrival to treatment\" interval was not different (1.13 vs. 1.02 hours; p=0.07). When looking at Hispanic patients only, there was no difference in baseline characteristics except for initial NIHSS in treated vs. non-treated patients (13.27 vs. 7.24; p<.001).</p><p><strong>Conclusion: </strong>Our analyses sought to determine the factors important to administration of rt-PA to Hispanic patients. These findings highlight the need for strategies to improve recognition and presentation pathways for Hispanics.</p>","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103626/pdf/nihms934845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36432288","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":"Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions.","authors":"J. P. Ho, D. T. Nguyen, M. Pirastefahr, R. Narula, L. Hailey, M. Mortin, K. Rapp, K. Agrawal, Branko Huisa-Garate, R. Modir, D. Meyer, T. Hemmen, B. Meyer","doi":"10.26420/AUSTINJCEREBROVASCDISSTROKE.2017.1068","DOIUrl":"https://doi.org/10.26420/AUSTINJCEREBROVASCDISSTROKE.2017.1068","url":null,"abstract":"Background\u0000Identification of large vessel occlusions (LVO) is important with recent guidelines supporting endovascular therapy in selected acute ischemic stroke patients. Many stroke centers perform CT angiography (CTA) in patients with suspected LVO, however this requires additional time and contrast administration. Non-enhanced CT maximum intensity projection (NECT-MIPs) may offer a rapid alternative to CTA.\u0000\u0000\u0000Methods\u0000We retrospectively reviewed acute stroke patients with LVO in the UCSD Stroke Registry, presenting between 6/2014-7/2016. NECT-MIPs were evaluated for presence of LVO. Gold standard comparison was to CTA. Results were stratified by level of training (Faculty, Fellow and Acute Care Practitioners [ACPs]). Inter-rater agreement was assessed using Fleiss' Kappa Coefficient.\u0000\u0000\u0000Results\u0000We reviewed 24 patients using NECT-MIPs for the detection of LVO. Faculty had a sensitivity and specificity of 95% & 92% for ICA/M1, 42% & 100% for M2, and 67% & 96% for basilar occlusions. Fellows and ACPs had a sensitivity and specificity of 61% & 94% for ICA/M1, 19% & 83% for M2, and 75% & 95% for basilar occlusions. Inter-rater agreement among Faculty readers was k=0.75 for ICA/M1, k=0.79 for M2 and k=0.14 for basilar occlusions. Among Fellows and ACPs, k=0.57 for ICA/M1, k=0.40 for M2, and k=0.27 for basilar occlusions.\u0000\u0000\u0000Conclusions\u0000NECT-MIPs have high sensitivity and specificity for the detection of LVO when compared to CTA. Inter-rater agreement is fair and higher amongst more experienced reviewers. These results suggest that NECT-MIPs may be helpful to streamline the identification of LVO and reduce door to needle and door to intervention times.","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42556526","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":"Sulforaphane Protects against Brain Diseases: Roles of Cytoprotective Enzymes.","authors":"Y Sun,&nbsp;T Yang,&nbsp;L Mao,&nbsp;F Zhang","doi":"10.26420/austinjcerebrovascdisstroke.2017.1054","DOIUrl":"https://doi.org/10.26420/austinjcerebrovascdisstroke.2017.1054","url":null,"abstract":"<p><p>Sulforaphane (SFN) is a kind of isothiocyanate derived from broccoli and other cruciferous vegetables. Because of its roles of antioxidant, anti-inflammatory, and anti-tumor through multiple targets and various mechanisms, SFN has drawn broad attention of the researchers. One of the most important target of SFN is nuclear factor erythroid 2 related factor 2 (Nrf2), wildly known for its ability to regulate the expression of a series of cytoprotective enzymes with antioxidative, prosurvival, and detoxification effects. Multiple researches have shown that SFN protects against central nervous system diseases through Nrf2pathway. In this article, we list SFN contents in common cruciferous vegetables, and summarize recent advances in the protective effects of SFN against acute brain injuries and neurodegenerative diseases through activating Nrf2 signaling pathway.</p>","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880051/pdf/nihms929609.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35977766","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":"Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions.","authors":"J P Ho,&nbsp;D T Nguyen,&nbsp;M Pirastefahr,&nbsp;R Narula,&nbsp;L Hailey,&nbsp;M Mortin,&nbsp;K Rapp,&nbsp;K Agrawal,&nbsp;B Huisa-Garate,&nbsp;R Modir,&nbsp;D M Meyer,&nbsp;T M Hemmen,&nbsp;B C Meyer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Identification of large vessel occlusions (LVO) is important with recent guidelines supporting endovascular therapy in selected acute ischemic stroke patients. Many stroke centers perform CT angiography (CTA) in patients with suspected LVO, however this requires additional time and contrast administration. Non-enhanced CT maximum intensity projection (NECT-MIPs) may offer a rapid alternative to CTA.</p><p><strong>Methods: </strong>We retrospectively reviewed acute stroke patients with LVO in the UCSD Stroke Registry, presenting between 6/2014-7/2016. NECT-MIPs were evaluated for presence of LVO. Gold standard comparison was to CTA. Results were stratified by level of training (Faculty, Fellow and Acute Care Practitioners [ACPs]). Inter-rater agreement was assessed using Fleiss' Kappa Coefficient.</p><p><strong>Results: </strong>We reviewed 24 patients using NECT-MIPs for the detection of LVO. Faculty had a sensitivity and specificity of 95% & 92% for ICA/M1, 42% & 100% for M2, and 67% & 96% for basilar occlusions. Fellows and ACPs had a sensitivity and specificity of 61% & 94% for ICA/M1, 19% & 83% for M2, and 75% & 95% for basilar occlusions. Inter-rater agreement among Faculty readers was k=0.75 for ICA/M1, k=0.79 for M2 and k=0.14 for basilar occlusions. Among Fellows and ACPs, k=0.57 for ICA/M1, k=0.40 for M2, and k=0.27 for basilar occlusions.</p><p><strong>Conclusions: </strong>NECT-MIPs have high sensitivity and specificity for the detection of LVO when compared to CTA. Inter-rater agreement is fair and higher amongst more experienced reviewers. These results suggest that NECT-MIPs may be helpful to streamline the identification of LVO and reduce door to needle and door to intervention times.</p>","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777582/pdf/nihms931537.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35764632","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":"Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors.","authors":"S N Housley, A R Garlow, K Ducote, A Howard, T Thomas, D Wu, K Richards, A J Butler","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation.</p><p><strong>Methods: </strong>Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy.</p><p><strong>Results: </strong>Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy.</p><p><strong>Conclusion: </strong>Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care.</p>","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195247","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":"A Prospective Safety Trial of Atorvastatin Treatment to Assess Rebleeding after Spontaneous Intracerebral Hemorrhage: A Serial MRI Investigation.","authors":"R A Knight,&nbsp;T N Nagaraja,&nbsp;L Li,&nbsp;Q Jiang,&nbsp;K Tundo,&nbsp;M Chopp,&nbsp;D M Seyfried","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>This study was designed to determine any rebleeding after atorvastatin treatment following spontaneous intracerebral hemorrhage (ICH) in a prospective safety trial.</p><p><strong>Patients: </strong>Atorvastatin (80 mg/day) therapy was initiated in 6 patients with primary ICH with admission Glasgow Coma Score (GCS) >5 within 24 hours of ictus and continued for 7 days, with the dose tapered and treatment terminated over the next 5 days. Patients were studied longitudinally by multiparametric magnetic resonance imaging (MRI) at three time points: acute (3 to 5 days), subacute (4 to 6 weeks) and chronic (3 to 4 months). Imaging sequences included T₁, T₂-weighted imaging (T₂WI), diffusion tensor imaging (DTI) and contrast-enhanced MRI measures of cerebral perfusion, blood volume and blood-brain barrier (BBB) permeability. Susceptibility weighted imaging (SWI) was used to identify primary ICH and to check for secondary rebleeding. Final outcome was assessed using Glasgow Outcome Score (GOS) at 3-4 months.</p><p><strong>Results: </strong>Mean admission GCS was 13.2±4.0 and mean GOS at 3 months was 4.5±0.6. Hemorrhagic lesions were segmented into core and rim areas. Mean lesion volumes decreased significantly between the acute and chronic study time points (p=0.008). Average ipsilateral hemispheric tissue loss at 3 to 4 months was 11.4±4.6 cm³. MRI showed acutely reduced CBF (p=0.004) and CBV (p=0.002) in the rim, followed by steady normalization. Apparent diffusion coefficient of water (ADC) in the rim demonstrated no alterations at any of the time points (p>0.2). The T₂ values were significantly elevated in the rim acutely (p=0.02), but later returned to baseline. The ICH core showed sustained low CBF and CBV values concurrent with a small reduction in ADC acutely, but significant ADC elevation at the end suggestive of irreversible injury.</p><p><strong>Conclusion: </strong>Despite the presence of a small, probably permanent, cerebral lesion in the ICH core, no patients exhibited post-treatment rebleeding. These data suggest that larger, Phase 2 trials are warranted to establish long term clinical safety of atorvastatin in spontaneous ICH.</p>","PeriodicalId":90444,"journal":{"name":"Austin journal of cerebrovascular disease & stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436718/pdf/nihms834677.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35016214","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}