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acute_ischemic_stroke

Acute ischemic stroke

Cerebral ischemia due to cerebral vasospasm is a feared complication in patients following aneurysmal subarachnoid hemorrhage (SAH).

Epidemiology

Of the approximately 795 000 strokes in the United States annually, 87% are from ischemia and result in significant morbidity and mortality.

Clinical Features

Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke.

Diagnosis

Diffusion weighted magnetic resonance imaging (DWI) is widely appreciated as an indispensable tool in the examination of the central nervous system. It is considered useful not only for the detection of acute ischemic stroke but also for the characterization and differentiation of brain tumors and abscess.

Treatment

Outcome

Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke.

The majority of victims must endure life-long disabilities that not only affect their livelihood, but also have an enormous societal economic impact.

Blood pressure (BP) variability is independently and linearly associated with the development of neurologic deterioration in acute stage of ischemic stroke 1).

For Nozoe et al. no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND 2).

Case series

retrospective study reviewed data from consecutive patients with AIS and an occluded M1 segment of the middle cerebral artery who underwent pretreatment perfusion CT between May 2009 and August 2017. The maximum cerebral blood flow (CBF) of collateral vessels (cCBFmax) within the Sylvian fissure was calculated for each patient. Good outcome was defined as a 90-day modified Rankin scale score of 0-2. Multivariable logistic regression analysis was used to determine the relationship between cCBFmax and (a) hemorrhagic transformation and (b) clinical outcome.

The final analysis included 204 patients (median age, 73 years; interquartile range, 62-80 years; 82 [40.2%] women). Multivariable logistic regression analysis showed that higher cCBFmax was an independent predictor for (a) a lower risk of hemorrhagic transformation (odds ratio [OR], 0.99; 95% confidence interval [CI]: 0.98, 1.00; P = .009) after adjusting for baseline National Institute of Health Stroke Scale (NIHSS), endovascular thrombectomy, baseline infarct core volume, and recanalization and (b) better outcome (OR, 1.02; 95% CI: 1.01, 1.03; P = .001) after adjusting for age, baseline NIHSS score, endovascular thrombectomy, hypertension, baseline infarct core volume, and recanalization, respectively.

The measurement of maximum cerebral blood flow of collateral vessels within the Sylvian fissure is a feasible quantitative collateral assessment at perfusion CT. Maximum cerebral blood flow of collateral vessels was associated with clinical outcome in patients with acute ischemic stroke. 3).


Nozoe et al., from the Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Department of Rehabilitation, Neurosurgical Hospital, Itami, Japan, compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). They enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND 4).

1)
Chung JW, Kim N, Kang J, Park SH, Kim WJ, Ko Y, Park JH, Lee JS, Lee J, Yang MH, Jang MS, Oh CW, Kwon OK, Jung C, Kim BJ, Han MK, Gorelick PB, Bae HJ. Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke. J Hypertens. 2015 Jul 31. [Epub ahead of print] PubMed PMID: 26237556.
2) , 4)
Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, Mase K. Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke. Eur Neurol. 2018 Sep 11;80(1-2):50-54. doi: 10.1159/000492794. [Epub ahead of print] PubMed PMID: 30205405.
3)
Shi F, Gong X, Liu C, Zeng Q, Zhang M, Chen Z, Yan S, Lou M. Acute Stroke: Prognostic Value of Quantitative Collateral Assessment at Perfusion CT. Radiology. 2019 Jan 8:181510. doi: 10.1148/radiol.2019181510. [Epub ahead of print] PubMed PMID: 30620255.
acute_ischemic_stroke.txt · Last modified: 2019/01/10 08:19 by administrador