Clinical Research on Ischemic Stroke: Novel Approaches in Acute and Chronic Phase

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (5 April 2021) | Viewed by 41728

Special Issue Editor


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Guest Editor
UOC Neurologia, Università Campus Bio-Medico di Roma, Roma, Italy
Interests: stroke care; stroke treatment; thrombolysis; neuroimaging; clinical neurophysiology; neuroplasticity; stroke recovery
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Special Issue Information

Dear Colleagues,

Stroke is a leading cause of long-term disability and death worldwide, and its burden is huge in terms of disabilities and mortality. Recently, there has been a relevant interest in disease-modifying therapies in acute stroke, and novel approaches have been tried to enhance recovery, reducing long-term disabilities.

This Special Issue of Brain Sciences will explore the current knowledge and innovative concepts regarding preclinical and clinical research into stroke mechanisms, prevention and treatments.

Authors are invited to submit original research, topic reviews, or case studies that will inform neurologists, neuroradiologists, and stroke clinicians about current strategies enhancing awareness of novel approaches and forecasting future developments in stroke care.

Topics include the following areas: clinical, neuroimaging, and neurophysiology applied to cerebrovascular diseases. Fields of clinical interest are prevention, acute and chronic management and treatments. Neuroimaging includes (but is not limited to) magnetic resonance imaging (MRI), computed tomography (CT), angiography, and related techniques. Neurophysiological techniques applied to stroke patients such as electroencephalography (EEG), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) are of interest. Studies about neurorehabilitation, alone or paired with novel neurophysiological approaches, are welcome.

Dr. Fabio Pilato
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stroke 
  • intracerebral hemorrhage 
  • thrombolysis 
  • cerebrovascular diseases 
  • transient ischemic attack (TIA) 
  • minor stroke 
  • cerebral ischemia 
  • neuroprotection 
  • neurophysiology 
  • TMS 
  • tDCS 
  • EEG 
  • neuro-rehabilitation

Published Papers (12 papers)

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Editorial

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6 pages, 207 KiB  
Editorial
New Perspectives in Stroke Management: Old Issues and New Pathways
by Fabio Pilato, Rosalinda Calandrelli, Fioravante Capone, Michele Alessiani, Mario Ferrante, Gianmarco Iaccarino and Vincenzo Di Lazzaro
Brain Sci. 2021, 11(6), 767; https://doi.org/10.3390/brainsci11060767 - 9 Jun 2021
Cited by 3 | Viewed by 2206
Abstract
Stroke is a leading cause of disability and death worldwide and social burden is huge in terms of disabilities, mortality and healthcare costs. Recently, in an acute stroke setting, renewed interest in disease-modifying therapies and novel approaches has led to enhanced recovery and [...] Read more.
Stroke is a leading cause of disability and death worldwide and social burden is huge in terms of disabilities, mortality and healthcare costs. Recently, in an acute stroke setting, renewed interest in disease-modifying therapies and novel approaches has led to enhanced recovery and the reduction of long-term disabilities of patients who suffered a stroke. In the last few years, the basic principle “time is brain” was overcome and better results came through the implementation of novel neuroimaging tools in acute clinical practice, allowing one to extend acute treatments to patients who were previously excluded on the basis of only a temporal selection. Recent studies about thrombectomy have allowed the time window to be extended up to 24 h after symptoms onset using advanced neuroradiological tools, such as computer tomography perfusion (CTP) and magnetic resonance imaging (MRI) to select stroke patients. Moreover, a more effective acute management of stroke patients in dedicated wards (stroke units) and the use of new drugs for stroke prevention, such as novel oral anticoagulants (NOACs) for atrial fibrillation, have allowed for significant clinical improvements. In this editorial paper, we summarize the current knowledge about the main stroke-related advances and perspectives and their relevance in stroke care, highlighting recent developments in the definition, management, treatment, and prevention of acute and chronic complications of stroke. Then, we present some papers published in the Special Issue “Clinical Research on Ischemic Stroke: Novel Approaches in Acute and Chronic Phase”. Full article

Research

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9 pages, 244 KiB  
Article
Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients
by Minwoo Lee, Jae-Sung Lim, Yerim Kim, Ju Hun Lee, Chul-Ho Kim, Sang-Hwa Lee, Min Uk Jang, Mi Sun Oh, Byung-Chul Lee and Kyung-Ho Yu
Brain Sci. 2021, 11(5), 612; https://doi.org/10.3390/brainsci11050612 - 11 May 2021
Cited by 7 | Viewed by 2657
Abstract
Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated [...] Read more.
Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions. Full article
10 pages, 264 KiB  
Article
Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke
by Dalibor Sila, Markus Lenski, Maria Vojtková, Mustafa Elgharbawy, František Charvát and Stefan Rath
Brain Sci. 2021, 11(4), 504; https://doi.org/10.3390/brainsci11040504 - 16 Apr 2021
Cited by 4 | Viewed by 2487
Abstract
Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with [...] Read more.
Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes. Full article
9 pages, 1655 KiB  
Article
Introducing Adam’s Scale of Posterior Stroke (ASPOS): A Novel Validated Tool to Assess and Predict Posterior Circulation Strokes
by Adam Wiśniewski, Karolina Filipska, Katarzyna Piec, Filip Jaskólski and Robert Ślusarz
Brain Sci. 2021, 11(4), 424; https://doi.org/10.3390/brainsci11040424 - 26 Mar 2021
Cited by 4 | Viewed by 2141
Abstract
Background: Assessing the severity of posterior circulation strokes, due to the variety of symptoms, is a significant clinical problem. Current clinimetric scales show lower accuracy in the measurement of posterior stroke severity, compared with that of anterior strokes. The aim of the study [...] Read more.
Background: Assessing the severity of posterior circulation strokes, due to the variety of symptoms, is a significant clinical problem. Current clinimetric scales show lower accuracy in the measurement of posterior stroke severity, compared with that of anterior strokes. The aim of the study was to design a validated tool, termed Adam’s Scale of Posterior Stroke (ASPOS), for better assessment and prediction of posterior stroke. Methods: This prospective, observational study involved 126 posterior circulation ischemic stroke subjects. Four researchers, previously trained in ASPOS, randomized the stroke severity using a novel tool and other appropriate stroke scales (The National Institute of Health Stroke Scale—NIHSS, modified Rankin Scale—mRS, Glasgow Coma Scale, Barthel Index, or Israeli Vertebrobasilar Stroke Scale—IVBSS) to assess the psychometric properties, reliability, and validity of ASPOS and investigate its predictive value. Results: ASPOS reached a Cronbach’s alpha coefficient of 0.7449, indicating good internal consistency. The Bland–Altman analysis showed a good coefficient of repeatability (CR) of 0.46, a 95% confidence interval (CI) of 0.41–0.53, and excellent intraclass correlation coefficients or weighted kappa values (>0.90), reflecting high reliability and reproducibility. Highly significant correlations with other scales confirmed the construct and predictive validity of ASPOS. A total ASPOS score of three points indicated a significantly increased probability of severe stroke based on the NIHSS, compared to a total ASPOS of 1–2 points (odds ratio (OR) 141; 95% CI: 6.72–2977.66; p = 0.0014). Conclusions: We developed a novel, valid, and reliable tool to assess posterior circulation strokes. This can contribute to a more comprehensive estimation of posterior stroke and, additionally, due to its predictive properties, it can be used to more accurately select candidates for specific treatments. Full article
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12 pages, 543 KiB  
Article
Glycated Albumin, a Novel Biomarker for Short-Term Functional Outcomes in Acute Ischemic Stroke
by Yerim Kim, Sang-Hwa Lee, Min Kyoung Kang, Tae Jung Kim, Han-Yeong Jeong, Eung-Joon Lee, Jeonghoon Bae, Kipyoung Jeon, Ki-Woong Nam and Byung-Woo Yoon
Brain Sci. 2021, 11(3), 337; https://doi.org/10.3390/brainsci11030337 - 6 Mar 2021
Cited by 4 | Viewed by 2327
Abstract
Background: There is growing interest in the use of new biomarkers such as glycated albumin (GA), but data are limited in acute ischemic stroke. We explored the impact of GA on short-term functional outcomes as measured using the modified Rankin Scale (mRS) at [...] Read more.
Background: There is growing interest in the use of new biomarkers such as glycated albumin (GA), but data are limited in acute ischemic stroke. We explored the impact of GA on short-term functional outcomes as measured using the modified Rankin Scale (mRS) at 3 months compared to glycated hemoglobin (HbA1c). Methods: A total of 1163 AIS patients from two hospitals between 2016 and 2019 were included. Patients were divided into two groups according to GA levels (GA < 16% versus GA ≥ 16%). Results: A total of 518 patients (44.5%) were included in the GA ≥ 16% group. After adjusting for multiple covariates, the higher GA group (GA ≥ 16%) had a 1.4-fold risk of having unfavorable mRS (95% CI 1.02–1.847). However, HbA1c was not significantly associated with 3-month mRS. In addition, GA ≥ 16% was independently associated with unfavorable short-term outcomes only in patients without diabetes. Conclusions: In light of these results, GA level might be a novel prognostic biomarker compared to HbA1c for short-term stroke outcome. Although the impact of GA is undervalued in the current stroke guidelines, GA monitoring should be considered in addition to HbA1c monitoring. Full article
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13 pages, 1361 KiB  
Article
Unfavorable Dynamics of Platelet Reactivity during Clopidogrel Treatment Predict Severe Course and Poor Clinical Outcome of Ischemic Stroke
by Adam Wiśniewski, Joanna Sikora, Aleksandra Karczmarska-Wódzka, Joanna Bugieda, Karolina Filipska and Robert Ślusarz
Brain Sci. 2021, 11(2), 257; https://doi.org/10.3390/brainsci11020257 - 18 Feb 2021
Cited by 2 | Viewed by 2307
Abstract
Background: Previous studies have revealed that high platelet reactivity while on clopidogrel may affect the severe course and worse prognosis of ischemic stroke. However, the above findings were based on a single measurement of platelet function. We aimed to investigate whether the dynamics [...] Read more.
Background: Previous studies have revealed that high platelet reactivity while on clopidogrel may affect the severe course and worse prognosis of ischemic stroke. However, the above findings were based on a single measurement of platelet function. We aimed to investigate whether the dynamics of platelet reactivity over time would more accurately determine its actual impact on clinical outcome. Methods: We enrolled 74 ischemic stroke subjects, taking a dose of 75 mg a day of clopidogrel to this prospective, single-center, and observational study. The determination of platelet function was based on the impedance aggregometry 6–12 h after the first dose of clopidogrel and 48 h later. We defined a favorable dynamics of platelet reactivity as a decrease in values at least equal to the median obtained in the entire study. The clinical condition was assessed by the National Institutes of Health Stroke Scale on the first, third, and ninetieth days and the functional status by modified Rankin Scale, respectively. Results: A favorable dynamics of platelet reactivity was associated with the mild clinical condition and favorable functional status, both early and late. Early neurological deterioration was related to unfavorable dynamics of platelet reactivity over time. In multivariate regression models, we found that unfavorable dynamics of platelet reactivity, alone and combined with a high baseline value of platelet reactivity, is an independent predictor of a severe clinical condition, the risk of deterioration, and poor early and late prognosis. Conclusion: We highlighted that dynamics of platelet reactivity over time predict the clinical course and prognosis of stroke better than a single value. Full article
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8 pages, 667 KiB  
Article
Prospective Observational Study of Safety of Early Treatment with Edoxaban in Patients with Ischemic Stroke and Atrial Fibrillation (SATES Study)
by Giovanni Frisullo, Paolo Profice, Valerio Brunetti, Irene Scala, Simone Bellavia, Aldobrando Broccolini, Pietro Caliandro, Riccardo Di Iorio, Roberta Morosetti, Fabio Pilato, Renzo Laborante and Giacomo Della Marca
Brain Sci. 2021, 11(1), 30; https://doi.org/10.3390/brainsci11010030 - 30 Dec 2020
Cited by 10 | Viewed by 3707
Abstract
New direct oral anticoagulants are recommended for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, no data are available regarding the optimal time to start oral anticoagulation after acute stroke. The aim of our study was to evaluate the occurrence of [...] Read more.
New direct oral anticoagulants are recommended for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, no data are available regarding the optimal time to start oral anticoagulation after acute stroke. The aim of our study was to evaluate the occurrence of symptomatic bleedings within 90 days from acute cardioembolic stroke in patients who received early treatment with Edoxaban. The study was conducted according to an observational prospective uncontrolled design. Secondary endpoints were the incidence of major bleeding (MB), hemorrhagic transformation within the first week of Edoxaban treatment, minor bleeding, and recurrent stroke. We included patients with Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥ 6, NVAF, no previous treatment with any other anticoagulant, preserved swallowing function. Patients with estimated Glomerular Filtration Rate < 50 mL/min, body weight < 60 kg, receiving cyclosporine, dronedarone, erythromycin, ketoconazole, or previous treatment with any other anticoagulant were excluded. We enrolled 75 elderly patients with moderate disability. We did not observe any symptomatic intracranial bleeding or recurrent stroke after 3 months of treatment with early administration of Edoxaban, while two gastrointestinal MB, and 11 minor bleedings were reported. Asymptomatic bleeding was evaluated with a brain Magnetic Resonance Imaging performed 5 days after starting anticoagulant treatment with Edoxaban. Specifically, we observed small petechiae in 12% of the patients, confluent petechiae in 6.6% of the patients, and small hematoma of the infarcted area in 2.7% of the patients. No intralesional hematoma or hemorrhagic lesion outside the infarcted area were observed. According to our data, the early use of Edoxaban seems to be safe in patients after cardioembolic stroke. However, due to the small size of the study sample, and the short follow-up period, further studies are needed. Full article
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14 pages, 2208 KiB  
Article
Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
by Fabio Pilato, Serena Silva, Iacopo Valente, Marisa Distefano, Aldobrando Broccolini, Valerio Brunetti, Pietro Caliandro, Giacomo Della Marca, Riccardo Di Iorio, Giovanni Frisullo, Mauro Monforte, Roberta Morosetti, Carla Piano, Rosalinda Calandrelli, Fioravante Capone, Andrea Alexandre, Alessandro Pedicelli, Cesare Colosimo and Anselmo Caricato
Brain Sci. 2020, 10(12), 911; https://doi.org/10.3390/brainsci10120911 - 26 Nov 2020
Cited by 19 | Viewed by 3341
Abstract
Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after [...] Read more.
Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency. Full article
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8 pages, 2912 KiB  
Article
ColorViz, a New and Rapid Tool for Assessing Collateral Circulation during Stroke
by Tommaso Verdolotti, Fabio Pilato, Simone Cottonaro, Edoardo Monelli, Carolina Giordano, Pamela Guadalupi, Massimo Benenati, Antonia Ramaglia, Alessandro Maria Costantini, Andrea Alexandre, Riccardo Di Iorio and Cesare Colosimo
Brain Sci. 2020, 10(11), 882; https://doi.org/10.3390/brainsci10110882 - 20 Nov 2020
Cited by 23 | Viewed by 3704
Abstract
Prognosis of patients with acute ischemic stroke is strictly related to the patency and prominence of the collateral leptomeningeal pathways distal to the arterial occlusion. The gold standard for assessment of collateral circulation is conventional angiography, but it is invasive and used in [...] Read more.
Prognosis of patients with acute ischemic stroke is strictly related to the patency and prominence of the collateral leptomeningeal pathways distal to the arterial occlusion. The gold standard for assessment of collateral circulation is conventional angiography, but it is invasive and used in selected cases. To date, the most reliable technique is multiphase CTA; currently, the available classifications of collateral circles are often complex, time-consuming, and require a trained observer. The purpose of our work is to establish the effectiveness of a new semi-automatic post-processing software (ColorViz FastStroke, GE Healthcare, Milwaukee, Wisconsin) in evaluation of collateral circulation compared to the six-point classifications of multiphase CTA already validated in literature. We selected 86 patients with anterior ischemic stroke symptoms who underwent multiphasic CTA in our emergency department. Two radiologists separately evaluated the collateral leptomeningeal vessels, analyzing respectively, the multiphase CTA (using the six-point scale and its trichotomized form) and ColorViz (using a three-point scale). Then the results were matched. We found a good correlation between the two different analyses; the main advantage of ColorViz is that, while maintaining fast diagnostic times, it allows a simpler and more immediate evaluation of collateral circulation, especially for less experienced radiologists. Full article
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9 pages, 237 KiB  
Article
Neutrophil-to-Lymphocyte Ratio and Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients Undergoing Revascularization
by Milena Świtońska, Natalia Piekuś-Słomka, Artur Słomka, Paweł Sokal, Ewa Żekanowska and Simona Lattanzi
Brain Sci. 2020, 10(11), 771; https://doi.org/10.3390/brainsci10110771 - 23 Oct 2020
Cited by 90 | Viewed by 4908
Abstract
Objectives: Symptomatic hemorrhagic transformation (sHT) is a life-threatening complication of acute ischemic stroke (AIS). The early identification of the patients at increased risk of sHT can have clinically relevant implications. The aim of this study was to explore the validity and accuracy of [...] Read more.
Objectives: Symptomatic hemorrhagic transformation (sHT) is a life-threatening complication of acute ischemic stroke (AIS). The early identification of the patients at increased risk of sHT can have clinically relevant implications. The aim of this study was to explore the validity and accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting sHT in patients with AIS undergoing revascularization. Methods: Consecutive patients hospitalized for AIS who underwent intravenous thrombolysis, mechanical thrombectomy or both were identified. The NLR values were estimated at admission. The study endpoint was the occurrence of sHT within 24 h from stroke treatment. Results: Fifty-one patients with AIS were included, with a median age of 67 (interquartile range, 55–78) years. sHT occurred in 10 (19.6%) patients. Patients who developed sHT had higher NLR at admission. NLR was an independent predictor of sHT and showed good discriminatory power (area under the curve 0.81). In a multivariable analysis, NLR and systolic blood pressure were independently associated with sHT. Conclusions: NLR at admission can accurately predict sHT in patients with AIS undergoing revascularization. Full article
14 pages, 1576 KiB  
Article
Effect of Brain Lesions on Voluntary Cough in Patients with Supratentorial Stroke: An Observational Study
by Kyoung Bo Lee, Seong Hoon Lim, Geun-Young Park and Sun Im
Brain Sci. 2020, 10(9), 627; https://doi.org/10.3390/brainsci10090627 - 10 Sep 2020
Cited by 6 | Viewed by 2406
Abstract
Patients with stroke are known to manifest a decreased cough force, which is associated with an increased risk of aspiration. Specific brain lesions have been linked to impaired reflexive coughing. However, few studies have investigated whether specific stroke lesions are associated with impaired [...] Read more.
Patients with stroke are known to manifest a decreased cough force, which is associated with an increased risk of aspiration. Specific brain lesions have been linked to impaired reflexive coughing. However, few studies have investigated whether specific stroke lesions are associated with impaired voluntary cough. Here, we studied the effects of stroke lesions on voluntary cough using voxel-based lesion-symptom mapping (VLSM). In this retrospective cross-sectional study, the peak cough flow was measured in patients who complained of weak cough (n = 39) after supratentorial lesions. Brain lesions were visualized via magnetic resonance imaging (MRI) at the onset of stroke. These lesions were studied using VLSM. The VLSM method with non-parametric mapping revealed that lesions in the sub-gyral frontal lobe and superior longitudinal and posterior corona radiata were associated with a weak cough flow. In addition, lesions in the inferior parietal and temporal lobes and both the superior and mid-temporal gyrus were associated with a weak peak cough flow during voluntary coughing. This study identified several brain lesions underlying impaired voluntary cough. The results might be useful in predicting those at risk of poor cough function and may improve the prognosis of patients at increased risk of respiratory complications after a stroke. Full article
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Review

Jump to: Editorial, Research

28 pages, 1193 KiB  
Review
Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review
by Mariagiovanna Cantone, Giuseppe Lanza, Valentina Puglisi, Luisa Vinciguerra, Jaime Mandelli, Francesco Fisicaro, Manuela Pennisi, Rita Bella, Rosella Ciurleo and Alessia Bramanti
Brain Sci. 2021, 11(1), 70; https://doi.org/10.3390/brainsci11010070 - 7 Jan 2021
Cited by 15 | Viewed by 7938
Abstract
Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported [...] Read more.
Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy. Full article
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