International Journal of Neuroscience

Wang, Yiping; Zhou, Saijun; Bao, Jianhong; Pan, Sipei; Zhang, Xu

doi: 10.1080/00207454.2016.1211649pmid: 27401927

Background: Early and accurate prediction of outcome in acute stroke is important. The aim of this prospective study was to explore the correlation between serum triiodothyronine level and prognosis in acute ischemic stroke patients. Methods: A prospective observational study which included 359 consecutive patients with acute ischemic stroke from December 2014 to November 2015 was interrogated. Serum triiodothyronine (T3) concentrations were measured on admission to understand their value in predicting functional outcome within 90 d using multivariable models adjusted for confounding factors. Receiver operating characteristic (ROC) curves were calculated to define the best cut-off value of triiodothyronine to predict outcome. The accuracy of the test was assessed measuring the area under the ROC curve (AUROC). Results: Triiodothyronine was significantly decreased in patients with an unfavorable functional outcome as compared to patients with a favorable functional outcome within 90 d (p = 0.01). Binary logistic regression analyses revealed that lower triiodothyronine concentrations on admission were associated with a risk for poor outcomes (OR 0.05, 95% CI 0.01–0.25; p < 0.01). In addition, in ROC curve analysis, triiodothyronine may improve the National Institutes of Health Stroke Scale (NIHSS) score in predicting functional outcome. The combined model AUROC was 0.84 for 30 d and 0.91 for 90 d, which were both significantly higher than the AUROCs of original NIHSS (0.83 and 0.87), triiodothyronine (0.64 and 0.69) and age (0.57 and 0.68) (all p < 0.05). Conclusions: Low serum triiodothyronine levels can be a predictive marker of short-term outcome after ischemic stroke. A combined model (triiodothyronine, age and NIHSS score) can add significant additional predictive information to the clinical score of the NIHSS.

Paterakis, Konstantinos; Koutsias, Stelios; Doxani, Chrysoula; Xanthopoulou, Paraskevi; Kokkali, Chrysoula; Mpoulimari, Ioanna; Tziastoudi, Maria; Karampelas, Ioannis; Dardiotis, Efthimios; Hadjigeorgiou, Georgios; Brotis, Alexandros G.; Zintzaras, Elias

Song, Xiaowei; Xue, Sufang; Wu, Jian; Ren, Yi

doi: 10.1080/00207454.2016.1212856pmid: 27412642

Background and purpose: To investigate the clinical prognosis and vascular outcome of ischemic stroke patients with isolated symptomatic middle cerebral artery stenosis, and further analysis of the predictors associated with the results. Methods: Ischemic stroke patients aged 18–55 years old with isolated symptomatic middle cerebral artery stenosis were evaluated and followed up prospectively for six months. Logistic regression was used to detect predictors of ipsilateral stroke recurrence, and factors associated with the dynamic changes of lesion vascular were analyzed. Results: Eighty patients were included, with a mean age of 41.8 ± 8.3 years old. Males predominated in this cohort at a proportion of 78.8% (63/80). Twenty percent of patients presented with ipsilateral ischemic stroke recurrence during this time but mostly with a good outcome (70% mRS ≤ 1); multiple logistic regression indicated that diabetes mellitus is an independent predictor for stroke recurrence; 38.6% patients presented with significant vascular changes during the follow-up, with progression in 12 (17.1%) and regression in 15 (21.4%) patients individually. No variables were detected as predictors of cerebral vascular progression. Conclusion: Isolated symptomatic middle cerebral artery stenosis in young adults had unaccepted high rates of recurrence but comparatively good prognosis; despite the dramatic change of lesion artery in the short period after stroke, no factors were detected as the probable factors associated with the dynamic process.

Chen, Zhonglun; Li, Wei; Sun, Wen; Xiao, Lulu; Dai, Qiliang; Cao, Yuezhou; Han, Yunfei; Zhu, Wusheng; Xu, Gelin; Liu, Xinfeng

doi: 10.1080/00207454.2016.1214825pmid: 27430627

Liu, Junfeng; Wang, Deren; Yuan, Ruozhen; Xiong, Yao; Liu, Ming

doi: 10.1080/00207454.2016.1216414pmid: 27451828

Background and purpose: Intracerebral hemorrhage (ICH) is the deadliest, most disable and least treatable form of acute cerebral accident. Prognostic risk factors of ICH are not yet fully identified. This study investigated the possible clinical factors leading to poor outcomes in patients with ICH, which can be used to guide clinical treatment and predict prognosis. Methods: We prospectively enrolled patients with ICH who were admitted within 7 d of stroke onset from January 2012 to April 2014. The prognostic factors of patients with ICH were analyzed in univariate analyses and logistic regression analyses. Results: A total of 908 consecutive patients with ICH (mean age, 57.87 ± 13.92 years) were finally included, of which 616 patients (67.8%) were male. 59.5%, 54.5% and 52.2% patients with ICH had poor outcomes (death/disability) at 3, 6 and 12 months, respectively. Stroke severity and stroke-related complications during hospitalization were independently associated with poor outcomes both at 3 and 12 months. In addition, hyperglycemia, hematocrit and blood urea nitrogen on admission were independently associated with poor outcomes at three months. Conclusion: This study found that severity of ICH and stroke-related complications were independent predictors of poor outcomes at three months and one year after ICH. Thereby, it highlights the importance of understanding the role of clinical features in ICH prognostic evaluation.

O'Neil-Pirozzi, Therese M.; Doruk, Deniz; Thomson, Jennifer M.; Fregni, Felipe

doi: 10.1080/00207454.2016.1216415pmid: 27453334

Purpose/aim: Memory impairment post-TBI is common, frequently persistent, and functionally debilitating. The purposes of this pilot study were to assess and to compare immediate behavioral auditory working memory and electrophysiologic effects of three different, randomized, conditions of left dorsolateral prefrontal cortex (LDLPFC) transcranial direct current stimulation (tDCS) applied to four neurotypical adults and four adults with chronic traumatic brain injury (TBI). Materials/methods: Pre- and post-anodal, cathodal, and sham tDCS auditory memory performance, auditory event-related potentials (P300 amplitude and latency) and power of alpha and theta EEG bands were measured across individuals in each group. Results: Post-anodal tDCS only, the neurotypical and TBI groups both demonstrated significantly improved immediate auditory memory function. Also post-anodal tDCS, the TBI group demonstrated significantly increased P300 amplitude versus post-sham tDCS. The neurotypical group demonstrated no pre- post-tDCS electrophysiologic changes across conditions. Conclusions: These findings are consistent with findings of other studies of immediate tDCS effects on other types of memory in neurotypical individuals and in individuals with Parkinson's disease, Alzheimer's disease and stroke and suggest that individuals with memory impairments second to chronic TBI may benefit from LDLPFC anodal tDCS. Pairing tDCS with traditional behavioral memory interventions may facilitate TBI rehabilitation outcomes and warrants continued investigation.

Ye, Shan; Lin, Shao-Peng; Wu, Keping; Fan, Yongxiang; Xu, Miqing

doi: 10.1080/00207454.2016.1218874pmid: 27476523

Background: Several prior studies have linked serum prealbumin (PA) as a predictor for perioperative infection. However, whether peripheral blood PA levels can be used as an indicator of stroke-associated infection (SAI) is still unclear. In this study, we attempt to find whether serum PA is a meaningful predictor in SAI after an ischemic stroke, so as to provide theoretical basis for clinical treatment. Methods: Consecutive patients with acute ischemic stroke who were admitted to our hospital were enrolled and serum PA was collected. A prospective study was conducted to observe the predictive value of PA in the SAI incident in ischemic stroke patients. Results: Of 104 patients, 29 (27.9%) developed an SAI after 7 d of follow-up. The stroke with SAI group had significantly lower PA levels than the stroke without SAI group (  p < 0.05). The optimal cutoff value for predicting SAI was PA ≤ 191 mg/L, with sensitivity and specificity of 58.62% and 81.33%, respectively. Kaplan–Meier survival analysis showed that stroke patients with low serum PA level (PA ≤ 191 mg/L) had a higher SAI rates (log-rank test, χ2 = 16.870, p < 0.001). Cox regression analysis showed that PA ≤ 191 mg/L (hazard ratio = 3.207; 95% CI, 1.430–7.190, p = 0.005) was an independent risk factor for SAI. Conclusions: Early detection of serum PA during the acute phase of ischemic stroke may help us to identify at-risk SAI patients, and hence rapidly guide the intervention to prevent SAI.

Zhang, Dao Pei; Yin, Suo; Zhang, Shu Ling; Zhang, Jie Wen; Ma, Qian Kun; Lu, Gui Feng

doi: 10.1080/00207454.2016.1220379pmid: 27488466

Objective: The aim of this study was to observe brainstem hemodynamic alterations associated with basilar artery hypoplasia (BAH). Methods: Nine hundred and fifty-two consecutive patients received emergency multimodal computed tomography; magnetic resonance imaging and magnetic resonance angiogram during the period of January 2011 to December 2014 were included. The vascular risk factors, brainstem auditory evoked potential (BAEP), blink reflex (BR), transcranial Doppler (TCD) and dynamic susceptibility contrast-enhanced perfusion-weighted imaging were completed. Results: There was significant difference in the abnormal rates of TCD and BAEP between BAH and non-BAH patients. A positive correlation between basilar artery diameter and systolic velocity among BAH patients was suggested. V-wave value was used to predict posterior circulation infarction (PCI) with the sensitivity of 0.933 and specificity of 0.50 with the cutoff value of 5.97 s. Abnormal BR rate was also significantly different in BAH and non-BAH patients. The latency of R2 was used to predict PCI with the sensitivity of 0.933 and specificity of 0.50 with the cutoff value of 46.4 ms. The incidence of hypoperfusion was higher in BAH than non-BAH group and it was significant difference. Conclusion: BAH is closely associated with hemodynamic alterations within the pons, which might contribute to vascular vertigo due to regional hypoperfusion.

Chen, Zhibo; Su, Zhongqian; Pang, Wanhui; Huang, Yuanyuan; Lin, Jie; Ding, Zhangna; Wu, Senmin; Xu, Shunyao; Quan, Weiwei; Zheng, Juzeng; Chen, Huale; Li, Zhengzheng; Li, Xiang; Li, Jia; Weng, Yiyun; Zhang, Xu

Shabab, Tara; Khanabdali, Ramin; Moghadamtousi, Soheil Zorofchian; Kadir, Habsah Abdul; Mohan, Gokula

doi: 10.1080/00207454.2016.1212854pmid: 27412492

Activated microglial cells play an important role in immune and inflammatory responses in central nervous system and neurodegenerative diseases. Many pro-apoptotic pathways are mediated by signaling molecules that are produced during neuroinflammation. In glial cells, NF-κB, a transcription factor, initiates and regulates the expression of several inflammatory processes during inflammation which are attributed to the pathology of the several neurodegenerative diseases. In this review, we discuss the most important neuroinflammatory mediators with their pathways. Attenuating cytokines production and controlling microglial inflammatory response, which are the result of understanding neuroinflammation pathways, are considered therapeutic strategies for treating neurodegenerative diseases with an inflammatory component.