Transient global amnesia - hippocampal lesions in magnetic resonance imaging.

BACKGROUND: Transient global amnesia is a benign syndrome characterized by a sudden onset loss of anterograde amnesia with full recovery. Magnetic resonance of the brain including diffusion-weighted imaging of patients with transient global amnesia revealed the presence of punctate hyperintense signal abnormalities in the hippocampus. OBJECTIVE: Analysis of the presence of hippocampal lesions in brain magnetic resonance imaging in patients with transient global amnesia and the possible influence of additional factors on their appearance. METHODS: In this retrospective, an observational study we assessed brain magnetic resonance imaging in 38 consecutive patients with transient global amnesia. The incidence of brain magnetic resonance imaging lesions was analyzed for the coexisting cardiovascular risk factors and precipitating events. RESULTS: Hippocampal brain magnetic resonance imaging lesions were detected in 47% of patients with transient global amnesia. Of those, 65% had unilateral lesions, 82% were left-sided, and 28% were right-sided. Most lesions were located in the CA1 subfield. The incidence of hypertension in patients with transient global amnesia was higher than in the general population. Stress and exercise preceded the onset of transient global amnesia only in 13% and 16% of patients, respectively. There was no higher incidence of migraine in transient global amnesia patients (13%). CONCLUSIONS: We found that nearly 50% of patients with transient global amnesia had hyperintense hippocampal brain magnetic resonance imaging lesions. In addition to hypertension, individuals with transient global amnesia had similar cardiovascular risk factors as the general population. We did not identify any precipitating events prior to the onset of transient global amnesia.

Mechanical thrombectomy in acute stroke - Five years of experience in Poland.

OBJECTIVES: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. METHODS AND RESULTS: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. RESULTS: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b-TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0-2 - in 31.4% and mRS of 6 in 22% of cases. CONCLUSION: Our results can help harmonize standards for MT in Poland according to international guidelines.

Can Prediction of Functional Outcome after Stroke Be Improved by Adding Fibrinogen to Prognostic Model?

BACKGROUND: Several studies demonstrated that elevated plasma fibrinogen level is associated with poor functional outcome after ischemic stroke. It remains, however, unclear if prediction of functional outcome after stroke can be improved by adding fibrinogen to prognostic model. We aimed to determine the prognostic value of plasma fibrinogen for the prediction of functional outcome after ischemic stroke. METHODS: We retrospectively analyzed the data of 727 ischemic stroke patients (median age: 70; 48% men). The functional outcome was assessed 1 month after stroke onset using modified Rankin Scale. Unfavorable outcome was defined as modified Rankin Scale score higher than 2. Using C-statistic and reclassification measures (net reclassification improvement-NRI and integrated discrimination improvement-IDI), we compared the predictive abilities of 2 models. The first model contained stroke severity and age, and the second one included fibrinogen in addition. RESULTS: After adjusting for age and stroke severity, plasma fibrinogen level higher than 2.95 g/L was associated with unfavorable outcome (OR: 1.80, 95% CI: 1.20-2.72, P < .01). The addition of fibrinogen did not lead to an improvement in predictive ability of the model. C-statistic did not differ between models (.90 versus .90, P = .34). The categorical NRI was .01 (P = .66) and the IDI was .006 (P = .08). CONCLUSIONS: The addition of fibrinogen to predictive model including age and stroke severity does not improve discrimination between favorable and unfavorable outcomes after ischemic stroke.

The ß-fibrinogen -455G/A gene polymorphism and the risk of ischaemic stroke in a Polish population.

BACKGROUND AND PURPOSE: Ischaemic stroke is considered to be multifactorial and interactions between environmental and genetic factors play an important role. Although vascular risk factors are well known, the genetic ones are still undiscovered. In the present study, we assessed the significance of the ß-fibrinogen -455G/A gene polymorphism and the risk of ischaemic stroke in a Polish population. MATERIAL AND METHODS: 426 ischaemic stroke patients classified according to stroke aetiologies (small vessel disease, large vessel disease or cardioembolic stroke) and 234 controls were included in the study. The association of the ß-fibrinogen genotypes with ischaemic stroke was tested using logistic regression analysis under dominant, recessive or additive models of inheritance. RESULTS: The allele and genotype distributions of the ß-fibrinogen -455G/A gene polymorphism did not differ significantly between patients and controls (patients: G - 75%, GG - 56.6%, GA - 36.8%, AA - 6.6%; controls: G - 73.7%, GG - 57.3%, GA - 32.9%, AA - 9.8%; p > 0.05, χ2). In addition, logistic regression analysis adjusted for the known risk factors, i.e. hypertension, ischaemic heart disease, myocardial infarction, hypercholesterolaemia, diabetes mellitus and smoking, did not show a role of the studied polymorphism in ischaemic stroke. CONCLUSIONS: The ß-fibrinogen -455G/A gene polymorphism is not a risk factor for ischaemic stroke in a Polish population.

The rs2200733 variant on chromosome 4q25 is a risk factor for cardioembolic stroke related to atrial fibrillation in Polish patients.

BACKGROUND AND PURPOSE: A few single nucleotide polymorphisms (SNPs) on chromosome 4q25, associated with atrial fibrillation (AF), are risk factors for ischaemic stroke. We studied the significance of the SNP rs2200733 on chromosome 4q25 in different types of cardioembolic (CE) stroke. MATERIAL AND METHODS: We genotyped 428 controls and 301 CE stroke patients, among whom 197 (65.4%) presented with high risk sources of embolism (CE stroke related to AF) and 104 with medium risk sources (CE stroke unrelated to AF). The SNP rs2200733 was analysed using real-time polymorphism chain reaction. RESULTS: Both univariate and multivariate regression analyses showed that the studied variant affected risk of all CE strokes or CE strokes related to AF in recessive and additive mo-dels. The two types of CE stroke differed significantly in demographics and distribution of vascular risk factors. CONCLUSIONS: The SNP rs2200733 on chromosome 4q25 is a risk factor for CE stroke related to AF only.

Periodontitis affects neurological deficit in acute stroke.

BACKGROUND AND PURPOSE: Periodontitis is an independent risk factor for ischaemic stroke, but its influence on stroke severity has not been investigated yet. We studied the association of advanced periodontitis or edentulousness with neurological deficit on admission and short-term outcome of stroke patients. METHODS: The study included 169 patients with ischaemic stroke. The neurological deficit on admission was evaluated using the NIH stroke scale (NIHSS). The outcome at discharge was assessed using the modified Rankin scale (mRS) and the Barthel Index (BI). The clinical attachement level (CAL), the distance between cemento-enamel junction and the probed base of periodontal pocket, was recorded for each tooth at six sites. Advanced periodontitis was defined as CAL≥6mm in at least one measured site. RESULTS: Patients with advanced periodontitis or edentulousness were older than those with no or mild periodontitis (71.4years vs. 60.1; p<0.001), had greater neurological deficit on admission (8.9 vs. 5.7; p=0.01) and worse outcome at hospital discharge measured in the mRS (2.2 vs. 1.4; p=0.009). The presence of advanced periodontitis or edentulousness was independent risk factor for greater NIHSS on admission (p=0.025), after adjusting for age, gender and the studied risk factors. The logistic regression model, however, showed that stroke severity on admission but not advanced periodontitis or edentulousness, affected the outcome of stroke patients. CONCLUSIONS: Advanced periodontitis or edentulousness in patients with ischaemic stroke is associated with greater neurological deficit on admission.