RESUMO
INTRODUCTION: Thrombosis of cerebral veins or sinuses (CVST) is a rare condition. In a monocentric retrospective cohort study the clinical characteristics, risk factors, radiological findings as well as course and prognosis of patients over the past 15 years were examined. METHODS: Between January 1998 and March 2013 all patients who were treated as inpatients for CVST at the department of neurology of the University of Heidelberg were systematically registered in a database. Along with all relevant clinical data the modified Rankin scale (MRS) was used to measure the clinical severity. A follow-up visit was performed at three time points. The odds ratios (OR) were calculated to establish predictors of good outcome (MRS 0-2), mortality at discharge and at follow-up. Significant variables after univariate analysis were tested for independency in a multivariate logistic regression model. RESULTS: A total of 143 patients were included in the study. The median age was 43 years (range 17-74 years) and 67.4 % of patients were female. The most common symptoms were headache (70.6 %), seizures (50.4 %) and paresis (37.8 %). The most prominent clinical risk factor was oral contraception (40.4 %). The two most common localizations of thrombosis were the transversal sinus with the sigmoid sinus (66.4 %) and the sagittal superior sinus (47.6 %). On admission 42.7 % of patients suffered additionally from intracerebral hemorrhage and 12.6 % from congestive infarction. Of the patients 9.5 % (10 out of 105) showed a pathologically reduced activated protein C (APC) resistance and 8.4 % (6 out of 94) a prothrombin mutation. All patients were initially treated with heparin and 88.7 % were switched to cumarin during the course of the disease. The median duration of anticoagulation was 15.75 months (range 1-121 months). On discharge 77.7 % had a good outcome and the in-hospital mortality was 4.7 %. The median time to follow-up in 108 patients was 36 months (range 3-132 months), 74.1 % of patients had a good outcome (MRS 0-2) and 18.5 % died. Independent predictors of in-hospital mortality were MRS on admission (OR 2.2, 95 % CI 1.03-4.7) and of mortality at follow-up the presence of a malignant disease (OR 50.2, 6-423) and intracerebral hemorrhage on admission (OR 10.3, 1.7-62.6). DISCUSSION: The results of this study are in line with previously published data on CVST. The most prominent clinical risk factors for CVST were female gender and oral contraception. At discharge from hospital and 3 years after CVST approximately 75 % of patients achieved a good clinical outcome. A severe clinical syndrome and the presence of an intracerebral hemorrhage on admission were independent predictors of mortality.
Assuntos
Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Trombose dos Seios Intracranianos/mortalidade , Trombose dos Seios Intracranianos/terapia , Adolescente , Adulto , Estudos de Coortes , Progressão da Doença , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco , Trombose dos Seios Intracranianos/diagnóstico , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: It has been suggested that inflammation may play a role in the development of cervical artery dissection (CeAD), but evidence remains scarce. METHODS: A total of 172 patients were included with acute (< 24 h) CeAD and 348 patients with acute ischaemic stroke (IS) of other (non-CeAD) causes from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study, and 223 age- and sex-matched healthy control subjects. White blood cell (WBC) counts collected at admission were compared across the three groups. RESULTS: Compared with healthy control subjects, CeAD patients and non-CeAD stroke patients had higher WBC counts (P < 0.001). Patients with CeAD had higher WBC counts and were more likely to have WBC > 10 000/µl than non-CeAD stroke patients (38.4% vs. 23.0%, P < 0.001) and healthy controls (38.4% vs. 8.5%, P < 0.001). WBC counts were higher in CeAD (9.4 ± 3.3) than in IS of other causes (large artery atherosclerosis, 8.7 ± 2.3; cardioembolism, 8.2 ± 2.8; small vessel disease, 8.4 ± 2.4; undetermined cause, 8.8 ± 3.1; P = 0.022). After adjustment for age, sex, stroke severity and vascular risk factors in a multiple regression model, elevated WBC count remained associated with CeAD, as compared with non-CeAD stroke patients [odds ratio (OR) = 2.56; 95% CI 1.60-4.11; P < 0.001) and healthy controls (OR = 6.27; 95% CI 3.39-11.61; P < 0.001). CONCLUSIONS: Acute CeAD was associated with particularly high WBC counts. Leukocytosis may reflect a pre-existing inflammatory state, supporting the link between inflammation and CeAD.
Assuntos
Dissecção Aórtica/sangue , Leucocitose/complicações , Acidente Vascular Cerebral/sangue , Adulto , Artérias Cerebrais/patologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Acidente Vascular Cerebral/etiologiaRESUMO
BACKGROUND AND PURPOSE: Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. METHODS: Stroke etiology was reported in detail for 3331 patients aged 15-49 years with first-ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low- and high-risk sources. Other determined group was divided into dissection and other non-dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. RESULTS: Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high-risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high-risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. CONCLUSIONS: The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.
Assuntos
Isquemia Encefálica/etiologia , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Isquemia Encefálica/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/epidemiologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: To analyze previously established gender differences in cervical artery dissection (CeAD). METHODS: This case-control study is based on the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) population comprising 983 consecutive CeAD patients (mean age: 44.1 ± 9.9 years) and 658 control patients with a non-CeAD ischemic stroke (IS) (44.5 ± 10.5 years). RESULTS: Cervical artery dissection was more common in men (56.7% vs. 43.3%, P < 0.001) and men were older (46.4 vs. 41.0 years, P < 0.001). We assessed putative risk factors for CeAD including vascular risk factors, recent cervical trauma, pregnancies, and infections. All gender differences in the putative risk factors and outcome were similar in the CeAD and the non-CeAD IS groups. CONCLUSION: Our analysis of the largest collection of CeAD patients to date confirms male predominance and differences in age at dissection between men and women. Gender differences in putative risk factors may explain the higher frequency of CeAD in men and their older age, but the putative risk factors are probably not specific for CeAD.
Assuntos
Dissecção Aórtica/epidemiologia , Caracteres Sexuais , Acidente Vascular Cerebral/epidemiologia , Adulto , Dissecção Aórtica/etiologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Observação , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicaçõesRESUMO
BACKGROUND: Spinocerebellar ataxia type 17 (SCA17) is caused by abnormal expansions of CAG/CAA trinucleotides within the TATA-box binding protein gene (TBP). The currently accepted critical threshold of abnormal expansions is ≥43. OBJECTIVE: To investigate the minimal CAG/CAA expansion within the TBP in SCA17. RESULTS: 285 patients with autosomal-dominant ataxia were examined, and abnormal or borderline expansions of CAG/CAA within TBP in eight cases were found. Of those, four patients from three families had exactly 42 CAG/CAA trinucleotides, that is, one codon less than the currently accepted critical threshold of 43. The four patients presented with a relatively benign phenotype. All had dysdiadochokinesia and dysarthria. Mild gait ataxia was observed in three of the four patients. CONCLUSION: The reference definition of at least 43 CAG/CAA codons for pathological SCA17 alleles should be lowered to 42.
Assuntos
Alelos , Aberrações Cromossômicas , Genes Dominantes/genética , Glutamina/genética , Ataxias Espinocerebelares/genética , Proteína de Ligação a TATA-Box/genética , Expansão das Repetições de Trinucleotídeos , Adulto , Idoso , Atrofia , Cerebelo/patologia , Códon , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Linhagem , Penetrância , Ataxias Espinocerebelares/diagnóstico , Adulto JovemRESUMO
Acute stroke must be considered as an emergency with highest priority. The same is true for patients with transient ischemic attacks, given their high risk for following stroke events within the first 48 hours. Early brain imaging is essential for discrimination of either ischemic or hemorrhagic stroke. In acute ischemic stroke, rapid establishment of reperfusion is the major therapeutic goal. This is achieved by intravenous thrombolysis, in selected cases by an intraarterial approach with pharmaceutical and/or mechanical recanalization. The effect of successful reperfusion is highly dependent on time: the earlier, the better the odds for substantial clinical improvement. The recent extension of the time window for systemic thrombolysis to 4.5 hours must not result in any delays of diagnosis and treatment initiation! Stroke units with facilities for early etiological workup with according secondary prevention measures, for prevention and treatment of complications, and for early rehabilitation have been shown to yield the best outcome for all stroke victims.
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Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Infarto Cerebral/diagnóstico , Infarto Cerebral/terapia , Serviço Hospitalar de Emergência , Doença Aguda , Angioplastia , Comportamento Cooperativo , Diagnóstico Diferencial , Unidades Hospitalares , Humanos , Comunicação Interdisciplinar , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/terapia , Equipe de Assistência ao Paciente , Fatores de Risco , Terapia TrombolíticaRESUMO
BACKGROUND: Cervical artery dissection (CAD) is a frequent cause of ischemic stroke, and occasionally death, in young adults. Several lines of evidence suggest a genetic predisposition to CAD. However, previous genetic studies have been inconclusive mainly due to insufficient numbers of patients. Our hypothesis is that CAD is a multifactorial disease caused by yet largely unidentified genetic variants and environmental factors, which may interact. Our aim is to identify genetic variants associated with an increased risk of CAD and possibly gene-environment interactions. METHODS: We organized a multinational European network, Cervical Artery Dissection and Ischemic Stroke Patients (CADISP), which aims at increasing our knowledge of the pathophysiological mechanisms of this disease in a large group of patients. Within this network, we are aiming to perform a de novo genetic association analysis using both a genome-wide and a candidate gene approach. For this purpose, DNA from approximately 1100 patients with CAD, and 2000 healthy controls is being collected. In addition, detailed clinical, laboratory, diagnostic, therapeutic, and outcome data are being collected from all participants applying predefined criteria and definitions in a standardized way. We are expecting to reach the above numbers of subjects by early 2009. CONCLUSIONS: We present the strategy of a collaborative project searching for the genetic risk factors of CAD. The CADISP network will provide detailed and novel data on environmental risk factors and genetic susceptibility to CAD.
Assuntos
Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/genética , Dissecação da Artéria Vertebral/epidemiologia , Dissecação da Artéria Vertebral/genética , Adulto , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/genética , DNA/genética , Meio Ambiente , Frequência do Gene , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Polimorfismo Genético/genética , Polimorfismo de Nucleotídeo Único/genética , Controle de Qualidade , Projetos de Pesquisa , Fatores de Risco , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Dissecação da Artéria Vertebral/complicações , População BrancaRESUMO
OBJECTIVE: The exposure of tissue factor (TF) to blood flow is the initial step in the coagulation process and plays an important role in thrombogenesis. We investigated the role of genetic polymorphisms and haplotypes of the TF gene in the risk of ischemic vascular disease. METHODS: Four hundred and twenty-two Italian patients with juvenile myocardial infarction (MI) and 434 controls, 808 US cases with MI and 1005 controls, 267 Italian cases with juvenile ischemic stroke and 209 controls and 148 German cases with juvenile ischemic stroke and 191 controls were studied. rs1361600, rs3917629 (rs3354 in the US population), rs1324214 and rs3917639 Tag single nucleotide polymorphisms were genotyped. Additionally, a meta-analysis of all previous studies on TF loci and the risk of ischemic coronary disease (ICD) was performed. RESULTS: After multivariable analysis none of the SNPs, major SNP haplotypes or haplotype-pairs showed any consistent association with MI. Pooled meta-analysis of six studies also suggested that TF polymorphisms are not associated with CHD. A significant, independent association between SNP rs1324214 (C/T) and juvenile stroke was found in Italian and German populations (OR for TT homozygotes = 0.47, 95% CI 0.24-0.92, in combined analysis). Pooled analysis also showed a significant association for haplotype H3 (OR = 0.76, 95% CI 0.57-1.00) and haplotype-pair H3-H3 (OR = 0.43, 95% CI 0.20-0.92). CONCLUSIONS: TF genetic variations were associated with the risk of ischemic stroke at young age, but did not affect ischemic coronary disease.
Assuntos
Isquemia/patologia , Polimorfismo Genético , Acidente Vascular Cerebral/genética , Tromboplastina/genética , Adulto , Estudos de Casos e Controles , Feminino , Variação Genética , Haplótipos , Homozigoto , Humanos , Interleucina-1beta/genética , Itália , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/genética , Polimorfismo de Nucleotídeo Único , RiscoRESUMO
BACKGROUND: The TT genotype of a functional factor XII (FXII) C46T gene polymorphism was shown to be a risk factor for peripheral venous thrombosis. We tested whether this genetic variant also increases the risk for cerebral venous thrombosis (CVT). METHODS: We performed a case-control study including 78 consecutive patients with proven CVT and 201 healthy population controls from South Germany. The FXII C46T genotype was assessed using a PCR technique. RESULTS: The TT genotype of the FXII C46T polymorphism was more common in patients (16.7%) than in controls (5.5%). A strong association of the TT genotype with CVT was found, which was independent of covariables (adjusted odds ratio 4.57; 95% CI 1.55 to 13.41; p = 0.006). CONCLUSION: The TT genotype of the functional factor XII C46T gene polymorphism may be a new independent risk factor for cerebral venous thrombosis (CVT). Our finding warrants confirmation in an independent study before this genetic variant should be added to the panel of established risk factors for CVT.
Assuntos
Fator XII/genética , Predisposição Genética para Doença , Trombose Intracraniana/genética , Polimorfismo de Nucleotídeo Único/genética , Risco , Trombose Venosa/genética , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-IdadeRESUMO
A common pro-inflammatory promoter variant of the selenoprotein S encoding gene (SEPS1) was studied in young stroke patients from Italy and Germany and in healthy control subjects. The -105A-allele was found in 56 of 205 (27.3%) patients with ischemic stroke IS because of a spontaneous cervical artery dissection (CAD), and in 69 of 295 (23.4%) patients <50 years with IS of non-CAD origin. The SEPS -105A promoter variant was detected in 87 of 393 healthy control subjects (22.1%) and in 11 of 55 CAD patients without IS (20%). The non-significant differences of SEPS1 allele frequencies between disease groups and healthy controls suggest that the SEPS1 -105A allele is not a major-risk factor for stroke.
Assuntos
Transtornos Cerebrovasculares/genética , Proteínas de Membrana/genética , Polimorfismo Genético , Regiões Promotoras Genéticas/genética , Selenoproteínas/genética , Adulto , Alelos , Transtornos Cerebrovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The methylene tetrahydrofolate reductase (MTHFR) C677T polymorphism was studied in 174 German patients with cervical artery dissection (CAD). The results were compared with published data on 927 healthy German controls. In the series of patients, the frequency of T alleles and of TT carriers was slightly higher (13.8%) than among the healthy controls (10.6%). In patients with multiple dissections (n = 50), the proportion of TT carriers (18%) was found to be even higher and correlated with the number of events. The MTHFR C677T polymorphism was suggested to modify the risk for CAD.
Assuntos
Dissecção Aórtica/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Artérias/patologia , Estudos de Casos e Controles , Genótipo , Alemanha , Humanos , Pescoço/irrigação sanguínea , Polimorfismo Genético , Fatores de RiscoRESUMO
In a primary study on proinflammatory genetic profiles in stroke, the authors found the E469K polymorphism of the intercellular adhesion molecule 1 (ICAM-1) highly represented in the subgroup with spontaneous cervical artery dissection (sCAD). They further investigated the same genetic variant in a second group of 65 patients with sCAD. An association between sCAD and EE genotype was confirmed (odds ratio 3.16; p < 0.01), indicating that a proinflammatory predisposition is a risk factor for sCAD.
Assuntos
Ácido Glutâmico/genética , Molécula 1 de Adesão Intercelular/genética , Lisina/genética , Polimorfismo Genético , Dissecação da Artéria Vertebral/genética , Adulto , Alelos , Substituição de Aminoácidos/genética , Feminino , Genótipo , Humanos , Molécula 1 de Adesão Intercelular/fisiologia , Masculino , Fatores de RiscoRESUMO
OBJECTIVES: Takayasu arteritis is well known as a cause of stroke in Asia but has rarely been described in the Western world. Here we report the clinical and neuroimaging follow-up of a series of patients with Takayasu arteritis from Europe. METHODS: Seventeen consecutive patients who fulfilled the diagnostic criteria for Takayasu arteritis of the American College of Rheumatology were evaluated on follow-up by standardized neurological examination, sonography and MRI. RESULTS: At follow-up almost 20 yr after onset of symptoms, the subclavian artery and the common carotid artery were often affected. In addition, evidence of intracranial pathology was found in seven patients. In contrast to the severe vessel involvement, the neurological state was stable. Two patients had suffered from stroke before the diagnosis was made and therapy was initiated, and one patient had recurrent transient ischaemic attacks. Intermittent dizziness was associated with pathology of the vertebral and basilar arteries. However, clinical symptoms of subclavian steal syndrome were rare. CONCLUSION: This case series shows that the clinical neurological course of Takayasu arteritis on treatment is benign in most cases despite the severe vascular involvement.
Assuntos
Artéria Carótida Primitiva/patologia , Artéria Subclávia/patologia , Arterite de Takayasu/etnologia , População Branca , Adolescente , Adulto , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , Seguimentos , Alemanha , Humanos , Ataque Isquêmico Transitório/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Artéria Subclávia/diagnóstico por imagem , Arterite de Takayasu/complicações , Arterite de Takayasu/patologia , Ultrassonografia DopplerRESUMO
Since antineoplastic activity varies, sensitive methods for individual assessment of efficacy are needed. We demonstrate the clinical value of MR spectroscopy in monitoring chemotherapy in a patient with recurrent glioma after stereotactic radiotherapy. Diagnostic imaging before and after chemotherapy included contrast-enhanced MRI, single-voxel proton MR spectroscopy ((1)H MRS), (1)H MR spectroscopic imaging ((1)H SI), and fluorodeoxyglucose (FDG) positron-emission tomography (PET). A significant decrease in choline signal intensity was observed 2 months after chemotherapy indicating tumour chemosensitivity, in line with tumour shrinkage on MRI and decreased uptake of FDG. Assessment of early response by MRS may help to improve treatment protocols in other patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ácido Aspártico/análogos & derivados , Astrocitoma/tratamento farmacológico , Neoplasias Encefálicas/tratamento farmacológico , Metabolismo Energético/efeitos dos fármacos , Processamento de Imagem Assistida por Computador , Espectroscopia de Ressonância Magnética , Recidiva Local de Neoplasia/tratamento farmacológico , Radiocirurgia , Lobo Temporal/efeitos dos fármacos , Adulto , Ácido Aspártico/metabolismo , Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Quimioterapia Adjuvante , Colina/metabolismo , Creatina/metabolismo , Humanos , Lomustina/administração & dosagem , Masculino , Recidiva Local de Neoplasia/patologia , Exame Neurológico/efeitos dos fármacos , Procarbazina/administração & dosagem , Lobo Temporal/patologia , Tomografia Computadorizada de Emissão , Resultado do Tratamento , Vincristina/administração & dosagemRESUMO
BACKGROUND AND PURPOSE: The vitamin K-dependent protein Z (PZ) has been shown to possess anticoagulant as well as procoagulant properties. Plasma levels of PZ show a broad interindividual variation, but it is unknown to which extent this variation is under genetic control. Recent clinical studies revealed contradictory results on the association of PZ plasma levels and the risk of ischemic stroke. METHODS: We performed a case-control study including 200 patients with cerebral ischemia aged < or =50 years and 199 control subjects from the same South German region. We investigated a possible association of 2 common single nucleotide mutations in the PZ gene with the risk of cerebral ischemia. Furthermore, enzyme-linked immunosorbent assay measurements were done in control subjects without vascular disease to detect a potential association of different genotypes with PZ plasma (antigen) levels. RESULTS: In patients, the frequency of the A allele of the intron F polymorphism G79A was significantly lower than in controls (15.7% versus 24.4%; odds ratio, 0.58; 95% CI, 0.39 to 0.86; P=0.007; adjusted for age, sex, and conventional risk factors). The G allele of the promoter polymorphism A-13G tended to be less common in patients (4.2% versus 7.0%; adjusted odds ratio, 0.56; 95% CI, 0.28 to 1.13; P=0.105). In 42 control subjects, the A allele of the intron F polymorphism was associated with lower PZ antigen levels (P=0.0032; Spearman correlation coefficient rs=-0.48). CONCLUSIONS: The A allele of an intron F polymorphism of the PZ gene appears to be a novel protective genetic marker for the risk of cerebral ischemia in young adults. In the context of juvenile stroke, high PZ plasma levels may represent a prothrombotic condition.
Assuntos
Proteínas Sanguíneas/análise , Proteínas Sanguíneas/genética , Isquemia Encefálica/genética , Polimorfismo de Nucleotídeo Único , Adulto , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , Fator V/genética , Feminino , Frequência do Gene , Variação Genética , Alemanha/epidemiologia , Humanos , Íntrons/genética , Masculino , Proteínas de Membrana , Prevalência , Regiões Promotoras Genéticas , Protrombina/genética , Medição de Risco , Proteínas Supressoras de TumorRESUMO
PURPOSE: To test whether the prognosis of systemic thrombolysis can be estimated with the attenuation values of vascular occlusions as measured with multi-slice computed tomography (MSCT). METHODS: Prior to thrombolysis with rt-PA, the attenuation values of vascular occlusions were determined with a helical MSCT using a collimation of 0.5 mm. We examined 5 patients that were 63 - 79 years old. With the help of reference values that were obtained from a phantom study we categorised the vascular occlusions according to their attenuation values as being mixed thrombi with low or high proportions of erythrocytes, or red thrombi. TOF angiographies were done before and after the thrombolytic therapy. RESULTS: The systemic therapy with rt-PA was effective in vascular occlusions that had attenuation values of red thrombi or of mixed thrombi with a high proportion of erythrocytes. The therapy showed no effect when the attenuation values matched with mixed thrombi with a low proportion of erythrocytes. Due to artefacts that were caused by beam hardening, attenuation measurements could not be performed in the posterior fossa. CONCLUSION: The presented cases are in accordance with the results of experimental studies which indicate that the efficacy of thrombolysis increases with the attenuation values of thromboembolic vascular occlusions. The predictive value of attenuation measurements by MSCT for the prognosis of systemic thrombolysis cannot be given yet.
Assuntos
Angiografia Cerebral , Processamento de Imagem Assistida por Computador , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/tratamento farmacológico , Terapia Trombolítica , Tomografia Computadorizada Espiral , Doença Aguda , Idoso , Algoritmos , Contagem de Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Prognóstico , Valores de Referência , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: Paradoxical embolism via persistent foramen ovale (PFO) is suspected to be a frequent cause of stroke in younger patients. We investigated whether the prevalence of the risk factors for venous thrombosis factor V Leiden (FVL) and prothrombin G20210A mutation (PT G20210A) is increased in this group of patients. METHODS: We examined FVL and PT G20210A mutation in 220 patients (group 1) with cerebral ischemia associated with a PFO and without other etiology, in 196 patients with cerebral ischemia of an etiology other than PFO (group 2), and in 362 healthy subjects (group 3) from the same region in Germany. RESULTS: Heterozygosity for the PT G20210A mutation was more common in group 1 (5.0%) than in group 3 (1.4%; sex- and age-adjusted odds ratio 3.66; 95% CI 1.25-10.75; p = 0.01). By contrast, the mutation was not more common in group 2 (2.6%; odds ratio 1.50; 95% CI 0.42-5.41; p = 0.5). Prevalences of FVL were not different between groups. CONCLUSIONS: We identified PT G20210A but not FVL - the strongest genetic risk factor for deep venous thrombosis - to be significantly associated with stroke attributed to PFO. These findings rise doubts about the concept of paradoxical brain embolism as the dominating mechanism in stroke associated with PFO.
Assuntos
Isquemia Encefálica/genética , Fator V/genética , Comunicação Interatrial/genética , Mutação/genética , Protrombina/genética , Adulto , Idoso , Isquemia Encefálica/fisiopatologia , Diabetes Mellitus/fisiopatologia , Feminino , Comunicação Interatrial/fisiopatologia , Heterozigoto , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Trombose Intracraniana/genética , Trombose Intracraniana/fisiopatologia , Ataque Isquêmico Transitório/genética , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fumar/fisiopatologia , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/fisiopatologia , Ultrassonografia Doppler TranscranianaRESUMO
BACKGROUND: The monocyte receptor for bacterial lipopolysaccharide CD14 is an important mediator of the inflammatory response. Recently, a polymorphism in the promotor of the CD14 gene, C (-260) T, was detected as a risk factor for coronary heart disease. OBJECTIVE: We tested the hypotheses that this polymorphism is a risk factor 1. for cerebral ischemia in general and 2. for cerebral ischemia due to large artery atherosclerosis or microangiopathy in particular. PATIENTS AND METHODS: We performed a case control study including 151 consecutive patients with acute cerebral ischemia treated at our university hospital and 149 control subjects. All control subjects were randomly selected from the general population of the same region in South-West Germany. Genotype frequencies of the C(-260) T polymorphism in the promotor of the CD14 gene were examined by restriction length analysis. RESULTS: The TT-genotype was not associated with cerebral ischemia in general either in univariate or in multivariate analysis together with classical vascular risk factors (odds ratio in multivariate analysis: 1.11; 95 %CI, 0.63 to 1.95). In 70 patients with cerebral ischemia due to atherosclerosis of large arteries or microangiopathy, there was a significantly higher prevalence of the TT-genotype than into control subjects (38.6 % vs. 23.5 %; odds ratio in multivariate analysis 2.26; 95 %CI, 1.13 to 4.54). CONCLUSIONS: We demonstrated that the TT-genotype of the CD14 C(-260) T polymorphism in a South-German population is not associated with an increased risk of cerebral ischemia in general. However, we found that the TT-genotype is associated with a risk of atherosclerotic or microangiopathic stroke. This finding requires confirmation by future studies in larger populations.
Assuntos
Isquemia Encefálica/genética , Predisposição Genética para Doença , Receptores de Lipopolissacarídeos/genética , Polimorfismo Genético , Acidente Vascular Cerebral/genética , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/etiologia , Estudos de Casos e Controles , Feminino , Genótipo , Alemanha , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/etiologia , Arteriosclerose Intracraniana/genética , Lipopolissacarídeos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Regiões Promotoras Genéticas , Fatores de RiscoRESUMO
BACKGROUND: Enhanced stimulus-induced release of pro-inflammatory cytokines by leucocytes may contribute to the pathogenesis of ischaemic stroke. DESIGN: We investigated the lipopolysaccharide-induced release of interleukin-1beta (IL-1beta), IL-6, IL-8, and tumour necrosis factor-alpha (TNF-alpha) in whole blood from 20 patients with a history of ischaemic stroke under the age of 50, 20 patients with a history of cervical artery dissection (CAD) and 21 age- and sex-matched healthy control subjects. RESULTS: Release of IL-8 was higher (P = 0.006) and release of TNF-alpha and IL-6 tended to be higher (P < 0.1) in young stroke patients than in control subjects. No increased release existed in CAD patients. Vascular risk factors or history of infection before stroke did not modify IL-8 production. A common T(250) --> A polymorphism in the IL-8 gene promotor was newly identified but did not correlate with the variability of IL-8 release. The C(260) --> T polymorphism in the gene of the monocytic LPS-receptor CD14--a risk factor for myocardial infarction--was not associated with increased cytokine release. CONCLUSIONS: We conclude that high inducible release of IL-8--and possibly of TNF-alpha and IL-6--may contribute to the odds of ischaemic stroke in young adults.