Cerebral and skin microcirculatory dysfunction in type 1 diabetes.

INTRODUCTION: An increase in cerebral pulsatility index (PI), measured by transcranial Doppler, reflects the presence of cerebral microangiopathy. A decrease in distance between skin capillaries (DISTANCE) and an increase in the ratio between the area of capillaries and total area of examined skin (COVERAGE), revealed by capillaroscopy, reflects skin microangiopathy. However, little is known about the association between the cerebral and skin microvasculature function in patients at risk of microcirculatory dysfunction. AIM: To assess PI of the middle cerebral artery by transcranial Doppler and the DISTANCE and COVERAGE of the nailfold capillaries by quantitative capillaroscopy in patients with type 1 diabetes and control subjects without diabetes, and to investigate relationships between these parameters. MATERIAL AND METHODS: The study group consisted of 51 patients with type 1 diabetes (median age: 37.5 years) and 23 volunteers free from chronic diseases (median age: 37.9 years). RESULTS: Median PI was higher in patients than in control subjects (0.82 vs. 0.75; p < 0.01). Median DISTANCE was lower in patients than in control subjects (220.9 µm vs. 239.7 µm; p = 0.03), while median COVERAGE was higher in patients than in control subjects (20.4% vs. 18.3%; p = 0.01). No correlations between PI and DISTANCE or COVERAGE were found, but PI was correlated with patients' age and diabetes duration. CONCLUSIONS: In spite of simultaneous presence of cerebral and skin microangiopathy, we found no association between cerebral and skin microvasculature dysfunction. This seems to indicate independent progression of microcirculatory injury in cerebral and peripheral vascular beds.

Cerebral thrombolysis in patients with ischemic stroke and heart failure.

BACKGROUND: Heart failure (HF) is common among patients with ischemic stroke (IS), however its impact on outcome after iv-thrombolysis has not been fully determined. Moreover, definition of HF has been recently modified, but majority of stroke studies classified patients regarding an old HF criteria. Thus, the aim of our study was to evaluate the relationship between both, newly and formerly defined HF and the long-term outcome, mortality and the presence of hemorrhagic complications in patients with acute IS treated with iv-thrombolysis. METHODS: We retrospectively evaluated data from 328 Caucasian patients with IS consecutively treated with iv-thrombolysis. HF was defined according to old and new definition; long-term outcome was assessed with modified Rankin Scale (mRS) score and mortality rate on 90th days after IS. RESULTS: The incidence of HF did not differ between patients with favorable (mRS 0-2) and unfavorable (mRS 3-6) functional outcome respectively for the old and for the new definition (10.4% vs. 15.5, p = 0.17; 17.4% vs. 18.1%, p = 0.88) and between those who survived and died within 90 days after IS (11.7% vs. 20.0%, p = 0.27; 17.2% vs. 25.0%, p = 0.38, respectively). Multivariate analysis showed no impact of HF diagnosis on outcome (p = 0.94) or mortality (p = 0.64). CONCLUSION: The presence of systolic HF, defined according to an old and a new definition, does not determine safety and efficacy of cerebral iv-thrombolysis in patients with IS.

Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers.

BACKGROUND AND PURPOSE: The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital. MATERIALS AND METHODS: We analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30-Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30-08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00-Friday 14:30, excluding national holidays) were used as the reference. RESULTS: Of 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29-0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0-2). CONCLUSIONS: There is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.

Hypertension, brain damage and cognitive decline.

Loss of cognitive function is one the most devastating manifestations of ageing and vascular disease. Cognitive decline is rapidly becoming an important cause of disability worldwide and contributes significantly to increased mortality. There is growing evidence that hypertension is the most important modifiable vascular risk factor for development and progression of both cognitive decline and dementia. High blood pressure contributes to cerebral small and large vessel disease resulting in brain damage and dementia. A decline in cerebrovascular reserve capacity and emerging degenerative vascular wall changes underlie complete and incomplete brain infarcts, haemorrhages and white matter hyperintensities. This review discusses the complexity of factors linking hypertension to brain functional and structural changes, and to cognitive decline and dementia. The evidence for possible clinical markers useful for prevention of decreased cognitive ability, as well as recent data on vascular mechanism in the pathogenesis of cognitive decline, and the role of antihypertensive therapies in long-term prevention of late-life cognitive decline will be reviewed.

Aortic stiffness predicts functional outcome in patients after ischemic stroke.

BACKGROUND AND PURPOSE: Increased aortic stiffness (measured by carotid-femoral pulse wave velocity) and central augmentation index have been shown to independently predict cardiovascular events, including stroke. We studied whether pulse wave velocity and central augmentation index predict functional outcome after ischemic stroke. METHODS: In a prospective study, we enrolled 99 patients with acute ischemic stroke (age 63.7 ± 12.4 years, admission National Institutes of Health Stroke Scale score 6.6 ± 6.6, mean ± SD). Carotid-femoral pulse wave velocity and central augmentation index (SphygmoCor) were measured 1 week after stroke onset. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale with modified Rankin Scale score of 0 to 1 considered an excellent outcome. RESULTS: In univariate analysis, low carotid-femoral pulse wave velocity (P=0.000001) and low central augmentation index (P=0.028) were significantly associated with excellent stroke outcome. Age, severity of stroke, presence of previous stroke, diabetes, heart rate, and peripheral pressures also predicted stroke functional outcome. In multivariate analysis, the predictive value of carotid-femoral pulse wave velocity (<9.4 m/s) remained significant (OR, 0.21; 95% CI, 0.06-0.79; P=0.02) after adjustment for age, National Institutes of Health Stroke Scale score on admission, and presence of previous stroke. By contrast, central augmentation index had no significant predictive value after adjustment. CONCLUSIONS: This study indicates that aortic stiffness is an independent predictor of functional outcome in patients with acute ischemic stroke.

Angiogenin in middle-aged type 1 diabetes patients.

BACKGROUND: Angiogenin levels are increased in children and adolescent patients with type 1 diabetes, regardless of the extent of diabetic microangiopathy. However, little is known about the angiogenin concentrations in adults with type 1 diabetes. Thus we studied its level in middle aged subjects with the presence of diabetic nephro-, retino and neuropathy. METHODS: We investigated the data of 57 (age 39±6.6 years, 45.6% of males) patients with type 1 diabetes and 38 age-matched control subjects without diabetes (age 37.1±5.9 years, 42.1% of males), including medical histories, evidences of microangiopathy and serum angiogenin concentrations. RESULTS: Serum angiogenin level was lower in patients with type 1 diabetes [384.2(190.4-999.8) ng/ml] compared to controls [460.4(230.6-708.2) ng/ml], p=0.04. In patients with overt diabetic nephropathy the angiogenin level was higher when compared to patients without nephropathy [568.2(269.6-999.8) vs 369.4(190.4-999.8) ng/ml, p=0.01]. There were no differences between angiogenin levels in subgroups of patients distinguished by the presence of other microvascular complications or other concomitant vascular risk factors despite cigarette smoking [smokers: 516.2(294.4-999.8) vs. non-smokers: 372.1(190.4-924.8) ng/ml, p=0.01]. CONCLUSIONS: Regardless of the presence of diabetic microangiopathy, angiogenin level in middle-aged type 1 diabetes patients is lower than in controls. The presence of overt nephropathy and smoking habit in middle-aged patients with type 1 diabetes are associated with higher angiogenin level.

Increased frequency of restless legs syndrome in myasthenia gravis.

BACKGROUND/AIMS: The objective of this study was to assess the prevalence of restless legs syndrome (RLS) in patients with myasthenia gravis (MG). METHODS: We interviewed 73 MG patients and 65 healthy controls by using a structured diagnostic questionnaire based on the International Restless Legs Syndrome Study Group diagnostic criteria. We also collected data about the course of MG therapy, the presence of other comorbidities, sleep complaints, and demographic characteristics. All of the MG patients underwent neurological assessment. RESULTS: RLS was present in 43.2% of the MG patients and in 20% of the controls (p = 0.0029). We failed to identify a relationship between the prevalence of RLS and the duration and type of MG therapy, other comorbidities, age or sex of the patients. Patients with MG more frequently reported daytime sleepiness. For 9.4% of the RLS-positive MG patients, RLS symptoms represented the most disturbing health problem; for 46.9% of them, RLS was as problematic as other diseases. CONCLUSIONS: RLS is common in MG patients. MG patients consider RLS symptoms as a troublesome health problem.

Intravenous thrombolysis for acute ischaemic stroke in patients not fully adhering to the European licence in Poland.

BACKGROUND AND PURPOSE: The European licence for alteplase excludes from thrombolysis large groups of acute stroke patients. The Polish licence was revised in 2010, but until then many patients could receive the treatment only off-label. Our aim was to evaluate the safety and effectiveness of intravenous alteplase in Polish patients not fully adhering to the original European drug licence compared to patients treated strictly on-label. MATERIAL AND METHODS: We analysed all patient data contributed to the Safe Implementation of Thrombolysis in Stroke registry from Polish centres between October 2003 and July 2009. RESULTS: Off-label thrombolysis was administered in 224/946 (23.7%) patients. The most frequent deviations were: use of intravenous antihypertensives (8.2%), age > 80 years (5.4%), time-to-treatment > 3 hours (4.5%), oral anticoagulation (4.2%), previous stroke with concomitant diabetes (2.1%), and previous stroke ≤ 3 months (1.5%). We found no differences in the ratio of symptomatic intracranial haemorrhage (sICH) according to SITS, ECASS and NINDS definitions. Adjusted odds for 3-month mortality were similar (OR 0.86, 95% CI: 0.51-2.41), excluding patients with previous stroke ≤ 3 months (OR 3.48, 95% CI: 0.96-12.7). Adjusted odds for death or dependency were slightly increased (OR 1.40, 95% CI: 0.92-2.13), especially in patients aged > 80 years (OR 2.80, 95% CI: 1.11-7.05), and with previous stroke ≤ 3 months (OR 4.07, 95% CI: 0.97-17.1). CONCLUSIONS: Polish stroke patients receiving off-label thrombolysis tended to achieve a less favourable outcome, but they were not at increased risk of sICH or death. Considering the current Polish license for alteplase, it may be reasonable to additionally stratify the risk in patients aged > 80 years or with previous stroke ≤ 3 months.

[Diagnostic difficulties in myasthenia gravis]. / Trudnosci diagnostyczne w przypadku miastenii.

The aim of this work is to approach the subject of myasthenia gravis (MG). The clinical symptoms of the disease has been described based on own clinical experience and literature review. Particular attention was dedicated to nonstandard beginning of MG. Diagnostic methods were presented with description of their applications and usefulness. Differential clinical view of MG depends of type of antibodies affecting neuromuscular junction. The most accurate test in MG diagnostic is SFEMG and most specific is measuring of AChRAB level in blood serum. The detection of antibodies anti-MuSK calls against execution of thymectomy on patients with MG.

Administration of CD4+CD25highCD127-FoxP3+ Regulatory T Cells for Relapsing-Remitting Multiple Sclerosis: A Phase 1 Study.

BACKGROUND: Multiple sclerosis (MS) is an immune-mediated disease in which autoimmune T conventional (Tconv) cells break the blood-brain barrier and destroy neurons of the central nervous system. It is hypothesized that CD4+CD25highCD127-FoxP3+ T regulatory (Treg) cells may inhibit this destruction through suppressive activity exerted on Tconv cells. METHODS: We present the results of a phase 1b/2a, open-label, two-arm clinical trial in 14 patients treated with autologous Treg cells for relapsing-remitting MS. The patients received either expanded ex vivo Treg cells intravenously (intravenous [IV] group, n = 11; dose 40 × 106 Treg cells/kg of body weight) or freshly isolated Treg cells intrathecally (intrathecal [IT] group, n = 3; dose 1.0 × 106 Treg cells). Importantly, patients were not treated with any other disease-modifying drugs for at least 6 months before the recruitment and during the follow-up. RESULTS: No severe adverse events were observed. Self-assessed quality of life (EuroQol-5 Dimensions [EQ-5D] form) did not change and did not differ significantly between the groups. A total of 12 relapses were noted in five intravenously treated patients, who had from one to three attacks per year. Three out of ten participants who completed the trial in the IV group deteriorated more than 1 point on the Expanded Disability Status Scale (EDSS) during the follow-up. At the same time, no patients in the IT group experienced a relapse or such a deterioration in the EDSS. No significant differences were found in the Multiple Sclerosis Functional Composite (MSFC) scale in both the IV and IT groups. Magnetic resonance imaging (MRI) scans revealed a significantly lower change in the T2 lesion volume in the IT group compared to the IV group. The increase in the number of new T2 lesions during the follow-up was significant for the IV group only. There were no significant changes in the level of Treg cells or Tconv cells in the peripheral blood throughout the follow-up or between the groups. Interestingly, Treg cells in all patients consisted of two different phenotypes: peripheral Treg cells Helios(-) (≈ 20%) and thymic Treg cells Helios(+) (≈ 80%). The analysis of the cytokine pattern revealed higher levels of transforming growth factor-α and proinflammatory factors MCP3, CXCL8, and IL-1RA in the IT group compared with the IV group. CONCLUSIONS: No serious adverse events were reported in the 14 patients with MS treated with Treg cells in this study. The results suggest that IT administration is more promising than IV administration. Because of the low number of patients recruited, the statistical results may be underpowered and further studies are necessary to reach conclusions on efficacy and safety. TRIAL REGISTRATION: EudraCT: 2014-004320-22; registered 18 November 2014.

Unaffected patients with a homozygous absence of the SMN1 gene.

In this report, we present three families in which we identified asymptomatic carriers of a homozygous absence of the SMN1 gene. In the first family, the bialleleic deletion was found in three of four siblings: two affected brothers (SMA type 3a and 3b) and a 25-years-old asymptomatic sister. All of them have four SMN2 copies. In the second family, four of six siblings are affected (three suffer from SMA2 and one from SMA3a), each with three SMN2 copies. The clinically asymptomatic 47-year-old father has the biallelic deletion and four SMN2 copies. In the third family, the biallelic SMN1 absence was found in a girl affected with SMA1 and in her healthy 53-years-old father who had five SMN2 copies. Our findings as well as those of other authors show that an increased number of SMN2 copies in healthy carriers of the biallelic SMN1 deletion is an important SMA phenotype modifier, but probably not the only one.

Improved HPLC method for total plasma homocysteine detection and quantification.

Recent clinical research has pointed at hyperhomocysteinemia as an independent risk factor in a number of cardiovascular and neurological diseases. We have improved a chromatographic method of total plasma homocysteine measurements in order to obtain higher sensitivity, reliability and reproducibility. The method demonstrates excellent linearity (R=0.999), range (<2-100 microM), precision (instrumental RSD 0.06 and method RSD 1.17), accuracy (recovery of 99.92 and RSD 1.27), reproducibility, quantification limit and ruggedness (e.g. pH from 2.0 to 2.5). Because even a small increase in homocysteine level can be a significant risk factor of cardiovascular diseases, such a precise method is required. The constructed method allows the measurement of plasma pyridoxal phosphate, PLP, the co-enzyme form of vitamin B(6), on the same column and similar reagents. The developed method has been successfully applied to measure both total plasma and serum homocysteine in a group of acute stroke patients.

CD271+, CXCR7+, CXCR4+, and CD133+ Stem/Progenitor Cells and Clinical Characteristics of Acute Ischemic Stroke Patients.

Ischemic stroke causes mobilization of various groups of progenitor cells from bone marrow to bloodstream and this correlates with the neurological status of stroke patients. The goal of our study was to identify the activity of chosen progenitor/stem cells in the peripheral blood of acute ischemic stroke patients in the first 7 days after the incident, through associations between the levels of the cells and clinical features of the patients. Thirty-three acute ischemic stroke patients and 15 non-stroke control subjects had their venous blood collected repeatedly in order to assess the levels of the CD45-CD34 + CD271+, the CD45-CD34 + CXCR4+, the CD45-CD34 + CXCR7+, and the CD45-CD34 + CD133+ stem/progenitor cells by means of flow cytometry. The patients underwent repeated neurological and clinical assessments, pulse wave velocity (PWV) assessment on day 5, and MRI on day 1 and 5 ± 2. The levels of the CD45-CD34 + CXCR7+ and the CD45-CD34 + CD271+ cells were lower in the stroke patients compared with the control subjects. Only the CD45-CD34 + CD271+ cells correlated positively with lesion volume in the second MRI. The levels of the CD45-CD34 + CD133+ cells on day 2 correlated negatively with PWV and NIHSS score on day 9. The patients whose PWV was above 10 m/s had significantly higher levels of the CD45-CD34 + CXCR4+ and the CD45-CD34 + CXCR7+ cells on day 1 than those with PWV below 10 m/s. This study discovers possible activity of the CD45-CD34 + CD271+ progenitor/stem cells during the first 7 days after ischemic stroke, suggests associations of the CD45-CD34 + CD133+ cells with the neurological status of stroke patients, and some activity of the CD45-CD34 + CD133+, the CD45-CD34 + CXCR4+, and the CD45-CD34 + CXCR7+ progenitor/stem cells in the process of arterial remodeling.

High magnesium or potassium hair accumulation is not associated with ischemic stroke risk reduction: a pilot study.

OBJECTIVES: Various studies suggest that deficiency of magnesium and potassium may be associated with increased risk of ischemic stroke. However, single time-point serum measurements may not be suitable for assessing long-term tissue levels. PATIENTS AND METHODS: We investigated Mg and K levels in hair of patients with acute ischemic stroke. The elements hair accumulation analysis might provide historical information on their concentrations over a longer period of time and probably reflects the corresponding nutritional condition. The concentrations of Mg and K in hair of 48 men with acute ischemic stroke and a control group were measured using spectroscopic methods. RESULTS: The mean Mg and K concentrations in hair of patients were significantly higher than in the controls. CONCLUSIONS: This analysis does not seem to confirm the results of the previous studies suggesting that Mg or K high levels (or their diet supplementation) might protect humans against ischemic stroke.

[Deep vein thrombosis in patients with stroke]. / Zakrzepica zyl glebokich u chorych na udar mózgu.

A frequent condition affecting patients with stroke is venous thromboembolism (VTE), which consists of two components: deep vein thrombosis, and pulmonary embolism as its complication The main risk factors of VTE are: age over 65 years, motor deficit with immobilisation, heart failure, infection, obesity and coagulopathy Typical symptoms of deep vein thrombosis (pain, tenderness, swelling of calf and increased skin temperature) can be masked by sensory and autonomic deficits following brain ischaemia Diagnosis of VTE is based on clinical symptoms confirmed by biochemical and radiological findings The treatment of VTE consists of anticoagulation; prevention of VTE in stroke patients is based on use of low-molecular heparins and non-pharmacological methods.

Percutaneous tracheostomy in patients with disorders of the central nervous system.

BACKGROUND AND PURPOSE: Patients with disorders of the central nervous system frequently require maintenance of an artificial airway due to impairment of the cough reflex and swallowing, or due to the necessity to apply long-term mechanical ventilation. The technique of percutaneous tracheostomy, introduced in recent years to clinical practice globally, enables tracheostomy and establishment of an artificial airway in a bedside setting, in a quick, simple and minimally traumatic manner. It does not require the operating theatre environment and is associated with lower complication rates than the traditional surgical technique. MATERIAL AND METHODS: In the period from March 2003 till February 2007, we performed 75 procedures of Griggs mode percutaneous tracheostomy in intravenous anaesthesia, with use of a disposable Percutaneous Tracheostomy Kit (SIMS Portex, UK). The group of patients comprised 36 women and 39 men. Mean patient age was 57.4+/-17.9 years. RESULTS: On average, the procedure was performed on the 8th (7.8+/-2.6) day after intubation, and its average duration was 6.0+/-3.3 minutes. The most frequent complication was local bleeding from the site (13%), most of which, however, regressed spontaneously. Also observed were: puncture of the tracheal tube sealing cuff (7%), damage to the isthmus of the thyroid (3%), and extratracheal positioning of the tracheal tube (3%). In all the cases the procedure was concluded successfully. CONCLUSIONS: Griggs mode is a simple and safe technique enabling percutaneous tracheostomy in patients with pathology of the central nervous system. However, further research is needed to evaluate potential delayed complications of the procedure.

[The comparison of selected spirometric parameters with functional muscles exercise evaluation in patients with myasthenia]. / Porównanie wybranych parametrów spirometrycznych z funkcjonalna ocena wysilkowa miesni u chorych na miastenie.

UNLABELLED: Pathological skeletal muscle weakness is an axial clinical symptom of myasthenia (MG). Diminished respiratory muscular force can be manifested by decreased peak expiratory flow (PEF) value. MATERIAL AND METHODS: Patients aged 13-77 years were studied at which according to Osserman classification ocular form (the type I) or generalized form (the type II) was diagnosed (n = 68). PEF and FVC values such as % of predicted value (PV) obtained in "flow-volume" measure were analysed. The trunk and extremities muscles force was estimated according to Besinger. RESULTS: Weakness of lower extremities muscles was found at all examined subjects. Positive result of trunk muscle test was found in 69% of patients with type I and 89% with type II. In type II upper extremities muscles (UEM) weakness was observed more often than in type I (74% subjects vs. 31%). In both types of MG the mean value of PEF was lower in patients with UEM weakness and amounted 89.5% vs. 112.4% in type I and 87.4% vs. 100.4% in type II. In type I the mean value of FVC was lower in patients with UEM weakness than in patients without symptoms (83.7% vs. 106.2%), with trunk muscles weakness (93.8% vs. 111.7%) and in patients with decreased muscles force up to 15% (87.5% vs. 106.7%). In this type of MG decreased value of FVC < 80% PV was observed in 50% of patients with UEM weakness and in 40% of patients with decreased muscles force up to 15%, but at none of subjects without symptoms in above tests. CONCLUSIONS: In patients with myasthenia of type I and II the weakness of upper extremities muscles correlates with decreased PEF value in spirometry. In addition in ocular myasthenia decreased FVC value was observed more often in patients with positive results of test of the functional muscles estimation.

Length of stay in emergency department and cerebral intravenous thrombolysis in community hospitals.

OBJECTIVES: Current guidelines for the early management of patients with acute ischemic stroke recommend completion of an evaluation within 60 min of the patient's arrival at the emergency department (ED) because prolongation of ED length of stay (LOS) may reduce the efficacy of acute stroke treatment. AIM: To evaluate the LOS in EDs at the community-based Polish stroke centers, to determine logistic, social, epidemiological, and clinical factors responsible for its prolongation, and to assess the association between increased LOS and the implementation of cerebral intravenous (IV) thrombolysis. MATERIALS AND METHODS: This study carried out an evaluation of the medical records of 8398 patients with stroke and transient ischemic attack who consecutively reported to the Pomeranian Stroke Registry from 2010 to 2012. RESULTS: The median ED LOS in the studied cohort was 97 (44-196) min and was prolonged (>60 min) in 63.1% of patients. Prolongation of ED LOS contributed to a low (4.9%) IV thrombolysis rate. Functional status at discharge was worse in patients with prolonged versus nonprolonged LOS [modified Rankin scale: 2 (0-3) vs. 1 (0-3) points; P<0.001]. Multivariate analysis showed that onset-to-door time more than 270 min or unknown time of symptoms onset, referral to ED in urban areas, living alone, presence of diabetes, motor, sensory, visual, and gait deficits at stroke onset, and NIHSS score on admission contributed toward prolongation of ED LOS. CONCLUSION: A prolonged ED LOS, because of ineffective prehospital logistics, ED urban location, patients' risk factors, and cohabitation profile and stroke symptoms and severity, commonly exists among patients with stroke and transient ischemic attack and contributes toward a low rate of IV thrombolysis in Polish community hospitals.

[The stroke variables assessment as a prognostic factor for post-stroke depression with the emphasis on the cerebral SPECT regional blood flow asymmetry]. / Ocena wartosci wybranych parametrów udaru, ze szczególnym uwzglednieniem asymetrii przeplywu mózgowego krwi mierzonego metoda SPECT, jako czynników prognostycznych wystapienia depresji poudarowej.

AIM: The aim of this paper was to assess the risk for depression in a 6-month-long post stroke follow up period as related to the stroke variables (i.e. stroke localisation, haemodynamic parameters). METHOD: The stroke localisation was determined with CT and/or MRI. Subsequently all the examined individuals underwent SPECT examination. The follow up examinations were performed by the consultant psychiatrist in 6, 12 and 24 weeks subsequent to the stroke episode. The depressive episode diagnosis was established on the basis of ICD-10 diagnostic criteria. RESULTS: Only right-handed patients (43 men aged 57.3 +/- 11.6 and 17 women aged 62.5 +/- 14.4) with unilateral brain lesion were examined. 23 subjects (38%) developed depression in the follow-up period. 5 women (29%) and 18 men (ca. 42%) developed a depressive episode. Only one of the observed depressive episodes met ICD-10 criteria for severe depressive episode. 10 patients suffered from moderate depressive episode and 12 subjects exhibited a mild depressive episode. CONCLUSIONS: The results obtained with CT and/or MRI techniques revealed no correlation between the post-stroke depression and stroke lateralisation. However the localisation of the deep brain functional abnormalities revealed with SPECT correlated with the occurrence of the affective disorders as related to the asymmetry in regional blood flow measures.