Early High-dosage Atorvastatin Treatment Improved Serum Immune-inflammatory Markers and Functional Outcome in Acute Ischemic Strokes Classified as Large Artery Atherosclerotic Stroke: A Randomized Trial.

Statins have beneficial effects on cerebral circulation and brain parenchyma during ischemic stroke and reperfusion. The primary hypothesis of this randomized parallel trial was that treatment with 80 mg/day of atorvastatin administered early at admission after acute atherosclerotic ischemic stroke could reduce serum levels of markers of immune-inflammatory activation of the acute phase and that this immune-inflammatory modulation could have a possible effect on prognosis of ischemic stroke evaluated by some outcome indicators. We enrolled 42 patients with acute ischemic stroke classified as large arteries atherosclerosis stroke (LAAS) randomly assigned in a randomized parallel trial to the following groups: Group A, 22 patients treated with atorvastatin 80 mg (once-daily) from admission day until discharge; Group B, 20 patients not treated with atorvastatin 80 mg until discharge, and after discharge, treatment with atorvastatin has been started. At 72 hours and at 7 days after acute ischemic stroke, subjects of group A showed significantly lower plasma levels of tumor necrosis factor-α, interleukin (IL)-6, vascular cell adhesion molecule-1, whereas no significant difference with regard to plasma levels of IL-10, E-Selectin, and P-Selectin was observed between the 2 groups. At 72 hours and 7 days after admission, stroke patients treated with atorvastatin 80 mg in comparison with stroke subjects not treated with atorvastatin showed a significantly lower mean National Institutes of Health Stroke Scale and modified Rankin scores. Our findings provide the first evidence that atorvastatin acutely administered immediately after an atherosclerotic ischemic stroke exerts a lowering effect on immune-inflammatory activation of the acute phase of stroke and that its early use is associated to a better functional and prognostic profile.

Frequency and determinants of intracranial atherosclerotic stroke in urban Pakistan.

BACKGROUND: Intracranial atherosclerosis (ICAD) is a frequent underlying mechanism of ischemic stroke. There is little direct evidence on its frequency and determinants from regions of high prevalence. This study explores the conventional and socioeconomic risk factors of ICAD in a South Asian population. METHODS: The Karachi Intracranial Stenosis Study is a case-control study of 313 cases of ischemic stroke secondary to ICAD and 331 controls enrolled from 4 major hospitals in Karachi, Pakistan. Stroke subtype was verified by a vascular neurologist using the Trial of Org 10172 in Acute Stroke Treatment classification. Relationships of conventional and socioeconomic risk factors with ICAD-related strokes are reported by calculating odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: ICAD was the cause of stroke in 81.1% cases with large-artery atherosclerosis and 19.5% of all stroke events. Along with risk factors like history of hypertension (OR, 3.33; CI, 2.31-4.78), history of diabetes (OR, 2.29; CI, 1.56-3.35), use of tobacco (OR, 1.49; CI, 1.03-2.16), waist-to-hip ratio (OR, 1.58; CI, 1.04-2.41), and family history of stroke (OR, 1.89; CI, 1.21-2.95), other significant social determinants of ICAD strokes were monthly income (OR, 1.59; CI, 1.01-2.51), unemployment (OR, 2.15; CI, 1.21-3.83), and chronic stress (OR, 3.67; CI, 2.13-6.34). These social determinants were independent predictors of the risk of ICAD, in addition to those described in other world populations. CONCLUSIONS: ICAD accounted for one fifth of all strokes making it the most common ischemic stroke mechanism. In addition to aggressive risk factor control, data also indicated broader holistic efforts on ameliorating inequity, unemployment, and stress reduction to reduce stroke because of ICAD.

Improvement of clinical outcome and cerebral perfusion in a patient of atherosclerotic cerebral infarction after repetitive hyperbaric oxygen treatment--a case report and literature review.

This is a case report of hyperbaric oxygen therapy (HBO2T) for ischemic stroke. HBO2T should be the potential or additional treatment (with thrombolytic therapy) for ischemic stroke according to the preclinical and clinical studies. Hereby, we present a 56-year-old Chinese man with vascular risk factors. He had an acute ischemic stroke on the left corona radiata, with right hemiparesis and dysarthria resulting from atherosclerosis. The patient could not get thrombolytic treatment because the time to ER was in excess of five hours. He experienced great improvement after the general course of HBO2T; this was evaluated with standard rating scales for stroke research and cerebral perfusion images, including brain-computed tomography perfusion (CTP) and single-photon emission computed tomography (SPECT). Although few clinical trials showed a negative result, we suggest that further trials on HBO2T are still needed. Meanwhile, we emphasize the importance of HBO2T protocol and the selection of a suitable patient, which may influence the outcome.

Homonymous central quadrantanopia caused by an extrastriate (v2/v3) infarction: a case report.

A 66-year-old Taiwanese aboriginal male had complained of right-side blurred vision for 2 months, especially when reading. He had a 10-year history of hypertension and cardiovascular disease. His best-corrected visual acuity was 20/25 in each eye. Ophthalmoscopy revealed asymmetrical cupping, but a normal disc. Humphrey perimetry showed an upper homonymous paracentral quadrantanopic defect. Brain magnetic resonance imaging showed an infarction in the left lower calcarine area over the extrastriate (V2/V3) cortical area and a narrowing of the left middle and posterior cerebral arteries due to severe arteriosclerosis.

Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection.

BACKGROUND: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. OBJECTIVE: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. DESIGN: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. SETTING: Large community-based teaching hospital. PATIENTS: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. MAIN OUTCOME MEASURE: Infarct patterns were analyzed according to established templates of vascular territories. RESULTS: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6). CONCLUSIONS: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.

Background and rationale of the SU.FOL.OM3 study: double-blind randomized placebo-controlled secondary prevention trial to test the impact of supplementation with folate, vitamin B6 and B12 and/or omega-3 fatty acids on the prevention of recurrent ischemic events in subjects with atherosclerosis in the coronary or cerebral arteries.

Cardiovascular diseases are the primary cause of mortality in France. Many epidemiological studies have shown that the total homocysteine concentration is a risk indicator for cardiovascular disease. Furthermore, it has been shown that the homocysteine concentration can be effectively lowered by supplementation with folic acid, vitamin B6 and B12. However, it is not yet known whether a reduction of the homocysteine concentration by such a supplementation indeed leads to a decreased risk of cardiovascular disease. Another possible dietary factor that may lower the risk of cardiovascular disease is fish-oil, which is rich in omega-3 fatty acids. These fatty acids lower platelet aggregation and triglyceride rich lipoproteins and may have antiarrhythmic effects. Some trials have investigated the effect of fish or fish-oil on cardiovascular mortality, and the results, although not conclusive, suggest a protective effect of a higher intake. In the SU.FOL.OM3 study we will evaluate the effect of supplementation at nutritional doses of folate (in the natural 5-methyl-tetrahydrofolate form) in combination with vitamin B6 and B12 and/or omega-3 fatty acids and/or placebo on recurrent ischemic diseases in a factorial design. The supplements will be randomly allocated to the participants in a double-blind fashion. In total 3,000 patients aged between 45 and 80 years who had a past history of myocardial infarction or unstable angina pectoris or an ischemic stroke will be included. The participants will be supplemented and followed up for a period of five years.

[Therapeutic effectiveness of zuzhongping on patients with arteriosclerostic cerebral infarction].

Forty-six patients with acute arteriosclerostic cerebral infarction were randomly divided into two groups: control group and treatment group. Each of them included 23 patients respectively. The patients in the control group were given Dextran-40 but the ones in the treatment group were given the mixture of Zuzhongping. The course of treatment was 3 weeks. It was found that there was a significant difference (P < 0.01) in the score percentage, before and after treatment of neurological defects, between the control group and the treatment group, and the former (29.70 +/- 33.52) was much lower than the latter (45.40 +/- 27.60). The total curative rate of the treatment group (87.0%, 20/23) was significantly higher than that of the control group (60.9%, 14/23). There was an obviously prolonged KPTT (kaolin partial thromboplastin time) value and a decreased Fb (fibrinogen) level in the treatment group. Before treatment they were 32.43 +/- 4.03 sec and 6.18 +/- 1.77 g/L respectively, but after treatment, 52.96 +/- 10.50 sec and 4.5 +/- 0.95 g/L respectively. The authors suggest that the significant therapeutic efficacy of Zuzhongping in the patients with acute arteriosclerostic cerebral infarction is related to its action of anticoagulation, modification of PGI2 and TXA2 level in the body, decreased blood Fb level, hyperglycemia, etc.

[The magneto-, photo- and laser therapy of headaches in patients with vascular brain lesions]. / Magnito-, foto- i lazerterapiia tsefalgii u bol'nykh s sosudistymi porazheniiami mozga.

To manage vascular cephalalgia, a combined approach is proposed: segmentally oriented magnetic, photo- and photomagnetic therapy plus intravenous laser treatment. The effect was directly correlated with cerebral hemodynamic condition, damage to vegetative innervation segmental-peripheral link and physiotherapeutic factors.

[The autonomic mechanisms of the initial manifestations of cerebral circulatory failure and a method for their correction]. / Vegetativnye mekhanizmy nachal'nykh proiavlenii nedostatochnsti krovosnabzheniia mozga i sposob ikh korrektsii.

Initial manifestations of cerebrovascular insufficiency against the background of atherosclerosis and hypertensive disease were evaluated in 50 sailors. Vegetative dysfunctions in these patients showed different states of the vegetative tone reactivity. It was found that ultraviolet irradiation of the blood produced a positive effect on the course of cerebro-vascular disturbances. The parasympathetic and sympathetic portions were selectively influenced.

[Reflexotherapy and carbon dioxide baths in the complex treatment of patients with circulatory encephalopathy of arteriosclerotic etiology]. / Refleksoterapiia i uglekislye mineral'nye vanny v kompleksnom lechenii bol'nykh distsirkuliatornoi éntsefalopatiei atero- skleroticheskoi étiologii.

Overall 106 patients with atherosclerotic cccccccirculatory encephalopathy (DE) were examined for changes in the EEG, REG and in certain psychological parameters (attention, memory, "associative" thinking) before and after acupuncture and carbon dioxide baths. In patients with stage I and stage II DE (in 93 and 80%, respectively), the clinical improvement was accompanied by positive changes such as a rise of alpha-activity, decrease of pathological waves and frequencies on the EEG, decline of the vascular tone and improvement of the blood content on the REG in addition to the shortening of the time required for the search for numbers according to Schulte's tables, a decrease of errors made during calculation, an increase of words and the family of words in the memorization and "associative" thinking tests. The data obtained may attest to the amelioration of cerebral function and hemodynamics because of the rehabilitation treatment.

Treatment of cerebral ischemia with electrical stimulation of the cervical spinal cord.

We observed an increase in cerebral blood flow (CBF) for control of pain but were otherwise normal. Based on that observation, we implanted stimulators for cervical spinal cord stimulation (cSCS) in three patients who had symptomatic cerebral ischemia. Two had severe basivertebral occlusive disease and one had bilateral carotid occlusive disease. In all three cases, cSCS alleviated the symptoms of ischemia. Xenon-CBF studies or single-photon emission computer tomography (SPECT) showed increased CBF in response to cSCS. Although no mechanism clearly responsible for this remarkable therapeutic efficacy can be proposed yet, further clinical trials of cSCS for inoperable cerebral ischemia may be justified.

[The use of melipramine in treating patients with a depressive syndrome accompanied by motor retardation]. / Primenenie melipamina v lechenii bol'nykh s depressivnym sindromom, soprovozhdaiushchimsia dvigatel'noi zatormozhennost'iu.

A study of 49 patients with the depressive syndrome and showing different motor activity indicates that melipramin treatment proved more effective during the first week of treatment. The obtained data are confirmed by results of experiments with immobilized animals.

[Treatment of vascular psychoses by detoxication methods--hemosorption and hyperbaric oxygenation]. / Lechenie sosudistykh psikhozov detoksikatsionnymi metodami--gemosorbtsiei i giperbaricheskoi oksigenatsiei.

Fifty-six elderly patients with depressive-delirious and hallucinatory disturbances, as well as with the syndrome of impaired consciousness were divided into three groups depending on the kind of treatment they received (hemosorption, hyperbaric oxygenation and psychotropic drugs). The treatment was evaluated using clinical and pathopsychological methods. The data obtained indicate a high efficacy of detoxicating methods as compared to psychotropic therapy. The reported reduction in triglyceride levels under the impact of hemosorption and hyperbaric oxygenation normalizes metabolic processes and indicates a reduced hypoxia of nerve cells.

[Effect of nifedipine (adalate) in neurology patients with arterial hypertension]. / Deistvie nifedipine (adalata) u nevrologicheskikh bol'nykh s arterial'noi gipertenziei.

Using rheoencephalography and gamma-scintigraphy, the cerebrovascular action of nifedipine was studied in 38 patients with an ischemic stroke and chronic cerebrovascular insufficiency. In patients with a crisis-like increase in the blood pressure, the drug induced a rapid and considerable drop in the blood pressure, a decrease of the tone and an elevation of the blood content of the cerebral vessels. In patients with a moderately elevated stable BP, this effect was less marked. An increase in the cerebral blood content was mostly seen in the zones of the arteries of the predominantly muscle type. It was effected by both the vasodilating action of nifedipine and the autoregulatory mechanism. Nifedipine did not induce the effect of intracerebral steal and did not impede the outflow of blood from the intracranial veins.

Generalized small-vessel stenosis in the brain. A case history of a patient treated with monoplace hyperbaric oxygen at 1.5 to 2 ATA.

Complete evaluation of older patients with mental changes always leaves us with a certain percentage whose condition can only be attributed to atherosclerosis. Little is being done for these patients because this generalized stenosis of the brain does not reverse with any known treatment. This writer has treated many such patients with hyperbaric oxygen (HBO), and presents this case history, along with regional cerebral blood flow (rCBF) studies, showing the type of changes which frequently occur. This case initially presented with symptoms of gross mental confusion, memory loss, both recent and remote, irrational speech and occasional violence. Although prior complete evaluations were concluded with no recommended treatment, the initial series of HBO treatment resulted in a well-functioning patient. This was maintained for four years with intermittent HBO. The patient then presented with acute stroke, total disorientation and confusion. He again became functional with HBO. A discussion of the mechanisms of HBO which might account for the changes is given.