RESUMO
Although stroke is a major human neurological disease, there is a paucity of effective neuroprotectants that can improve its treatment. Casticin is a natural monomer drug with many biological effects such as anti-inflammatory and anti-tumor actions. However, it is not clear whether it has a neuroprotective effect in ischemic stroke. In this study, the neuroprotective effect of casticin in a rat middle cerebral artery occlusion (MCAO) model was investigated. Results showed that casticin reduced the volume of the cerebral infarction, mNSS scores, swimming distance, time to find the submerged platform, and serum concentrations of TNF-α, TGF-ß, IL-6 in MCAO rats. Moreover, casticin also decreased the expression of TLR4, NF-κB p65, and NF-κB p50 proteins and reversed the reduced expression of IκB protein in the brain tissue of MCAO rats. The in vitro study revealed that casticin decreased apoptosis of OGD/R-PC12 cells, reduced the expression of TLR4, NF-κB p65, and NF-κB p50, while increased IκB protein expression. In conclusion, casticin improved the neurological functions of MCAO rats via inhibiting the TLR4/NF-κB pathway and might have the potential to be developed into a neuroprotective agent for stroke patients.
Assuntos
Flavonoides/farmacologia , Infarto da Artéria Cerebral Média/tratamento farmacológico , Fármacos Neuroprotetores/farmacologia , Animais , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Flavonoides/uso terapêutico , Humanos , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/patologia , Masculino , NF-kappa B/metabolismo , Neurônios/efeitos dos fármacos , Neurônios/patologia , Fármacos Neuroprotetores/uso terapêutico , Ratos , Transdução de Sinais/efeitos dos fármacos , Receptor 4 Toll-Like/metabolismoRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Ferula sinkiangensis K. M. Shen is a traditional Chinese medicine that has a variety of pharmacological properties relevant to neurological disorders and inflammations. Kellerin, a novel compound extracted from Ferula sinkiangensis, exerts a strong anti-neuroinflammatory effect by inhibiting microglial activation. Microglial activation plays a vital role in ischemia-induced brain injury. However, the potential therapeutic effect of kellerin on focal cerebral ischemia is still unknown. AIM OF THE STUDY: To explore the effect of kellerin on cerebral ischemia and clarify its possible mechanisms, we applied the middle cerebral artery occlusion (MCAO) model and the LPS-activated microglia model in our study. MATERIALS AND METHODS: Neurological outcome was examined according to a 4-tiered grading system. Brain infarct size was measured using TTC staining. Brain edema was calculated using the wet weight minus dry weight method. Neuron damage and microglial activation were observed by immunofluorescence in MCAO model in rats. In in vitro studies, microglial activation was examined by flow cytometry and the viability of neuronal cells cultured in microglia-conditioned medium was measured using MTT assay. The levels of pro-inflammatory cytokines were measured by qRT-PCR and ELISA. The proteins involved in NF-κB signaling pathway were determined by western blot. Intracellular ROS was examined using DCFH-DA method and NADPH oxidase activity was measured using the NBT assay. RESULTS: We found that kellerin improved neurological outcome, reduced brain infarct size and decreased brain edema in MCAO model in rats. Under the pathologic conditions of focal cerebral ischemia, kellerin alleviated neuron damage and inhibited microglial activation. Moreover, in in vitro studies of LPS-stimulated BV2 cells kellerin protected neuronal cells from being damaged by inhibiting microglial activation. Kellerin also reduced the levels of pro-inflammatory cytokines, suppressed the NF-κB signaling pathway, and decreased ROS generation and NADPH oxidase activity. CONCLUSIONS: Our discoveries reveal that the neuroprotective effects of kellerin may largely depend on its inhibitory effect on microglial activation. This suggests that kellerin could serve as a novel anti-inflammatory agent which may have therapeutic effects in ischemic stroke.
Assuntos
Anti-Inflamatórios/farmacologia , Isquemia Encefálica/tratamento farmacológico , Ferula/química , Infarto da Artéria Cerebral Média/tratamento farmacológico , Fármacos Neuroprotetores/farmacologia , Extratos Vegetais/farmacologia , Animais , Anti-Inflamatórios/uso terapêutico , Edema Encefálico/tratamento farmacológico , Isquemia Encefálica/etiologia , Isquemia Encefálica/patologia , Linhagem Celular Transformada , Linhagem Celular Tumoral , Citocinas/metabolismo , Modelos Animais de Doenças , Humanos , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/patologia , Inflamação/tratamento farmacológico , Lipopolissacarídeos/toxicidade , Camundongos , Microglia/efeitos dos fármacos , Microglia/patologia , NADPH Oxidases/antagonistas & inibidores , Subunidade p50 de NF-kappa B/antagonistas & inibidores , Neurônios/efeitos dos fármacos , Fármacos Neuroprotetores/uso terapêutico , Extratos Vegetais/uso terapêutico , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacosRESUMO
CASE: Two years ago, annual magnetic resonance imaging for unruptured right internal carotid artery aneurysm of a 47-year-old woman detected a cerebral infarct in her right occipital lobe which was unknown etiology and antiplatelet therapy was initiated. She presented with sensory disorder of her left fingers 4 months ago. Infarction in right parieto-occipital cortex and severe stenosis of right middle cerebral artery was revealed. Her laboratory test was normal except remarkably high homocysteine value. Regardless of dual anti-platelet therapy, she suffered from repeated minor stroke and the stenosis was progressing. Therefore, right superficial temporal artery - middle cerebral artery bypass was undertaken. Aspirin and clopidogrel were withdrawn 1 week before the surgery. Two branches were anastomosed with 2 separate frontal M4 branches. Although patency was confirmed immediately after the anastomosis, thrombus formation was revealed after 10 minutes. We needed to perform removal of the thrombus and re-anastomosis twice. Intraoperative administration of aspirin and ozagrel alleviated thrombotic tendency. After surgery, antiplatelet therapy and supplementation with folate and vitamin B were performed. Her postoperative course was uneventful and patency of both anastomoses was confirmed. DISCUSSION: Controversy still exists regarding preoperative antiplatelet therapy before superficial temporal artery-middle cerebral artery bypass, and folates and B6-12 vitamins supplementation for hyperhomocysteinemia. Considering intraoperative thrombo tendency in our case, it is recommended to evaluate the homocysteine level before bypass surgery for intracranial stenosis especially for young patients or patients with unknown etiology. Before bypass surgery of the patient with hyperhomocysteinemia, continuation of perioperative antiplatelet drugs and supplementation with folates and B6-12 vitamins are mandatory.
Assuntos
Hiper-Homocisteinemia/complicações , Infarto da Artéria Cerebral Média/cirurgia , Artéria Cerebral Média/cirurgia , Artérias Temporais/cirurgia , Enxerto Vascular/efeitos adversos , Trombose Venosa/etiologia , Suplementos Nutricionais , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Hiper-Homocisteinemia/diagnóstico , Hiper-Homocisteinemia/tratamento farmacológico , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/etiologia , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Artérias Temporais/diagnóstico por imagem , Trombectomia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia , Complexo Vitamínico B/administração & dosagemRESUMO
An extract of Dracocephalum moldevica (DML) was found to exert protective effects on cerebral ischemia-reperfusion injury (CIRI); however, the mechanisms underlying the observed actions of this plant-derived mixture remain to be determined. Thus, the aim of this study was to examine the influence of DML on CIRI rat model induced by middle cerebral artery occlusion (MCAO). The following parameters were measured: (1) viable neurons in the infarcted area using Nissl staining; and (2) immunohistochemistry and Western blot were employed to determine protein expression levels of p53, bcl-2 associated X protein (bax) and B-cell lymphoma-2 (bcl-2), three biomarkers of apoptosis. MCAO significantly decreased the number of viable cortical pyramidal neurons in the infarcted area, while treatment with DML extract significantly elevated the number of viable neurons. MCAO was found to significantly elevate in gene expression levels of p53 and protein expression levels bax accompanied by diminished protein expression levels of bcl-2. Prior administration of DML extract produced marked reduction in gene expression levels of p53 and protein expression levels bax but increased in protein expression levels of bcl-2. Data suggested apoptosis was initiated in MCAO and that DML was effective in treating CIRI via an anti-apoptotic action as evidenced by inhibition of gene expression levels of p53 and protein expression levels of bax with concomitant elevation in protein expression levels of bcl-2. Our findings suggest that extract of DML may prove beneficial in treatment of cerebrovascular disorders.
Assuntos
Apoptose , Infarto da Artéria Cerebral Média/tratamento farmacológico , Lamiaceae/química , Extratos Vegetais/administração & dosagem , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Apoptose/efeitos dos fármacos , Expressão Gênica , Genes p53 , Infarto da Artéria Cerebral Média/etiologia , Masculino , Família Multigênica , Proteínas Proto-Oncogênicas c-bcl-2 , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/etiologiaRESUMO
Background The aims of the present study were to investigate the relationships between prior direct oral anticoagulant ( DOAC ) therapy and infarct volume and the site of arterial occlusion in patients with acute ischemic stroke and non-valvular atrial fibrillation. Methods and Results From March 2011 through November 2016, consecutive patients with acute ischemic stroke in the middle cerebral artery territory and non-valvular atrial fibrillation were recruited. The infarct volume was assessed semi-automatically using initial diffusion-weighted imaging, and the arterial occlusion site was evaluated on magnetic resonance angiography. The effect of prior DOAC treatment on the site of arterial occlusion was assessed by multivariate ordinal logistic regression analysis. A total of 330 patients (149 women; median age 79 [quartiles 71-86] years; median National Institutes of Health Stroke Scale score 11 [4-21]) were enrolled. Of these, 239 were on no anticoagulant, 40 were undertreated with a vitamin K antagonist ( VKA ), 22 were sufficiently treated with VKA ( PT - INR ≥1.6), and 29 were on a DOAC before the acute ischemic stroke. The infarct volume on admission differed among the groups (median 14.5 [2.0-59.8] cm3 in patients with no anticoagulation, 24.8 [2.1-63.0] in undertreated VKA , 1.3 [0.3-13.5] in sufficient VKA , and 2.3 [0.5-21.0] in DOAC , P=0.001). Multivariate analysis showed that prior DOAC treatment was independently and negatively associated with more proximal artery occlusion (odds ratio [OR] 0.34, P=0.015), compared with no anticoagulant. Conclusions DOAC treatment before the event was associated with smaller infarct volume and decreased risk of greater proximal artery occlusion in acute ischemic stroke patients with non-valvular atrial fibrillation, compared with no anticoagulation.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Angiografia Cerebral , Dabigatrana/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Infarto da Artéria Cerebral Média/etiologia , Coeficiente Internacional Normatizado , Modelos Logísticos , Angiografia por Ressonância Magnética , Masculino , Análise Multivariada , Tempo de Protrombina , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana/uso terapêutico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Tiazóis/uso terapêutico , Varfarina/uso terapêuticoRESUMO
Inflammatory damage plays an important role in cerebral ischemic pathogenesis and represents a new target for treatment of stroke. Berberine is a natural medicine with multiple beneficial biological activities. In this study, we explored the mechanisms underlying the neuroprotective action of berberine in mice subjected transient middle cerebral artery occlusion (tMCAO). Male mice were administered berberine (25, 50 mg/kg/d, intragastric; i.g.), glycyrrhizin (50 mg/kg/d, intraperitoneal), or berberine (50 mg/kg/d, i.g.) plus glycyrrhizin (50 mg/kg/d, intraperitoneal) for 14 consecutive days before tMCAO. The neurological deficit scores were evaluated at 24 h after tMCAO, and then the mice were killed to obtain the brain samples. We showed that pretreatment with berberine dose-dependently decreased the infarct size, neurological deficits, hispathological changes, brain edema, and inflammatory mediators in serum and ischemic cortical tissue. We revealed that pretreatment with berberine significantly enhanced uptake of 18F-fluorodeoxyglucose of ischemic hemisphere comparing with the vehicle group at 24 h after stroke. Furthermore, pretreatment with berberine dose-dependently suppressed the nuclear-to cytosolic translocation of high-mobility group box1 (HMGB1) protein, the cytosolic-to nuclear translocation of nuclear factor kappa B (NF-κB) and decreased the expression of TLR4 in ischemic cortical tissue. Moreover, co-administration of glycyrrhizin and berberine exerted more potent suppression on the HMGB1/TLR4/NF-κB pathway than berberine or glycyrrhizin administered alone. These results demonstrate that berberine protects the brain from ischemia-reperfusion injury and the mechanism may rely on its anti-inflammatory effects mediated by suppressing the activation of HMGB1/TLR4/NF-κB signaling.
Assuntos
Berberina/uso terapêutico , Proteína HMGB1/antagonistas & inibidores , Infarto da Artéria Cerebral Média/tratamento farmacológico , Subunidade p50 de NF-kappa B/antagonistas & inibidores , Fármacos Neuroprotetores/uso terapêutico , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Encéfalo/patologia , Edema Encefálico/tratamento farmacológico , Regulação para Baixo , Ácido Glicirrízico/uso terapêutico , Proteína HMGB1/genética , Proteína HMGB1/metabolismo , Infarto da Artéria Cerebral Média/etiologia , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Subunidade p50 de NF-kappa B/genética , Subunidade p50 de NF-kappa B/metabolismo , Traumatismo por Reperfusão/complicações , Transdução de Sinais/efeitos dos fármacos , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/metabolismo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
OBJECTIVE: To observe the effects of acupuncture on mRNA of the neurotransmitter serotonin transporter (5-HTT), 5-HT1Areceptor (5-HT1AR), norepinephrineα2 receptor (NEα2R) in brain tissue in rats with post-stroke depression. METHODS: Forty male SD rats were randomly divided into a normal group, a model group, a medication group and an acupuncture group, 10 rats in each one. The model of post-stroke depression was established by occlusion of middle cerebral artery and chronic unpredictable mild stress method. After model was successfully established, the rats in the normal group and model group received no treatment; the rats in medication group were treated with intragastric administration of fluoxetine (2 mg/kg); the rats in acupuncture group were treated with acupuncture at "Baihui" (GV 20), "Fengfu" (GV 16), "Shenmen" (HT 7) and "Taichong" (LR 3) for 20 min, during which manual stimulation was given once, once a day, 7 days as one course, and totally 3 courses were given with an interval of one day between courses. The changes of rat behavior and 5-HT, NE were observed after intervention; the RT-PCR method was applied to observe the mRNA of 5-HTT, 5-HT1AR, NEα2R in hippocampus, raphe nucleus and locus coeruleus. RESULTS: After treatment, compared with the normal group, the Zea Longa score in the model group was increased, while sugar water consumption, the number of horizontal and vertical movement of open-field test was reduced (all P<0.01); compared with the model group, the Zea Longa score in the medication group and acupuncture group was reduced, while sugar water consumption, the number of horizontal and vertical movement of open-field test were increased (P<0.01, P<0.05); compared between the medication group and acupuncture group, the behavior changes were not significantly different (all P>0.05). After treatment, compared with the normal group, the content of 5-HT and NE in brain tissue and mRNA expression of 5-HTT, 5-HT1AR in hippocampus, raphe nucleus and locus coeruleus in the model group were reduced (all P<0.01), but the mRNA expression of NEα2R was increased (P<0.01);compared with the model group, the content of 5-HT and NE in brain tissue and mRNA expression of 5-HTT, 5-HT1AR in hippocampus, raphe nucleus and locus coeruleus in the medication group and acupuncture group were increased (P<0.01, P<0.05), while the mRNA expression of NEα2R was reduced (all P<0.01). The differences between medication group and acupuncture group were not significantly different (all P>0.05). CONCLUSIONS: Acupuncture could significantly improve behavioral change in rats with post-stroke depression, which may be related to the regulation of 5-HT, NE in cerebral cortex as well as mRNA expressions of 5-HTT, 5-HT1AR, NEα2R in hippocampus, raphe nucleus and locus coeruleus.
Assuntos
Terapia por Acupuntura/métodos , Encéfalo/metabolismo , Depressão/terapia , Infarto da Artéria Cerebral Média/complicações , Pontos de Acupuntura , Animais , Depressão/etiologia , Depressão/genética , Modelos Animais de Doenças , Hipocampo/metabolismo , Infarto da Artéria Cerebral Média/etiologia , Masculino , Ratos , Ratos Sprague-Dawley , Receptor 5-HT1A de Serotonina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Serotonina/metabolismoRESUMO
Phaseic acid (PA) is a phytohormone regulating important physiological functions in higher plants. Here, we show the presence of naturally occurring (-)-PA in mouse and rat brains. (-)-PA is exclusively present in the choroid plexus and the cerebral vascular endothelial cells. Purified (-)-PA has no toxicity and protects cultured cortical neurons against glutamate toxicity through reversible inhibition of glutamate receptors. Focal occlusion of the middle cerebral artery elicited a significant induction in (-)-PA expression in the cerebrospinal fluid but not in the peripheral blood. Importantly, (-)-PA induction only occurred in the penumbra area, indicting a protective role of PA in the brain. Indeed, elevating the (-)-PA level in the brain reduced ischemic brain injury, whereas reducing the (-)-PA level using a monoclonal antibody against (-)-PA increased ischemic injury. Collectively, these studies showed for the first time that (-)-PA is an endogenous neuroprotective molecule capable of reversibly inhibiting glutamate receptors during ischemic brain injury.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Ácido Glutâmico/metabolismo , Infarto da Artéria Cerebral Média/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Receptores de Glutamato/química , Sesquiterpenos/uso terapêutico , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/metabolismo , Células Cultivadas , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ratos , Ratos Sprague-Dawley , Receptores de Glutamato/metabolismoRESUMO
Intraluminal monofilament occlusion of the middle cerebral artery (MCAO) in mice is the most used rodent model to study the pathophysiology of stroke. However, this model often shows brain damage in regions not supplied by the MCA such as the hypothalamus, hippocampus and thalamus. Several studies have suggested some explanations on these localized infarcts. We aim to provide an alternative explanation which could allow each experimenter to better grasp the MCAO model. We propose that the MCA occlusion by the monofilament also occludes deep and small cerebral arteries arising directly from the internal carotid artery, proximally to the origin of MCA. Then, drawbacks and pitfalls of the MCAO model must be appreciated and the almost systematic risk of inducing lesions in some unwanted territories for neuroanatomical reasons, i.e. vascular connections between deep arteries and hypothalamic, thalamic and hippocampal areas in rodents has to be integrated.
Assuntos
Modelos Animais de Doenças , Hipocampo/patologia , Hipotálamo/patologia , Infarto da Artéria Cerebral Média/patologia , Infarto da Artéria Cerebral Média/fisiopatologia , Tálamo/patologia , Animais , Artéria Carótida Interna/patologia , Artéria Carótida Interna/fisiopatologia , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Hipocampo/irrigação sanguínea , Hipotálamo/irrigação sanguínea , Infarto da Artéria Cerebral Média/etiologia , Tálamo/irrigação sanguíneaAssuntos
Inibidores da Angiogênese/efeitos adversos , Dissecação da Artéria Carótida Interna/induzido quimicamente , Indóis/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Pirróis/efeitos adversos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Inibidores da Angiogênese/uso terapêutico , Afasia/etiologia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Terapia Combinada , Procedimentos Endovasculares , Hematoma/etiologia , Humanos , Hiper-Homocisteinemia/complicações , Indóis/uso terapêutico , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/etiologia , Inflamação/complicações , Neoplasias Renais/complicações , Neoplasias Renais/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nefrectomia , Paresia/etiologia , Inibidores de Proteínas Quinases/uso terapêutico , Pirróis/uso terapêutico , Radiografia , Radioterapia Adjuvante , Stents , Sunitinibe , Vasa Vasorum/efeitos dos fármacos , Deficiência de Vitamina B 12/complicaçõesRESUMO
We characterized the effect of acute ischemic stroke on the activation of the hypothalamic-pituitary-adrenal (HPA) axis and evaluated the role of glucocorticoids (GC) in the clinical outcome following ischemic stroke. Male spontaneous hypertensive rats underwent permanent middle cerebral artery occlusion (PMCAO) and developed a cortical infarct. At 4h post-PMCAO or sham operation, serum levels of ACTH and corticosterone (CS) were elevated 5 and 4 fold respectively as compared to controls and then returned to basal levels at 24h post surgery. In these experimental groups we found also a significant depletion of median eminence (ME)-CRH(41). In adrenalectomized (Adx) rats that underwent PMCAO the degree of motor disability and infarct volume was similar to that of intact rats. Administration of dexamethasone (Dex) to Adx-PMCAO rats significantly improved the motor disability and decreased the infarct volume. However, in sham-Adx with PMCAO, Dex had no effect on these two parameters. In rats with PMCAO or sham-PMCAO, brain production of PGE(2) was significantly increased. This effect was further enhanced in Adx-PMCAO rats and significantly inhibited by Dex. In conclusion, activation of the HPA axis following PMCAO is due to stress induced by surgery. This activation is mediated by hypothalamic CRH(41). Absence of endogenous GC or administration of Dex in naïve rats does not alter motor and pathological parameters in the acute stage following PMCAO. In contrast, administration of Dex significantly improved the outcome following cerebral ischemia in Adx rats which may be due to increased glucocorticoid receptors. Brain production of PGE(2) does not play an important role in the pathophysiology of the acute phase of cerebral ischemia.
Assuntos
Córtex Suprarrenal/fisiologia , Isquemia Encefálica/fisiopatologia , Glucocorticoides/fisiologia , Glucocorticoides/uso terapêutico , Infarto da Artéria Cerebral Média/tratamento farmacológico , Acidente Vascular Cerebral/fisiopatologia , Adrenalectomia , Hormônio Adrenocorticotrópico/sangue , Animais , Anti-Inflamatórios/uso terapêutico , Isquemia Encefálica/complicações , Corticosterona/sangue , Hormônio Liberador da Corticotropina/metabolismo , Dexametasona/uso terapêutico , Dinoprostona/metabolismo , Sistema Hipotálamo-Hipofisário/fisiologia , Hipotálamo/metabolismo , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/fisiopatologia , Coxeadura Animal/etiologia , Coxeadura Animal/patologia , Masculino , Eminência Mediana/fisiologia , Fragmentos de Peptídeos/metabolismo , Ratos , Ratos Endogâmicos SHR , Receptores de Glucocorticoides/efeitos dos fármacos , Receptores de Glucocorticoides/fisiologia , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Although hypercoagulability-induced thromboembolism is generally accepted as cause of cerebral ischaemia in thalassemic patients, cardiogenic embolism has been recently suggested as another possible stroke etiology. METHODS: We present four adult ß-thalassemia major patients with manifest cardiac involvement who suffered territorial strokes. RESULTS: In the presence of siderotoxic cardiomyopathy and arrhythmia, we assumed cardiogenic embolism as etiology of stroke and initiated oral anticoagulation as preventive medication. Two of our patients were the first ß-thalassemia major patients who underwent successful thrombolysis with rtPA. CONCLUSIONS: Cardioembolism seems to be the cause of stroke in cases of ß-thalassemia major. Thrombolysis can be applied in the setting of acute brain ischaemia in such high risk patients.
Assuntos
Anticoagulantes/uso terapêutico , Isquemia Encefálica/etiologia , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Talassemia beta/complicações , Adulto , Antiarrítmicos/uso terapêutico , Afasia/etiologia , Fibrilação Atrial/etiologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Cardiomiopatias/etiologia , Cardiomiopatia Dilatada/complicações , Terapia por Quelação , Terapia Combinada , Feminino , Hemiplegia/etiologia , Hemossiderose/etiologia , Humanos , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/etiologia , Embolia Intracraniana/complicações , Masculino , Esplenectomia , Tomografia Computadorizada por Raios X , Reação Transfusional , Talassemia beta/tratamento farmacológico , Talassemia beta/cirurgia , Talassemia beta/terapiaAssuntos
Doenças das Artérias Carótidas/diagnóstico , Seio Carotídeo , Infarto da Artéria Cerebral Média/etiologia , Massagem/efeitos adversos , Doença Aguda , Idoso de 80 Anos ou mais , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Infarto da Artéria Cerebral Média/tratamento farmacológico , Síncope/diagnóstico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Falha de TratamentoRESUMO
BACKGROUND: Scalp acupuncture (SA) therapy on strokes has been empirically established and widely used in clinics in China. The evidence from clinical studies suggests that SA produces significant benefits for some patients with stroke. METHODS: The effect of scalp acupuncture was studied using MRI for two different stroke models: spontaneously hypertensive stroke-prone (SHR-SP) rats and rats with transiently induced focal cerebral ischaemia by middle cerebral artery occlusion for 2 h (MCAO rats). RESULTS: Stroke onset in SHR-SP rats was characterised by a development of vasogenic oedema without any appearance of cytotoxic oedema. Scalp acupuncture reduced rapidly neurological dysfunction in SHR-SP rats and reduced the volume of the vasogenic oedema during the same period. In contrast, in MCAO rats, focal cerebral ischaemia caused an immediate development of cytotoxic oedema without any appearance of vasogenic oedema. Vasogenic oedema developed after reperfusion. Scalp acupuncture had no significant effects on the cytotoxic oedema, vasogenic oedema or neurological dysfunction of the MCAO rats within the time span examined. CONCLUSION: Scalp acupuncture had a rapid and strong effect on neurological dysfunction only in the hypertensive stroke-model by reducing the vasogenic oedema. Our results suggest that, if there are similar underlying mechanisms in human strokes, scalp acupuncture may be more beneficial for patients with strokes of hypertension-caused vasogenic origin than ischaemic origin.
Assuntos
Terapia por Acupuntura/métodos , Isquemia Encefálica/terapia , Modelos Animais de Doenças , Infarto da Artéria Cerebral Média/classificação , Infarto da Artéria Cerebral Média/terapia , Couro Cabeludo , Pontos de Acupuntura , Animais , Encéfalo/fisiopatologia , Isquemia Encefálica/complicações , China , Hipertensão/complicações , Infarto da Artéria Cerebral Média/etiologia , Imageamento por Ressonância Magnética , Ratos , Ratos Endogâmicos SHRRESUMO
BACKGROUND: Cerebral vasospasm triggered by subarachnoid haemorrhage is one of the major causes of post-haemorrhage morbidity and mortality. Several treatment modalities have been proposed, and none of them are fully effective. METHODS: In this study we treated five patients with prostacyclin suffering vasospasm after a ruptured aneurysm not responding to high i.v. doses of nimodipine. All patients were severely ill, unconscious and in need of intensive care. FINDINGS: A low dose of prostacyclin i.v. infusion for 72 h reversed the vasospasm as measured by transcranial Doppler technique. The mean MCA blood flow velocity decreased from 199 +/- 31 cm/s to 92 +/- 6 cm/s within 72 h after the start of the prostacyclin infusion. CONCLUSIONS: We suggest that low-dose prostacyclin treatment, an old treatment strategy, can be a treatment option in patients with vasospasm not responding to ordinary measures.
Assuntos
Epoprostenol/administração & dosagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/fisiopatologia , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/fisiopatologia , Adulto , Anti-Hipertensivos/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/efeitos dos fármacos , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular/efeitos dos fármacos , Circulação Cerebrovascular/fisiologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Resistência a Medicamentos/fisiologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/etiologia , Masculino , Pessoa de Meia-Idade , Nimodipina/administração & dosagem , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/etiologiaRESUMO
To explore the effects of reperfusion on evolution of focal ischemic injury, spontaneously hypertensive male rats were subjected to photothrombotic distal middle cerebral artery occlusion (MCAO) with or without YAG laser-induced reperfusion. The volume of fodrin breakdown zone, water content, and brain tissue levels of sodium (Na(+)) and potassium (K(+)) were measured in the ischemic core and penumbra. Reperfusion attenuated fodrin breakdown, and the volume containing fodrin breakdown product at 3 h after reperfusion (5 h after MCAO) (30+/-7 mm(3)) was significantly smaller than the 42+/-3 mm(3) of the permanent occlusion group. After 3 to 6 h of ischemia, Na(+) increased, and K(+) decreased in the ischemic core. Reperfusion after 2 h of MCA occlusion did not mitigate the ischemia-induced changes in brain tissue electrolytes and water content at 3 to 6 h of ischemia. Even in reperfusion after comparatively long periods of occlusion where brain infarction size, assessed 3 days after MCAO, was not significantly reduced by reperfusion, and the precipitating indicators of the ischemic core (Na(+), K(+), water content) did not improve, temporary improvement or a delay in progression of ischemic injury was discernible in the penumbra. These results indicate the possibility that treatment with reperfusion is permissive to the effects of neuroprotection.
Assuntos
Infarto da Artéria Cerebral Média/terapia , Lasers , Fármacos Neuroprotetores/administração & dosagem , Reperfusão/métodos , Animais , Velocidade do Fluxo Sanguíneo/fisiologia , Edema Encefálico/etiologia , Edema Encefálico/patologia , Edema Encefálico/prevenção & controle , Proteínas de Transporte/metabolismo , Córtex Cerebral/irrigação sanguínea , Córtex Cerebral/patologia , Circulação Cerebrovascular/fisiologia , Modelos Animais de Doenças , Eletrólitos/metabolismo , Corantes Fluorescentes/administração & dosagem , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/metabolismo , Infarto da Artéria Cerebral Média/patologia , Terapia a Laser , Lasers/efeitos adversos , Masculino , Proteínas dos Microfilamentos/metabolismo , Ratos , Ratos Endogâmicos SHR , Reperfusão/instrumentação , Rosa Bengala/administração & dosagem , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the neuroprotective effects of apigenin on acute transient focal cerebral ischemia-reperfusion injury in rats. METHODS: The acute transient focal cerebral ischemia-reperfusion model was established with modified method of insertion of thread fish nylon into and staying for two hours and then withdrawing from middle cerebral artery in rats. In experiment groups the neurological behavior scores, TTC stain of brain slices, neurocyte morphology were observed, and brain water content and Evans blue (EB) content were measured. RESULTS: Abnormal neurological behavior scores were existed in apigenin-treated group and model group. Typical cortical infarct lesions in model group were found by TTC stain. The neurocyte morphology in model group 4 hours was found in swollen glia and obvious edema near capillary and within nervous process, and karyopycnosis in neuron of ischemic cortex and hippocampus CA1 under electric microscope. However lesion was alleviated in apigenin-treated group. The brain water content and EB content in apigenin-treated group were lower than model group. CONCLUSION: Apigenin may play an important neuroprotective role in acute transient focal cerebral ischemia-reperfusion injury in rats.
Assuntos
Apigenina/farmacologia , Infarto da Artéria Cerebral Média/prevenção & controle , Fármacos Neuroprotetores/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Animais , Apigenina/uso terapêutico , Barreira Hematoencefálica/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/patologia , Edema Encefálico/etiologia , Edema Encefálico/patologia , Modelos Animais de Doenças , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/patologia , Masculino , Fármacos Neuroprotetores/uso terapêutico , Plantas Medicinais/química , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologiaRESUMO
OBJECTIVE: To observe the effect of electro-acupuncture (EA) on dendritic spine and ephrin-A5 and to investigate the action of EA on neural plasticity after acute cerebral ischemic infarction. METHODS: Focal acute cerebral ischemia model was established by middle cerebral artery occlusion (MCAO) with electrocoagulation contralateral method. Ninety male Sprague-Dawley rats were randomly divided into sham operation (SO) group, MCAO group and EA treatment (ET) group. Golgi dying, double immunofluorescence method and RT-PCR were used to detect dendritic spine density, expression patterns of ephrin-A5 and the effect of EA on them at the end of the first, second and fourth week after ischemia. RESULTS: The dendritic spine density in MCAO group significantly decreased after ischemia (p<0.01). The dendritic spine density was raised in ET group in the corresponding time period (p<0.01) and among the ET groups. It was higher at the end of the fourth week than before (p<0.05). The signal of ephrin-A5 was detected mainly in neuron cytoplasm, and the mRNA expression in MCAO group and ET group increased compared to that in SO group (p<0.01). The mRNA expression in ET group at the first week was much higher than that in MCAO group (p<0.01). In ET groups, the mRNA expression of ephrin-A5 was down-regulated along with the time going (p<0.01). CONCLUSION: It is possibly the regulation of the ephrin-A5 expression by which EA treatment improves the neural plasticity at the peri-infarct cerebral cortex in acute cerebral ischemia rat. There may be a time window in EA treatment for acute cerebral ischemia.
Assuntos
Isquemia Encefálica/complicações , Eletroacupuntura/métodos , Infarto da Artéria Cerebral Média/terapia , Plasticidade Neuronal/fisiologia , Doença Aguda , Animais , Espinhas Dendríticas/metabolismo , Espinhas Dendríticas/patologia , Modelos Animais de Doenças , Efrina-A5/genética , Efrina-A5/metabolismo , Imunofluorescência , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the protective effects of resveratrol on inflammatory process induced by focal cerebral ischemia-reperfusion in rats. METHOD: Rats were pretreated with resvreratrol at the dose of 10, 20, 40 mg kg(-1) for 7 days and then subjected to cerebral ischemia/reperfusion induced by a middle cerebral artery occlusion (MCAO). The infarct volume and the neurological deficit were determined by the method of TTC (2, 3, 5-triphenylterazolium chloride) staining and Longa's score. The permeability of blood-brain barrier (BBB) was evaluated by measurement of the evans blue (EB) content in the brain with spectrophotometer. The content of interleukin-lbeta, interleukin-6 (IL-6, IL-1beta) in serum and tumor necrosis factor-alpha (TNF-alpha), myeloperoxidase (MPO) in brain were determined by radio-immunoassay and ELISA assay. RESULT: Resveratrol reduced infarct volume, ameliorated the neurological deficit and the permeability of BBB, the content of IL-6, IL-1beta in serum and TNF-alpha, MPO activity in brain tissue also were significantly decreased. CONCLUSION: These results showed that resveratrol had protective effects on cerebral injury by inhibiting the releasing of the inflammatory mediators after ischemia/reperfusion injury.
Assuntos
Infarto da Artéria Cerebral Média/prevenção & controle , Mediadores da Inflamação/sangue , Traumatismo por Reperfusão/complicações , Estilbenos/farmacologia , Animais , Barreira Hematoencefálica/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/patologia , Isquemia Encefálica/complicações , Infarto da Artéria Cerebral Média/sangue , Infarto da Artéria Cerebral Média/etiologia , Interleucina-1beta/sangue , Interleucina-6/sangue , Masculino , Fármacos Neuroprotetores/farmacologia , Peroxidase/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Resveratrol , Fator de Necrose Tumoral alfa/metabolismoRESUMO
We report the rare presentation of lacunar stroke syndrome secondary to single perforator mouth occlusion from radiation-induced middle cerebral artery (MCA) stem arteriopathy. A 30-year-old female had acute-onset right-sided ataxic hemiparesis and dysarthria. As a child, she had a medulloblastoma of the posterior fossa and had surgery followed by cranial radiotherapy. She had no significant vascular risk factors. Acute CT showed extensive bilateral basal ganglia and left thalamic calcification; DWI showed a left internal capsule lacunar infarct; and MRA and CTA showed a 50% stenosis of the proximal left MCA.