Platelet Reactivity in Patients With Stroke and Hyperlipidemia, GPIbα Assessment.

The aim of this study was to assess platelet reactivity in patients after ischemic stroke and to investigate the influence of hyperlipidemia (HL) on platelet activity markers. A total of 41 patients after ischemic stroke were divided into the following 2 groups: patients with HL and patients with normolipidemia. Expression of CD42b on resting, thrombin-activated blood platelets, and fibrinogen level was assessed. The CD42b-positive platelets were analyzed using the flow cytometer, anti-CD61, and anti-CD42b monoclonal antibodies. The results confirmed increased platelet reactivity to thrombin in all patients after ischemic stroke manifested by significantly lower CD42b expression and percentage of CD42b(+) platelets after activation by thrombin. The influence of HL on the expression of CD42b on resting and thrombin-activated platelets was not found. However, increased level of fibrinogen but no influence of HL on fibrinogen concentration was observed in patients after ischemic stroke. Increased susceptibility to platelet agonists was found in patients after ischemic stroke in the convalescent phase.

The influence of statin therapy on platelet activity markers in hyperlipidemic patients after ischemic stroke.

INTRODUCTION: Low-density lipoprotein cholesterol (LDL-C) has been reported to increase platelet activation. Reducing the level of LDL-C with statins induces important pleiotropic effects such as platelet inhibition. This association between platelet activity and statin therapy may be clinically important in reducing the risk of ischemic stroke. We investigated the effect of simvastatin therapy on platelet activation markers (platelet CD62P, sP-selectin, and platelet-derived microparticles (PDMPs)) in hyperlipidemic patients after ischemic stroke. MATERIAL AND METHODS: The study group consisted of 21 hyperlipidemic patients after ischemic stroke confirmed by CT, and 20 healthy subjects served as controls. We assessed the CD62P expression on resting and thrombin-activated blood platelets. CD62P and PDMPs were analyzed by the use of monoclonal antibodies anti-CD61 and anti-CD62 on a flow cytometer. The level of sP-selectin in serum was measured by the ELISA (enzyme-linked immunosorbent assay) method. All markers were re-analyzed after 6 months of treatment with simvastatin (20 mg/day). RESULTS: Hyperlipidemic patients presented a significantly higher percentage of CD62+ platelets and higher reactivity to thrombin compared to control subjects. After simvastatin therapy hyperlipidemic patients showed a reduction of the percentage of resting CD62P(+) platelets (p = 0.005) and a reduction of expression and percentage of CD62P(+) platelets after activation by thrombin (median p < 0.05; percentage: p = 0.001). A decrease of sP-selectin levels (p = 0.001) and percentage of PDMPs (p < 0.05) in this group was also observed. CONCLUSIONS: HMG-CoA reductase inhibitor therapy in stroke patients with hyperlipidemia may be useful not only due to the lipid-lowering effect but also because of a significant role in reduction of platelet activation and reactivity.

[Patients' knowledge regarding modifiable risk factors of stroke]. / Wiedza pacjentów na temat modyfikowalnych czynników ryzyka udaru mózgum.

UNLABELLED: Regular physical activity constitutes effective measure of both primary and secondary protection against modern-age diseases. The aim of the paper was to assess the level of patients' knowledge regarding the influence of low physical activity and other modifiable risk factors affecting the increase in stroke occurrence in early stages of rehabilitation (day 9 after the cerebrovascular accident). AIM: The aim of the paper was to assess the level of patients' knowledge regarding the influence of low physical activity and other modifiable risk factors affecting the increase in stroke occurrence in early stages of rehabilitation (day 9 after the cerebrovascular accident). MATERIALS AND METHODS: The study group included 96 patients hospitalized in the Department of Neurology and Epileptology with Stroke Unit, who were diagnosed with a stroke with motion deficits and who were recommended kinesitherapy. All patients were interviewed, which was complemented with the authors' questionnaire including questions regarding the knowledge of modifiable risk factors of stroke. RESULTS: The risk factor of stoke which was most frequently mentioned by the patients was arterial hypertension - 87 patients (90.6%). Only 7 respondents indicated low physical activity. On average, less risk factors were known by women. No correlation between age and the number of indicated risk factors was found. CONCLUSIONS: Majority of the patients after stroke do not know how important low physical activity is in terms of it being a risk factor of stroke. The most recognized stroke factors are: arterial hypertension, carotid artery stenosis and atrial fibrillation. The level of patients' knowledge regarding modifiable risk factors of stroke connected with the style of life is insufficient. It is necessary to intensify educational activities that promote physical activity as an important element of prevention of modern-age diseases, including stroke.

The influence of hyperlipidemia on platelet activity markers in patients after ischemic stroke.

BACKGROUND: To investigate the relationship between hyperlipidemia and platelet activation markers--platelet and soluble P-selectin (sP-selectin), and platelet-derived microparticles (PDMPs)--in patients after ischemic stroke. METHODS: 41 patients after ischemic stroke (>3 months) confirmed by CT were divided into 2 groups: with hyperlipidemia (HL, n = 21) and normolipidemia (NL, n = 20). Twenty healthy subjects served as controls. CD62P-positive platelets and PDMPs in whole blood were analyzed by the use of a flow cytometer and anti-CD61 and anti-CD62P monoclonal antibodies. Platelets were activated by thrombin (0.08 units). The level of sP-selectin in serum was measured by ELISA. RESULTS: We observed a significantly higher CD62P expression and percentage of CD62P-positive resting and thrombin-activated platelets in the HL as compared to the NL group. The sP-selectin concentration was also significantly higher in HL than NL subjects (p < 0.05). Moreover, we observed a significantly higher percentage of PDMPs in patients after stroke (NL: p < 0.05; HL: p = 0.005) in comparison with the control group. CONCLUSIONS: Patients after stroke present symptoms of platelet hyperreactivity. HL in the patients may be a risk factor for vascular events due to the increase in platelet activation.

[The usefulness of P300 potential in hepatic encephalopathy diagnostics of alcoholic etiology]. / Przydatnosc potencjalu P300 w diagnostyce encefalopatii watrobowej o etiologii alkoholowej.

UNLABELLED: The consequence of consuming excessive amount of alcohol is the damage of internal organs, particularly liver. In the liver there comes in turn to its fatty degeneration, hepatitis, fibrosis and finally to its cirrhosis. The aim of the study was the analysis of P300 potential in subjects chronically abusing alcohol with alcohol-related toxic liver damage and the assessment of the usefulness of this potential in the diagnosis of hepatic encephalopathy. MATERIAL AND METHODS: Group I--consisted of 30 men meeting the criteria of alcohol dependency syndrome, with diagnosed alcohol-related toxic liver damage. Comparative group--consisted of 30 physically and mentally healthy men, with no alcohol dependency syndrome. The following were carried out in all the examined: examination of auditory endogenic P300 potential. RESULTS: In subjects chronically abusing alcohol, with diagnosed toxic liver damage statistically significant prolonged latency and also reduced amplitude (p < 0.001) were found in comparison with the control group. CONCLUSIONS: 1. Changes in P300 parameters (latency elongation and amplitude reduction) in alcohol-dependent subjects with alcohol-related liver damage were confirmed. 2. P300 potential may be a complementary method in the diagnosis of hepatic encephalopathy.

[The case of multiple brain abscesses conservatively treated]. / Przypadek mnogich ropni mózgu leczonych zachowawczo.

We report the case of patient with rheumatoid arthritis treated by sulfasalazin. He was hospitalized because of general erythrodermia and diarrhoea with dysproteinemia. The consciousness disturbances and the meningitis syndrome occured in the course of disease. The findings of cerebrospinal fluid suggested viral meningitis and encephalitis. The treatment was started. After short-term improvement, the focal neurological deficits and the consciousness disturbances appeared again. The examinations of the computed tomography and the magnetic resonance image suggested inflammatory or neoplasmatic process. The inflammatory process seemed to be more probable and antibiotic treatment was administered. The following CT and MRI findings confirmed inflammatory changes of brain tissue and abscess formation tendency. After the neurosurgeon consultation the conservatively treatment was continued. The 2 month therapy achieved a successful outcome. We report this case because of the difficulties of diagnostic and treatment choices and the 50% mortality connected with the multiple brain abscesses. It seems that in our case the bacterial infection was secondary to the viral encephalomeningitis. We couldn't find the primary focus of bacterial infection, although the infection cause was undoubtedly hematogenous (abscesses location on the boundaries of cerebral cortex and white matter). There is no evident therapeutic standards and the choice of the best treatment is still under discussion. However, neuroimagining techniques are very useful in the correct diagnosis and optimal treatment.

[The dynamics of changes glucose concentration of patients with ischemic stoke in chosen times of day]. / Dynamika zmian stezen glukozy we krwi chorych w przebiegu udaru niedokrwiennego mózgu w wybranych porach doby.

UNLABELLED: Cerebral ischemic stroke which basic exponent is an sudden occurrence of neurological deficits is also characterized by deep disturbances of human organism homeostasis. It is known that many functions of a healthy human organism is subjected to the rhythmical changes during the twenty-four hours, and the state of illness can disturb them in a crucial way. The aim of the study was to examine the dynamics of changes of glucose concentration in blood of patients with acute phase of cerebral ischemic stroke in chosen times of day. MATERIAL AND METHODS: The examinations were carried out on 16 non-diabetic patients (11 men, 5 women), aged between 57 and 76 where the cerebral ischemic stroke was confirmed by the Computer Tomography of the head. The patients were on high protein diet with total energy value of 2283 +/- 130.0 kcal per twenty-four hours in three meal times: at 09AM, 02PM, 06PM. The venous blood for examinations was drawn 6 times during the day: at 01AM, 05AM, 09AM, 01PM, 05PM, 09PM on the 1st, 3rd, 5th and 10th day after the stroke occurred. The following concentrations in blood were denoted glucose. RESULTS: In patients with the acute phase of cerebral ischemic stroke the significant disorders of carbohydrate metabolism can be observed in times between 09AM and 01PM on both the 1st, 3rd and the 5th day of the duration of the disease. CONCLUSIONS: The received results may take effect in the proofreading of pharmacological treatment with the consideration of the times of day.

[Masked (atypical) depression in patients with back pain syndrome in outpatient neurological care]. / Depresja maskowana (atypowa) u chorych z zespolem bólowym kregoslupa w praktyce ambulatoryjnej neurologa.

UNLABELLED: Affective disorders, mainly depression is fast growing problem in highly civilised communities. The literature reports that 30-40% of patients seeking medical advice from specialists (not psychiatrists) in outpatient departments, suffer from these disorders. Many authors mention also diagnostic difficulties in dealing with atypical depression, and draw attention to the fact that this process is often "masked" by chronic pain. In neurological care we find a remarkable group of outpatients with back pain syndrome, mainly cervical and lumbar, with no corresponding lesions found on examination. This enabled us to assume that in some patients presenting with somatic symptoms and therefore referred to a neurologist, the reason of complaints can be depressive disorders. The aim of the study was to verify this hypothesis and to estimate the frequency of masked depression in neurological care. MATERIAL AND METHOD: 100 patients were examined in the neurological outpatient department, with the use of the two--Beck and Hamilton--scales of depression evaluation. RESULTS: A statistical analysis of the data thus obtained, showed that: back pain syndrome, as a symptom of depression, occurred in 14% of all patients referred to a neurologist, whereas in 37%--depressive disorders, not diagnosed before, were detected; in 88,2% they were of mild and moderate type. CONCLUSION: In some patients presenting with somatic symptoms and therefore referred to a neurologist, the reason of complaints are depresive disorders.

[Central pontine myelinolysis--case report]. / Centralna mielinoliza mostu--opis przypadku.

Central pontine myelinolysis (CPM) is a neurologic disorder, consists of demyelinisation without inflammation in the base of pons, with a relative sparing of the axons and the nerve cells. Clinical symptoms have various manifestations. They include pseudobalbular paralysis, tetraparesis, locked-in syndrome, coma. Rapid correction of persistence hyponatremia is a well recognized factor predisposing to CPM and nutritional deficiency is a commonly evoked cause of CMP as well. In more than half the cases it appeared in the late stages of chronic alcoholism. Among other medical conditions conjoined with CMP are liver failure and transplantation, electrolyte disturbances, cachexia from various causes, carcinoma, and severe bacterial infections. The autors report the cases of 31 year old patient with 4 year history of alkohol abuse in whom CPM developed with mild tetraparesis.

[Statins and stroke]. / Statyny a udar mózgu.

The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nevertheless, large, long-term statin trials in patients with established CHD or et high risk for CHD (diabetes, hypertension) have shown that statins decrease stroke incidence in these populations even with a normal baseline cholesterol concentration. In patients with previous stroke statins reduce the incidence of coronary events, but whether they actually reduce the incidence of recurrent strokes in secondary prevention is unproved. In this review we discuss the potential reason for the effects of statins on stroke and the mechanisms of action. Statins probably reduce stroke by a variety of mechanisms. Several studies indicate that statins have multiple effects beyond lowering the cholesterol level. There is evidence that statins have neuroprotective properties for the acute ischaemic brain. Statins interfere with platelet aggregation and have anti-inflammatory and antioxidative properties. Also statins promote stabilisation of atherosclerotic plaques and improve blood flow to the ischaemic brain. The protective effects of statins might be due to their direct effect on endothelial cells leading to improved nitric oxide (NO) bioavailability. However further studies are needed to understand the full role of statins in the prevention of stroke in patients without established cardiovascular disease, representative of the typical stroke population.

[Potential P300 in diagnostics of cognitive functions]. / Potencjal P300 w diagnostyce zaburzen poznawczych.

On the base of accessible literature and own experience general information concerning potential P300, the methodology of its research as well as the influence of different factors on each its components were reviewed. The possibilities of the clinical use of potential P300 in the diagnostics of cognitive disturbances were presented. It emerges that P300 potential can have practical use in the diagnostics of dementias, but because of its physiological and individual changeability it cannot be treated as a fully objective diagnostic method.