Aspirin resistance predicts unfavorable functional outcome in acute ischemic stroke patients.

OBJECTIVE: To investigate the prognostic value of aspirin reaction units (ARU) in a 3-month follow-up study in a cohort of Chinese patients with first-ever ischemic stroke. METHODS: Prospective single-center survey of acute ischemic stroke patients receiving aspirin therapy. Two hundred and seventy-five Chinese patients with first-ever ischemic stroke who previously received aspirin therapy were enrolled. ARU was measured using the VerifyNow system. A cutoff of 550 ARU was used to determine the presence of aspirin resistance (AR). RESULTS: Median age at study entry was 67 years (IQR: 59-75) and 142(51.6%) were male. A total of 52 of 275 enrolled patients (18.9%) were AR. Median regression estimated a statistically significant increase in NIHSS score of 0.033 point for every 1-point increase in ARU (95% CI, 0.024 to 0.068; P < 0.001). The unfavorable outcomes distribution across the ARU quartiles ranged between 11.8% (first quartile) to 64.8% (fourth quartile). After adjusting for other established risk factors, in multivariate models comparing the third and fourth quartiles against the first quartile of the ARU, levels of ARU were associated with unfavorable outcome, and the adjusted risk of unfavorable outcome increased by 145% (OR = 2.45 [95% CI 1.46-3.87], P = 0.011) and 317% (4.17[2.76-6.15], P < 0.001), respectively. Similarly, the adjusted risk of mortality increased by 215% (OR = 3.15 [95% CI 1.98-4.73], P = 0.008) and 429% (5.29[4.02-8.17], P < 0.001), respectively. CONCLUSIONS: The results suggest that AR is a meaningful and independent marker to predict short-term functional outcome in patients with ischemic stroke.

Increased intracranial pressure in Guillain-Barré syndrome: A case report.

RATIONALE: Guillain-Barré syndrome (GBS) is an inflammatory autoimmune demyelinating polyneuropathy that affects most of the peripheral nervous system. Papilledema and raised intracranial pressure (ICP) are seen in some patients, and are thought to be associated with elevated cerebrospinal fluid (CSF) protein-though CSF protein levels are normal in some patients, thus the specific mechanisms remain unclear. Interleukin (IL)-17 levels are elevated in the CSF and plasma in GBS patients, and elevated IL-17 in the CSF of patients with idiopathic intracranial hypertension has been reported. Intravenous immunoglobulin (IVIG) exerts therapeutic effects by downregulating IL-17 in GBS patients. PATIENT CONCERNS: Herein we describe a case of a 14-year-old girl who initially presented with relapsing limb weakness. DIAGNOSES: Magnetic resonance imaging revealed an enlarged ventricle, electromyography, and nerve conduction studies were suggestive of polyradiculopathy, and lumbar puncture revealed elevated ICP with normal cells and elevated protein values. INTERVENTIONS: She was treated with IVIG 0.4 g/kg per day for 5 days. OUTCOMES: At a 6-month follow-up there had been no recurrence. LESSONS SUBSECTIONS: In GBS patients who have a relapsing course and develop papilledema with possible immunological disturbance, an accurate early diagnosis in conjunction with the prompt initiation of immunotherapy may improve clinical symptoms and the prognosis.

An Increased Serum Level of Lipoprotein(a) Is a Predictor for Deep Vein Thrombosis in Patients with Spinal Cord Injuries.

OBJECTIVE: This prospective cohort-designed study was performed to verify whether higher levels of serum lipoprotein(a) (Lp(a)) could be a risk factor for deep vein thrombosis (DVT) in Chinese patients with spinal cord injuries (SCI). METHODS: During 2013-2014, consecutive patients with first-ever SCI were recruited and assessed for DVT using color Doppler ultrasonography for 15 days after injury and whenever clinically requested. Using logistic regression models, multivariate analyses were performed. Receiver operating characteristic curves tested the overall predicted accuracy of Lp(a) and other markers. RESULTS: In this study, 358 patients were screened in the analysis, and 279 patients with SCI were included and completed the 15-day follow-up. Fifty-five patients (19.7%) were diagnosed with DVT. Patients with SCI with DVT had significantly higher Lp(a) levels on admission (554 mg/L [interquartile range, 416-790 mg/L] vs. 158 mg/L [interquartile range, 72-252 mg/L]; P < 0.0001). Adjusted for common risk factors, multivariate analyses showed that serum Lp(a) ≥ 300 mg/L could be used independently to predict DVT (odds ratio, 10.35; 95% confidence interval [CI], 2.37-45.35; P < 0.0001). With an area under the curve (AUC) of 0.91 (95% CI, 0.86-0.94), Lp(a) showed a significantly greater discriminatory ability in predicting DVT compared with high-sensitivity C-reactive protein (AUC, 0.81; 95% CI, 0.74-0.88; P < 0.01), homocysteine (AUC, 0.78; 95% CI, 0.71-0.84; P < 0.01) and age (AUC, 0.66; 95% CI, 0.59-0.73; P < 0.001). CONCLUSIONS: Increased serum Lp(a) levels were independent predictors of DVT in patients with SCI in China, suggesting a possible role of Lp(a) in the pathogenesis of DVT.

Association of CYP2J2 gene polymorphisms with ischemic stroke.

OBJECTIVE: The present study aims to investigate the relationship between CYP2J2 gene polymorphisms and ischemic stroke (IS) in a Chinese Han population. METHODS: We performed a case-control study including 300 stroke patients and 300 healthy control subjects to compare the distribution of genetic polymorphism G-50T in CYP2J2 gene. RESULTS: We found GT genotype of G-50T in CYP2J2 gene was associated with the risk for IS (13.7% vs. 7.7%, P = 0.037). After adjustment of confounders, the difference remains significant (OR = 1.890, 95% CI: 1.042-3.011). CONCLUSION: CYP2J2 gene polymorphism might increase the risk of stroke in Chinese population.

Plasma levels of copeptin predict 1-year mortality in patients with acute ischemic stroke.

To evaluate the association between plasma levels of copeptin and 1-year mortality in a cohort of Chinese patients with acute ischemic stroke. We prospectively studied 275 patients with ischemic stroke who were admitted within 24 h after the onset of symptoms. Copeptin and NIH stroke scale (NIHSS) score were measured at the time of admission. The prognostic value of copeptin to predict mortality within 1 year was compared with the NIHSS score and other known outcome predictors. Nonsurvivors had significantly higher copeptin levels on admission compared with survivors (P<0.0001). Multivariate logistic regression analysis showed that elevated plasma levels of copeptin were an independent stroke mortality predictor, with an adjusted odds ratio of 4.48 [95% confidence interval (CI), 2.18-9.06]. The area under the receiver operating characteristic curve of copeptin was 0.882 (95% CI, 0.847-0.921) for stroke mortality, which yielded a sensitivity of 90.7% and a specificity of 84.5%. Copeptin improved the NIHSS score (area under the curve of the combined model, 0.94; 95% CI, 0.91-0.97; P=0.011). Elevated plasma copeptin levels at admission were an independent predictor of long-term mortality after ischemic stroke in a Chinese sample, suggesting that these alterations might play a role in the pathophysiology of stroke.

Executive dysfunction in patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion.

Impairment of executive functions (EFs) was investigated in patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion. Several EFs were measured in patients with cerebral angiostenosis/occlusion and healthy subjects. The vascular conditions, regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT), time to peak (TTP), and delay time were assessed. The scores of the vascular stenosis/occlusion group were significantly lower than those of the control group. rCBV and rCBF were negatively correlated with the error response times in the Stroop test, and the persistent error responses in the Wisconsin Card Sorting Test (WCST) were positively correlated with the Montreal Cognitive Assessment (MoCA) scores. TTP was positively correlated with the reaction and error reaction times, and the persistent error response in WCST was negatively correlated with the times of sorting in WCST and MoCA scores. MTT was positively correlated with the persistent error response in WCST. In the Stroop test, delay time was positively correlated with response time, and negatively correlated with error response times, and the persistent error response in WCST and MoCA scores. Patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion had executive dysfunctions in working memory, sustained attention, response inhibition, cognitive flexibility, thought organization, planning, and implementation. Moreover, their executive dysfunctions were related with the decline in rCBF and rCBV. The prolonged TTP, MTT, and delay time suggested a slow blood flow and the poor compensation of collateral circulation, resulting in impairment of the EFs.