Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, but currently no single clinical method or ancillary test can reliably predict which subset of patients will develop delayed cerebral ischemia (DCI). The aim of this study was to find hematologic derangements and clinical factors present during the first 7 days after bleeding that could help identify patients at risk for development of DCI. MATERIALS AND METHODS: Databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. Data from demographics, imaging, laboratory, and clinical factors were collected. Statistical testing was conducted to test for association to the outcome, and multivariate logistic regression was used to design a predictive model. RESULTS: Of 55 patients, 14 developed DCI (25%). Anemia and leukocytosis on the third day after bleeding were significantly correlated with the outcome (for anemia: P<.032; confidence interval, 1.12-15.16; odds ratio, 4.12; for leukocytosis: P<.046; confidence interval, 1.03-26.13; odds ratio, 5.18). Anemia and leukocytosis were still statistically significant after adjustment for age, sex, modified Fisher scale, and Hunt-Hess scale. CONCLUSION: The presence of leukocytosis and anemia during the third day after SAH was statistically correlated with the occurrence of DCI.

Review of Preclinical and Clinical Studies of Bone Marrow-Derived Cell Therapies for Intracerebral Hemorrhage.

Stroke is the second leading cause of mortality worldwide, causing millions of deaths annually, and is also a major cause of disability-adjusted life years. Hemorrhagic stroke accounts for approximately 10 to 27% of all cases and has a fatality rate of about 50% in the first 30 days, with limited treatment possibilities. In the past two decades, the therapeutic potential of bone marrow-derived cells (particularly mesenchymal stem cells and mononuclear cells) has been intensively investigated in preclinical models of different neurological diseases, including models of intracerebral hemorrhage and subarachnoid hemorrhage. More recently, clinical studies, most of them small, unblinded, and nonrandomized, have suggested that the therapy with bone marrow-derived cells is safe and feasible in patients with ischemic or hemorrhagic stroke. This review discusses the available evidence on the use of bone marrow-derived cells to treat hemorrhagic strokes. Distinctive properties of animal studies are analyzed, including study design, cell dose, administration route, therapeutic time window, and possible mechanisms of action. Furthermore, clinical trials are also reviewed and discussed, with the objective of improving future studies in the field.

Radiopharmaceutical stem cell tracking for neurological diseases.

Although neurological ailments continue to be some of the main causes of disease burden in the world, current therapies such as pharmacological agents have limited potential in the restoration of neural functions. Cell therapies, firstly applied to treat different hematological diseases, are now being investigated in preclinical and clinical studies for neurological illnesses. However, the potential applications and mechanisms for such treatments are still poorly comprehended and are the focus of permanent research. In this setting, noninvasive in vivo imaging allows better understanding of several aspects of stem cell therapies. Amongst the various methods available, radioisotope cell labeling has become one of the most promising since it permits tracking of cells after injection by different routes to investigate their biodistribution. A significant increase in the number of studies utilizing this method has occurred in the last years. Here, we review the different radiopharmaceuticals, imaging techniques, and findings of the preclinical and clinical reports published up to now. Moreover, we discuss the limitations and future applications of radioisotope cell labeling in the field of cell transplantation for neurological diseases.

Resting metabolic rate analysis in chronic hemiparesis patients.

The objective of the present study was to compare resting metabolic rate (RMR) of chronic hemiparetic patients to sedentary health individuals. The sample was composed of 16 individuals, that were divided into two groups. The first group had eight hemiparetic patients and the second group was formed by eight sedentary individuals. To access and analyze the gases information a VO2000 analyzer was used. The following variables were measured: VO2, VCO2, VE, QR, grams of fat (GrFAT), grams of carbohydrate. RMR was calculated based on Weir's equation. There was a significant shift on ventilation variables: VE (P<0.0003), VO2 (P<0.0004) and VCO2 (P<0.0001) on hemiparetic individuals group when compared to control group. When the energetic substrate used behavior is observed, it shows that fat consumption (represented by GrFAT) is higher on the hemiparetic group when compared to controls (P<0.0001) significant differences were observed for RMR between groups (P<0.0001). RMR showed a correlation to VO2 on the hemiparetic group (r=0.9277, P=0.0022). To sum up, it was observed through the results that individuals with hemiparesis as a sequel of stroke showed a RMR larger than normal individuals.

Past, present, and future of stroke in middle-income countries: the Brazilian experience.

BACKGROUND: Stroke is one of the major public health challenges in middle-income countries. Brazil is the world's sixth largest economy but was clearly behind the milestones in the fight against stroke, which is the leading cause of death and disability in the country. Nevertheless, many initiatives are now reshaping stroke prevention, care, and rehabilitation in the country. AIMS: The present article discusses the evolution of stroke care in Brazil over the last decade. METHODS: We describe the main characteristics of stroke care before 2008; a pilot study in a Southern Brazilian city between 2008 and 2010, the Brazilian Stroke Project initiative; and the 2012 National Stroke Policy Act. RESULTS: The National Stroke Project was followed by a major increased on the number of stroke center in the country. The key elements of the 2012 National Stroke Policy Act included: definition of the requirements and levels of stroke centers; improved reimbursement for stroke care; promotion of stroke telemedicine; definition of the Line of Stroke Care (to integrate available resources and other health programs); increased funding for stroke rehabilitation; funding for training of healthcare professionals and initiatives to increase awareness about stroke within the population. CONCLUSIONS: The evolution of stroke care in Brazil over the last decade is a pathway that exemplifies the challenges that middle-income countries have to face in order to improve stroke prevention, treatment and rehabilitation. The reported Brazilian experience can be extrapolated to understand the past, present, and future of stroke care in middle-income countries.

The rise of cell therapy trials for stroke: review of published and registered studies.

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Approximately 16 million first-ever strokes occur each year, leading to nearly 6 million deaths. Nevertheless, currently, very few therapeutic options are available. Cell therapies have been applied successfully in different hematological diseases, and are currently being investigated for treating ischemic heart disease, with promising results. Recent preclinical studies have indicated that cell therapies may provide structural and functional benefits after stroke. However, the effects of these treatments are not yet fully understood and are the subject of continuing investigation. Meanwhile, different clinical trials for stroke, the majority of them small, nonrandomized, and uncontrolled, have been reported, and their results indicate that cell therapy seems safe and feasible in these conditions. In the last 2 years, the number of published and registered trials has dramatically increased. Here, we review the main findings available in the field, with emphasis on the clinical results. Moreover, we address some of the questions that have been raised to date, to improve future studies.

The "eye sign" due to hemispatial neglect: A case report.

Conjugate eye deviation is characterized by a sustained shift in horizontal gaze, usually toward the affected brain hemisphere. When detected on neuroimaging, it is called the "eye sign". It is classically associated with lesions involving the frontal eye fields, ipsilateral to the side of the deviation. Neglect may be conceptualized as a spatially addressed bias of the sensory events in explicit behaviors and in the absence of perceptual and motor deficits. Hemispatial neglect is a common disabling condition that occurs following acute unilateral brain damage, usually to the right side. We report a case of a patient presenting with the "eye sign" on tomography, following an acute subinsular stroke, in the absence of conjugated eyes deviation. Our hypothesis was that the sign may have been due to hemispatial neglect in this patient. The aim of this article was to discuss the mechanisms involved in the attention network and its neuroanatomic correlates.

Desvio conjugado do olhar é caracterizado por um desvio sustentado horizontal da mirada, normalmente para o lado do hemisfério afetado. Quando visto por métodos de imagem, é chamado "sinal do olhar". O sinal é normalmente associado a lesões envolvendo o "campo frontal do olho" ipsilateral ao lado do desvio. Negligência pode ser conceitualizada como um viés espacial dos eventos sensoriais no comportamento explícito, na ausência de alterações da percepção e motoras. Negligência hemiespacial é uma condição comum e incapacitante que ocorre após lesão cerebral aguda, principalmente à direita. Nós relatamos um caso de um paciente que apresenta o "sinal do olhar" na tomografia, após um infarto subinsular, na ausência de desvio conjugado do olhar. Nossa hipótese é que, neste paciente, o sinal pode ser devido à negligência hemiespacial. O objetivo deste artigo é discutir os mecanismos envolvidos na rede da atenção e seus correlatos anatômicos.