Prediction of prognosis in patients with ischemic stroke combined with type 2 diabetes mellitus based on serum total bilirubin levels.

Serum bilirubin levels may have therapeutic benefits in oxidative stress-related diseases, but their role in stroke remains unclear. This study aimed to investigate the relationship between serum bilirubin levels on admission and clinical outcomes in ischemic stroke patients. We prospectively collected data from consecutive ischemic stroke admissions. Serum total bilirubin (TBIL) and direct bilirubin levels on admission were measured. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale, and functional status at discharge was evaluated using the modified Rankin scale. Among 180 patients, lower TBIL levels were observed in all 3 groups, with the mild group (7.89 ±â€…2.12 µmol/L) having lower levels than the moderate group (8.01 ±â€…2.12 µmol/L) and the severe group (9.12 ±â€…2.12 µmol/L). Although TBIL levels were initially associated with stroke severity, this relationship did not hold after adjusting for confounding factors. Serum bilirubin levels appear to be related to stroke severity but not independently associated with outcomes in ischemic stroke patients. Further research is needed to understand the underlying mechanisms of this relationship. There is a strong correlation between serum bilirubin levels and the severity and prognosis of ischemic stroke in patients with type 2 diabetes. Therefore, early control of serum TBIL and direct bilirubin is crucial for the treatment and prognosis of ischemic stroke in patients with type 2 diabetes.

A case report of the rare fifteen-and-a-half syndrome.

RATIONALE: The dorsal tegmentum of the caudal pons, including the medial longitudinal fasciculus (MLF), the paramedian pontine reticular formation (PPRF), abducens nucleus, and the adjacent facial nerve is the anatomical basis of the the fifteen and a half syndrome (15½) syndrome. No patients of 15½ Syndrome presenting with bilateral peripheral facial paralysis and one-and-a-half simultaneously at the onset have been reported up to now. PATIENT CONCERNS: A 54-year-old woman complained of diplopia, slurred speech, and slightly distal numbness of the left upper limb for 4 days in our hospital. DIAGNOSES: The diffusion weighted image (DWI) and apparent dispersion coefficient (ADC) of MRI revealed the causative lesion in pons including bilateral pontine tegmentum and a narrow lesion along the midline in the right of the pons. Her clinical manifestations with results of MRI resulted in the diagnosis of the fifteen-and-a-half-syndrome. INTERVENTIONS: The patient received antiplatelet aggregation, plaque stabilization, free radicals elimination, circulation improvement, nerves nourishment, and other symptomatic treatments. OUTCOMES: Two months later, her ocular movement recovered, and the bilateral facial paresis showed some improvement. LESSONS: First, our patient with 15½ syndrome maybe one of mutants whose bilateral pontine tegmentum is supplied by unilateral pontine paramedian perforator artery. Second, DWI combined with ADC may be applied in the diagnosis of fifteen-and-half syndrome when the lesions of infarction are too small to be revealed by MRI scan.