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1.
Ann Clin Transl Neurol ; 6(1): 121-128, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30656190

RESUMO

Objective: Features of cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy ( CADASIL) caused by NOTCH3 mutations vary between ethnicities and regions. In Taiwan, more than 70% of CADASIL patients carry the mutation hot spot of p.R544C. We investigated the prevalence of NOTCH3 p.R544C mutation in stroke patients in Taiwan. Methods: This prospective, multicenter study recruited acute stroke patients within 10 days of symptom onset. The p.R544C mutation was identified by polymerase chain reaction with confronting two-pair primers and sequencing. Clinical parameters, vascular risk factors, stroke subtypes, and stroke outcomes were analyzed. Results: Of the 1970 stroke patients (mean age 61.1 ± 13.6 years, male 69.5%) included, 1705 (86.5%) had ischemic stroke and 265 (13.5%) had intracerebral hemorrhage. The prevalence of p.R544C in the study population was 2.8% (95% confidence interval [CI] = 2.1-3.5%). The prevalence was highest in patients with small vessel occlusion type of ischemic stroke (5.6%), followed by intracerebral hemorrhage (5.3%), and infarct of undetermined etiology (2.7%), and was low in patients with cardioembolism (0.8%) and large artery atherosclerosis (0.7%). All p.R544C patients with intracerebral hemorrhage were nonlobar hemorrhage. Sibling history of stroke (odds ratio [OR] = 4.50, 95% CI = 1.67-12.14 in ischemic stroke; OR = 6.03, 95% CI = 1.03-35.47 in intracerebral hemorrhage, respectively) and small vessel occlusion (OR, 4.03, 95% CI, 1.26-12.92) were significantly associated with p.R544C. Interpretation: p.R544C NOTCH3 mutation is underdiagnosed in stroke patients in Taiwan, especially in those with small vessel occlusion and sibling history of stroke.


Assuntos
Receptor Notch3/genética , Acidente Vascular Cerebral , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/patologia , Taiwan
3.
Dis Markers ; 2018: 9831079, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30034558

RESUMO

Translocator protein 18 kDa (TSPO) has been used as a biomarker of brain injury and inflammation in various neurological diseases. In this study, we measured the level of TSPO in acute ischemic stroke patients and determined its association with the degree of stroke severity and its ability to predict stroke functional outcomes. In total, 38 patients with moderate to severe acute ischemic stroke were enrolled. Demographic information, cerebral risk factors, and stroke severity were examined at the baseline. The National Institutes of Health Stroke Scale, modified Rankin Scale, and Barthal Index were assessed at discharge as measures of poor functional outcomes and severe disability. The baseline fasting plasma TSPO level was assessed within 24 h after the incident stroke and during hospitalization (on days 8-10). The proportion of patients with poor functional outcomes was significantly higher in the higher-TSPO group (compared to the lower group) in terms of clinical worsening (odds ratio (OR) = 11.69, 95% confidence interval (CI) = 2.08-65.6), poor functional outcomes (OR = 10.5, 95% CI = 1.14-96.57), and severe disability (OR = 4.8, 95% CI = 1.20-19.13). Plasma TSPO may be intimately linked with disease progression and worse functional outcomes in acute ischemic stroke patients.


Assuntos
Isquemia Encefálica/sangue , Receptores de GABA/sangue , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/patologia , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Acidente Vascular Cerebral/patologia , Análise de Sobrevida
4.
J Formos Med Assoc ; 117(7): 640-645, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29254683

RESUMO

Under the time-based criteria, patients with unknown onset stroke (UOS) are ineligible for reperfusion therapies. However, previous studies suggest that some patients with UOS may benefit from reperfusion. Several imaging modalities have been suggested to select patients for intervention, but the optimal imaging criteria are still controversial. Herein we present a series of four cases using 10-point CT-ASPECTS to support our decision of reperfusion therapy. We decided based on history, symptoms, and the 10-point CT-ASPECTS alone. Each patient's history suggested that the stroke just took place. All four patients had apparent clinical symptoms, with 10-point CT-ASPECTS. All of them had a reduction in their NIHSS after the reperfusion therapy. 10-point CT-ASPECTS could be used to support the presumption that the stroke just happens in patients with UOS. Further study is warranted to elucidate the value of CT-ASPECTS for UOS patients.


Assuntos
Isquemia Encefálica/terapia , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Índice de Gravidade de Doença , Trombectomia , Resultado do Tratamento
5.
J Am Heart Assoc ; 6(11)2017 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-29151031

RESUMO

BACKGROUND: Cumulative evidence has shown that low mitochondrial DNA (mtDNA) content is related to elevated oxidative stress and atherosclerosis, which play important roles in ischemic stroke. The objective of this study was to explore the association between mtDNA content in peripheral blood leukocytes and ischemic stroke. METHODS AND RESULTS: A total of 350 patients with first-ever ischemic stroke and 350 healthy controls were recruited in this case-control study. The mtDNA content in peripheral blood leukocytes was determined by quantitative real-time polymerase chain reaction. The levels of oxidized glutathione, reduced glutathione, and 8-hydroxy-2'-deoxyguanosine were measured by ELISA kits. Multivariate logistic regression models were used to analyze the relationship between mtDNA content in peripheral blood leukocytes and ischemic stroke. Our results show that mtDNA content of patients with ischemic stroke was notably lower compared with controls. A significant association was found between low mtDNA content and ischemic stroke. Furthermore, significant interactions were identified between low mtDNA and proven risk factors in patients with ischemic stroke. The levels of oxidized glutathione and 8-hydroxy-2'-deoxyguanosine were significantly greater in patients with ischemic stroke compared with controls. CONCLUSIONS: Our results demonstrate that low mtDNA content in peripheral blood leukocytes is associated with ischemic stroke. The relationship of low mtDNA content and ischemic stroke was particularly notable in individuals who had low mtDNA content combined with diabetes mellitus, metabolic syndrome, or cigarette smoking. Oxidative stress may be one of the contributory factors to decreased mtDNA content in patients with ischemic stroke.


Assuntos
Isquemia Encefálica/sangue , DNA Mitocondrial/genética , Leucócitos/metabolismo , Mitocôndrias/genética , Estresse Oxidativo , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/genética , Estudos de Casos e Controles , DNA Mitocondrial/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mitocôndrias/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Tomografia Computadorizada por Raios X
6.
PLoS One ; 12(4): e0175434, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28388675

RESUMO

BACKGROUND: Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). METHODS: Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups. RESULTS: Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients with MCA stenosis had higher prevalence of hypertension, diabetes and hypercholesterolemia. Patients with combined MCA and extracranial ICA stenosis had even higher NIHSS, worse functional outcome, higher risk of stroke recurrence or death (hazard ratio, 2.204; 95% confidence intervals, 1.440-3.374; p<0.001) at 3 months after stroke than those without MCA stenosis. CONCLUSIONS: In conclusion, MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan. Patients with MCA stenosis, especially combined extracranial ICA stenosis, had more severe neurological deficit and worse outcome.


Assuntos
Constrição Patológica/patologia , Artéria Cerebral Média/patologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/patologia
7.
Clin Interv Aging ; 12: 103-109, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28123290

RESUMO

OBJECTIVES: The main purpose of this study was to investigate whether carotid artery stenting (CAS) plus medicine in patients with severe carotid artery stenosis provide a better long-term blood pressure (BP) control compared to other medical treatments alone. The other aim was to explore the correlation between post-CAS hypotension within 6 h and long-term BP reductions after CAS. MATERIALS AND METHODS: Patients with severe carotid stenosis were recruited either in the CAS group or in the medication group. BPs and the number of classes of antihypertensive agents were recorded at baseline, 6, and 12 months. Extra BP information was collected at 6 h, 3 days, and 1 month after CAS. Univariate and multivariate linear regressions were performed to test the relationship of BP changes among CAS and medication groups after 6 and 12 months of follow-up. Univariate linear regressions were also used to determine the correlations between the mean or maximal systolic BP (SBP) reductions at 6 h and 1 year post-CAS. RESULTS: In total, 72 members in the CAS group and 82 members in the medication group were recruited. Compared with the medication group, patients in the CAS group had greater BP reductions at 6 and 12 months of follow-up after adjusting for confounding factors (13.56 mmHg at 6 months, P=0.0002; 16.98 mmHg at 12 months, P<0.0001). This study also shows significant positive correlations between the mean or maximal SBP reductions 6 h post-CAS and SBP reductions 1 year post-CAS (ß =0.20±0.07, P=0.0067 and ß =0.47±0.10, P<0.0001, respectively). CONCLUSION: As compared to medical treatment alone, CAS may provide significant beneficial effect on long-term BP control 1 year post-CAS. Furthermore, SBP reductions 6 h post-CAS may predict the SBP reductions 1 year post-CAS.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Hipertensão/tratamento farmacológico , Hipotensão/etiologia , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/fisiopatologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
8.
Brain Dev ; 35(2): 158-64, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22516515

RESUMO

Hypoperfusion on single-photon emission computed tomography (SPECT) of the stroke-like lesion (SLL) at the hyperacute stage of mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) is considered to be a supportive evidence of the mitochondrial angiopathy theory. Our objectives were to examine whether other neuroimages, especially transcranial color-coded sonography (TCCS), done at the hyperacute stage of stroke-like episode (SLE) is consistent with hypoperfusion of the SLL. We reviewed the magnetic resonance imaging (MRI), SPECT, cerebral angiography, and TCCS of a patient with MELAS syndrome, all of which were performed at the hyperacute stage of one SLE. MRI on the 1st day post SLE showed right temporoparietal lesion with vasogenic edema. SPECT on the 2nd day showed focal decreased uptake of technetium-99m hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) in the same region, but cerebral angiography and TCCS on the 3rd day showed increased regional cerebral blood flow (rCBF) and distal arteriole dilation in the same region. TCCS can delineate increased rCBF of the SLL at the hyperacute stage of SLE. We propose that the discrepancy between the decreased (99m)Tc-HMPAO uptake and increased rCBF might be caused by mitochondrial dysfunction. The phenomenon of "hypoperfusion" on SPECT might be caused by cell dysfunction but not decreased rCBF. We suggest that SPECT can be complemented by angiography and TCCS in future studies to delineate the perfusion status of SLLs.


Assuntos
Circulação Cerebrovascular/fisiologia , Síndrome MELAS/patologia , Acidente Vascular Cerebral/patologia , Adulto , Edema Encefálico/etiologia , Edema Encefálico/patologia , Angiografia Cerebral , Humanos , Hiperemia/etiologia , Hiperemia/fisiopatologia , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Artéria Cerebral Média/patologia , Perfusão , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Exametazima , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana
9.
Neurologist ; 17(3): 151-3, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21532384

RESUMO

Rhino-orbito-cerebral mucormycosis is a fatal infection in immunocompromised hosts. Prompt recognition of this clinical condition is essential for early diagnosis to avoid a delay of treatment. The presence of black eschar, usually in the nasal cavity, is the most alerting sign to the diagnosis. We present a patient with extremely fulminant ROCM in which the disease might be acquired via an orbital infection without nasal or paranasal involvement. With black eschars appearing at the bilateral canthi as the first alarm to extensive vascular involvement, the lethal infection rapidly evolved to occlusion of the bilateral ophthalmic arteries and eventually major intracranial arteries.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/patologia , Mucormicose/diagnóstico , Mucormicose/patologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/patologia , Adulto , Olho/irrigação sanguínea , Olho/patologia , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Mucormicose/mortalidade , Doenças Nasais/diagnóstico , Doenças Nasais/patologia
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