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Among stroke patients, the dietary lipid content is likely associated with the age at stroke onset and ischemic stroke subtype. Specifically, middle-onset stroke patients may have a higher serum level of saturated fatty acids and higher incidence of lacunar or atherosclerotic stroke, whereas late-onset stroke patients may have a higher serum level of n-3 polyunsaturated fatty acids (PUFA; a fish oil component) and lower incidence of lacunar or atherosclerotic stroke. This retrospective study aimed to investigate the relationships among serum fatty acid levels, age at stroke onset and stroke subtype in ischemic stroke patients.

BackgroundCerebral hyperperfusion syndrome (CHS) is likely to occur after carotid revascularization in patients with stage 2 hemodynamic failure (st2HF), in whom the oxygen extraction fraction (OEF) increases.ObjectiveThe purpose of our study was to investigate whether measurement of the global cerebral OEF (gcOEF) by blood sampling can be used to estimate st2HF and anticipate CHS following carotid artery stenting (CAS).MethodsThe OEF was calculated by blood sampling just before and after elective CAS. Data were collected prospectively. Patients who underwent elective CAS and gcOEF calculation were included in the study. Patients’ baseline features, pre-CAS gcOEF, post-CAS gcOEF, and incidence of CHS (defined as headache, seizure, focal neurologic deficits, and/or restlessness) were evaluated.Results141 patients met the inclusion criteria and 134 patients were analyzed. Median pre-CAS gcOEF and post-CAS gcOEF were 0.41 and 0.42, respectively. Nine patients developed CHS. Median pre-CAS gcOEF was higher in patients with than in those without CHS (Mann–Whitney U test, P<0.05), but median post-CAS gcOEF was not significantly higher in patients with CHS (P=0.058). Scattergrams of patients with and without CHS showed that the cut-off values of the pre-CAS gcOEF and post-CAS gcOEF for anticipation of CHS were 0.46 (P<0.01) and 0.49 (P<0.001), respectively.ConclusionElevation of the pre-CAS or post-CAS gcOEF by blood sampling allowed for anticipation of CHS following CAS. Elevation of the pre-CAS gcOEF might be associated with st2HF.

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Introduction:Functional outcomes after acute ischemic stroke (AIS) are related to initial neurological severity (NS). Therefore, neuroprotective drugs against ischemic injury are promising. Not only statins but also eicosapentaenoic acid (EPA) have neuroprotective effects.Hypothesis:Highly purified EPA (hp-EPA) pre-stroke may reduce NS at the onset of AIS.Methods:We retrospectively included patients with AIS and hyperlipidemia admitted to our institution between July 2012 and March 2019 from the prospectively and consecutively enrolled institutional stroke registry database. Hyperlipidemia was defined as serum values of low-density lipoprotein cholesterol (LDL-C) at arrival ≥140 mg/dl or triglycerides ≥150 mg/dl. We excluded patients: (1) admitted to our institution 24 h after AIS onset, (2) who did not stay in the hospital, and (3) in whom dyslipidemia drugs pre-stroke except the hp-EPA were administered. We collected data on age; sex; pre-stroke statin use, antiplatelets, anticoagulants, antihypertensives, and antidiabetic drugs; serum albumin, glucose, glycated hemoglobin (HbA1c), cholesterol, triglycerides, and c-reactive protein levels; pre-stroke modified Rankin scale and the National Institutes of Health Stroke Scale (NIHSS) scores; stroke subtypes at admission; hospitalizations; and home discharge. We performed a multivariable linear regression analysis to identify significant variables of NIHSS scores at arrival.Results:Of the 2,199 patients with AIS and hyperlipidemia during the study period, 691 met our inclusion and exclusion criteria, their median age was 75 years, and 18 (2.6%) received pre-stroke hp-EPA. In patients with and without pre-stroke EPA use, the median NIHSS scores were one and three, respectively. Multivariable regression analysis showed that the glucose, mRS, age, LDL-C, and anticoagulants increased the NIHSS score, albumin, HbA1c, high-density lipoprotein cholesterol, antihypertensives, antidiabetic drugs, and hp-EPA use decreased the NIHSS score.ConclusionPre-stroke hp-EPA use reduced NS at the AIS onset in patients with hyperlipidemia and without other dyslipidemia drugs.

Introduction:Statins have protective effects against ischemic injury, and pre-stroke statin use augments cerebral blood flow, reduces infarct size, and improves neurological function in mice.Hypothesis:Pre-stroke statin is associated with mild neurological symptoms at the onset of acute ischemic stroke (AIS).Methods:We retrospectively included patients with AIS admitted to our institution within 24 hours of onset between April 2011 and March 2019. We collected data on age, sex, pre-stroke use of stains, antiplatelets, anticoagulants, antihypertensive drugs, and diabetes drugs, the National Institutes of Health Stroke Scale (NIHSS) score, serum levels of albumin, glucose, glycated hemoglobin, lipids, and c-reactive protein, and stroke subtypes at admission. In addition, we defined mild neurological symptoms (mNS) as the NIHSS score of three or less. We compared variables between patients with and without pre-stroke statins and identified variables with significant differences between them. We conducted a logistic regression analysis using variables for pre-stroke statin use except for the NIHSS score, mNS, lipids, or stroke subtypes, calculated propensity scores for a pre-stroke statin and implemented a one-to-one propensity score matching (PSM). We evaluated differences between matched pairs and whether pre-stroke statin was significant for mNS at admission. We used the McNemar test to evaluate symmetry on a binary matched pairs contingency table of mNS.Results:Two thousand six hundred fifteen patients met our inclusion criteria during the study period. In 594 patients (22.7%) with pre-stroke statins and 2021 patients without them, 308 (51.9%) and 895 (44.3%) patients presented mNS (p=0.0012). After one-to-one PSM, 555 patients underwent pre-stroke statin treatment, and 555 patients did not undergo it. There were no differences in variables between matched pairs except for the NIHSS score, mNS, or cholesterol levels; 286 patients with pre-stroke stains and 252 patients without them presented mNS at admission (p=0.0411), and the binary matched pairs contingency table of mNS was not symmetrical (p=0.0385).Conclusions:Pre-stroke statin use is associated with mNS at the onset of AIS.

Background Transbrachial approach is an alternative technique for coil embolization of posterior circulation aneurysms. The purpose of our study was to investigate the anatomical features of the vertebral artery (VA) for transbrachial direct VA cannulation of a guiding catheter (GC) to perform coil embolization of posterior circulation aneurysms.Methods Included in retrospective analysis were patients who underwent transbrachial coil embolization of cerebral aneurysms in the posterior cerebral circulation by direct VA cannulation of a GC from 2007 to 2013. Investigated were patient characteristics, preoperative sizes of aneurysms, aneurysms location, the angle formed by the target VA and the subclavian artery (AVS), and the VA diameter at the level of the fourth cervical vertebral body (VAD) in the side of the transbrachial access route.Results Thirty-one patients with 32 aneurysms met our criteria. The locations of aneurysms were the VA (n= 16), basilar artery (BA) tip (n= 10), BA trunk (n= 3), BA superior cerebellar artery (n= 1), BA anterior inferior cerebellar artery (n= 1), and VA posterior inferior cerebellar artery (n= 1). The right brachial artery was punctured in 27 cases with 28 aneurysms as transbrachial direct cannulation of a GC, and left was in 4 cases with 4 aneurysms. The average AVS, ranging from 45° to 95°, was 77°, and the average VAD, ranging from 3.18 to 4.45 mm, was 3.97 mm.Conclusion For transbrachial direct cannulation of a GC, it seems required that the AVS is about 45° or more and the VAD is about 3.18 mm or more.

BackgroundThe transfemoral approach has been a common technique for carotid artery stenting (CAS). When aortic or peripheral arterial conditions limit the transfemoral approach, the transbrachial approach may be used as an alternative. The purpose of our study was to report initial experiences of CAS with a novel sheath guide specifically designed for transbrachial carotid cannulation.MethodsPatients who underwent transbrachial CAS with a novel sheath guide between May 2011 and July 2012 were analyzed. The sheath guide has an internal diameter of 6 Fr (2.24 mm, 0.088 inch) and is 90 cm long with a soft distal part and a particular distal shape like a modified Simmons catheter.ResultsSixty-two patients underwent transbrachial CAS with the sheath guide. Transbrachial carotid cannulation was easy and successful and CAS procedures were performed easily through the sheath guide in every case. No sheath-related periprocedural complications occurred.ConclusionsThe sheath guide specifically designed for transbrachial carotid cannulation is useful for transbrachial CAS.

Introduction:Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission of acute stroke, IPC of the legs with DVT may cause migration of the thrombi resulting in pulmonary emboli. Therefore, whole-leg ultrasonography to detect DVT should be performed at admission; however, it is not always done in many institutions. Therefore, risk factors to estimate DVT presence at admission are necessary.Hypothesis:The frequency of DVT at admission is high, and IPC should not be used in patients with significant factors of DVT presence at admission.Methods:We included patients admitted within 24 h of stroke onset between 2016 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers. We evaluated variables with significant differences between groups of DVT presence and absence, excluded variables with multicollinearity, and conducted multiple logistic regression analyses to identify independent discriminants of DVT presence from absence. The threshold values of discriminants were identified by receiver operating characteristic curves.Results:Of 1936 stroke patients, 1461 met our inclusion criteria. DVT was detected in 255 patients (17.5%). Compared to patients without DVT (n=1206), patients with DVT were older, female sex, lower body weight, higher C-reactive protein levels, lower albumin or triglyceride levels, higher National Institutes of Health Stroke Scale score, and higher pre-stroke modified Rankin stroke scale score. Female sex, low albumin, high C-reactive protein, low triglycerides, and old age were independent DVT-presence discriminants. The threshold values of albumin, C-reactive protein, triglycerides, and age were ≤ 37g/L, ≥ 3450 ug/L, ≤ 1.569 mmol/L, and ≥ 79 years, respectively.Conclusion:The DVT-presence frequency of 17.5% at admission was high, and significant DVT-presence factors at admission were female sex, low albumin, high C-reactive protein, low triglyceride levels, and old age. Therefore, in patients with the five significant factors, IPC should be avoided, or whole-leg ultrasonography should be performed before IPC.

Introduction:Hyperglycemia must be improved in acute stroke patients. However, effective treatment has not been established.Hypothesis:Moderate-carbohydrate (carbo) diet and sodium-glucose cotransporter 2 (SGLT2) inhibitors can lower blood glucose level (BGL) safely and soon in patients with oral ingestion and normal renal function.Methods:For the retrospective observational study, we included patients who 1) were admitted within 24 h of stroke onset between Jan 2011 and March 2019, 2) had not undergone insulin therapy, 3) presented hemoglobin A1c ≥ 6.5%, BGL ≥ 11.1 mmol/L, and estimated glomerular filtration rate ≥ 60 mL/min/1.73m2 at admission, 4) took diet and drugs orally during hospitalization, and 5) underwent blood examination on the 6th day. We classified patients into three groups: 60% carbo diet without SGLT2 (C60 group); 40% carbo diet without SGLT2 (C40 group); 40% carbo diet with SGLT2 (C40-SGLT2 group). We calculated daily carbo intake and evaluated sulfonylurea (SU) use during hospitalization, median BGL and median HL at admission and on the 6th day in three groups.Results:Of 5724 stroke patients, 84 patients met our inclusion criteria. There were 26 patients in the C60 group, 22 in the C40 group, and 36 in the C40-SGLT2 group. In three groups, median age was 70, 62, and 68 years, respectively, median body mass index was 24.1, 25.1, and 24.3 kg/m2, respectively, median daily carbo intake was 195, 140, and 140 g (p< 0.0001), respectively, 46%, 9%, and 0% of patients used SU (p< 0.0001), respectively, median BGL at admission were 14.2, 14.6, and 14.4 mmol/L, respectively, median HL at admission were 42.4, 44.1, and 43.3%, respectively, median BGL on the 6th day were 7.9, 8.2, and 6.4 mmol/L (p= 0.0003), respectively, and median HL on the 6th day were 40.5, 41.7, and 40.5%, respectively. BGL on the 6th day was decreased in three groups, and it was the most improved in the C40-SGLT2 group. BGL on the 6th day was not different between C60 and C40 groups; however, SU was seldom used in the C40 group. No dehydration occurred.Conclusion:SU was seldom necessary for the C40 group and unnecessary for the C40-SGLT2 group. SGLT2 inhibitors coupled with 40% carbo-diet lowered BGL safely and soon in patients with oral ingestion and normal renal function.

Purpose: To report a case of successful stenting after a subacute stroke.Case Report: A 75-year-old man presented with sudden onset of right-sided weakness and difficulty speaking. Imaging revealed an occlusion of the left petrous to lacerum internal carotid artery (ICA) segment and slightly decreased cerebral blood flow in the left hemisphere; there were stenoses of the ostial and cavernous ICA segments on the right. On the seventh day after the stroke, he underwent protected carotid angioplasty of the left intracranial ICA occlusion to reduce the high risk of ischemic stroke owing to bilateral disease. An external arteriovenous shunt was established with an occluding balloon in the proximal ICA and a filter in the femoral vein. After protected balloon dilation of the ICA occlusion, a 3.5times18-mm balloon-expandable coronary stent was deployed across the residual stenotic segment. An intraluminal filling defect of the petrous ICA segment suggested an arterial dissection or intraluminal thrombus, so another 2 coronary stents were deployed. Macroscopically visible materials were captured in the filter. The patient had a good clinical course and was discharged without neurological deficits on the twelfth day after the stroke. Angiography at 3 months confirmed no restenosis of the stented vessel.Conclusion: This experience suggests that short atherothrombotic intracranial ICA occlusions can be opened in the subacute stroke stage without distal migration of thrombi under proximal protection and flow reversal.

Background:We quantified the expression of various growth-related factors in an adrenocorticotropic hormone (ACTH)-secreting adenoma that had recurred very rapidly as invasive macroadenoma. Methods/Results:A 43-year-old woman underwent successful transsphenoidal surgery for Cushing’s disease. Seven years later, she was admitted to our ward for further endocrine examinations. In spite of a very high plasma ACTH level, the serum cortisol level was normal. Discrepancies between ACTH and cortisol levels were detected on the basis of diurnal rhythms, dexamethasone suppression tests, and corticotropin-releasing hormone test. The patient showed no clinical features of Cushing’s disease. Magnetic resonance imaging of the pituitary showed an almost empty sella, and no microadenoma was found. These results, along with those of Sephadex column gel filtration and high-performance liquid chromatography of plasma-immunoreactive ACTH, suggested that the patient’s residual corticotrophs secreted biologically inactive ACTH. Two years later, the patient suddenly developed diplopia and right abducens nerve palsy. She was slightly moonfaced and centrally obese. Her plasma ACTH and serum and urinary free cortisol levels were elevated, although discrepancies between ACTH and cortisol still existed. Magnetic resonance imaging revealed a large pituitary mass with suprasellar and cavernous sinus extensions. The tumor was excised, and the proopiomelanocortin gene and the expression of growth-related factors were analyzed. No mutations were found in the ACTH-coding region of the proopiomelanocortin gene. A significant expression of insulin-like growth factor II and proliferating cell nuclear antigen mRNAs was demonstrated. A high MIB-1 antibody labeling index was also detected in the adenoma tissue, suggesting high Ki-67 expression. Conclusion:These growth- and proliferation-related factors might be involved in the rapid growth and aggressiveness of this patient’s pituitary adenoma.

Introduction:Intermittent pneumatic compression (IPC) is used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if existing DVT is not examined during admission, IPC massage of the legs with DVT may cause migration of the thrombi.Hypothesis:The frequency of DVT at acute stroke admission is high and significant factors indicate the presence of DVT at acute stroke admission.Methods:We included patients admitted within 24 hours of stroke onset, between 2017 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers such as D-dimer and lipids.Results:Of 1129 stroke patients, 907 met our inclusion criteria. DVT was detected in 159 patients (17.5%). Compared to patients without DVT (n=748), patients with DVT were older, females, with lower body weight, higher D-dimer and C-reactive protein levels, lower albumin or triglyceride (TG) levels, and higher National Institutes of Health Stroke Scale score. Multiple logistic regression analysis showed that sex, D-dimer, and TG were independent DVT-presence variables.Conclusions:DVT occurred in 17.5% of acute stroke patients at admission, and significant DVT-presence factors were female sex, high D-dimer level, and low TG level. Patients with the three significant factors at admission must immediately undergo whole-leg ultrasonography to detect DVT.

Purpose: To report an important complication related to carotid stenting.Methods and Results: A 71-year-old man with symptomatic subtotal occlusion of the left internal carotid artery had a 30-mm lesion treated percutaneously with implantation of 2 stents. Although the procedure was completed satisfactorily, left intraventricular hemorrhage occurred 4 hours later, possibly related to hyperperfusion injury. The patient expired 30 days after the stent procedure. Preoperative single-photon emission computed tomography revealed severely reduced vasoreactivity in the affected territory after acetazolamide challenge.Conclusions: The risk of hyperperfusion injury must be considered and minimized in patients with significant restriction of regional vasoreactivity. We recommend that cerebral hemodynamic status be determined prior to carotid stenting.

The effects of substance P on cultured rabbit osteoclasts were investigated. The intracellular Ca2+concentration ([Ca2+]i) which was monitored by the microfluorometric technique using fura-2, in osteoclasts elevated by the addition of substance P (0.3–5 μM). The EC50value of substance P was about 200 nM. This substance P-evoked [Ca2+]ielevation was not observed in the Ca2+-free medium. Simultaneous application of spantide, a substance P receptor antagonist, blocked the Ca2+response. The addition of substance P (0.1–10 μM) to cultured osteoclasts enhanced their bone resorption activity which was evaluated by the pit formation assay. Maximum enhancement of the pit formation by substance P (5 μM) peaked at about 170% of the control level. The addition of substance P receptor antagonists also inhibited the enhancement of the bone resorption by substance P addition. Substance P possibly stimulates the bone remodeling by osteoclasts via the [Ca2+]ielevation.

Abstract: Pineal parenchymal cell tumors (PPCTs) with or without metastasis into the lumbar region by way of the cerebrospinal fluid were treated successfully with combination chemotherapy using cisplatin, vinblastin, and bleomycin (PVB) or cisplatin and vinblastin (PV) and low-dose irradiation (25∼30 Gy). Our series included a case of pineoblastoma, two cases of mixed pinocytoma/pineoblastoma, and a case of pineocytoma, compared to which the data held by the All Japan Brain Tumor Registry (AJBTR) included information on 47 cases pineocytoma and 20 of pineoblastoma. All our patients have survived, with scores of 90% or over on Karnofsky's performance scale, for 2–12 years of follow-up so far; however, the 5-year survival rates of the patients recorded by AJBTR were 83% for pineocytoma treated with radiation and 43% without radiation; and 42% for pineoblastoma treated with radiation and 50% without radiation. Incomplete or varied chemotherapeutic regimens used in different medical centers to treat PPCTs precluded an evaluation such as was made by AJBTR. Our results suggested that combination chemotherapy with low-dose back-up radiotherapy may be the treatment of choice for primary or recurrent disease with or without dissemination in PPCTs.

Introduction:Intracranial hemorrhage occasionally occurs after carotid revascularization in presents with hemodynamic insufficiency. Positron emission tomography is unavailable in most facilities, and a feasible index is required to identify high-risk patients. Reduced signal intensity (SI) of the middle cerebral artery (MCA) on magnetic resonance angiography (MRA) is associated with postoperative hyperperfusion.Hypothesis:Reduced signal intensity (SI) of the MCA on MRA is associated with decreased regional cerebral blood flow (rCBF) on single-photon emission CT (SPECT) and increased blood-sampling whole-brain oxygen extraction fraction (wb-OEF).Methods:We included patients who: 1) were admitted from 2015 to 2019 for carotid artery stenting (CAS), 2) MRA, and SPECT before CAS, and 3) examined the wb-OEF immediately before CAS. We measured bilateral MCA SI on MRA and defined the MCA relative SI as (SI in the affected MCA)/ (SI in the contralateral MCA). We defined the rCBF% as rCBF in the affected MCA territory against the ipsilateral cerebellum. Before CAS, we sampled blood, measured the arterial oxygen and the venous oxygen content in the dominant-sided jugular vein, and calculated the wb-OEF. We evaluated the correlation between the MCA relative SI, the MCA slow flow, the rCBF%, and the wb-OEF. We estimated the upper limits of the MCA relative SI for the rCBF% < 80% or wb-OEF ≥ 0.40 using the area under the curve (AUC) values derived from the receiver operating characteristic (ROC) curves.Results:During the study period, 150 patients met our inclusion criteria. The MCA relative SI was positively correlated with rCBF% and negatively with the wb-OEF. The ROC curve for the rCBF% < 80% showed that the upper limit of the relative SI was 0.77 (the sensitivity of 53.9%, the specificity of 83.9%, AUC of 0.723). The ROC curve for the wb-OEF ≥ 0.40 showed that the upper limit of the relative SI was 0.95 (the sensitivity of 67.7%, the specificity of 55.2%, AUC of 0.625).Conclusion:Reduced MCA SI on MRA ≤ 0.77 is a practical and feasible index of hemodynamic insufficiency, indicating the decreased rCBF and increased wb-OEF.

Background:Compositions of serum fatty acids (s-FAs), such as palmitic acid (PA), oleic acid (OlA), linoleic acid (LiA) and docosahexaenoic acid (DHA), and their correlation with serum lipids (s-LPs), such as total cholesterol (T-CHO) and triglycerides (TG), have been reported in healthy young or middle subjects. However, little is known about s-FAs features in acute ischemic stroke (AIS) patients.Hypothesis:Serum FAs features in AIS elderly patients are different from those in healthy young subjects and concentrations of s-FAs provide different correlation with s-LPs from compositions.Methods:We conducted a cross-sectional study of patients aged 50 years or older who were admitted to our institution between August 2016 and July 2019 within 24 hours of first AIS onset. We evaluated concentrations and compositions of s-FAs and their association with s-LPs, age and ischemic stroke subtype.Results:Three hundred sixty-six patients met our inclusive criteria. Their average age was 74.7 years, median T-CHO and TG were 203.5 and 102 mg/dl, respectively and median concentrations of PA, OlA, LiA and DHA were 642.5, 566.0, 723.0 and 129.8 μg/ml, respectively, and their median or mean compositions were 23.6, 20.9, 26.5 and 4.7 %, respectively. Concentrations of s-FAs had positive correlation with s-LPs. Concentrations of s-LPs and most of s-FAs had negative correlation with age. In stroke subtype of large-artery atherosclerosis or small-vessel occlusion (LAA_SVO) and in stroke subtype of cardioembolism or others (CE_O), mean age was 72.6 and 76.4 years (p<0.001), median TCHO was 214 and 194 mg/dl (p<0.0001), median TG was 113 and 95 mg/dl (p<0.05), median PA was 678.8 and 611.2 μg/ml (p<0.0001), median OlA was 613.8 and 532.4 μg/ml (p<0.001), median LiA was 767.2 and 696.1 μg/ml (p<0.001), and mean DHA was 131.4 and 127.9 μg/ml (ns). Compositions of PA, OlA, LiA and DHA had no correlation with T-CHO and compositions of PA and OlA had positive correlation with TG, whereas compositions of LiA and DHA had negative correlation with TG. Compositions of OlA had negative correlation with age, whereas DHA composition had positive correlation with age. There was little difference of compositions between stroke subtypes.Conclusions:In first AIS elderly patients, concentrations of most of s-FAs had positive correlation with s-LPs. In LAA_SVO, patients were younger and their concentrations of s-LPs and most of s-FAs were larger than in CE_O. On the other hand, correlation of s-FAs compositions with s-LPs was not constant and there was little difference of compositions between ischemic stroke subtypes.

Introduction:Non-alcoholic fatty liver disease (NAFLD) is reported to be a predictor of cardiovascular disease (CD). NAFLD is probably associated with stroke in middle and old-aged patients.Hypothesis:In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission is high and its metabolic factors are body mass index (BMI), triglycerides (TG), some fatty acids, blood sugar or HbA1c and aspartate aminotransferase / alanine aminotransferase ratio (AST/ALT ratio) as well as reported in ischemic heart disease.Methods:We included acute stroke patients aged 40-79 years who 1) were admitted from August 2016 to July 2019 within 24 hours of onset, 2) underwent abdominal ultrasonography and 3) took blood examination of serum fatty acids on admission. We evaluated prevalence and associated metabolic factors of non-alcoholic fatty liver disease.Results:Among 1672 acute stroke patients, 676 patients met our inclusive criteria. Their median age was 70 years, 267 patients (39.5%) had NAFLD. In NAFLD and non-NAFLD patients, median age was 68 and 71 years (p<0.0001), BMI was 24.8 and 21.6 kg/m2(p<0.0001), Alb was 4.2 and 4.0 g/dl (p<0.0001), HbA1c was 6.0 and 5.8 % (p<0.0001), T-CHO was 206 and 198 mg/dl (p<0.05), TG was 135 and 93 mg/dl (p<0.0001), palmitic acid (PA) was 727 and 627.4 μg/ml (p<0.0001), oleic acid (OA) was 672.6 and 563.1 μg/ml (p<0.0001), linoleic acid (LiA) was 772.3 and 730.2 μg/ml (p<0.05), dihomo-gamma-linolenic acid (DGLA) was 34.1 and 26.5 μg/ml (p<0.0001) and AST/ALT ratio was 1.09 and 1.36 (p<0.0001), respectively.Conclusions:In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission was high and metabolic factors of NAFLD were younger Age, higher BMI, higher serum concentrations of Alb, T-CHO, TG and fatty acids, higher HbA1c and lower AST/ALT ratio.

Introduction:Non-alcoholic fatty liver disease (NAFLD) is reported to be a predictor of cardiovascular disease (CD). However, prevalence and associated metabolic factors of NAFLD in acute stroke middle and old-aged patients remain unknown.Hypothesis:In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission is high and its metabolic factors are body mass index (BMI), triglycerides (TG), some fatty acids, blood sugar or HbA1c and aspartate aminotransferase / alanine aminotransferase ratio (AST/ALT ratio) as well as reported in ischemic heart disease.Methods:We included acute stroke patients who 1) were admitted from August 2016 to July 2017 and aged 40-79 years, 2) underwent abdominal ultrasonography and 3) took blood examination of serum fatty acids on admission. We evaluated prevalence and associated metabolic factors of non-alcoholic fatty liver disease.Results:Among 582 acute stroke patients, 273 patients met our inclusive criteria. Their median age was 70 years, 108 patients (39.6%) had NAFLD. In NAFLD and non-NAFLD patients, median age was 68 and 71 years (p<0.05), BMI was 24.8 and 21.9 kg/m2(p<0.0001), Alb was 4.2 and 4.0 g/dl (p<0.01), HbA1c was 7.0 and 6.1 % (p<0.05), T-CHO was 214.7 and 197.7 mg/dl (p<0.01), TG was 181.8 and 115.0 mg/dl (p<0.0001), palmitic acid (PA) was 826.6 and 680.3 ?g/ml (p<0.0001), oleic acid (OA) was 802.9 and 632.2 ?g/ml (p<0.0001), linoleic acid (LiA) was 854.7 and 781.8 ?g/ml (p<0.05), dihomo-gamma-linolenic acid (DGLA) was 35.8 and 28.5 ?g/ml (p<0.0001) and AST/ALT ratio was 1.05 and 1.38 (p<0.0001), respectively. Multiple stepwise regression analysis showed that BMI, DGLA and AST/ALT ratio were independent factors of NAFLD. Receiver operating characteristic (ROC) curves for NAFLD showed that cut-off values of BMI, DGLA and AST/ALT ratio were 22.2 or more, 30.1 or more and 1.29 or less, respectively.Conclusions:In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission was high and independent metabolic factors of NAFLD were higher BMI, higher DGLA (20:3, n-6) and lower AST/ALT ratio.

We report the case of a patient with distal migration of a floating carotid thrombus caused by oral contraceptives.