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Objectives: Many factors affect the results of acute recanalization treatment and prognosis of ischemic stroke patients. Some markers which has a role in inflammation process cause atherosclerosis that leads to ischemic stroke. We aimed to evaluate the relationship between admission laboratory findings and prognosis in patients to whom acute recanalization therapy were applied. Methods: In our study, we evaluated 139 acute stroke patients to whom acute recanalization therapies had been applied. Demographic data, glomerular filtration rate, uric acid, albumin, lipid profile, C-reactive protein, fibrinogen values were evaluated. Admission and discharge National Institutes of Health Stroke Scale and modified Rankin Scale scores were recorded. The effect of laboratory parameters on prognosis was examined. P

BACKGROUND To see the relationship of early admission parameters with the type of stroke and/or with the 30-days mortality from this disease. METHODS Stroke patients at their early hyperacute phase (n = 180) were enrolled in this study (156 ischemic strokes and 24 hemorrhagic strokes). Blood levels of C-reactive protein (CRP), testosterone, and estradiol were determined at admission, before any specific intervention. Patients' clinical data, including the above-mentioned laboratory parameters, were compared between the above two stroke types (in total and between sexes). RESULTS The mean age of the patients was 69.55 ± 12.03 years old (69.92 ± 11.94 years old in ischemic stroke and 67.12 ± 12.54 years old in hemorrhagic stroke). Serum estradiol levels of both males of ischemic stroke and females of hemorrhagic stroke patients were significantly higher than the females of the ischemic stroke. Serum CRP levels of both females and males of the hemorrhagic group were higher than their peers of the opposite group. Early admission serum CRP level ≥ 0.74 mg/dL in males helped predict hemorrhagic stroke while a serum estradiol level ≥ 14.07 ng/mL helped predict the same type of stroke in females. CONCLUSIONS Our study results show that simple early laboratory measures (such as CRP and estradiol) may help in the early phase management of stroke. Further studies are needed to confirm our findings.

A 51-year-old male presented with dysarthria and weakness on his left side. In his history, he had an operation due to aortic coarctation 13 years ago, and 5 years ago, he had a transient ischemic attack along with difficulty in speaking. During his neurological examination, he was conscious, cooperative, and oriented. Mild dysarthria and left hemiparesis were seen (4/5, 4/5). He smoked at least one cigarette packet per day for 30 years. Vascularization was performed only by narrowed right vertebral artery on cranial and cervical magnetic resonance angiography. He had a mild increase in his left hemiparesis during his stay in the hospital (2/5, 4/5). A stent had been inserted into his right vertebral artery during digital subtraction angiography. In his last neurological examination, he was conscious, cooperative, and oriented. We started prasugrel (10 mg/day) and acetylsalicylic acid (300 mg/day) for his mild dysarthria and mild hemiparesis. In this case, we explain that although there was three-vessel occlusion and narrowing in the right vertebral artery, the patient’s neurologic status was not too bad due to collateral circulation around the cerebral arteries. This showed us the importance of collateral circulation between cerebral arteries.

A 70-year-old man was admitted to our hospital with acute stroke. He had a history of hypertension with trandolapril-verapamil 4/240 mg per day therapy. He had confusion and right-sided hemiplegia. Diffusion magnetic resonance imaging revealed an ischemic lesion on the left middle cerebral artery territory. After receiving intravenous (iv) recombinant tissue plasminogen activator (r-tPA) infusion, he developed tongue swelling. With standard anti anaphylactic medication tongue swelling disappeared. Termination of iv r-tPA may not be required in some tongue swelling cases. Timing of angioedema, circumstances under which iv r-tPA is administered and the severity of relevant respiratory problems may be helpful in the decision of termination or continuation of iv r-tPA administration.

Background Intravenous tissue plasminogen activator (IV tPA) was shown to be an effective treatment for acute ischemic stroke (AIS). According to stroke guidelines, there is no need to wait for the complete blood count (CBC) and coagulation test results before application of IV alteplase if there is no suspected coagulation disorder. In this study, a patient with AIS and thrombotic thrombocytopenic purpura (TTP) symptoms during thrombolytic treatment was presented. Case A 33-year-old male patient was admitted at the 2.5th hour of AIS symptoms onset with right hemiparesis and sensorimotor aphasia. Cranial computed tomography (CT) and diffusion magnetic resonance imaging did not reveal any abnormality. In his medical history, the patient did not have any contraindication for thrombolytic treatment. To avoid delays to thrombolytic therapy, blood samples were taken, and after that, IV bolus alteplase treatment was applied. During maintenance treatment, agitation and vomiting developed. The result of blood samples showed less than 26,000 mm3 platelet count and maintenance therapy was stopped. In control cranial CT, there was no hemorrhage. In the laboratory examination; anemia, low platelet count; increased indirect bilirubin, lactate dehydrogenase (LDH) levels were found, and fever was 38.4°C. Schistocytes were observed in peripheral blood smear and the patient was diagnosed as TTP. Conclusions Stroke guidelines recommend not to wait for the results of CBC and coagulation tests before IV tPA treatment in patients who do not have any history of coagulopathy disorder. If possible, before applying IV tPA we may wait for the results of coagulation and CBC tests, keeping in mind the diseaes with high mortality such as TTP.