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Background: Patient selection for endovascular revascularization treatment (ERT) in acute ischemic stroke depends on the expected benefit-risk ratio. As rapid revascularization is a major determinant of good functional outcome, we aimed to identify its predictors after ERT.Methods: Consecutive stroke patients from a single stroke center with distal internal carotid artery-, proximal middle cerebral artery- or T-occlusions treated with ERT were retrospectively selected. We assessed admission noncontrast computed tomography and computed tomography angiography for thrombus location, thrombus load (clot burden score), and collateral status. Clinical data were extracted from medical charts. Univariate and multivariate regression analyses were performed to identify predictors of revascularization (thrombolysis in cerebral infarction ≥2b) after ERT.Results: A total of 63 patients were identified (median age, 73 years; interquartile range: 62-77; 40 females). Sixteen patients (25.4%) underwent intravenous thrombolysis (ivT) before ERT. Twenty-two patients (34.9%) had additional intra-arterial application of recombinant tissue plasminogen activator. The overall recanalization rate was 66.7%, and 9.5% had symptomatic intracranial bleeding. In-hospital mortality was 15%, and 30% reached good functional outcome at discharge. In the univariate analysis, preceding ivT and the number of passes for thrombectomy (dichotomized ≤2 versus >2) were associated with recanalization. There was a trend for number of thrombectomy passes (as continuous variable) and multimodal ERT. In the multivariate regression analysis, ivT prior to ERT and passes of thrombectomy were identified as independent predictors for recanalization.Conclusion: ivT and lower passes of thrombectomy are associated with recanalization after ERT for ischemic stroke with proximal vessel occlusions. [ABSTRACT FROM AUTHOR]

Background: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) has been proposed as a straightforward alternative to the less reliable visual estimation of tissue at risk. We evaluated the association between admission ASPECTS on computed tomography perfusion (CTP) parameter maps and final infarct ASPECTS in patients with acute ischemic stroke who were treated by endovascular therapy (eT) and compared the results with thrombolysis candidates treated conservatively.Methods: eT was performed in 26 consecutive ischemic stroke patients within 6 hours of symptom onset. The control group was matched for age and admission National Institutes of Health Stroke Scale having the same admission imaging protocol and a transcranial Doppler sonography within 24 hours. ASPECTS determined from CTP maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and time to peak (TTP) were compared with final infarct ASPECTS on day 5 noncontrast CT.Results: Recanalization rate was 73% in treatment and 50% in control group. ASPECTS for all CTP parameters were significantly lower than ASPECTS-CT in both groups (P < .005). In the treatment group, this applied to patients with successful recanalization. Only controls without recanalization showed a strong correlation between ASPECTS-CTP parameters and ASPECTS-CT (CBV: P = .005; CBF and TTP: P = .028). Patients with early recanalization (≤4 hours) had greater differences between ASPECTS-CTP and ASPECTS-CT than patients with late recanalization (>4 hours; CBF: P = .056; CBV: P = .095; TTP: P = .048).Conclusions: The initial ASPECTS-CTP lesion was significantly larger than the final infarct determined by ASPECTS in case of recanalization. Initial perfusion lesion, including CBV, is reversible in case of reperfusion, especially in early reperfusion. [ABSTRACT FROM AUTHOR]

Clinical and neuroimaging data indicate a cerebellar contribution to emotional processing, which may account for affective-behavioral disturbances in patients with cerebellar lesions. We studied the neurophysiology of cerebellar involvement in recognition of emotional facial expression. Participants comprised eight patients with discrete ischemic cerebellar lesions and eight control patients without any cerebrovascular stroke. Event-related potentials (ERP) were used to measure responses to faces from the Karolinska Directed Emotional Faces Database (KDEF), interspersed in a stream of images with salient contents. Images of faces augmented N170 in both groups, but increased late positive potential (LPP) only in control patients without brain lesions. Dipole anaylsis revealed altered activation patterns for negative emotions in patients with cerebellar lesions, including activation of the left inferior prefrontal area to images of faces showing fear, contralateral to controls. Correlation analysis indicated that lesions of cerebellar area Crus I contribute to ERP deviations. Overall, our results implicate the cerebellum in integrating emotional information at different higher order stages, suggesting distinct cerebellar contributions to the proposed large-scale cerebral network of emotional face recognition. [ABSTRACT FROM AUTHOR]

Abstract: Multiple sclerosis (MS) is associated with the occurrence of white matter plaques in the central nervous system. These are frequently located in areas interconnecting areas associated with the processing of emotions. Although recent behavioral studies indicated social and affective disturbances in many of these patients, functional studies investigating specific emotional recognition in MS are lacking. We used functional magnetic resonance imaging (fMRI) and lesion mapping in MS-patients to investigate correlates between these measures and emotional facial recognition. Eleven patients whose affective ability was impaired were compared with eleven unimpaired MS-patients and eleven healthy controls (HCs) using a facial expression matching task. Decreased recognition performance was limited to the detection of unpleasant facial expressions (sad, fearful, angry). In evaluating the functional activation maps for the unpleasant facial expressions, we found decreased insular and ventrolateral prefrontal cortex (VLPFC) activation in the impaired group versus the unimpaired groups. We found a close relationship between the inability of solving the task and decreased activation of the left VLPFC and the left anterior insula. In addition, we found a correlation between decreased performance accuracy and the presence of lesions in the left temporal white matter. These data suggest that emotion recognition deficits in MS-patients might be due to the interruption of processing emotionally relevant information, which leads to decreased activation of the VLPFC and the insula. [Copyright &y& Elsevier]

Abstract: In aged humans, stroke is a major cause of disability for which no neuroprotective measures are available. A viable alternative to conventional drug-based neuroprotective therapies is brain/body cooling, or hypothermia. In animal studies of focal ischemia, short-term hypothermia consistently reduces infarct size. Nevertheless, efficient neuroprotection requires long-term, regulated lowering of whole body temperature. Focal cerebral ischemia was produced by reversible occlusion of the right middle cerebral artery in 17-month-old male Sprague–Dawley rats. After stroke, the aged rats were exposed for 2 days to a mixture of air and a mild inhibitor of oxidative phosphorylation, hydrogen sulfide (H2S), which resulted in sustained, deep hypothermia (30.8±0.7°C). Long-term hypothermia led to a 50% reduction in infarct size with a concomitant reduction in the number of phagocytic cells. At the transcription level, hypothermia caused a reduction in the mRNA coding for caspase 12, NF-kappa B and grp78 in the peri-infarcted region, suggesting an overall decrease in the transcriptional activity related to inflammation and apoptosis. Behaviorally, hypothermia was associated with better performance on tests that require complex sensorimotor skills, in the absence of obvious neurological deficits or physiological side effects, in aged rats. Conclusions: Prolonged, H2S-induced hypothermia is a simple and efficacious method to limit the damage inflicted by stroke in aged rats. [Copyright &y& Elsevier]

Abstract: Objectives: An association of sleep with cardiovascular disease has been suggested. We analyzed the association of sleep duration with carotid intima-media thickness (IMT) as measure of generalized atherosclerosis. Methods: IMT of the common carotid arteries was measured in 2437 participants of the Study of Health in Pomerania (SHIP). Participants indicated their daily sleep duration as sum of night and afternoon sleep. Results: There was a J-shaped association of sleep duration (5 to 11/12h) with IMT. In this association, IMT values were lowest among subjects with an average sleep duration of 7–8h (0.76±0.15 and 0.79±0.16mm, respectively) but increased with shorter and, still more so, with longer sleep duration. Subjects with only 5h sleep showed age- and sex-adjusted differences of 0.042mm IMT (95% confidence interval 0.008–0.076 versus 8h sleep). IMT values were still greater among subjects with 11–12h sleep (adjusted differences versus 8h sleep 0.084mm [0.040–0.128] IMT). Further adjustment for lifestyle indicators, socioeconomic determinants, and biological variables attenuated these differences, but they remained significant. Conclusions: Both longer and shorter sleep duration is associated with an increased risk of atherosclerosis. These findings support the hypothesis that sleep is related to cardiovascular disease. [Copyright &y& Elsevier]

We sought to investigate the potential benefit in examining extracranial vertebral arteries (ExVA) with an echo contrast agent. A total of 26 patients with insufficiently assessable ExVA underwent extracranial duplex sonography without and with an echo contrast medium. All examinations were recorded and analysed independently by two experienced sonographers. Interrater agreement was fair in assessment of B-mode quality, colour-coding, blooming artefacts, change of vmax, good to very good in all other rated categories. Using an echo contrast medium reduced overall inassessable ExVA by 48% and 36% according to the two raters, respectively. After contrast enhancement, diagnosis was clarified in ExVA formerly inassessable for hypoplasia in 60% vs. 56%, extracranial occlusion in 67% vs. 56% and resistance signal in 63% vs. 45%, respectively. Application of an echo contrast agent leads to clarification of ExVA sonographic diagnosis in approximately one third of poorly examinable patients (35% and 30%, respectively), and contributes in ruling out extracranial occlusion, hypoplasia and resistance signal. (E-mail: akhaw@neuro.columbia.edu) [Copyright &y& Elsevier]