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Objective To explore the grading of acute gastrointestinal injury (AGI) events in patients with different severities of acute ischemic stroke (AIS) and correlation of short-term prognosis. Methods AIS patients admitted from the Advanced Stroke Center of the Eighth Clinical Medical College of Guangzhou University of Chinese Medicine from January 2023 to November 2023 were retrospectively selected, and depending on the degree of nerve function defect (NIHSS) scores. AIS patients were divided into two groups: NIHSS ≤ 14 group and NIHSS > 14 group.The National Institute of Health Stroke Scale (NIHSS) score, general baseline data, clinical test indicators, AGI event classification and short-term prognosis were collected at admission. Results A total of 270 patients were included, with an average age of (64.95 ± 13.65) years, 70.0% males and 30.0% females. The proportion of AIS patients with AGI incident accounted for 66.30%. AIS patients after AGI incidents, 90 days after the onset of the modified Rankin rating scale (mRS) score > 2 points of 83 people, accounting for 30.7%；The poor clinical outcomes of 270 AIS patients with different AGI event grades were significantly different (P < 0.05), among which AGI grade 0 and AGI grade Ⅰ were significantly different from AGI grade Ⅲ and AGI grade Ⅳ, respectively. The incidence of poor prognosis of AGI grade Ⅲ and AGI grade Ⅳ is significantly higher than that of AGI grade 0 and AGI grade Ⅰ. In AIS patients with NIHSS > 14 group, there were significant differences in the adverse clinical outcomes between AGI grade 0, AGI gradeⅠ and AGI grade Ⅲ (P < 0.05), and the incidence of poor prognosis of AGI grade Ⅲ was significantly higher than that of AGI grade 0 and AGI grade Ⅰ. Multivariate Logistic regression analysis showed that NIHSS score was an independent risk factor for AGI events in AIS patients (P < 0.05). The higher the NIHSS score, the higher the risk of AGI events in AIS patients. And age, NIHSS score, systolic blood pressure is 90 days after AGI events affect AIS patients independent risk factors of poor prognosis (P < 0.05), the higher the age, the greater the NIHSS score, the higher systolic blood pressure of patients with AIS 90 days after AGI events are at higher risk of poor prognosis. Conclusion AGI event grading in patients with AIS of different severity is associated with short-term prognosis. [ABSTRACT FROM AUTHOR]

Background: Platelets play a major role in inflammation, thrombosis and atherogenesis. Platelet size and function is measured by Mean platelet volume (MPV). Platelet activity is accentuated in acute ischemic stroke due to blood vessel occlusion that leads to ischemia, endothelial damage. MPV has been identified as independent predictor of stroke in high-risk individuals and in carotid atherosclerosis. Platelet indices panel is readily available in hemogram and can be used with cost effectiveness. In South Asian population very few studies are available on this association. Present study conducted to study association between MPV and acute ischemic stroke and its correlation with clinical severity and carotid artery disease. Materials and Methods: This case control study was done in department of neurology of NRI Medical college. 150 cases of acute ischemic stroke patients and age and sex matched controls were considered. Patients on antiplatelet drugs were excluded from study. CT/MRI brain imaging done. Modified Rankin score(MRS) and NIHSS score were noted during admission. Carotid artery Doppler study was used to measure the carotid intima media thickness(IMT) and percentage of stenosis. Results: MPV was significantly higher in acute ischemic stroke patients (12.8 +/- 1.2) compared to controls (9.29+/-0.7). Platelet count was 1.93 in cases and 1.84 in controls. MPV was significantly higher in patients with high MRS scores. MPV in small infarct group is 10.47+/-0.9 and in large infarct group is 12.79+/-1.47. MPV in normal IMT(<1mm) group is 10.31+/-1.06 and in IMT >1mm with mild stenosis group is 11.32+/-1.36 and in moderate to severe stenosis group is 12.8+/-1.2. Conclusion: MPV and platelet count was higher in patients with acute ischemic stroke and it correlates with clinical severity. In this study there is significant association between mean platelet volume and carotid intima media thickness. [ABSTRACT FROM AUTHOR]

Background: Serum Fibrinogen levels may be elevated in patients with acute Ischemic stroke and correlating with severity of the disease using NIHSS score is useful. Objective. To categorize the severity of ischemic stroke cases clinically, on admission by NIHSS score and to quantitatively assess serum fibrinogen levels and to correlate with clinical severity Methods: 118 patients presenting with acute ischemic stroke in Medicine department, KIMS hospital meeting inclusion criteria were considered for the study. Written and informed consent was obtained from the patients. The patient's clinical severity was assessed based on the NIHSS score, following which the patients venous blood is collected and tested for serum Fibrinogen levels and other appropriate investigations were performed and were correlated with clinical severity. Result: In our study of 118 patients, 14% were in mild category followed by 40%, 20% and 28% in mild to moderate, severe and very severe categories based on NIHSS score. The mean serum fibrinogen level in our study is 558.2 mg/dl with SD of 218.2, and the mean serum fibrinogen was highest in very severe category (819.4+105.5 mg/dl) and lowest in mild category (259.2+ 69.6 mg/dl) the difference in mean across the four categories was statistically significant (P < 0.001). The mean serum fibrinogen was highest in age group more than 75 years, there was no statistical significance of fibrinogen levels between males and females. Our study showed that there is a positive correlation between smoking, tobacco use and increase in serum fibrinogen levels. Conclusion: Serum fibrinogen levels were higher in patients with acute ischemic stroke. Among the patients with acute ischemic stroke, higher serum fibrinogen levels correlates with Clinical severity assessed by The National Institute of Health Stroke Scale. There is a positive correlation between serum fibrinogen levels with hypertension, smoking and tobacco use. Serum Fibrinogen levels can be used as predictor for severity of Acute Ischemic Stroke. Serum Fibrinogen levels can also be used to predict the prognosis in Acute Ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of National Institutes of Health Stroke Scale (NIHSS) score, serum brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) in post-stroke depression (PSD). Methods A total of 180 patients with stroke were selected and divided into the PSD group (n=80, HAMD≥8 points) and the non-PSD (NPSD) group (n=100, HAMD＜8 points), according to HAMD score at 3 months after stroke. The basic information, NIHSS score, serum BDNF and IL-6 were compared between the two groups. The influencing factors of PSD were analyzed by Logistic regression method. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of NIHSS score, serum BDNF and IL-6 for PSD. Results Compared with the NPSD grope, low density lipoprotein cholesterol (LDL-C) and serum BDNF level were significantly lower, NIHSS score and serum IL-6 level were significantly increased in the PSD group (P＜0.05). Results of Logistic regression analysis showed that increased NIHSS score and serum IL-6 were risk factors for PSD, and increased serum BDNF was the protective factor in patents with PSD (P＜0.05). The area under curve (AUC) of NIHSS score, serum BDNF and IL-6 and their combination prediction of PSD were 0.762, 0.746, 0.796 and 0.839, respectively. The sensitivity of the combined prediction was 86.0% and a specificity was 95.0%. Conclusion Compared with NPSD patients, the NIHSS score and serum IL-6 level are increased, and the serum BDNF level is decreased in patients with PSD. The combination of all three has a high predictive value for patients of PSD. [ABSTRACT FROM AUTHOR]

The interrelation between acute ischemic stroke, persistent disability, and uncertain prognosis underscores the need for improved methods to predict clinical outcomes. Traditional approaches have largely focused on analysis of clinical metrics, lesion characteristics, and network connectivity, using techniques such as resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI). However, these methods are not routinely used in acute stroke diagnostics. This study introduces an innovative approach that not only considers the lesion size in relation to the National Institutes of Health Stroke Scale (NIHSS score), but also evaluates the impact of disrupted fibers and their connections to cortical regions by introducing a disconnection value. By identifying fibers traversing the lesion and estimating their number within predefined regions of interest (ROIs) using a normative connectome atlas, our method bypasses the need for individual DTI scans. In our analysis of MRI data (T1 and T2) from 51 patients with acute or subacute subcortical stroke presenting with motor or sensory deficits, we used simple linear regression to assess the explanatory power of lesion size and disconnection value on NIHSS score. Subsequent hierarchical multiple linear regression analysis determined the incremental value of disconnection metrics over lesion size alone in relation to NIHSS score. Our results showed that models incorporating the disconnection value accounted for more variance than those based solely on lesion size (lesion size explained 44% variance, disconnection value 60%). Furthermore, hierarchical regression revealed a significant improvement (p < 0.001) in model fit when adding the disconnection value, confirming its critical role in stroke assessment. Our approach, which integrates a normative connectome to quantify disconnections to cortical regions, provides a significant improvement in assessing the current state of stroke impact compared to traditional measures that focus on lesion size. This is achieved by taking into account the lesion's location and the connectivity of the affected white matter tracts, providing a more comprehensive assessment of stroke severity as reflected in the NIHSS score. Future research should extend the validation of this approach to larger and more diverse populations, with a focus on refining its applicability to clinical assessment and long-term outcome prediction. [ABSTRACT FROM AUTHOR]

Objective To investigate the evolving patterns of relationship between NIHSS scores at different onset times in acute ischemic stroke through network analysis. Methods Data on NIHSS scores from 833 patients with acute ischemic stroke were collected. Network analysis methods were used to compare the between NIHSS scores within 72 hours of onset and on day 7. Resailts In the network analysis of NIHSS scores within 72 hours and on day 7 of onset in patients with acute ischemic stroke, the strongest node strength was observed in upper limb movement (Strength=1.48) and level of cognition (Strength二 1.75). The strongest edge weight was both in upper limb movement-lower limb movement (edge weight strength of 0.63 and 0.69). The top three nodes were upper limb movement, lower limb movement, and level of cognition. The network stability for the two time points were 0.75 and 0.67, and there was no significant difference between the two network models (P=0.38). Conclusion Motor function and level of cognition are important factors for the early course of acute ischemic stroke patients, and their correlation and prediction have high consistency in the acute period. [ABSTRACT FROM AUTHOR]

Objective: To investigate risk factors affecting short-term functional prognosis after discharge in patients with acute cerebral infarction and explore the correlation between relevant factors and National Institutes of Health Stroke Scale (NIHSS) scores. Methods: A retrospective analysis of 4,048 patients with acute cerebral infarction hospitalised between January 2014 and November 2018 in Department of Neurology, Renqiu Kangji Xintu Hospital, Hebei were conducted. The enrolled patients, including 2,506 men and 1,542 women, were divided into mild (n=3,696), moderate (n=278) and severe groups (n=74) based on NIHSS score. Baseline data (gender, history of hypertension, diabetes, hyperlipidaemia, drinking, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein (a), urea nitrogen, creatinine) were compared among the three groups, and the relationship between relevant factors and NIHSS scores was studied. Results: Through single factor regression analysis, it was found that age, history of stroke, atrial fibrillation, coronary heart disease, antiplatelet medication usage, systolic blood pressure and uric acid were risk factors for the moderate group. Multivariate logistic regression analysis showed that, after adjusting for confounding factors, age, history of stroke and systolic blood pressure (P<0.01) were independent risk factors for the moderate group. Age (OR=1.089;, history of stroke, atrial fibrillation, diastolic blood pressure, fasting plasma glucose and uric acid (P<0.05) were independent risk factors for the severe group. Conclusion: Age, history of stroke, atrial fibrillation, systolic and diastolic blood pressure, fasting plasma glucose and uric acid levels are independent risk factors affecting the short-term post-discharge functional prognosis of patients with acute cerebral infarction and are related to the NIHSS scores of these patients after discharge. [ABSTRACT FROM AUTHOR]

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Background This study was conducted to determine optimal predictive ability of National Institutes of Health Stroke Scale (NIHSS) measurements at baseline, 24 hours, and change from baseline to 24 hours after thrombolysis on functional recovery in patients with acute ischemic stroke who participated in the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods and Results ENCHANTED was an international, multicenter, 2×2 quasifactorial, prospective, randomized open trial of low‐dose versus standard‐dose intravenous alteplase and intensive versus guideline‐recommended blood pressure lowering in thrombolysis‐eligible patients with acute ischemic stroke. Absolute (baseline minus 24 hours) and percentage (absolute change/baseline × 100) changes in NIHSS scores were calculated. Receiver operating characteristic curve analyses assessed performance of different NIHSS measurements on 90‐day favorable functional recovery (modified Rankin Scale [mRS] score 0–2) and excellent functional recovery (mRS score 0–1). Youden index was used to identify optimal predictor cutoff points. A total of 4410 patients in the ENCHANTED trial were enrolled. The 24‐hour NIHSS score had the highest discriminative ability for predicting favorable 90‐day functional recovery (mRS score 0–2; area under the curve 0.866 versus 0.755, 0.689, 0.764; P

The interrelation between acute ischemic stroke, persistent disability, and uncertain prognosis underscores the need for improved methods to predict clinical outcomes. Traditional approaches have largely focused on analysis of clinical metrics, lesion characteristics, and network connectivity, using techniques such as resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI). However, these methods are not routinely used in acute stroke diagnostics. This study introduces an innovative approach that not only considers the lesion size in relation to the National Institutes of Health Stroke Scale (NIHSS score), but also evaluates the impact of disrupted fibers and their connections to cortical regions by introducing a disconnection value. By identifying fibers traversing the lesion and estimating their number within predefined regions of interest (ROIs) using a normative connectome atlas, our method bypasses the need for individual DTI scans. In our analysis of MRI data (T1 and T2) from 51 patients with acute or subacute subcortical stroke presenting with motor or sensory deficits, we used simple linear regression to assess the explanatory power of lesion size and disconnection value on NIHSS score. Subsequent hierarchical multiple linear regression analysis determined the incremental value of disconnection metrics over lesion size alone in relation to NIHSS score. Our results showed that models incorporating the disconnection value accounted for more variance than those based solely on lesion size (lesion size explained 44% variance, disconnection value 60%). Furthermore, hierarchical regression revealed a significant improvement (p < 0.001) in model fit when adding the disconnection value, confirming its critical role in stroke assessment. Our approach, which integrates a normative connectome to quantify disconnections to cortical regions, provides a significant improvement in assessing the current state of stroke impact compared to traditional measures that focus on lesion size. This is achieved by taking into account the lesion’s location and the connectivity of the affected white matter tracts, providing a more comprehensive assessment of stroke severity as reflected in the NIHSS score. Future research should extend the validation of this approach to larger and more diverse populations, with a focus on refining its applicability to clinical assessment and long-term outcome prediction.

The study was aimed to test the blood glucose level in acute stroke patients to find out any correlation with types and prognosis of different glycaemic groups.

AbstractObjectiveMethodsResultConclusionTo analyze the risk factors and characteristics of cognitive impairment in patients with cerebral infarction during the recovery period.This retrospective case-control study included 183 patients with cerebral infarction in the recovery period. According to the MMSE score, they were divided into a cognitive impairment group of 79 cases and a cognitive normal group of 104 cases. Collect clinical data from all patients, including age, gender, body mass index, laboratory test results, past medical history, National Institute of Health Stroke Scale (NIHSS) score, modified Barthel index, Oxfordshire Community Stroke Project (OCSP) classification, and number of infarcted lesions. Multiple logistic regression analysis was used to identify risk factors related to cognitive impairment in patients with cerebral infarction.There were significant differences (p < 0.05) between the cognitive impairment group and the cognitive normal group in terms of age, body mass index, low-density lipoprotein level, NIHSS score, modified Barthel index, and number of infarcted lesions. Multivariate logistic regression analysis showed that age ≥ 65 years, stroke, carotid artery plaques, NIHSS score ≥ 5, anterior circulation infarction type, and multiple infarcted lesions were important risk factors for cognitive impairment.Elderly age, presence of carotid artery plaques, high NIHSS score, multiple infarct lesions, and specific infarct types are important risk factors for cognitive dysfunction in patients during the recovery period of cerebral infarction. [ABSTRACT FROM AUTHOR]

Background and purpose: Significant differences in the outcomes observed in patients with acute ischemic stroke (AIS) have led to research investigations for identifying the predictors. In this retrospective study, we aimed to investigate the relationship of different clinical and imaging factors with the prognosis of AIS. Materials and methods: All clinical and imaging metrics were compared between the good and poor prognosis groups according to the modified Rankin Scale (mRS) score at 90 days after discharge. Clinical factors included gender, age, NIHSS scores at admission, and other medical history risk factors. Imaging markers included the lesion’s size and location, diffusion, and perfusion metrics of infarction core and peripheral regions, and the state of collateral circulation. Spearman’s correlations were analyzed for age and imaging markers between the different groups. The Chi-square test and Cramer’s V coefficient analysis were performed for gender, collateral circulation status, NIHSS score, and other stroke risk factors. Results: A total of 89 patients with AIS were divided into the good (mRS score ≤ 2) and poor prognosis groups (mRS score ≥ 3). There were differences in NIHSS score at the admission; relative MK (rMK), relative MD (rMD), relative CBF (rCBF) of the infarction core; relative mean transit time (rMTT), relative time to peak (rTTP), and relative CBF (rCBF) of peripheral regions; and collateral circulation status between the two groups (p < 0.05). Among them, the rMK of infarction lesions had the strongest correlation with the mRS score at 90 days after discharge (r = 0.545, p < 0.001). Conclusion: Perfusion and diffusion metrics could reflect the microstructure and blood flow characteristics of the lesion, which were the key factors for the salvage ability and prognosis of the infarction tissue. The characteristics of the infarction core and peripheral regions have different effects on the outcomes. Diffusion of infarction core has strong relations with the prognosis, whereas the time metrics (MTT, TTP) were more important for peripheral regions. MK had a more significant association with prognosis than MD. These factors were the primary markers influencing the prognosis of cerebral infarction patients. [ABSTRACT FROM AUTHOR]

Objective: We aimed to study the correlation between pregnancy-associated plasma protein-A (PAPP-A) and acute cerebral infarction (ACI). Methods: Patients who had the symptoms of paralysis, aphasia, or sudden neurological impairment from June 2020 to October 2021 were chosen. There were 159 patients diagnosed with ACI as the experimental group and 102 patients without ACI as the control group. We collected clinical data and observed whether they have a certain impact on plasma PAPP-A levels. The ACI group was divided into two groups: mild neurological deficit group (NIHSS score < 3) and moderate and severe neurological deficit group (NIHSS score> 3). The ACI group was divided into the atherosclerotic-type group and the arteriolar occlusion-type group according to the TOAST classification. The ACI group was divided into a good prognosis group (mRS≤2 points) and a poor prognosis group (mRS>2 points) using the Modified Rankin Scale (mRS) for 90 days of follow-up. Plasma PAPP-A levels were compared between those groups. Results: (1) The plasma PAPP-A level in patients with ACI (1.840 ± 0.281) was significantly higher than that in the control group (1.690 + 0.260). Smoking history, leukocyte count, cystatin C, homocysteine, and plasma PAPP-A levels were independently correlated with ACI. (2) The level of PAPP-A in patients with moderate and severe neurological impairment was lower than that in patients with mild neurological impairment. (3) The level of PAPP-A in patients in the arteriolar occlusion-type group was higher than that in patients in the atherosclerosis-type group. (4) The PAPP-A levels in the group with elevated low-density lipoprotein are higher than those in the group with normal low-density lipoprotein. (5) Plasma PAPP-A level was not correlated with infarction location, infarction volume, or prognosis at the 90-day follow-up. Conclusion: (1) The level of plasma PAPP-A could be the independent risk factor of ACI. It is positively correlated with triglyceride and cholesterol content. (2) PAPP-A level is positively correlated with low-density lipoprotein. (3) PAPP-A levels between different disease severities have a significant difference. (4) The level of plasma PAPP-A in the arteriolar occlusion-type group was higher than that in the atherosclerotic-type group. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of HALP+NIHSS score in predicting the prognosis of patients with large artery atherosclerosis (LAA) cerebral infarction. Methods A retrospective analysis was performed for the clinical data of 500 patients who were diagnosed with LAA cerebral infarction in our hospital from January 2020 to October 2021. On day 30 after di-sease onset, modified Rankin Scale (mRS) score was used to evaluate clinical outcome, and according to the mRS score, the patients were divided into good prognosis group (mRS score ≤2) and poor prognosis group (mRS score >2). Related clinical data were compared between the two groups. A logistic regression analysis was used to evaluate the influencing factors for poor prognosis in patients with LAA cerebral infarction, and the receiver operating characteristic (ROC) curve was plotted to analyze the value of NIHSS score, HALP score, and NIHSS+HALP score in predicting the prognosis of patients with LAA cerebral infarction. Results The multivariate logistic regression analysis showed that old age, hypertension, high NIHSS score, and increased low-density lipoprotein level were risk factors for poor prognosis in patients with LAA cerebral infarction (P

Abstract Background Stroke had been accounted to cause almost 50% of epilepsy in the elderly and may lead to poor functional outcomes. Many studies examining the risk factors have been conducted despite showing inconsistent results and currently still difficult to predict the occurrence of post-stroke epilepsy. The study aimed to determine risk factors related to post-stroke epilepsy that influence clinical seizure, electroencephalography (EEG), and functional outcome of patients. Analytic retrospective case–control study was conducted with a total sampling of 62 samples of post-stroke epilepsy and 62 samples of control from all stroke patients in the Neurology Clinic from January 2019 to December 2021. Epilepsy was classified according to the criteria of the International League Against Epilepsy (ILAE) in 2017. The relevant demographic and clinical data were collected. Result The study involved 62 patients in the case group (average age of onset = 57.69; 42 men, 20 women; 51 ischemic stroke, 11 hemorrhagic stroke) and 62 patients in the control group (average age of onset = 56.90; 24 men, 38 women; 52 ischemic stroke, 10 hemorrhagic stroke). We found that 31 patients had focal-to-bilateral seizures, 26 patients had generalized seizures and 5 patients had focal seizures. Men (p = 0.001; OR 3.325) and NIHSS Score (p = 0.027; OR 5.094) had significant correlations with post-stroke epilepsy. Ischemic stroke had a significant correlation (p = 0.008) with seizure onset. Women also had a significant correlation (p = 0.012) with EEG abnormalities. The study found that 59 of 62 post-stroke epilepsy patients had poor functional outcomes (mRS > 2). Conclusion Our study confirmed that most patients had focal-to-bilateral seizure patterns that occurred in 1–2 years after stroke, and had poor functional outcomes. Men had 3.325 times more likely to develop post-stroke epilepsy than women. Also, NIHSS score ≥ 15 correlated and 5.094 times more likely to develop post-stroke epilepsy. Ischemic stroke had a peak of epilepsy onset at 1–2 years after stroke and women had significant showing abnormalities on EEG recording than men.

Miaomiao Han,1,2 Bo Ma,3 Ruifang She,4 Yan Xing,5 Xiaohong Li1 1Department of Neurology, Jinan Central Hospital, Shandong University, Jinan City, People’s Republic of China; 2Encephalopathy Department, Zibo Hospital of Integrated Traditional Chinese and Western Medicine, Zibo City, People’s Republic of China; 3Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, People’s Republic of China; 4Department of Neurology, Tai’ an City Central Hospital, Tai’ an City, People’s Republic of China; 5Zibo Center for Disease Control and Prevention, Zibo City, People’s Republic of ChinaCorrespondence: Xiaohong Li, Department of Neurology, Jinan Central Hospital, Shandong University, No. 105, Jiefang Road, Jinan City, Shandong Province, 250013, People’s Republic of China, Tel + 86 13370582096, Email lxh5231@126.comPurpose: This retrospective observational study was conducted to determine the correlations between serum CXCL9/12 and the severity of acute ischemic stroke (AIS).Methods: Total 138 patients with AIS were enrolled in the study. These patients underwent Brain CT on admission and blood samples were collected. Serum CXCL9 and CXCL12 were detected by ELISA assay. The correlations of serum CXCL9/12 with AIS was analyzed based on Oxfordshire Community Stroke Project (OCSP) classification, Trial of Org 10,172 in acute stroke treatment (TOAST) classification, National Institutes of Health Stroke Score (NIHSS) score, infarct volume, and modified Rankin scale (mRS) score.Results: Compared with the controls, patients with AIS had higher levels of serum CXCL9 and CXCL12. Logistic regression analysis determined that CXCL9 and CXCL12 were independent risk factors for AIS. In addition, the increased serum CXCL9 and CXCL12 were associated with TOAST classification, NIHSS score, and infarct volume. However, serum CXCL9 and CXCL12 were not associated with functional outcomes (mRS score). CXCL9 and CXCL12 both exhibited a high diagnostic value in AIS.Conclusion: Serum CXCL9 and CXCL12 were elevated in patients with AIS, closely correlated with the severity of AIS.Keywords: acute ischemic stroke, CXCL9, CXCL12, stroke severity, NIHSS score

Objective·To examine the level change of serum renalase in the patients with acute ischemic stroke (AIS), and analyze its role in evaluating disease.Methods·A total of 118 AIS patients admitted to the Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2020 to November 2021 were enrolled in the case group (AIS group). The patients were assessed for neurological deficits according to the National Institutes of Health Stroke Scale (NIHSS), and were classified as mild and moderate-severe neurological deficits. Another 133 healthy people who participated in physical examination in the physical examination center of the hospital during the same period were selected as the control group. The serum renalase levels of the two groups were detected by ELISA. Spearman's rank correlation analysis was used to evaluate the correlation between the levels of serum renalase and gender, age, fasting blood glucose, blood lipids and NIHSS scores in the patient with AIS. The predictive value of renalase expression level in AIS diagnosis was analyzed by receiver operator characteristic (ROC) curve. The factors that were statistically significant in the results of the univariate Logistic regression analysis were included in the multivariate Logistic regression model.Results·The level of serum renalase in the AIS group was 2 960.01 (1 557.99, 4 053.70) pg/mL, which was higher than 821.02 (391.29, 1 752.70) pg/mL in the control group, with a statistically significant difference (P=0.000). Spearman's rank correlation analysis showed that the levels of serum renalase in the patients with AIS were negatively correlated with the NIHSS scores (r=-0.216, P=0.019), positively correlated with the serum fasting glucose (r=0.200, P=0.030), and not significantly correlated with gender, age, low-density lipoprotein levels, total cholesterol levels, and the presence of hypertension, diabetes, or coronary heart disease. Serum renalase levels were higher in the AIS with mild neurological deficit patients than those in the moderate-severe deficit patients, and the difference was statistically significant (P=0.034). The ROC curve showed that the cut-off value of serum renalase level to diagnose AIS was 1 856.49 pg/mL, the area under the curve was 0.777±0.030 and its 95%CI was 0.718‒0.836 (P=0.000). Multivariate Logistic regression analysis showed that elevated serum renalase level [>1 856.49 pg/mL, odds ratio (OR)=6.980, P=0.000], hypertension (OR=5.382, P=0.000), and diabetes (OR=2.453, P=0.040) were risk factors for AIS.Conclusion·Serum renalase level is significantly elevated in AIS patients, and negatively correlated with NIHSS score. Serum renalase might be a potential biomarker for the auxiliary diagnosis and assessment of AIS, providing new ideas for the assessment of stroke disease progression and precise treatment.

Purpose : The aim of this study is to evaluate the safety and effectiveness of endovascular treatment (EVT) for acute ischemic stroke caused by large-vessel obstruction or stenosis (AIS-LVO/S) over 24 h after first AIS symptom recognition (FAISSR). Methods: A total of 33 AIS-LVO/S cases with EVT over 24 h after FAISSR during the period from January 2019 to February 2022 in our hospital were divided into the 90d mRS ≤ 2 group [favorable outcome (FO) group] and 90d mRS > 2 group [unfavorable outcome (UFO) group] and retrospectively analyzed. Results: The reperfusion was successfully established with EVT in 97% (32/33) of cases, and most (63.6%, 21/33) had 90d mRS ≤ 2 and only 36.4% (12/33) had 90d mRS > 2. Preoperative DWI-ASPECT and ASITN/SIR scores were significantly higher and NIHSS scores were significantly lower in the FO group than those in the UFO group (P < 0.05). In addition, the FAISSR to exacerbation time, FAISSR to groin puncture time, and FAISSR to reperfusion time were significantly longer, and the groin puncture to reperfusion time was significantly shorter in the FO group than those in the UFO group (P < 0.05), but there was no significant difference in the stroke exacerbation to groin puncture time (P > 0.05). The patients with cerebral infarction due to artery dissection had more favorable EVT outcomes, but the patients with posterior cerebral circulation infarction had very poor EVT outcomes. Conclusions: The FAISSR to groin puncture time over 24 h may not be a taboo for EVT and it may be safe and effective for AIS-LVO/S in anterior cerebral circulation, especially with lower preoperative NIHSS scores. [ABSTRACT FROM AUTHOR]

Background: Stroke vastly contributes to death and disability worldwide. Acute ischemic stroke (AIS) is caused by a reduction in supply of blood to the brain. Accumulation of unnecessary intracellular serum calcium in AIS induces the cytotoxic actions that activates enzymes involved in cell death. The present investigation assessed the relationship of total serum calcium level (at admission) and initial diffusion weighted imaging (DWI) infarct volume and correlated with National Institute of Health Stroke Scale (NIHSS) scores. Methods: A hospital-based observational study was conducted on 74 consecutive patients identified with AIS fulfilling the inclusion criteria. NIHSS scores and serum ionized calcium were calculated in every patient and compared with DWI infarct volume for assessing correlation between these three. Statistical software R Version 4.0.2 and Microsoft Excel were used for statistical analysis. Results: Out of the 74 patients, most of them were in age group of 50-69 years, with a male preponderance (68.9%). A significant association was noticed between diabetes and dyslipidemia with age (P=0.01499). A strong negative correlation was observed between NIHSS scores (at admission & discharge) with ionized calcium, while a strong positive correlation was noticed between stroke scores with infarct volume. A statistically significant negative correlation was recorded between serum calcium (on admission) and infarct size (r=-0.851755, P=0.0001). The mean of NIHSS scores on admission (8.24±5.19) has been remarkably higher when compared with NIHSS scores at discharge (5.25±3.89). Conclusion: In patients with AIS examined within 6-24 hours of symptoms onset, serum ionized calcium and volume of infarct on DWI showed inverse association. Serum calcium serves as a marker of severity and acts as prognostic factor in AIS.

Abstract In the present study, we explored multiple plasma factors to predict the outcomes of patients with AIS after IVT. Fifty AIS patients who received IVT with alteplase were recruited and divided into two groups according to their NIHSS scores. Serum from all subjects was collected to quantitatively analyze the levels of different plasma factors, IL-6, MMP-9, ADAMTS13, TNC, GSN and TRX, using Luminex assays or ELISA measurements. Compared with the levels assessed at the onset of AIS, the levels of MMP-9 (P 5 group at admission (P

Objective: The effect of vitamin D, which is a steroid hormone, on bone health has long been known. Vitamin D is also found to be associated with various diseases such as diabetes, hypertension, chronic kidney disease, coronary artery disease, and cancer. Neuroprotective effect of vitamin D makes it an important marker in clinical course of neurological diseases such as cognitive impairment, dementia and Alzheimer's disease. Vitamin D deficiency is also associated with increased risk of stroke. In this study, we aimed to show the effect of vitamin D levels on severity and prognosis of stroke. Materials and Methods: This was a prospective, observational study conducted in a tertiary medical center in Rohtak on 200 stroke patients admitted in Medicine ward. The National Institute of Health Stroke scale (NIHSS) and modified Rankin Scale were used to assess the severity of stroke at admission and functional outcome at 3 months, respectively. The patients were divided into 4 groups on the basis of vitamin D levels. Results: Vitamin D deficiency was associated with higher NIHSS score and independently associated with poor functional outcome. Patients with severe and mild vitamin D deficiency, and vitamin D insufficiency had 9, 6.7, and 3.9 times higher adjusted odds of poorer functional outcomes at 3 months in comparison to the patients with normal vitamin D levels (p

Background: Stroke had been accounted to cause almost 50% of epilepsy in the elderly and may lead to poor functional outcomes. Many studies examining the risk factors have been conducted despite showing inconsistent results and currently still difficult to predict the occurrence of post-stroke epilepsy. The study aimed to determine risk factors related to post-stroke epilepsy that influence clinical seizure, electroencephalography (EEG), and functional outcome of patients. Analytic retrospective case–control study was conducted with a total sampling of 62 samples of post-stroke epilepsy and 62 samples of control from all stroke patients in the Neurology Clinic from January 2019 to December 2021. Epilepsy was classified according to the criteria of the International League Against Epilepsy (ILAE) in 2017. The relevant demographic and clinical data were collected. Result: The study involved 62 patients in the case group (average age of onset = 57.69; 42 men, 20 women; 51 ischemic stroke, 11 hemorrhagic stroke) and 62 patients in the control group (average age of onset = 56.90; 24 men, 38 women; 52 ischemic stroke, 10 hemorrhagic stroke). We found that 31 patients had focal-to-bilateral seizures, 26 patients had generalized seizures and 5 patients had focal seizures. Men (p = 0.001; OR 3.325) and NIHSS Score (p = 0.027; OR 5.094) had significant correlations with post-stroke epilepsy. Ischemic stroke had a significant correlation (p = 0.008) with seizure onset. Women also had a significant correlation (p = 0.012) with EEG abnormalities. The study found that 59 of 62 post-stroke epilepsy patients had poor functional outcomes (mRS > 2). Conclusion: Our study confirmed that most patients had focal-to-bilateral seizure patterns that occurred in 1–2 years after stroke, and had poor functional outcomes. Men had 3.325 times more likely to develop post-stroke epilepsy than women. Also, NIHSS score ≥ 15 correlated and 5.094 times more likely to develop post-stroke epilepsy. Ischemic stroke had a peak of epilepsy onset at 1–2 years after stroke and women had significant showing abnormalities on EEG recording than men. [ABSTRACT FROM AUTHOR]

Objective To observe the short-term efficacy of domestic RECO stent used in endovascular treatment of acute posterior circulation infarction, and to analyze the factors affecting the prognosis of patients. Methods The clinical data of 148 patients with acute posterior circulatory infarction who used domestic RECO stents and Solitaire stents for endovascular treatment admitted to The First Department of Neurosurgery, Tieling Central Hospital from December 2018 to October 2020 were analyzed retrospectively. The recanalization of the blood vessels in patients with two different thrombectomy stents were observed, and the mRS score of patients after 3 months were counted. After 3 months, patients with mRS scores of 0-2 were classified as the good prognosis group, and patients with mRS scores of 3-6 were classified as the poor prognosis group. The general clinical data of the two groups of patients with good and poor prognosis using domestic RECO stents were compared. The relevant factors that may affect the prognosis of patients were analyzed. And the clinical effect of using other stents in the same period for emergency postertor-circulation embolectomy were compared. Results Among 98 patients with acute posteriorcirculatory infarction using domestic RECO embolization stent, 90 were recanalized and 8 were not recanalized. After 3 months, the mRS score showed good prognosis group was 60 cases, and poor prognosis group was 38 cases. There were 50 patients with acute posterior circulation infarction, 45 patients with recanalization, 5 patients without recanalization, 3 patients with postoperative death, 31 patients with good prognosis and 19 patients with poor prognosis after 3 months of mRS score. There was no significant difference in the short-term efficacy of domestic RECO stent used in the treatment of acute posterior circulation infarction compared with Solitaire stent (P ＞ 0. 05). After analyzing the related factors that may lead to poor prognosis of patients who use domestic RECO stents to remove thrombi,it is concluded that PC-ASPECTS score at admission,collateral compensation,NIHSS score at admission,time from onset to femoral artery puncture,times of thrombus removal,and whether diabetes are associated with the related factors that affect the prognosis of patients. Conclusions The domestic RECO stent used in the endovascular treatment of acute posterior circulation infarction has a significant short-term effect. The higher the patient's PC-ASPECTS score,the better the collateral compensation,the lower the NIHSS score at admission,and the shorter the time from onset to femoral artery puncture. The near-term prognosis is better. [ABSTRACT FROM AUTHOR]

Abstract Background and aim HCV infection is associated with increased risk of ischemic cerebral stroke. HCV stroked patients are younger with a lower burden of classical risk factors and higher levels of systemic inflammation. The present study aimed to discover the association between HCV infection functional outcome of stroke. Patients and methods The present prospective study included 60 patients with acute ischemic stroke. All patients were subjected to careful history taking and through clinical and neurological examination. Stroke severity at presentation was assessed using National Institute of Health Stroke Scale (NIHSS). Quantitative HCV RNA test was used to diagnose HCV infection. The prognosis of the studied patients was 3 months after treatment using modified Rankin scale (mRS) for neurologic disability. Results The present study was conducted on 60 patients with ischemic stroke. They comprised 13 patients (21.7%) with HCV and 47 patients without. Stroke patients with HCV had significantly higher frequency of carotid artery stenosis, higher NIHSS (17.9 ± 6.9 versus 9.9 ± 5.3, p

Introduction: Calcium plays an important role in the pathogenesis of ischemic cell damage. Intracellular calcium accumulation leads to neuronal damage by triggering the cycle of cytotoxic events. In this study, the association of serum calcium levels with clinical severity of ischemic stroke as defined by the National Institute of Health Stroke Scale (NIHSS) score was evaluated. Materials and Methods: After obtaining ethical approval from the institutional ethics committee, data was collected from 60 ischemic stroke patients, who were divided into two groups of 30 patients each: group 1 with serum ionized calcium less than 4.5 mg/dl and group 2 with serum ionized calcium levels more than 4.5 mg/dl. The stroke severity in the two groups was assessed using the NIHSS score. Results: The severity of ischemic stroke according to the NIHSS score was greater in patients with low serum ionized calcium levels compared to the severity of ischemic stroke in patients with normal serum ionized calcium levels. Conclusion: Serum ionized calcium certainly plays a role in the pathogenesis of ischemic stroke by influencing the cycle of cytotoxic events that result in ischemic cell death. This study showed that the severity of ischemic stroke was greater in patients with low serum ionized calcium levels compared to patients with normal serum ionized calcium levels.

Background: We aimed to evaluate the feasibility and performance of myocardial work echocardiography in assessing the severity of acute stroke and neurological deficits in patients with acute ischemic stroke. Methods: A total of 176 patients were examined by echocardiography within 24-48 hours of symptom onset with the measurement of global and regional myocardial work. The National Institutes of Health Stroke Scale score of each patient was documented. Results: With the increase of the National Institutes of Health Stroke Scale score, myocardial constructive work or positive work decreased (P < .05), while myocardial wasted work or negative work increased (P < .05). Except for global constructive work, global positive work, and global systolic constructive work, other myocardial work parameters all correlated with the National Institutes of Health Stroke Scale score (P < .05). Moreover, global wasted work, global negative work and global systolic wasted work had the strongest correlation with the National Institutes of Health Stroke Scale score (P < .001). Among these parameters, the ratio of global positive work/global negative work had the largest area (0.969, 0.938-1.001) under receiver operating characteristic curve in discriminating if the National Institutes of Health Stroke Scale score >15 or not. The optimal cutoff value was 3.89, with a sensitivity of 100%, a specificity of 93.0%, a positive predictive value of 84.9%, a negative predictive value of 100%, and an accuracy of 95.7%. Conclusion: Noninvasive myocardial work is highly competent in assessing the severity of acute stroke and neurological deficits, which can be used as a powerful supplement to the conventional scoring system. [ABSTRACT FROM AUTHOR]

Background: The majority of epidemiological studies have shown that vitamin D deficiency is a risk factor for arterial hypertension and cerebrovascular disease. Experimental studies support the notion that vitamin D exerts antihypertensive effects and has a beneficial impact on the overall cerebrovascular risk profile and on stroke outcome. OBJECTIVES:  To study the incidence of Vitamin-D deficiency in patients with cerebrovascular disease.  To study if Vitamin-D deficiency is an independent risk factor for ischemic stroke. Material & Methods: Study Design: Hospital based observational study. Study area: M V J Medical College and Research Hospital, Hosakote, Bengaluru. Study Period: August 2021 to Feb. 2022. Study population: Patients of ischaemic cerebrovascular stroke attending the OP/ER were included in the study. Sample size: Study consisted a total of 50 cases. The VIDAS® 25-OH Vitamin D Total Assay exhibits excellent analytical data which makes it suitable for use in a clinical setting. The Measuring range is broad (8.1-126 ng/mL) with excellent linearity. It has excellent correlation with Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS). It is the most relevant clinical indicator for the determination and monitoring of vitamin D nutritional status. Results: Correlation between NIHSS score and Vit-D was moderately negative (r=-0.697) and it was highly statistically significant. So, the NIHSS score and Vit-D levels were inversely related. Correlation between orpington score and Vit-D was moderately negative (r=-0.66) and it was highly statistically significant. So, the Orpington score and Vit-D levels were inversely related. CONCLUSION: In addition to the already known risk factors, Vit-D deficiency can be considered as a modifiable emerging risk factor for Cerebrovascular stroke, though further studies are required to prove this. Understanding is important because it may provide the rationale to use vitamin D supplementation to reduce stroke risk in some patients. [ABSTRACT FROM AUTHOR]

Aim: This study investigated demographic and clinical risk factors associated with severity in acute ischemic stroke (AIS) patients with a history of coronary artery disease (CAD). Materials & methods: Multivariate logistic regression models were used to determine specific factors associated with worsening or improving neurologic functions among AIS patients with CAD treated in the telestroke. Results: AIS patients with CAD, peripheral vascular disease (OR: 3.995; 95% CI: 1.035-15.413; p = 0.044) and hypertension (OR: 6.056; 95% CI: 1.207-30.374; p = 0.029) were associated with worsening neurologic functions. Conclusion: Our findings suggest the need to develop strategic management to improve the care of AIS patients with a history of CAD that present with hypertension and peripheral vascular disease in the telestroke network. [ABSTRACT FROM AUTHOR]

Objective To investigate the short-term poor prognosis and its influencing factors of patients with acute ischemic stroke, in order to provide reference for the formulation of measures to improve the prognosis. Methods The patients with acute ischemic stroke who were hospitalized in the hospital from December 2020 to March 2022 were selected, and they were divided into the good prognosis (≤2 points) group and the poor prognosis (≥3 points) group according to the prognosis situation (Modified Rankin Scale score on the 21st day of onset) . Then the clinical data of the two groups were compared, and the influencing factors of short-term prognosis of patients were analyzed by multivariate logistic regression analysis. Results A total of 61 patients were finally included, including 35 in the good prognosis group and 26 in the poor prognosis group. The univariate analysis showed that complications (P=0.029), high National Institutes of Health Stroke Scale (NIHSS) score at admission (P<0.001), high urea nitrogen (P=0.015), and high absolute value of neutrophil/lymphocyte (P=0.022) were the influencing factors for the short-term poor prognosis in patients with acute ischemic stroke. Multivariate logistic regression analysis showed that high NIHSS score at admission was an independent risk factor for short-term prognosis in patients with acute ischemic stroke (P=0.003). Conclusion A high NIHSS score at admission is a prognostic factor for short-term poor prognosis in patients with acute ischemic stroke, which should be paid more attention to. [ABSTRACT FROM AUTHOR]

The ability of the current grading systems to predict optimal outcomes in stroke patients with favourable collaterals remains unexplored. We evaluated differences in the performance of grading systems between Careggi Collateral Score and ASITN/SIR collateral score to predict clinical and radiological outcomes in stroke patients with favourable collaterals who underwent thrombectomy. We included stroke patients receiving thrombectomy within 360 min after symptom onset with MCA occlusion and favourable collaterals (i.e., without poor collaterals) defined by ASITN/SIR collateral score between 2 and 4. Using ordinal regression, we estimated the association of each CCS and ASITN/SIR grade with mRS shift (0–6) at 3 months, NIHSS score (0–42) and ASPECT score (10–0) at baseline, TICI score (3–0), infarct growth, cerebral bleeding, and cerebral edema grading at 24 h by calculating the odds ratios (ORs) with two-sided 95% confidence intervals after adjustment for predefined variables. Using the best collateral grade (CCS = 4) as reference, ORs of the CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (2.325 for CCS = 3; 5.092 for CCS = 2), in the direction of more severe baseline NIHSS score (5.434 for CCS = 3; 16.041 for CCS = 2), 24-h infarct growth (2.659 for CCS = 3; 8.288 for CCS = 4) and 24-h cerebral edema (1.057 for CCS = 3; 5.374 for CCS = 2) shift. ORs of the ASITN/SIR grades were associated in the direction of more severe baseline NIHSS score (4.332 for ASITN/SIR = 3; 16.960 for ASITN/SIR = 2) and 24-h infarct growth (2.138 for ASITN/SIR = 3; 7.490 for ASITN/SIR = 2) shift. The AUC ROC of CCS and ASITN/SIR for predicting 3-month mRS score 0–1 were 0.681 (95% CI: 0.562–0.799; p = 0.009) and 0.599 (95% CI: 0.466–0.73; p = 0.156), respectively. CCS = 4 and ASITN/SIR ≥ 3 were the optimal cut-offs to predict 3-month mRS score 0–1, respectively. CCS grading system performed better than the ASITN/SIR collateral score predicting 3-month mRS score and 24-h CED grading in stroke patients with favourable collaterals who received thrombectomy for MCA occlusion. [ABSTRACT FROM AUTHOR]

Background: Stroke vastly contributes to death and disability worldwide. Acute ischemic stroke (AIS) is caused by a reduction in supply of blood to the brain. Accumulation of unnecessary intracellular serum calcium in AIS induces the cytotoxic actions that activates enzymes involved in cell death. The present investigation assessed the relationship of total serum calcium level (at admission) and initial diffusion weighted imaging (DWI) infarct volume and correlated with National Institute of Health Stroke Scale (NIHSS) scores. Methods: A hospital-based observational study was conducted on 74 consecutive patients identified with AIS fulfilling the inclusion criteria. NIHSS scores and serum ionized calcium were calculated in every patient and compared with DWI infarct volume for assessing correlation between these three. Statistical software R Version 4.0.2 and Microsoft Excel were used for statistical analysis. Results: Out of the 74 patients, most of them were in age group of 50-69 years, with a male preponderance (68.9%). A significant association was noticed between diabetes and dyslipidemia with age (P=0.01499). A strong negative correlation was observed between NIHSS scores (at admission & discharge) with ionized calcium, while a strong positive correlation was noticed between stroke scores with infarct volume. A statistically significant negative correlation was recorded between serum calcium (on admission) and infarct size (r=-0.851755, P=0.0001). The mean of NIHSS scores on admission (8.24±5.19) has been remarkably higher when compared with NIHSS scores at discharge (5.25±3.89). Conclusion: In patients with AIS examined within 6-24 hours of symptoms onset, serum ionized calcium and volume of infarct on DWI showed inverse association. Serum calcium serves as a marker of severity and acts as prognostic factor in AIS. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Shenfu injection in treating patients with acute internal watershed cerebral infarction. Methods Totally 154 patients with AIWCI admitted to the Department of Encephalopathy of Dongzhimen Hospital from October 2018 to October 2020 were divided into the experimental group (n=96)and the control group(n=58). All cases received a comprehensive treatment including anti-platelet aggregation, lowering blood lipid, regulating blood pressure, replenishing blood volume, improving microcirculation and protecting brain cells. Patients in the experimental group were additionally given Shenfu injection for 14 days as a course of treatment. Before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) was used to score the neurological impairment, and transcranial doppler (TCD) was used to measure the blood flow velocity of the middle cerebral artery at the affected side. Results The blood flow velocity of middle cerebral artery in 2 groups was increased after treatment, and the experimental group had a better improvement in Peak systolic velocity (Vs) and end-diastolic flow velocity (Vd) compare with the control group(P

In this study, we investigated the metabolism of white matter by magnetic resonance spectroscopy (MRS) in stroke complicated with diabetes mellitus in combination with glycosylated hemoglobin (HbAlc) detection and clinical neurological deficit score (NIHSS). Fifty-three patients with stroke within 24 h after onset were collected and scanned by MRS. The biochemical, clinical and imaging characteristics of patients were analyzed. Patients were divided into three groups according to HbAlc levels: Good glycemic control (A): < 6.5%; satisfactory glycemic control (B): 6.5–7.5% and poor glycemic control (C): > 7.5%. The results showed that HbA1c levels were positively correlated with NIHSS in patients with acute ischemic stroke (AIS). There is significant difference in NAA/Cr between the infarcted site of the three groups and the mirror site. HbA1C level was negatively correlated with NAA/Cr in patients with AIS, and there was no significant correlation between NIHSS score and NAA/Cr. The data above demonstrated that the MRS imaging can be used to explain the adverse effects of hyperglycated hemoglobin on brain parenchyma from the perspective of imaging. This imaging technique and clinical NIHSS score have a high consistency in evaluating stroke.

In the present study, we explored multiple plasma factors to predict the outcomes of patients with AIS after IVT. Fifty AIS patients who received IVT with alteplase were recruited and divided into two groups according to their NIHSS scores. Serum from all subjects was collected to quantitatively analyze the levels of different plasma factors, IL-6, MMP-9, ADAMTS13, TNC, GSN and TRX, using Luminex assays or ELISA measurements. Compared with the levels assessed at the onset of AIS, the levels of MMP-9 (P < 0.001), ADAMTS13 (P < 0.001), and TRX (P < 0.001) significantly decreased after IVT. The level of IL-6 was significantly increased in the NIHSS > 5 group at admission (P < 0.001) compared to the NIHSS ≤ 5 group. AIS patients with a poor prognosis had lower levels of ADAMTS13 at 72 h post-IVT compared with patients with a good prognosis (P = 0.021). IL-6 also was notably higher in the poor outcome group (P = 0.012). After adjusting for confounders, ADAMTS13 at 72 h post-IVT was an independent protective factor for prognosis in AIS patients with an adjusted OR of 0.07 (P = 0.049), whereas IL-6 was an independent predictor of risk for AIS patients with an adjusted OR of 1.152 (P = 0.028). IVT decreased MMP-9, ADAMTS13, and TRX levels in the plasma of AIS patients. Patients with a NIHSS score of less than 5 exhibited lower IL-6 levels, indicating that increased levels of IL-6 correlated with AIS severity after IVT. Therefore, IL-6 and ADAMTS13 might be useful plasma markers to predict the prognosis in AIS patients at 90-days after IVT. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Neurology / Turk Noroloji Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Background: Stroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia. Methodology: A retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level = 75 nmol/L], insufficient [25(OH)D serum level is 50-75 nmol/L], and deficient [25(OH)D serum level = 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients' clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability. Results: The study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients' distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: 0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13-5.16), p = 0.023] when compared to participants with normal vitamin D level. Conclusion: Low vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings. [ABSTRACT FROM AUTHOR]

BackgroundStroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia.MethodologyA retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level ≥ 75 nmol/L], insufficient [25(OH)D serum level is 50–75 nmol/L], and deficient [25(OH)D serum level ≤ 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients’ clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability.ResultsThe study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients’ distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: −0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13–5.16), p = 0.023] when compared to participants with normal vitamin D level.ConclusionLow vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings.

BACKGROUND AND PURPOSE: The ability of the National Institutes of Health Stroke Scale (NIHSS) score to predict functional outcome in minor stroke is controversial. In this study, we examined the association of itemized NIHSS score with discharge outcome. METHODS: We included all patients with final diagnosis of stroke with an NIHSS score of 0 to 5 untreated with thrombolysis enrolled in the Stroke Warning Information and Faster Treatment trial. Individual components of the NIHSS score were the primary predictors. Poor outcome was defined as not being discharged home. Logistic regression was used to identify predictors of outcome. RESULTS: A total of 861 patients met the inclusion criteria; 162 (19%) were not discharged home. In multivariable regression, predictors of discharge other than home were age (odds ratio [OR] = 1.02 per year increase, P < .001) and total NIHSS score (OR per unit increase in the NIHSS = 1.51, P < .001). Motor (OR = 2.32, P < .001), level of consciousness (LOC; OR = 6.62, P = .004), and ataxia (OR = 3.10, P < .001) were also associated with not being discharged home. Motor (area under the curve [AUC] 0.623) appeared to be more predictive of poor outcome than ataxia (AUC 0.569) and LOC (AUC 0.517). The total NIHSS had a fair correlation with discharge outcome (AUC 0.683). CONCLUSION: Total and itemized NIHSS components have a fair correlation with outcome in minor stroke highlighting the importance of other measures of stroke severity for clinical trials.

Objective To analyze the prognostic factors of Trousseau syndrome with acute cerebral infarction using the least absolute shrinkage and selection operator (LASSO) regression. Methods A total of 49 Trousseau syndrome patients with acute cerebral infarction were selected in this study. Patients were divided into the good prognosis group (＜3 points, n= 17) and the poor prognosis group (≥3 points, n=32) according to the modified Rankin Scale (mRS) score 90 days after discharge. The general clinical data, imaging data on admission, laboratory examination results and prognosis were compared between the two groups. LASSO regression was used to screen variables related to prognosis, and the model was constructed. The predictive value of the model was evaluated by receiver operating characteristic (ROC) curve and H-L goodness of fit test. Results There were 39 cases of adenocarcinoma in pathological type in all of patients. Compared with the good prognosis group, there were higher National Institutes of Health Stroke Scale (NIHSS) score at admission, higher proportion of patients diagnosed with tumor less than 6 months after cerebral infarction, lower hemoglobin (Hb) level, and lower proportion of patients treated with monoclonal anticoagulation in the poor prognosis group (P＜0.05). LASSO regression analysis showed that Hb level and monoclonal anticoagulation therapy were positively correlated with prognosis, and NIHSS score at admission was inversely correlated with prognosis. The AUC of the LASSO regression model was 0.871 (95%CI: 0.766-0.976), sensitivity was 0.875 and the specificity was 0.706. H-L goodness of fit test P=0.978. Conclusion In Trousseau syndrome patients with acute cerebral infarction, Hb level and monoclonal anticoagulation therapy were positively correlated with prognosis, and NIHSS score at admission was inversely correlated with prognosis. [ABSTRACT FROM AUTHOR]

Abstract Background Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. In this study, clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy was investigated. Methods Retrospective data for baseline clinical and demographic data for patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center was analyzed. Improving (NIHSS score ≤ 7) or worsening (NIHSS score > 7) of neurologic functions were the determined measures of treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or improving neurologic functions. Results Adjusted multivariate analysis showed that in an AIS population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015–1.048, P

Background Stroke is a medical emergency that is risk-stratified using a national scoring system called the National Institute of Health Stroke Scale (NIHSS). The management of an acute stroke necessitates prompt management and swift decision-making. Human factors were identified in the literature as the main rate-limiting step to improving door-to-needle (DTN) time. We felt it would be prudent to design a local stroke course implemented at Great Western Hospital Swindon that incorporates both traditional and simulation-based elements to improve theoretical knowledge and emulate real-life scenarios. The objective of this course was to improve practical application in the efficient assessment and management of stroke patients, as this is critical to delivering timely treatment with thrombolysis or thrombectomy.  Methods Twenty-four medical professionals (medical students and resident doctors) participated in our course between November 2022 and July 2023. The domains assessed included understanding thrombolysis, understanding thrombectomy, confidence in performing NIHSS, and confidence in the assessment of stroke patients. The effectiveness of the stroke simulation course was assessed both quantitatively and qualitatively with pre- and post-course questionnaires. Results There was a significant improvement (p<0.05) in all four assessed domains. There was a significant increase (p=0.0003) in the mean difference of score 3.75 (95% CI: 2.43-5.07) in understanding thrombolysis. Similarly, understanding of thrombectomy was significantly improved (p=0.0002) with a mean difference in score of 3.4 (95% CI: 2.28-4.46). There was also a significant increase (p<0.0001) in confidence in completing NIHSS scoring by a mean of 4.33 (95% CI: 3.55-5.12). Lastly, there was a significant increase (p=0.0012) in the mean by 2.75 (95% CI: 1.51-3.99) in confidence in the assessment of stroke. Overall, 95.8% of the participants found the course at least good, if not very good or excellent, and 91.7% would recommend this course to others. Conclusion We found traditional and simulation-based training to be effective in improving understanding of thrombolysis, understanding of thrombectomy, confidence in NIHSS scoring, and confidence in the assessment of stroke patients. This study validates the effectiveness of our course in improving assessment and management in acute stroke patients. We infer that improvements in these domains coupled with simulation training focused on human factors (e.g., fatigue affecting decision-making or logistical issues such as delays in neuroimaging due to scanner availability) would achieve better DTN time in the participants of our course., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Swindon Academy Medical Ethics and Research (SAMER) committee issued approval TA0623. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ambulkar et al.)

Objective: We aimed to investigate the role of serum uric acid and lactate levels and mean platelet volume in predicting treatment success in patients with ischemic stroke. Methods: One hundred and five patients who were diagnosed with cerebrovascular disease and received thrombolytic or thrombectomy treatment were included in the study. Patients were divided into two groups as patients who developed complications and who did not develop complications. Demographical characteristics, laboratory findings, the National Institutes of Health Stroke Scale (NIHSS) scores at admission and at discharge, and Modified Rankin Scale (mRS) score were investigated retrospectively. Results: Of all patients, 58.1% of the were male. There were no differences in terms of laboratory parameters between the groups. NIHSS score at admission, NIHSS score at discharge, and mRS score were significantly higher in the group that developed complications after treatment (p<0.05). Laboratory values did not differ significantly between the groups. Early mortality rate in the group which developed complications was significantly higher than the group which did not develop complications (p<0.05). Univariate model revealed significant effectiveness of NIHSS score at admission and at discharge, and mRS score in the differentiation of patients with and without complications (p<0.05). In the multivariate model, a significant and independent effectiveness of the NIHSS score at discharge was observed in the differentiation of patients with and without complications (sensitivity =83.3%, positive prediction =30.8%, specificity =57.1% and negative prediction =93.8%; p<0.05). Conclusion: We found no significant associations between the development of complications after thrombolytic therapy and laboratory findings. The NIHSS score may be a suitable parameter in predicting complications. [ABSTRACT FROM AUTHOR]

Background: The goal of this study is to elucidate clinical characteristics in patients with acute ischemic stroke (AIS) that are associated with a potential improvement or worsening neurologic function who previously were taking an anti-hypertensive medication and then received recombinant tissue plasminogen activator (rtPA). Methods: The binary logistical regression model was developed to identify clinical determinants that are associated with an improving or worsening neurologic function in AIS patients taking an anti-HTN medication who received thrombolytic therapy. The area under the receiver operating curve was used to determine the sensitivity of the model. Results: In the adjusted analysis for AIS population on combined rtPA and an anti-HTN medication therapy, increasing age (Odd ratio; OR = 1.035, 95% CI, 1.022–1.049, P

Hemorrhagic transformation (HT) is a severe complication following acute ischemic stroke, particularly with reperfusion interventions, leading to poor prognosis. Serum occludin level is related with blood brain barrier disruption, and the National Institute of Health stroke scale (NIHSS) score reflects stroke severity. We investigated whether the two covariates are independently associated with HT and their combination can improve the accuracy of HT prediction in ischemic stroke patients with reperfusion therapy. Seventy-six patients were screened from the established database of acute ischemic stroke in our previous study, which contains all clinical information, including serum occludin levels, baseline NIHSS score, and hemorrhagic events. Multivariate logistic regression analysis showed that serum occludin level (OR = 4.969, 95% CI: 2.069–11.935, p < 0.001) and baseline NIHSS score (OR = 1.293, 95% CI 1.079–1.550, p = 0.005) were independent risk factors of HT after adjusting for potential confounders. Compared with non-HT patients, HT patients had higher baseline NIHSS score [12 (10.5–18.0) versus 6 (4–12), p = 0.003] and serum occludin level (5.47 ± 1.25 versus 3.81 ± 1.19, p < 0.001). Moreover, receiver operating characteristic curve based on leave-one-out cross-validation showed that the combination of serum occludin level and NIHSS score significantly improved the accuracy of predicting HT (0.919, 95% CI 0.857–0.982, p < 0.001). These findings suggest that the combination of two methods may provide a better tool for HT prediction in acute ischemic stroke patients with reperfusion therapy.

Background and Purpose: Acute ischemic stroke (AIS) is a serious threat to the life and health of middle-aged and elderly people. Mechanical thrombectomy offers the advantages of rapid recanalization, but the response of patients to this treatment varies greatly. This study investigated the risk factors for futile recanalization in AIS patients after thrombectomy through multivariate analyses.Methods: A retrospective study was conducted in AIS patients with anterior circulation occlusion from a derivation cohort and a validation cohort who underwent thrombectomy and reperfusion defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Using the modified Rankin Scale (mRS) at 90 days after the operation, the patients were divided into two groups, the meaningful recanalization group (mRS ≤ 2), and the futile recanalization group (mRS > 2). Multivariate logistic regression analyses were performed, and the receiver operating characteristic (ROC) curve was used to construct a risk prediction model for futile recanalization. The performance of prediction model was evaluated on the validation cohort.Results: A total of 140 patients in the derivation cohort were enrolled, 46 patients in the meaningful recanalization group and 94 patients in the futile recanalization group. The two groups were significantly different in age, preoperative National Institute of Health Stroke Scale (NIHSS) score, and collateral circulation ASITN/SIR grade (P < 0.05). In multivariate regression analyses, patients' age ≥ 71, NIHSS ≥ 12, and ASITN/SIR ≤ 3 were risk factors for futile recanalization. Hence, an ANA (Age-NIHSS-ASITN/SIR) score scale consisting of age, NIHSS score, and ASITN/SIR grade factors can effectively predict the risk for futile recanalization (area under curve 0.75, 95% CI 0.67–0.83, specificity 67.4%, and sensitivity 73.4%). The proportion of patients with futile recanalization in ANA groups 0, 1, 2, and 3 were 21.05, 56.76, 79.03, and 90.91%, respectively. Furthermore, ANA score scale had also a good performance for predicting futile recanalization on the validation cohort.Conclusions: Old age, high baseline NIHSS, and poor collateral circulation are risk factors for futile recanalization in AIS patients treated with thrombectomy. An ANA score that considers age, NIHSS, and collateral ASITN/SIR can effectively predict the risk for futile recanalization. Further studies with a larger sample size are needed to validate the prognostic value of this combined score for futile recanalization.