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Predictors of mortality in patients with craniocervical artery dissection
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Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
Abstract — WCN 2013 No: 463 Topic: 3 — Stroke Aetiopathogenesis of cerebral ischemia in young Turkish patients
Conclusion: Identifying predictors of mortality is important for starting appropriate treatment and setting targets in the management of patients with dissection.
C. Emira, S. Çelikb, C. Örkena, S. Çelika, F. Budaka. aHealth Ministry Okmeydani Training and Education Hospital, Istanbul, Turkey; bHealth Ministry Erenköy Training Hospital, Istanbul, Turkey
doi:10.1016/j.jns.2013.07.684
This study evaluates the risk factors and etiological spectrum in young stroke patients (aged 45 or younger). Methods: Risk factors and aetiology of cerebral ischemia were retrospectively investigated in 230 patients (age ranges 9–45), admitted to our Neurology Unit with cerebral transient ischemic attacks (TIA) or infarction. 230 consecutive patients were divided into two groups according to their ages. Group I consists of patients whose age ranges 9–30 and in Group II, age range was 30–45. Results: Hypertension, hyperlipidemia, smoking were the most common risk factors. Atherosclerosis was the leading etiology occurring in group II (35%) and vasculopathy was markedly high in group I (23%). In addition cardiac embolism was determined in 20% of all cases. Among these cases cardiac valve disease (58%), atrial fibrillation (16%) and ischemic heart disease (27%) were determined by the investigation methods. Conclusion: The most striking finding of our study was the high frequency of cardiac valve disease in young adult ischemic strokes in our country when compared with the previous reports in the literature.
doi:10.1016/j.jns.2013.07.683
Abstract — WCN 2013 No: 465 Topic: 3 — Stroke Predictors of mortality in patients with craniocervical artery dissection Y. Kaplana, H. Celika, O. Kamislia, S. Kamislia, S. Altınayara, S. Yologlub, C. Ozcana. aNeurology, Inonu University, Malatya, Turkey; bBiostatistics, Inonu University, Malatya, Turkey Background: Dissection of the carotid (CAD) or vertebral (VAD) artery is a major cause of ischemic stroke in young adults. The prognosis varies and the dissection can range from asymptomatic to causing a profound neurological deficit and death. Little is known of the predictors of mortality in these patients. Objectives: The aim of the study was to investigate the predictors related to mortality in patients with craniocervical artery dissection. Material and methods: We reviewed retrospectively all patients diagnosed with CAD or VAD admitted to our clinic between January 2000 and January 2013 and included 67 such patients in the study. Age, gender, modified Rankin Scale (mRS) prestroke and at time of admission, clinical presentation of dissection, location of dissection, vascular risk factors, and length of hospital stay were considered mortality-related prognostic factors. Of the 67 patients, 12 (17.9%) patients died: 5 (7.46%) patients with CAD and 7 (10.44%) with VAD. The patients were divided into four subgroups: surviving patients with CAD, dying patients with CAD, surviving patients with VAD, and dying patients with VAD. Then, surviving-CAD versus dying-CAD and surviving-VAD versus dying-VAD compared according to prognostic factors. Results: Disability at admission (mRS 3–5) was significantly higher in dying-CAD than surviving-CAD. Comparing dying-VAD with surviving-VAD, the mean age, disability at admission (mRS 3–5), presentation with stroke, and dissection location in intracranial vertebral artery were significantly higher in dying-VAD.
Abstract — WCN 2013 No: 456 Topic: 3 — Stroke Heat stress induces selective cell damage in the cerebellum. An experimental study using immunohistochemistry and ultrastructural investigations in rats H.S. Sharmaa, D.F. Muresanub, A. Sharmaa. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bClinical Neurosciences, Medicine & Pharmacy Cluj-Napoca, Cluj-Napoca, Romania The possibility that thermal stress caused by systemic heat exposure may lead to a specific cellular damage in the cerebellum was examined in young rats (age 8–9 weeks). The cell changes in the cerebellum were examined using immunohistochemistry and light and electron microscopy. Subjection of conscious young animals to a 4-h HS resulted in marked hyperthermia (41.6 ± 0.45 °C). In these animals the cerebellum showed pronounced and selective cellular damage in the Purkinje cell layers and granule cells. This damage was most marked in specific regions of the vermis and in the lateral cerebellar cortices. Deeper cerebellar nuclei also showed marked cell damage. Immunohistochemistry showed profound upregulation of GFAP, S-100 and Vimentin indicating abnormal glial cell reactions in the cerebellum. Marked decrease in MBP suggests profound degradation of myelinated nerve fibers. Electron microscopy showed marked damage to the cerebral endothelium. Lanthanum an electron dense particle was found to be present within the endothelial cells, basal lamina and in vesicular profiles. Nerve cells showed abnormal reactions, edema and distortion in many parts of the cerebellum. Loss of Nissl substance was much pronounced in several regions of the cerebellum. These nerve, glial and myelin cell changes were less evident in animals subjected to similar heat stress under anesthesia. These observations for the first time show that cerebellum is vulnerable in heat stress and this selective vulnerability is somehow associated with a specific breakdown of the BBB permeability. doi:10.1016/j.jns.2013.07.685
Abstract — WCN 2013 No: 458 Topic: 3 — Stroke Cardiac arrest alters regional ubiquitin levels in the porcine brain. Neuroprotective effects of methylene blue H.S. Sharmaa, R. Patnaikb, A. Sharmaa, L. Wiklunda. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bNational Institute of Technology, School of Biomedical Engineering, Banaras Hindu University, Varanasi, India Ubiquitin is recently implicated the central nervous system (CNS) diseases. Overexpression of ubiquitin occurs in stroke, trauma, Alzheimer's disease, Parkinson's disease and Huntington's disease in the areas associated with neuronal damages. However, the role of ubiquitin in brain pathology or neuroprotection is still not well known. Cardiac arrest (CA) and subsequent cardiopulmonary resuscitation induces widespread brain damages. In a porcine model of CA our laboratory showed marked neuronal, glial and myelin damages in
Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
Abstract — WCN 2013 No: 463 Topic: 3 — Stroke Aetiopathogenesis of cerebral ischemia in young Turkish patients
Conclusion: Identifying predictors of mortality is important for starting appropriate treatment and setting targets in the management of patients with dissection.
C. Emira, S. Çelikb, C. Örkena, S. Çelika, F. Budaka. aHealth Ministry Okmeydani Training and Education Hospital, Istanbul, Turkey; bHealth Ministry Erenköy Training Hospital, Istanbul, Turkey
doi:10.1016/j.jns.2013.07.684
This study evaluates the risk factors and etiological spectrum in young stroke patients (aged 45 or younger). Methods: Risk factors and aetiology of cerebral ischemia were retrospectively investigated in 230 patients (age ranges 9–45), admitted to our Neurology Unit with cerebral transient ischemic attacks (TIA) or infarction. 230 consecutive patients were divided into two groups according to their ages. Group I consists of patients whose age ranges 9–30 and in Group II, age range was 30–45. Results: Hypertension, hyperlipidemia, smoking were the most common risk factors. Atherosclerosis was the leading etiology occurring in group II (35%) and vasculopathy was markedly high in group I (23%). In addition cardiac embolism was determined in 20% of all cases. Among these cases cardiac valve disease (58%), atrial fibrillation (16%) and ischemic heart disease (27%) were determined by the investigation methods. Conclusion: The most striking finding of our study was the high frequency of cardiac valve disease in young adult ischemic strokes in our country when compared with the previous reports in the literature.
doi:10.1016/j.jns.2013.07.683
Abstract — WCN 2013 No: 465 Topic: 3 — Stroke Predictors of mortality in patients with craniocervical artery dissection Y. Kaplana, H. Celika, O. Kamislia, S. Kamislia, S. Altınayara, S. Yologlub, C. Ozcana. aNeurology, Inonu University, Malatya, Turkey; bBiostatistics, Inonu University, Malatya, Turkey Background: Dissection of the carotid (CAD) or vertebral (VAD) artery is a major cause of ischemic stroke in young adults. The prognosis varies and the dissection can range from asymptomatic to causing a profound neurological deficit and death. Little is known of the predictors of mortality in these patients. Objectives: The aim of the study was to investigate the predictors related to mortality in patients with craniocervical artery dissection. Material and methods: We reviewed retrospectively all patients diagnosed with CAD or VAD admitted to our clinic between January 2000 and January 2013 and included 67 such patients in the study. Age, gender, modified Rankin Scale (mRS) prestroke and at time of admission, clinical presentation of dissection, location of dissection, vascular risk factors, and length of hospital stay were considered mortality-related prognostic factors. Of the 67 patients, 12 (17.9%) patients died: 5 (7.46%) patients with CAD and 7 (10.44%) with VAD. The patients were divided into four subgroups: surviving patients with CAD, dying patients with CAD, surviving patients with VAD, and dying patients with VAD. Then, surviving-CAD versus dying-CAD and surviving-VAD versus dying-VAD compared according to prognostic factors. Results: Disability at admission (mRS 3–5) was significantly higher in dying-CAD than surviving-CAD. Comparing dying-VAD with surviving-VAD, the mean age, disability at admission (mRS 3–5), presentation with stroke, and dissection location in intracranial vertebral artery were significantly higher in dying-VAD.
Abstract — WCN 2013 No: 456 Topic: 3 — Stroke Heat stress induces selective cell damage in the cerebellum. An experimental study using immunohistochemistry and ultrastructural investigations in rats H.S. Sharmaa, D.F. Muresanub, A. Sharmaa. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bClinical Neurosciences, Medicine & Pharmacy Cluj-Napoca, Cluj-Napoca, Romania The possibility that thermal stress caused by systemic heat exposure may lead to a specific cellular damage in the cerebellum was examined in young rats (age 8–9 weeks). The cell changes in the cerebellum were examined using immunohistochemistry and light and electron microscopy. Subjection of conscious young animals to a 4-h HS resulted in marked hyperthermia (41.6 ± 0.45 °C). In these animals the cerebellum showed pronounced and selective cellular damage in the Purkinje cell layers and granule cells. This damage was most marked in specific regions of the vermis and in the lateral cerebellar cortices. Deeper cerebellar nuclei also showed marked cell damage. Immunohistochemistry showed profound upregulation of GFAP, S-100 and Vimentin indicating abnormal glial cell reactions in the cerebellum. Marked decrease in MBP suggests profound degradation of myelinated nerve fibers. Electron microscopy showed marked damage to the cerebral endothelium. Lanthanum an electron dense particle was found to be present within the endothelial cells, basal lamina and in vesicular profiles. Nerve cells showed abnormal reactions, edema and distortion in many parts of the cerebellum. Loss of Nissl substance was much pronounced in several regions of the cerebellum. These nerve, glial and myelin cell changes were less evident in animals subjected to similar heat stress under anesthesia. These observations for the first time show that cerebellum is vulnerable in heat stress and this selective vulnerability is somehow associated with a specific breakdown of the BBB permeability. doi:10.1016/j.jns.2013.07.685
Abstract — WCN 2013 No: 458 Topic: 3 — Stroke Cardiac arrest alters regional ubiquitin levels in the porcine brain. Neuroprotective effects of methylene blue H.S. Sharmaa, R. Patnaikb, A. Sharmaa, L. Wiklunda. aSurgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; bNational Institute of Technology, School of Biomedical Engineering, Banaras Hindu University, Varanasi, India Ubiquitin is recently implicated the central nervous system (CNS) diseases. Overexpression of ubiquitin occurs in stroke, trauma, Alzheimer's disease, Parkinson's disease and Huntington's disease in the areas associated with neuronal damages. However, the role of ubiquitin in brain pathology or neuroprotection is still not well known. Cardiac arrest (CA) and subsequent cardiopulmonary resuscitation induces widespread brain damages. In a porcine model of CA our laboratory showed marked neuronal, glial and myelin damages in