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Prediction of tissue outcome in acute stroke with perfusion CT
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Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
frequent symptom, present in twenty out of twenty-three patients (86.9%). Other often occurring symptoms were seizures (9/23, 39.1%), motor deficits (7/23, 30.4%) and aphasia (6/23, 26.0%). The sinus most frequently involved was the lateral sinus (22/23, 95.6%), either isolated or in association with other sinuses. A complete recovery (mRS = 0–1) was observed in 16/23 (69.5%) cases. One patient died of heart failure. Conclusion: Our results confirm that headache is the most frequent symptom and may be the only clinical presentation of the CVT in a high percentage of cases. CVT seems to have a more benign prognosis than previously considered. doi:10.1016/j.jns.2013.07.847
Abstract — WCN 2013 No: 1742 Topic: 3 — Stroke Prediction of tissue outcome in acute stroke with perfusion CT D. Sergeeva, A. Suslinb, A. Sergeevab, M. Piradova, M. Krotenkovab. a Intensive Care, Research Center of Neurology, Russian Academy of Medical Sciences, Moscow, Russia; bRadiology, Research Center of Neurology, Russian Academy of Medical Sciences, Moscow, Russia
The purpose of the study is to evaluate the content of excitatory (glutamate and aspartate) and inhibitory (GABA, glycine) neurotransmitter amino acids (NTA) in the cerebrospinal fluid (CSF) of patients with intracerebral hemorrhage (ICH), and give a comparative description with ischemic hemispheric stroke (IHS). Materials and methods: The study included 75 patients: 40 with ICH, 20 with IHS and 15 dyscirculatory encephalopathy (DE) under sub-compensation (control group). All patients with ischemic acute stroke had severe disease severity (according to clinical scales). Determining the level of excitatory and inhibitory NTA in the CSF was performed by liquid chromatography (Cohen's method). Results: These studies have shown that in patients with ICH, the average content of glutamate was 402.0 ± 11.60 nmol/ml, aspartate — 345.0 ± 13.83 nmol/ml, glycine — 316.5 ± 10.4 nmol/ml and GABA — 100.3 ± 4.8 nmol/ml. In the early days of ICH, average content of excitatory amino acids increased dramatically, significantly surpassing both the control group (4.14 times), and patients with IHS (2.65 times). Conclusions: Thus, the ICH and IHS accompanied by significant changes in the content of both excitatory and inhibitory amino acids in the acute phase of the disease. doi:10.1016/j.jns.2013.07.849
Background: Perfusion CT allows assessment of tissue viability in acute cerebral ischemia. Objective: To evaluate the outcome of ischemic tissue depending on the initial perfusion deficit. Patients and methods: Thirty patients (21 men, median age 59 years) with acute hemispheric stroke in the first 24 h of symptoms onset underwent perfusion CT on admission and noncontrast CT on Day 10. Relative (intact/affected side) values of perfusion parameters within hypoperfused area on initial perfusion CT scan in the regions corresponding to hypodense and normal tissue zones on non-contrast CT were studied with ROC analysis. No patients were eligible for recanalization therapies, and received standard antiplatelet treatment and supportive care. Results: Median initial NIHSS score was 8.1. Thresholds for relative values of perfusion parameters indicating tissue survival (i.e., no infarction on final CT scan) were 5.06 for rCBF, 1.13 for rCBV, and 0.41 for rMTT. Despite no difference was found between areas under ROC curves (p N 0.05), AUROC value was numerically higher for rCBV (0.84 vs 0.80 vs 0.59 compared with values for rCBF and rMTT, respectively). The rCBV threshold had sensitivity of 88.9% and specificity of 75.0%. Conclusion: In patients with acute stroke who did not receive thrombolysis the viability of tissue can be best predicted with the change of CBV parameter relative to intact tissue on initial perfusion CT, with decrease of CBV N 13% indicating worse tissue outcome. doi:10.1016/j.jns.2013.07.848
Abstract — WCN 2013 No: 1792 Topic: 3 — Stroke Specification of amino acid neurotransmitters in the cerebrospinal fluid in intracerebral hemorrhage Y. Musaevaa, F. Saidvalievb, S. Kuranbaevab. aTashkent Medical Academy, Tashkent, Uzbekistan; bNeurology, Tashkent Medical Academy, Tashkent, Uzbekistan Introduction: Current knowledge of the mechanisms of neuronal death in stroke shows that the damaged nerve cells play an important role in imbalanced neurotransmitter amino acids, set in motion a cascade of calcium glutamate.
Abstract — WCN 2013 No: 1774 Topic: 3 — Stroke The role of hemodynamic disturbance on extracranial carotid artery on the occurrence of brain aneurysm M. Vukicevic, T. Jaramaz Ducic, S. Djokovic, A. Bezmarevic, S. Trajkovic Bezmarevic, N. Basurovic, B. Georgievski Brkic. Special Hospital for Cerebrovascular Diseases 'Sveti Sava', Belgrade, Serbia Introduction and purpose: An aneurysm occurs as a result of weakening of the wall. They may be congenital or acquired. The most common causes are atherosclerosis, hemodynamically induced damage of the vessel wall and vasculopathy. The purpose of this study was to find a relationship between hemodynamic disturbance on extracranial carotid artery and occurrence of intracranial aneurysm in our patients. Material and methods: We tested 52 patients with the diagnosis — Aneurysm cerebri non ruptum (confirmed by CTA, MRA or DSA), 44 (84.6%) women and 8 (15.4%) men, age 24–78 years (average 58.2 years). We used findings of Doppler sonography to evaluate blood flow in the cervical carotid arteries and compare with the presence of an aneurysm at the side with hemodynamic disturbance (HD) with high flow velocity. For statistical analysis we used Chi-square test. Results: We have found HD in 28 (53.8%) ICA right, and 25 (48.1%) ICA left; significant arterial stenosis on carotid bulb was observed only in three patients. There was statistical significant difference between the hemodynamic disturbance in the left cervical ICA as a consequence of presence of Kinking and the occurrence of intracranial aneurysms in carotid branch (p b 0.02). We observed the following co-morbidities in our patients: 43 patients (82.7%) had arterial hypertension, 8 (15.4%) had diabetes, 9 (17.3%) had hypercholesterolemia, 22 (42.3%) had smoking and 6 (11.5%) had aneurysm in family. Conclusion: Hemodynamic disturbance due to kinking may play a role in the development of an aneurysm in the smoker's brain vessel. doi:10.1016/j.jns.2013.07.850
Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
frequent symptom, present in twenty out of twenty-three patients (86.9%). Other often occurring symptoms were seizures (9/23, 39.1%), motor deficits (7/23, 30.4%) and aphasia (6/23, 26.0%). The sinus most frequently involved was the lateral sinus (22/23, 95.6%), either isolated or in association with other sinuses. A complete recovery (mRS = 0–1) was observed in 16/23 (69.5%) cases. One patient died of heart failure. Conclusion: Our results confirm that headache is the most frequent symptom and may be the only clinical presentation of the CVT in a high percentage of cases. CVT seems to have a more benign prognosis than previously considered. doi:10.1016/j.jns.2013.07.847
Abstract — WCN 2013 No: 1742 Topic: 3 — Stroke Prediction of tissue outcome in acute stroke with perfusion CT D. Sergeeva, A. Suslinb, A. Sergeevab, M. Piradova, M. Krotenkovab. a Intensive Care, Research Center of Neurology, Russian Academy of Medical Sciences, Moscow, Russia; bRadiology, Research Center of Neurology, Russian Academy of Medical Sciences, Moscow, Russia
The purpose of the study is to evaluate the content of excitatory (glutamate and aspartate) and inhibitory (GABA, glycine) neurotransmitter amino acids (NTA) in the cerebrospinal fluid (CSF) of patients with intracerebral hemorrhage (ICH), and give a comparative description with ischemic hemispheric stroke (IHS). Materials and methods: The study included 75 patients: 40 with ICH, 20 with IHS and 15 dyscirculatory encephalopathy (DE) under sub-compensation (control group). All patients with ischemic acute stroke had severe disease severity (according to clinical scales). Determining the level of excitatory and inhibitory NTA in the CSF was performed by liquid chromatography (Cohen's method). Results: These studies have shown that in patients with ICH, the average content of glutamate was 402.0 ± 11.60 nmol/ml, aspartate — 345.0 ± 13.83 nmol/ml, glycine — 316.5 ± 10.4 nmol/ml and GABA — 100.3 ± 4.8 nmol/ml. In the early days of ICH, average content of excitatory amino acids increased dramatically, significantly surpassing both the control group (4.14 times), and patients with IHS (2.65 times). Conclusions: Thus, the ICH and IHS accompanied by significant changes in the content of both excitatory and inhibitory amino acids in the acute phase of the disease. doi:10.1016/j.jns.2013.07.849
Background: Perfusion CT allows assessment of tissue viability in acute cerebral ischemia. Objective: To evaluate the outcome of ischemic tissue depending on the initial perfusion deficit. Patients and methods: Thirty patients (21 men, median age 59 years) with acute hemispheric stroke in the first 24 h of symptoms onset underwent perfusion CT on admission and noncontrast CT on Day 10. Relative (intact/affected side) values of perfusion parameters within hypoperfused area on initial perfusion CT scan in the regions corresponding to hypodense and normal tissue zones on non-contrast CT were studied with ROC analysis. No patients were eligible for recanalization therapies, and received standard antiplatelet treatment and supportive care. Results: Median initial NIHSS score was 8.1. Thresholds for relative values of perfusion parameters indicating tissue survival (i.e., no infarction on final CT scan) were 5.06 for rCBF, 1.13 for rCBV, and 0.41 for rMTT. Despite no difference was found between areas under ROC curves (p N 0.05), AUROC value was numerically higher for rCBV (0.84 vs 0.80 vs 0.59 compared with values for rCBF and rMTT, respectively). The rCBV threshold had sensitivity of 88.9% and specificity of 75.0%. Conclusion: In patients with acute stroke who did not receive thrombolysis the viability of tissue can be best predicted with the change of CBV parameter relative to intact tissue on initial perfusion CT, with decrease of CBV N 13% indicating worse tissue outcome. doi:10.1016/j.jns.2013.07.848
Abstract — WCN 2013 No: 1792 Topic: 3 — Stroke Specification of amino acid neurotransmitters in the cerebrospinal fluid in intracerebral hemorrhage Y. Musaevaa, F. Saidvalievb, S. Kuranbaevab. aTashkent Medical Academy, Tashkent, Uzbekistan; bNeurology, Tashkent Medical Academy, Tashkent, Uzbekistan Introduction: Current knowledge of the mechanisms of neuronal death in stroke shows that the damaged nerve cells play an important role in imbalanced neurotransmitter amino acids, set in motion a cascade of calcium glutamate.
Abstract — WCN 2013 No: 1774 Topic: 3 — Stroke The role of hemodynamic disturbance on extracranial carotid artery on the occurrence of brain aneurysm M. Vukicevic, T. Jaramaz Ducic, S. Djokovic, A. Bezmarevic, S. Trajkovic Bezmarevic, N. Basurovic, B. Georgievski Brkic. Special Hospital for Cerebrovascular Diseases 'Sveti Sava', Belgrade, Serbia Introduction and purpose: An aneurysm occurs as a result of weakening of the wall. They may be congenital or acquired. The most common causes are atherosclerosis, hemodynamically induced damage of the vessel wall and vasculopathy. The purpose of this study was to find a relationship between hemodynamic disturbance on extracranial carotid artery and occurrence of intracranial aneurysm in our patients. Material and methods: We tested 52 patients with the diagnosis — Aneurysm cerebri non ruptum (confirmed by CTA, MRA or DSA), 44 (84.6%) women and 8 (15.4%) men, age 24–78 years (average 58.2 years). We used findings of Doppler sonography to evaluate blood flow in the cervical carotid arteries and compare with the presence of an aneurysm at the side with hemodynamic disturbance (HD) with high flow velocity. For statistical analysis we used Chi-square test. Results: We have found HD in 28 (53.8%) ICA right, and 25 (48.1%) ICA left; significant arterial stenosis on carotid bulb was observed only in three patients. There was statistical significant difference between the hemodynamic disturbance in the left cervical ICA as a consequence of presence of Kinking and the occurrence of intracranial aneurysms in carotid branch (p b 0.02). We observed the following co-morbidities in our patients: 43 patients (82.7%) had arterial hypertension, 8 (15.4%) had diabetes, 9 (17.3%) had hypercholesterolemia, 22 (42.3%) had smoking and 6 (11.5%) had aneurysm in family. Conclusion: Hemodynamic disturbance due to kinking may play a role in the development of an aneurysm in the smoker's brain vessel. doi:10.1016/j.jns.2013.07.850