Our study demonstrates an intrathecal production of IL-6 and IL-1 beta in patients with stroke, supporting the notion of localized inflammatory response to acute brain lesion. In addition, the significant correlation between early intrathecal production of IL-6 and the subsequent size of the brain lesion can be used as a prognostic tool, predicting the size of the brain damage before it is possible to accurately visualize it with radiological methods.
Objectives: The aim of this study was to determine the prevalence of idiopathic normal-pressure hydrocephalus (iNPH) in elderly persons in a large population-based sample using radiologic and clinical examinations. Methods:We examined representative elderly populations aged 70 years and older that had undergone neuropsychiatric evaluations and CT of the brain between 1986 and 2000 (n 5 1,238). Gait was evaluated by clinical examination and history of walking difficulty. Cognitive function was evaluated with the Mini-Mental State Examination and urinary incontinence by selfreport. iNPH was diagnosed in concordance with the American-European iNPH guidelines. Exclusion criteria were history of meningitis, severe head trauma, and subarachnoid hemorrhage.Results: The prevalence of probable iNPH was 0.2% in those aged 70-79 years (n 5 2) and 5.9%(n 5 24) in those aged 80 years and older, with no difference between men and women. Only 2 of these persons had been treated for iNPH. Hydrocephalic ventricular enlargement, i.e., a CT image consistent with NPH, was found in 56 persons (4.5%). An Evans Index .0.3 was found in 256 (20.7%) and occluded sulci at the high convexity in 67 persons (5.4%). All of these findings were more common in the older age groups. The number of elderly and people with dementia is increasing in most parts of the world.1 It is therefore important to learn more about the prevalence of treatable causes of dementia. Idiopathic normal-pressure hydrocephalus (iNPH) is a treatable neurologic disorder first described by Salomón Hakim in 1965.2 iNPH is characterized by gait and balance impairment, cognitive deterioration, and urinary incontinence, and radiologically by a communicating ventricular enlargement.3 Treatment by diversion of CSF to the peritoneal cavity or heart is successful in reversing symptoms in more than 80% of the patients. 4 iNPH is thus one of the few causes of reversible dementia, but it is still underdiagnosed. 5,6 The prevalence of iNPH in selected populations and in community-based studies on young elderly varies between 0.1% and 2.9%.5,7-10 However, few large population-based studies have investigated the prevalence of iNPH, and most included few persons older than 80 years. Thus, the prevalence still has to be examined in population-based studies including many persons older than 80 years.The aim of this study was to determine the prevalence of iNPH by examining CT images of the brain and clinical signs of iNPH in a large representative elderly population.METHODS Study population. Between 1986 and 2000, studies on representative elderly populations in Gothenburg, Sweden, were conducted using identical examinations (including neuropsychiatric examinations and key informant interviews) at each
SUMMARYA growing body of evidence points out the potential role of inflammatory mechanisms in the pathophysiology of ischaemic brain damage. We have recently demonstrated that stroke patients display an intrathecal production of proinflammatory cytokines, such as IL-1b and IL-6 already within the first 24 h after the beginning of symptoms (Tarkowski et al., 1995). The aim of the present study was to investigate patterns of local inflammatory responses as a consequence of acute stroke. Thirty stroke patients were studied prospectively on days 0-3, 7-9, 21-26 and after day 90 with clinical evaluations, radiological assessments and analysis of cerebrospinal fluid (CSF) cytokine levels. In addition, 15 healthy control CSF samples were used. Significantly increased CSF levels of IL-8, granulocytemacrophage colony-stimulating factor (GM-CSF) and IL-10 were observed early during the stroke with a peak on day 2 for the proinflammatory cytokines IL-8 and GM-CSF, and on day 3 for the immunoregulatory cytokine IL-10. Patients with a brain infarct predominantly located in the white matter showed significantly higher levels of IL-8 in CSF than patients with an infarct mainly located in the grey matter. Also, high levels of intrathecal tumour necrosis factor-alpha (TNF-a) were associated with the presence of white matter disease. Our study demonstrates an intrathecal production of proinflammatory and immunoregulatory cytokines in patients with stroke, supporting the notion of localized immune response to the acute brain lesion. A better understanding of the inflammatory response in stroke may lead to new treatment strategies.
increase in CSF-tau levels after acute ischemic stroke indicate that CSF-tau reflect the degree of neuronal damage. The reason for unchanged levels of CSFamyloid β(1-42) and CSF-apoE after ischemic stroke remains unclear.
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