The prognosis of BAS greater than 50% or BAO is diverse and certain clinical characteristics seem to predict a lower risk of poor outcome. Their presence may help to decide the most suitable therapy.
Our results showed that Tc-99m HMPAO can be used to label ABMMN cells for in vivo cell visualization, and that brain SPECT imaging with labeled ABMMN cells is a feasible noninvasive method for studying the fate of transplanted cells in vivo. Additionally, our findings demonstrate the localization of these intra-arterially injected cells.
ObjectiveTo evaluate the relationships of brain iron and heme with the inflammatory
response of the systemic and central nervous systems and to investigate the
role of defensive systems against the toxicity of iron and heme in the
central nervous system.MethodsWe assessed a prospective cohort of patients presenting with intracerebral
and subarachnoid hemorrhage. We assayed plasma and cerebrospinal fluid
samples for the presence of iron, heme, hemopexin, haptoglobin, enolase,
S100-β and cytokines for the first three days following hemorrhagic
stroke. We also analyzed the dynamic changes in these components within both
fluids and their relationship with early mortality rates.ResultsHemopexin and haptoglobin concentrations were nearly negligible in the brain
after intracerebral and subarachnoid hemorrhage. Cerebrospinal fluid iron
and heme concentrations correlated with a pro-inflammatory response in the
central nervous system, and plasmatic and cerebrospinal fluid inflammatory
profiles on the third day after hemorrhagic stroke were related to early
mortality rates. Interleukin 4 levels within the cerebrospinal fluid during
the first 24 hours after hemorrhagic stroke were found to be higher in
survivors than in non-survivors.ConclusionIron and heme are associated with a pro-inflammatory response in the central
nervous system following hemorrhagic stroke, and protections against
hemoglobin and heme are lacking within the human brain. Patient inflammatory
profiles were associated with a poorer prognosis, and local
anti-inflammatory responses appeared to have a protective role.
Patients with an acute basilar artery occlusion (BAO) have a high risk of long-lasting disability and death. Only limited data are available on functional outcome in elderly patients with BAO. Using data from the Basilar Artery International Cooperation Study, we aimed to determine outcomes in patients ≥75 years. Primary outcome measure was poor functional outcome (modified Rankin scale score 4–6). Secondary outcomes were death, insufficient vessel recanalization (defined as thrombolysis in myocardial infarction score 0–1) and symptomatic intracranial hemorrhage (SICH). Patients were divided into four age-groups, based on quartiles: 18–54, 55–64, 65–74, and ≥75 years. Outcomes were compared between patients ≥75 years and patients aged 18–54 years. Risk ratios with corresponding 95 % confidence intervals (CI) were calculated and Poisson regression analyses were performed to calculate adjusted risk ratios (aRR). We included 619 patients [18–54 years n = 153 (25 %), 55–64 years n = 133 (21 %), 65–74 years n = 171 (28 %), and ≥75 years n = 162 (26 %)]. Compared with patients aged 18–54 years, patients ≥75 years were at increased risk of poor functional outcome [aRR 1.33 (1.14–1.55)] and death [aRR 2.47 (1.75–3.51)]. Nevertheless, 35/162 (22 %, 95 % CI 15–28 %) of patients ≥75 years had good functional outcome. No significant differences between age groups were observed for recanalization rate and incidence of SICH. Although patients ≥75 years with BAO have an increased risk of poor outcome compared with younger patients, a substantial group of patients ≥75 years survives with a good functional outcome.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-012-6498-2) contains supplementary material, which is available to authorized users.
VITATOPS aims to recruit and follow-up 8000 patients between 1998 and 2008, and provide a reliable estimate of the safety and effectiveness of folic acid, vitamin B(12), and vitamin B(6) supplementation in reducing recurrent serious vascular events among a wide range of patients with TIA and stroke throughout the world.
-Purpose: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. Methods: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. Results: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. Conclusion: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.
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