Background and Purpose-Studies on the relation between blood pressure (BP) and stroke outcome have shown contradictory results. We explored the association of systolic (SBP) and diastolic (DBP) BP during acute stroke with early neurological deterioration, infarct volume, neurological outcome, and mortality at 3 months. Methods-We included 304 patients with acute ischemic stroke. SBP and DBP on admission and on the first day were the average values of all readings obtained in the emergency department and during a 24-hour period after patient allocation in the stroke unit. Results-A U-shaped effect was observed: for every 10 mm Hg Յ180 mm Hg of SBP, the risk of early neurological deterioration, poor outcome, and mortality increased by 6%, 25%, and 7%, respectively, whereas for every 10 mm Hg Ͼ180 mm Hg, the risk of early neurological deterioration increased by 40% and the risk of poor outcome increased by 23%, with no effect on mortality. Mean infarct volume increased 7.3 and 5.5 cm 3 for every 10 mm Hg Յ180 and Ͼ180 mm Hg. A similar pattern was found in patients with DBP Յ100 or Ͼ100 mm Hg. These effects disappeared after adjustment for the use of antihypertensive drugs and BP drop Ͼ20 mm Hg within the first day, with the latter being the more important prognostic factor of poor outcome. Conclusions-High

Background and Purpose-Matrix metalloproteinase-9 (MMP-9) activity has been associated with hemorrhagic transformation (HT) in experimental models of cerebral ischemia. Our aim was to investigate the relationship between MMP-9 concentrations in blood within 24 hours of stroke onset and subsequent HT of cerebral infarction. Methods-We studied 250 patients with a hemispheric ischemic stroke of 7.8Ϯ4.5 hours' duration. Early CT signs of cerebral infarction were evaluated on admission. The HT and infarct volume were analyzed from the CT performed on days 4 through 7. MMP-9 levels were determined by enzyme-linked immunosorbent assay in blood samples obtained on admission. Results-HT was observed in 38 patients (15.2%): 24 (63.2%) had a hemorrhagic infarction, and 14 (36.8%) had a parenchymal hematoma. A total of 108 patients (43%) received anticoagulants before the second CT scan. Systolic and diastolic blood pressures, body temperature, frequency of early CT signs of ischemia (92% versus 22%), and treatment with anticoagulants (79% versus 37%) were significantly higher in the group with HT (PϽ0.001). Mean infarct volume was 126Ϯ60 cm 3 in the HT group and 90Ϯ68 cm 3 in the group without HT (Pϭ0.003). Median (quartiles) plasma MMP-9 concentrations were higher in the HT group (193 [163, 213] versus 62 [40, 93] ng/mL, PϽ0.001), even in the 24 patients seen within 3 hours of symptom onset (Pϭ0.014). MMP-9 levels Ն140 ng/mL had a positive and negative predictive value of HT of 61% and 97%, respectively. MMP-9 Ն140 ng/mL was associated with HT (odds ratio, 12; 95% confidence interval, 3 to 51; PϽ0.001) after adjustment for potential confounders and final infarct volume. Conclusions-High

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Statin withdrawal is associated with increased risk of death or dependency at 90 days. Hence, this treatment should be continued in the acute phase of ischemic stroke.

SummaryBackground Citicoline is approved in some countries for the treatment of acute ischaemic stroke. The drug has shown some evidence of effi cacy in a pooled analysis. We sought to confi rm the effi cacy of citicoline in a larger trial.