Acute cerebral ischemia triggers local and systemic immune response. The aims of this project was to assess the blood serum concentration of the markers of inflammation and markers of the blood brain barrier damage on the first day of ischemic stroke, and the mutual correlations between these marker levels. Methods Our prospective study included 138 patients with first-in-life stroke, who were analyzed according to: plasma concentration of the following markers on the first day of stroke: Il-2 and IL-6, S100B, TNF alfa, GRN, NSE, uPA, VEGF, BDNF, CRP, leucocyte and thrombocyte counts; their neurological status on the first day of stroke (NIHSS) and their functional status at 30 days following stroke (mRS). Result The study included 138 patients with mean age: 73.11 ± 11.48 [36-103]. Patients with a higher score on the NIHSS than those obtaining lower scores showed significantly higher concentrations of TNF-alpha, WBC, CRP, NSE, IL-6 and S100B. Patients with a higher score on the mRS than those obtaining lower scores showed significantly higher concentrations of WBC, CRP, GRN, IL-6, S100B. Factors with an independent influence on the neurological status on the first day of stroke were: sex, WBC, PLT, CRP, S100B and IL-6 levels. Atrial fibrillation, leukocyte count, CRP, NSA, uPA, interleukin 6 and S100B showed an independent impact on the functional status on the 30th day of stroke. Patients with symptomatic atherosclerosis of carotid/cerebral and/or coronary arteries, as compared to others, were older (p= 0.003) and had higher levels of CRP, Il-6, and S100B. In each case, the differences were statistically significant. Conclusions The concentration of Il-6 and S100B on the first day of stroke are significant for both the neurological status and the functional status in the acute period of the disease. Increased CRP and leukocyte count are associated with a worse prognosis regarding the course of acute stroke. The expression of pro-inflammatory agents and markers of blood-brain barrier damage in the acute phase of stroke is more prominent in patients with symptomatic atherosclerosis than in patients with no clinical features of atherosclerosis.

IntroductionAvailable reports underline the significance of the inflammatory process in the development, progression and destabilisation of atherosclerotic plaques in the internal carotid artery (ICA). The aim of this study was to evaluate the relationship between the degree of ICA stenosis, ultrasound plaque morphology and serum concentration of selected inflammatory markers.Material and methodsSixty-five patients with ICA stenosis > 50% (39 symptomatic) and 30 healthy volunteers were enrolled in the study. Clinical, neurological examination and laboratory evaluation (leucocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, tumour necrosis factor-α (TNF-α), interleukins (1β, 6 and 10), anti-cytomegalovirus IgG antibody titre) were performed. Stenosis grade ≥ 70%, ulcerations on the plaque surface and a hypoechoic (or predominantly hypoechoic) structure of the plaque, obtained by colour-coded duplex examination, were accepted as the characteristics of unstable stenoses.ResultsUnstable ultrasound features of ICA stenosis were found significantly more often in symptomatic than in asymptomatic patients (71.79% vs. 30.71% for stenosis degree ≥ 70%, p = 0.001 and 61.23% vs. 38.46% for unstable plaque morphology, p = 0.01). Patients with ICA stenosis had significantly higher serum concentrations of interleukin-6, fibrinogen, ESR and higher CRP values than the individuals from the control group (p = 0.001, p = 0.009, p = 0.036, p = 0.009 respectively). Patients with unstable plaques structure had significantly higher concentrations of TNF-α, interleukin-6, fibrinogen, higher number of leukocytes, monocytes and higher CRP values than patients with stable plaques (p = 0.008, p = 0.049, p = 0.012, p = 0.0002, p = 0.006, p = 0.0003 respectively). No significant differences in above-mentioned parameters between the groups with stenosis < 70% and ≥ 70% were found.ConclusionsThere is a relationship between the activity of the selected inflammatory markers in serum and atherosclerotic unstable internal carotid artery stenosis. There is no relationship between serum concentration of inflammatory markers and degree of carotid artery stenosis.

213 www.journals.viamedica.pl/neurologia_neurochirurgia_polska Agata Czarnowska et al., SARS-CoV-2 infection in MS patients treated with disease-modifying therapies

IntroductionHemostasis is affected by interactions between physiological processes, including those connected with the coagulation system, whose essence is converting fibrinogen into fibrin. The role of factor VIII (FVIII) consists in activating factor X, which directly participates in the generation of thrombin, which is able to produce stable fibrin, which in turn forms blood clots. There are divergent opinions regarding the significance of high levels of FVIII in stroke pathogenesis.AimThe aim of our study was to evaluate FVIII activity in individuals with cryptogenic stroke in order to determine a potential relationship between it and cerebral ischemia.Material and methodsNine patients suffering with stroke were used in this study: six women and three men aged 49–63 years. In all of the patients, the presence of known and potential risk factors for stroke had been excluded during previous diagnostic procedures. These patients accounted for 1.2% of the 719 people who suffered a stroke and were hospitalized in 2011 at the Stroke Unit. FVIII activity was examined in each of the nine qualified subjects within 1–2 months of the occurrence of stroke (the first test) and repeated (the second test) in five patients with abnormal results obtained from the first examination.ResultsIncreased activity of FVIII was found in 5 out of 9 patients. In patients with abnormal results, elevated FVIII was found in follow-up examinations in the 8th–10th month following stroke. Hemodynamic abnormalities in carotid or cerebral artery (presence of thrombus) were found in 3 of the 5 patients with increased FVIII levels. In the first 24 hours following stroke the neurological state of patients with abnormal FVIII was worse than individuals with normal FVIII activity. The patients with abnormal FVIII levels were found to be more disabled in the examination of self-dependence on the 90th day after stroke.ConclusionWhen searching for the causes of stroke, it is worth examining the coagulation system, including FVIII concentration, the abnormality of which may play a significant part in brain ischemia. More research is needed to determine the relationship between abnormal FVIII activity and stroke.

Background: An increase in the troponin I (TnI) level is a marker of myocardial damage in acute coronary syndromes (ACS) and other conditions. According to the latest reports, an increase in the concentration of TnI in the acute phase of stroke relates to 1-34% of patients. The aim of this study was to evaluate the prevalence of elevated TnI concentration in patients with acute first-ever stroke and to examine its significance for the prediction of post-stroke disability degree and death within 30 days of stroke. An additional aim of the study was to compare the anatomic location of stroke in patients with normal and elevated TnI concentrations on the 1st day of stroke. Methods: Patients (M/F: 609/459; mean age 72 ± 11) with stroke numbering 1,068 were included in the prospective study. Their neurological deficit (National Institutes of Health Stroke Scale), TnI concentration (normal range ≤0.014 ng/ml), creatine kinase and ECG were examined on the 1st day of stroke. A follow-up and ECG were performed one day later in patients with abnormal TnI. The anatomical location of stroke (the right and left hemispheres and the brain stem) was compared in patients with normal and elevated TnI concentrations on the first day of stroke. The patients' functioning status was assessed using the by modified Rankin Scale (mRS) on the 30th day, and mortality was assessed within 30 days. The analysis was performed using a single and multi-factorial method of non-linear estimation for logistic regression in order to identify the independent factors for post-stroke disability at 4-6 points on the mRS on the 30th day following the onset and for death within 30 days of stroke in relation to the entire study group. The relative risk of a 4-6 point scoring on the mRS and of death among patients with abnormal TnI concentrations was also assessed. Results: Abnormal TnI concentration during stroke was observed in 9.73% of patients. The functioning status (mRS) of patients with elevated TnI was significantly worse 30 days post stroke as compared to patients with normal TnI concentration. Stroke was significantly more frequent in the right-hemisphere in patients with elevated TnI and no ischaemic changes in the ECG. For patients with ACS Tn+ during stroke, the mortality within 30 days after stroke was significantly more frequent than for patients without ACS Tn+. The abnormal TnI level neurological status on the 1st day of stroke and age were independent mortality factors within 30 days following stroke. Elevated TnI concentration, hypertension and neurological status on the 1st day of stroke were independent factors for post-stroke disability. Conclusions: Elevated TnI concentration occurs in 1/10 of patients with acute ischaemic stroke. It is connected with an unfavourable course of stroke leading to a significant disability and less independence in their everyday functioning. The right hemisphere is the most common site of stroke accompanied by elevated concentration of troponin in patients with no ischaemic changes in the electrocardiogra...

Our study demonstrated a neutral impact of AF on the safety and efficacy of mechanical thrombectomy in the ultra-acute phase of stroke (≤ 6 hours from onset). Exposure to anticoagulant therapy preceding stroke does not significantly increase the risk of symptomatic intracranial bleeding after mechanical thrombectomy, which is also true for patients with INR in the therapeutic range. We identified the crucial parameters for the functional post-stroke status in AF-related stroke patients on days 10, 30 and 90 following mechanical thrombectomy. These parameters include age, the neurological status on the first day of stroke, and the result of post-interventional reperfusion (according to TICI scale).

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(1) Background: To report and analyze the presence of residual symptoms after SARS-CoV-2 infection among Polish patients with multiple sclerosis (MS) treated with different disease-modifying therapies (DMTs). (2) Methods: The study included 426 individuals with MS treated with DMTs and confirmed SARS-CoV-2 infection from 12 Polish MS centers. The data were collected through to 31 May 2021. The information included demographics, specific MS characteristics, course of SARS-CoV-2 infection, and residual (general and neurological) symptoms lasting more than four and 12 weeks after the initial infection. The results were obtained using maximum likelihood estimates for odds ratio and logistic regression. (3) Results: A total of 44.84% patients with MS reported symptoms lasting between four and 12 weeks after the initial infection; 24.41% people had symptoms that resolved up to 12 weeks, and 20.42% patients had symptoms that lasted over 12 weeks. The most common symptoms were: fatigue, disturbance of concentration, attention, and memory, cognitive complaints, and headache. None of the DMTs were predisposed to the development of residual symptoms after the initial infection. A total of 11.97% of patients had relapse three months prior or after SARS-CoV-2 infection. (4) Conclusion: Almost half of individuals with MS treated with different DMTs had residual symptoms after SARS-CoV-2 infection. None of the DMTs raised the probability of developing post-acute COVID symptoms.