High risk of early neurological worsening of lacunar infarction

Næss, Halvor; Thomassen, Lars; Waje‐Andreassen, Ulrike; Glad, S.; Kvistad, Christopher Elnan

doi:10.1111/ane.13029

Cited by 4 publications

(4 citation statements)

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“…Gap infarction is the most common type of cerebral infarction in diabetic patients and is one of the main causes of death[ 19 ]. Lacunar cerebral infarction occurs in the deep part of the cerebral hemisphere or the small perforating artery of the brain stem[ 20 ]. With long-term hypertension, vascular wall lesions occur, resulting in lumen occlusion and the formation of cystic lesions 0.2-15 mm in diameter; this diameter is slightly larger than the vascular diameter, thereby causing embolism, which is common in the elderly and especially in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction

Yu¹,

Wang²,

Zhu³

et al. 2021

WJD

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BACKGROUND The main pathological factor of cerebral infarction is atherosclerosis, which is the pathological process of chronic inflammatory diseases such as vascular smooth muscle hyperplasia, inflammatory cell infiltration, extracellular matrix increase, and thrombosis. At present, the focus of clinical treatment is anti-platelet aggregation and improving blood status, and current research is limited to improving symptoms only. AIM To observe the effect of sodium ozagrel and atorvastatin on type 2 diabetes patients with lacunar cerebral infarction. METHODS Eighty-two patients with type 2 diabetes and lacunar cerebral infarction admitted to our hospital from January 2018 to February 2020 were equally categorized into two groups according to their treatment method. The control group was administered atorvastatin, and the observation group was administered sodium ozagrel combined with atorvastatin. The National Institutes of Health stroke scale (NIHSS) score, activities of daily living (ADL) score, blood glucose, lipid levels, inflammatory factors, high-mobility group box 1 (HMGB1) levels, paraoxonase-1 (PON-1) levels, erythrocyte sedimentation rate (ESR), and macrophage migration inhibitory factor (MIF) levels were recorded before and after treatment. The total effective rate and adverse reaction rate of the two groups were analyzed. RESULTS The total effective rate of the observation group (94.00%) was significantly higher than that of the control group (80.00%) ( χ 2 = 3.998; P = 0.046). The blood glucose indexes, total cholesterol levels, triglyceride levels, low-density lipoprotein cholesterol levels, high-sensitivity C-reactive protein levels, interleukin-1β levels, tumor necrosis factor-α levels, HMGB1 Levels, ESR, MIF levels, platelet aggregation rates, and plasma viscosity of the two groups decreased after treatment; however, high-density lipoprotein cholesterol and PON-1 Levels increased after treatment. After treatment, the blood glucose indexes; blood lipid indexes; inflammatory factors; HMGB1, PON-1, and MIF levels; ESR; platelet aggregation rate; and plasma viscosity of the observation group were better than those of the control group ( P < 0.05). After treatment, all patients in the observation group had higher ADL scores and lower NIHSS scores than those in the control group ( P < 0.05). CONCLUSION Sodium ozagrel with atorvastatin can reduce inflammatory reactions; regulate ESR and HMGB1, PON-1, and MIF levels; control blood glucose and lipid indexes; and alleviate nerve injury without increasing adverse effects of atorvastatin alone.

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Section: Discussionmentioning

confidence: 99%

Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction

Yu¹,

Wang²,

Zhu³

et al. 2021

WJD

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“…Although it has been suggested that low body temperature is therapeutic, as it slows down the cerebral artery flow velocity leading to low perfusion pressure (7), this, in turn, may increase blood viscosity, promote erythrocyte aggregation and platelet microemboli, activate leukocytes, and reduce microcirculatory blood flow (8), ultimately resulting in arterial infarction. This notion is supported by several reports, including that of Naess et al, who have reported that low body temperature is associated with neurological worsening in patients with lacunar infarction (9). Similarly, Kvistad et al reported that hypothermia within 6 h of symptom onset is associated with more severe neurological damage in the early phase of stroke (10).…”

Section: Introductionmentioning

confidence: 69%

Lower Body Temperature Independently Predicts Delayed Cerebral Infarction in the Elderly With Ruptured Intracranial Aneurysm

Lin

Wang

et al. 2022

Front. Neurol.

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Purpose: To assess the correlation between admission body temperature and delayed cerebral infarction in elderly patients with ruptured intracranial aneurysm (IA).Methods: Patients with ruptured IA diagnosed between 2012 and 2020 were retrospectively analyzed. Patients were divided into a non-infarction and an infarction group based on the presence of cerebral infarction after treatment. The demographic and clinical information of the patients was gathered. Outcomes at the 3-month follow-up were assessed using the modified Rankin Scale. Correlation between admission body temperature and cerebral infarction was assessed using Spearman's rank correlation coefficient. A receiver operating characteristic (ROC) curve was used to assess the specificity and sensitivity of admission body temperature to predict cerebral infarction.Results: A total of 426 patients (142 men and 284 women) with ruptured IA were enrolled. Elderly patients with cerebral infarction (12.4%) had a lower body temperature at admission (p < 0.001), higher prevalence of hypertension and diabetes (p = 0.051 and p = 0.092, respectively), and higher rate of poor outcomes (p < 0.001). Admission body temperature was independently associated with cerebral infarction (odds ratio [OR] = 5.469, p < 0.001); however, hypertension (OR = 0.542, p = 0.056), diabetes (OR = 0.750, p = 0.465), and aneurysm size (OR = 0.959, p = 0.060) showed no association. An inverse correlation between admission body temperature and the incidence of cerebral infarction was observed (Spearman's r =−0.195, p < 0.001). An admission body temperature of 36.6°C was able to distinguish infarction and non-infarction patients. The area under the ROC curve was 0.669 (specificity, 64.15%; sensitivity, 81.50%; p < 0.001).Conclusions: Lower body temperature at admission (≤36.6°C) is an independent predictor of delayed cerebral infarction in elderly patients who have undergone treatment for ruptured IA. Therefore, it could be a risk factor for adverse outcomes of IA.

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“…Other reports support this view. One study reported that hypothermia upon hospital admission was associated with early neurological deterioration in patients with lacunar infarction 36 . Another study reported that hypothermia within 6 h of onset was associated with severe neurological dysfunction in the early stages of cerebral infarction 37 .…”

Section: Discussionmentioning

confidence: 99%

Hypothermia on the first day of ICU admission leads to increased in-hospital mortality in patients with subarachnoid hemorrhage

Du,

Yang,

Lou

et al. 2024

Sci Rep

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The relationship between early spontaneous hypothermia and adverse clinical outcomes in patients with subarachnoid hemorrhage (SAH) has not been paid much attention. We designed this retrospective cohort study to determine this relationship by analyzing the association between the lowest body temperature (T-lowest) on the first day of ICU admission and in-hospital mortality. In this study, 550 participants with non-traumatic SAH were chosen from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Multivariate Cox regression analysis showed that T-lowest was nonlinearity correlated with in-hospital mortality (HR = 0.72, 95% CI: 0.59–0.86, p < 0.001). We divided the T-lowest into quartile groups. In comparison to reference group Q1 (31.30–36.06 ℃), group Q3 (36.56–36.72 ℃) had a 50% lower risk of death in the hospital (HR: 0.5, 95% CI: 0.28–0.87, p = 0.014). We further confirmed the curve-like relationship between T-lowest and in-hospital mortality using restricted cubic splines. The mortality is lowest when the T-lowest is close to 36.5 °C, and the risk of death is increased when the temperature is lower or higher than that. Our study demonstrates that in-hospital mortality is associated with T-lowest. Patients with non-traumatic SAH are at increased risk of death if their body temperature on the first day of ICU admission is too low.

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High risk of early neurological worsening of lacunar infarction

Abstract: Lacunar infarctions with minor neurological deficits within 3 hours of stroke onset are at high risk of neurological worsening especially if concomitant low body temperature and leukoaraiosis.

Cited by 4 publications

References 20 publications

Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction

Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction

Lower Body Temperature Independently Predicts Delayed Cerebral Infarction in the Elderly With Ruptured Intracranial Aneurysm

Hypothermia on the first day of ICU admission leads to increased in-hospital mortality in patients with subarachnoid hemorrhage

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