Early neurological worsening in acute ischaemic stroke patients

Nacu, Aliona; Bringeland, Gerd Haga; Khanevski, Andrej Netland; Thomassen, Lars; Waje‐Andreassen, Ulrike; Næss, Halvor

doi:10.1111/ane.12418

Cited by 29 publications

(21 citation statements)

References 16 publications

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“…Marked worsening in neurological outcome after the initial ischemic event occurs in 8–38% of stroke patients [54, 55]. This has been associated with insufficient collateral-dependent flow, early reocclusion, reduced body temperature, clot progression, and other metabolic factors and comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Cerebral Collateral Circulation

Faber

Moore

Lucitti³

et al. 2016

Transl. Stroke Res.

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Premenopausal women and intact female rodents sustain smaller cerebral infarctions than males. Several sex-dependent differences have been identified as potential contributors, but many questions remain unanswered. Mice exhibit wide variation in native collateral number and diameter (collateral extent) that is dependent on differences in genetic background, aging, and other comorbidities and that contributes to their also-wide differences in infarct volume. Likewise, variation in infarct volume correlates with differences in collateral-dependent blood flow in patients with acute ischemic stroke. We examined whether extent of pial collateral arterioles and posterior communicating collateral arteries (PComAs) differ depending on sex in young, aged, obese, hypertensive, and genetically different mice. We combined new data with meta-analysis of our previously published data. Females of C57BL/6J (B6) and BALB/cByJ (BC) strains sustained smaller infarctions than males after permanent MCA occlusion. This protection was unchanged in BC mice after introgression of the B6 allele of Dce1, the major genetic determinant of variation in pial collaterals among mouse strains. Consistent with this, collateral extent in these and other strains did not differ with sex. Extent of PComAs and primary cerebral arteries also did not vary with sex. No dimorphism was evident for loss of pial collateral number and/or diameter (collateral rarefaction) caused by aging, obesity, and hypertension, nor for collateral remodeling after pMCAO. However, rarefaction was greater in females with long-standing hypertension. We conclude that smaller infarct volume in female mice is not due to greater collateral extent, greater remodeling, or less rarefaction caused by aging, obesity, or hypertension.

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Section: Discussionmentioning

confidence: 99%

Sex Differences in the Cerebral Collateral Circulation

Faber

Moore

Lucitti³

et al. 2016

Transl. Stroke Res.

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“…Neurological deterioration (ND) is among the predictors of poor outcome in patients with acute ischemic stroke [1][2][3]. Several factors have been reported to be associated with ND in this patient population, such as age, diabetes mellitus, high blood pressure, disease severity, and inflammatory changes (such as C-reactive protein levels) [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke

et al. 2018

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Autonomic dysfunction is one of the predictors of poor outcome in patients with acute ischemic stroke. We compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). We enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND.

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“…END is an important problem in AIS because it is correlated with longer hospitalization and poor prognosis [18][19][20] . Although several serum biomarkers [21][22][23][24] , vascular factors [25][26][27][28][29] and neuroimaging parameters [30,31] have been reported to be potential predictors of END, persistent large artery occlusion has been recognized as a major independent risk factor for END. However, many patients with severe large artery stenosis or occlusion have neither a large infarction nor END because of good collateral circulation, and they may not have significant hypoperfusion.…”

Section: Discussionmentioning

confidence: 99%

Asymmetrical Cortical Vein Sign Predicts Early Neurological Deterioration in Acute Ischemic Stroke Patients with Severe Intracranial Arterial Stenosis or Occlusion

Xiao

Luo

et al. 2020

Preprint

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Background: Susceptibility weighted imaging (SWI) provides a rough assessment of tissue perfusion with the prominent hypointense cortical veins in the ischemic territory due to increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO).Results: One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) increasement≧2 points despite standard treatment in the first 72h after admission. APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P=0.001). Patient with APCVS were more likely to have END (40.0%, vs. 12.2%, P=0.001), in comparation with those without END. Multivariate logistic regression indicated that APCVS (OR=4.349, 95% C.I.=1.580-11.970, P=0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume.Conclusions: In acute ischemic stroke patients with SIASO, APCVS might be a useful neuroimaging marker for predicting END, suggesting the importance of evaluation of perfusion status.

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Early neurological worsening in acute ischaemic stroke patients

Cited by 29 publications

References 16 publications

Sex Differences in the Cerebral Collateral Circulation

Sex Differences in the Cerebral Collateral Circulation

Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke

Asymmetrical Cortical Vein Sign Predicts Early Neurological Deterioration in Acute Ischemic Stroke Patients with Severe Intracranial Arterial Stenosis or Occlusion

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