Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction

ElSadek, Ahmed; Gaber, Ahmed; Afifi, Hossam; Farag, Sherin; Salaheldien, Nouran

doi:10.1186/s41983-018-0045-8

Cited by 10 publications

(4 citation statements)

References 10 publications

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“…Employing multivariable analysis, we identified watershed infarction as the most prominent and significant risk factor for PSE within our cohort. Two mechanisms are considered to be involved in watershed infarction: low-flow and micro-embolism (39). Clinical data indicate that outcomes of watershed strokes caused by these etiologies may differ in their clinical manifestations and prognosis (21).…”

Section: Discussionmentioning

confidence: 99%

Post-stroke seizures, epilepsy, and mortality in a prospective hospital-based study

Freiman,

Hauser,

Rider

et al. 2023

Front. Neurol.

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Background and objectivesPost-stroke epilepsy (PSE) is a significant concern in the elderly population, with stroke being a leading cause of epilepsy in this demographic. Several factors have shown consistent associations with the risk of developing PSE, including cortical lesions, initial stroke severity, younger age, and the occurrence of early seizures. The primary objectives of this study were two-fold: (1) to determine the incidence of PSE and (2) to identify the risk factors associated with PSE in a prospective cohort of post-stroke patients.MethodsA prospective single-hospital study was conducted, involving patients diagnosed with acute ischemic and hemorrhagic stroke. The patients were followed up for 2 years (or until death) from the time of admission. Data about seizure occurrence and recurrent stroke were collected. Kaplan–Meyer curves were used for the assessment of PSE incidence and mortality. Possible predictors of PSE and mortality were selected from between-group analysis and tested in multivariable regressions.ResultsOur study enrolled a total of 424 patients diagnosed with acute stroke. Among them, 97 cases (23%) experienced early post-stroke seizures, and 28 patients (6.6%) developed PSE. The cumulative risks of developing PSE were found to be 15.4% after hemorrhagic stroke and 8.7% after ischemic stroke. In multivariable fine and gray regression with competitive risk of death, significant predictors for developing PSE in the ischemic cohort were watershed infarction (HR 6.01, 95% CI 2.29–15.77, p < 0.001) and low Barthel index at discharge (HR 0.98, CI 0.96–0.99, p = 0.04). Furthermore, patients who eventually developed PSE showed slower recovery and presented a worse neurologic status at the time of discharge. The in-hospital dynamics of the National Institutes of Health Stroke Scale (NIHSS) were significantly worse in the PSE group compared to the non-PSE group (p = 0.01).DiscussionA higher proportion of cases experienced early seizures compared to what has been commonly reported in similar studies. Watershed stroke and low Barthel index at discharge were both identified as independent risk factors of PSE in ischemic strokes, which sheds light on the underlying mechanisms that may predispose individuals to post-stroke epilepsy after experiencing an ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Post-stroke seizures, epilepsy, and mortality in a prospective hospital-based study

Freiman,

Hauser,

Rider

et al. 2023

Front. Neurol.

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“…However, an MR examination revealed border zone ischemic lesions in the right hemisphere. An ischemic stroke bordering on various areas of vascularity usually occurs in the course of hypotonia, possibly as a result of narrowing of the cerebral artery [ 17 , 18 ]. On admission to hospital, the patient had low blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Ischemic stroke as a rare complication of wasp venom allergy: two clinical scenarios

Nittner-Marszalska¹,

Gurański²,

Bladowska³

et al. 2022

cejoi

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Neurological complications after a single Hymenoptera insect sting are very rare. The authors of this paper describe two instances of cerebral ischemic stroke that occurred immediately after a wasp sting. Two distinct pathomechanisms involved in the cases are put forward. When diagnosing such cases, it is vital to rule out the possibility of an immunoglobulin E (IgE)-dependent reaction of hypersensitivity. However, if sIgE antibodies against wasp venom extract and/or its allergenic components are detected, after hospitalization the patient should be qualified for venom immunotherapy, which is the only efficient method of protection from severe allergic reactions caused by an insect sting. Although the incidence of ischemic stroke in patients stung by insects is very low, it is important to be aware of this complication. This will allow rapid implementation of appropriate diagnostics and treatment. The optimal stroke treatment (thrombolysis or mechanical thrombectomy) in these rare cases has not yet been established.

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“…External or cortical border zone strokes (CBZ) are due to microemboli, sometimes associated with cerebral hypoperfusion [ 10 ]. They are localized between the ACA/MCA and MCA/PCA distribution territories [ 11 ].…”

Section: Anatomy Of Border Zone Infarctsmentioning

confidence: 99%

Diagnosis and treatment of Watershed strokes: a narrative review

Dogariu,

Vasile

et al. 2023

JMedLife

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Watershed strokes have been described previously as ischemic strokes located in vulnerable border zones between brain tissue supplied by the anterior, posterior, and middle cerebral arteries in the distal junction between two non-anastomotic arterial territories. Ischemic strokes in border zones are well-recognized entities and well-described in terms of imaging features, but the pathophysiological mechanism of brain injury production is not fully defined. Border zone ischemia is caused by cerebral hypoperfusion through decreased cerebral blood flow and arterial embolism in unstable atheroma plaque. It is often difficult to say which mechanisms are fully responsible for producing cerebral ischemic lesions. This review aimed to highlight the imaging aspect of watershed strokes and to correlate the clinical characteristics of this type of stroke with the diagnostic algorithm for optimal therapeutic management. Neurologists should promptly recognize this type of stroke and investigate its etiology in the shortest possible time.

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Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction

Cited by 10 publications

References 10 publications

Post-stroke seizures, epilepsy, and mortality in a prospective hospital-based study

Post-stroke seizures, epilepsy, and mortality in a prospective hospital-based study

Ischemic stroke as a rare complication of wasp venom allergy: two clinical scenarios

Diagnosis and treatment of Watershed strokes: a narrative review

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