Post-stroke inflammatory response is linked to volume loss in the contralateral hemisphere

Okar, Serhat; Topçuoğlu, Mehmet Akif; Yemişçi, Müge; Aktas, Canan Cakir; Oğuz, Kader K.; Arsava, Ethem Murat

doi:10.1016/j.jneuroim.2020.577247

Cited by 7 publications

(9 citation statements)

References 42 publications

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“…Regional changes in the brain volume after stroke have been found with declines in the volumes of the hippocampus and thalamus reported in the first 3 months after stroke (4). One recent study focusing on early atrophy, found a decrease in contralateral brain volume in a cohort of 50 patients of 14 ml after a mean of 3 months (18). We found a decrease in global volume of a larger magnitude occurring already within the first month after stroke.…”

Section: Discussionsupporting

confidence: 65%

“…(14) We rated basal ganglia, centrum semiovale, and midbrain EPVS. Basal ganglia and centrum semiovale EPVSs were rated 0 (none), 1 (1-10), 2 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 3 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), and 4 (>40), and midbrain EPVSs were rated 0 (none visible) or 1 (visible). At the midbrain, basal ganglia and centrum semiovale levels, we counted EPVSs on both sides and summed the EPVS scores of each level.…”

Section: Imagingmentioning

confidence: 99%

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Early Brain Volume Changes After Stroke: Subgroup Analysis From the AXIS-2 Trial

Чурилов

Khlif

et al. 2022

Front. Neurol.

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Background and PurposeThe evolution of total brain volume early after stroke is not well understood. We investigated the associations between age and imaging features and brain volume change in the first month after stroke.MethodsWe retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial. Total brain volume change from hyperacute MRI data to the first month after stroke was assessed using unified segmentation in SPM12. We hypothesized that age, ischemic brain lesion size, and white matter (WM) changes were associated with larger brain volume change. Enlarged perivascular spaces (EPVSs) and white matter hyperintensities (WMHs) were rated visually and the presence of lacunes was assessed.ResultsWe enrolled 173 patients with a mean age of 67 ± 11 years, 44% were women. There was a median 6 ml decrease in volume (25th percentile −1 ml to 75th percentile 21 ml) over time, equivalent to a median 0.5% (interquartile range [IQR], −0.07%−1.4%), decrease in brain volume. Age was associated with larger brain volume loss (per 10 years of age, 5 ml 95% CI 2–8 ml). Baseline diffusion weighted imaging (DWI) lesion volume was not associated with greater volume loss per 10 ml of lesion volume, change by 0 ml (95% CI −0.1 to 0.1 ml). Increasing Fazekas scores of deep WMH were associated with greater tissue loss (5 ml, 95% CI 1–10 ml).ConclusionsTotal brain volume changes in a heterogenous fashion after stroke. Volume loss occurs over 1 month after stroke and is associated with age and deep WM disease. We did not find evidence that more severe strokes lead to increased early tissue loss.

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Section: Discussionsupporting

confidence: 65%

Section: Imagingmentioning

confidence: 99%

Early Brain Volume Changes After Stroke: Subgroup Analysis From the AXIS-2 Trial

Чурилов

Khlif

et al. 2022

Front. Neurol.

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“…Stroke is the third leading cause of death globally, and ∼80% of all strokes are ischemic strokes, which occur when brain cells die of reduced blood supply to various parts of the brain (1)(2)(3). Within minutes after the onset of stroke, immune processes are activated by ischemic cascades, from intravascular events triggered by the occlusion and moving of vessels to brain parenchymal inflammatory responses, leading to tissue damage and repair (4)(5)(6)(7)(8)(9)(10). The pathophysiological features of ischemic stroke, such as the production of reactive oxygen species (ROS) (11), the release of ATP and UTP by dying cells (12), and the loss of beneficial nitric oxide (NO) in states of oxidative stress (13), can trigger the activation of a neuroinflammatory response (14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Monocyte Transmodulation: The Next Novel Therapeutic Approach in Overcoming Ischemic Stroke?

et al. 2020

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The immune response following neuroinflammation is a vital element of ischemic stroke pathophysiology. After the onset of ischemic stroke, a specialized vasculature system that effectively protects central nervous system tissues from the invasion of blood cells and other macromolecules is broken down within minutes, thereby triggering the inflammation cascade, including the infiltration of peripheral blood leukocytes. In this series of processes, blood-derived monocytes have a significant effect on the outcome of ischemic stroke through neuroinflammatory responses. As neuroinflammation is a necessary and pivotal component of the reparative process after ischemic stroke, understanding the role of infiltrating monocytes in the modulation of inflammatory responses may offer a great opportunity to explore new therapies for ischemic stroke. In this review, we discuss and highlight the function and involvement of monocytes in the brain after ischemic injury, as well as their impact on tissue damage and repair.

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“…In recent years, a considerable amount of literature has been published on the predictive role of the NLR in PSI, particularly PSP [ 4 , 9 – 32 ]. In fact, the elevated NLR has been postulated to signal an aberrant inflammatory state predisposing to further complications [ 33 ]. As studies continue to emerge regarding this important topic, the need for a systematic review to guide clinical decision making is apparent.…”

Section: Introductionmentioning

confidence: 99%

The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis

et al. 2022

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Ischemic and hemorrhagic strokes have multiple downstream consequences for patients. One of the most critical is poststroke infection (PSI). The goal of this systematic review and meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) as a reliable means to detect early PSI development, particularly poststroke pneumonia (PSP) development to help clinicians institute early interventions and improve outcomes. The following were the inclusion criteria: (1) cross-sectional, case-control, and cohort studies; (2) studies comparing NLR data from PSI or PSP patients to controls; and (3) studies with a control group of stroke patients without infection. There was not any language or publication preference. The Newcastle-Ottawa Scale was used by two writers to assess the quality of the included studies. We assessed the certainty of the associations with GRADE methods. Web of Science, PubMed, and Scopus were searched, and 25 studies were included in the qualitative review. Among them, 15 studies were included in the meta-analysis. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Patients with PSI had significantly higher NLR levels than stroke patients without infection ( SMD = 1.08 ; CI 95 % = 0.78 ‐ 1.39 , P value < 0.001). In addition, the NLR levels of the stroke patients with pneumonia were significantly higher than those without pneumonia ( SMD = 0.98 ; CI 95 % = 0.81 ‐ 1.14 , P value < 0.001). However, data extracted from the qualitative review suggested that NLR could not predict urinary tract infection, sepsis, or ventriculitis in stroke patients. Our study indicated that NLR could be recommended as an inexpensive biomarker for predicting infection, particularly pneumonia, in stroke patients. It can help clinicians institute early interventions that can reduce PSI and improve outcomes.

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Post-stroke inflammatory response is linked to volume loss in the contralateral hemisphere

Cited by 7 publications

References 42 publications

Early Brain Volume Changes After Stroke: Subgroup Analysis From the AXIS-2 Trial

Early Brain Volume Changes After Stroke: Subgroup Analysis From the AXIS-2 Trial

Monocyte Transmodulation: The Next Novel Therapeutic Approach in Overcoming Ischemic Stroke?

The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis

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