The Hemispheric Cerebrovascular Response to Hemodilution Is Attenuated by a Focal Cryogenic Brain Injury

Todd, Michael M.; Wu, Bei; Warner, David S.

doi:10.1089/neu.1994.11.149

Cited by 23 publications

(11 citation statements)

References 46 publications

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“…In addition, animal studies provide evidence that anemic hypoxia may exacerbate primary neurological injury [24,25]. Although the concept of an ischemic penumbra in hemorrhagic stroke has increasingly been challenged [26,27], new hypotheses claim the presence of a metabolic penumbra [28,29].…”

Section: Discussionmentioning

confidence: 99%

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

et al. 2010

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IntroductionThe impact of anemia on functional outcome and mortality in patients suffering from non-traumatic intracerebral hemorrhage (ICH) has not been investigated. Here, we assessed the relationship between hemoglobin (HB) levels and clinical outcome after ICH.MethodsOne hundred and ninety six patients suffering from supratentorial, non-traumatic ICH were extracted from our local stroke database (June 2004 to June 2006). Clinical and radiologic computed tomography data, HB levels on admission, mean HB values and nadir during hospital stay were recorded. Outcome was assessed at discharge and 3 months using the modified Rankin score (mRS).ResultsForty six (23.5%) patients achieved a favorable functional outcome (mRS ≤ 3) and 150 (76.5%) had poor outcome (mRS 4 - 6) at discharge. Patients with poor functional outcome had a lower mean HB (12.3 versus 13.7 g/dl, P < 0.001) and nadir HB (11.5 versus 13.0 g/dl, P < 0.001). Ten patients (5.1%) received red blood cell (RBC) transfusions. In a multivariate logistic regression model, the mean HB was an independent predictor for poor functional outcome at three months (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P = 0.007), along with National Institute of Health Stroke Scale (NIHSS) at admission (OR 1.17, 95% CI 1.11 - 1.24, P < 0.001), and age (OR 1.08, 95% CI 1.04 - 1.12, P < 0.001).ConclusionsWe report an association between low HB and poor outcome in patients with non-traumatic, supratentorial ICH. While a causal relationship could not be proven, previous experimental studies and studies in brain injured patients provide evidence for detrimental effects of anemia on brain metabolism. However, the potential risk of anemia must be balanced against the risk of harm from red blood cell infusion.

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Section: Discussionmentioning

confidence: 99%

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

et al. 2010

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“…32 Experimental animal studies have indicated that anemic hypoxia may intensify primary neurologic injury. 33 to 1559/2029 (76.8%) anemic, and after adjusting for potential confounders. In the same study, it was demonstrated that improving anemia may improve the outcome in this patient population.…”

Section: Treatmentmentioning

confidence: 99%

Anemia and stroke: Where do we stand?

et al. 2016

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Anemia seems to have a clear relationship with cerebrovascular events (CVEs), as there is a direct connection between central nervous system, blood supply, and tissue oxygen delivery. Anemia is considered a hyperkinetic state which disturbs endothelial adhesion molecule genes that may lead to thrombus formation. Furthermore, blood flow augmentation and turbulence may result in the migration of this thrombus, thus producing artery-to-artery embolism. It is for this reason that anemia is characterized as "the fifth cardiovascular risk factor." Anemia is consistently present in patients with acute stroke, ranging from 15% to 29%, while the mortality rate was significantly higher in patients suffering from anemia at the time of admission. Different types of anemia (sickle cell disease, beta thalassemia, iron deficiency anemia [IDA]) have been associated with increased cardiovascular and CVE risk. The relation between hemoglobin level and stroke would require further investigation. Unfortunately, treatment of anemia in cardiovascular and cerebrovascular disease still lacks clear targets and specific therapy has not developed. However, packed red blood cell transfusion is generally reserved for therapy in patients with CVEs. What is more, treatment of IDA prevents thrombosis and the occurrence of stroke; although iron levels should be checked, chronic administration favors thrombosis. Regarding erythropoietin (EPO), as there is lack of studies in anemic stroke patients, it would be desirable to utilize both neuroprotective and hematopoietic properties of EPO in anemic stroke patients. This review aims to clarify the poorly investigated and defined issues concerning the relation of anemia and CVEs.

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“…Oxygen demand of penumbral tissue and oligemic areas cannot be met and as a result, penumbral infarct develops, and poor clinical outcome and mortality rate will increase [23]. Consistently, animal studies also confirm the fact that anemic hypoxia aggravates primary neurologic injury [24,25]. However, in clinical practice, either the optimal Hb or Htc value to provide the penumbral area for increased oxygen demand or minimum tolerable Hb level in anemic AIS patients are not clear yet.…”

Section: Discussionmentioning

confidence: 90%

Moderate to Severe Anemia Is Associated with Poor Functional Outcome in Acute Stroke Patients Treated with Mechanical Thrombectomy

2017

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Background: Anemia will negatively affect cerebral collaterals and penumbra. Eventually, it may cause worse clinical outcomes and even increase mortality rates in stroke patients. Anemia has recently been suggested to be an independent risk factor for ischemic stroke. Therefore, we aimed to investigate the effects of the presence of anemia on clinical outcomes in ischemic stroke patients undergoing mechanical thrombectomy. Methods: This was a retrospective study involving the prospectively and consecutively collected data of 90 adult patients between January 2015 and August 2016. Hemoglobin (Hb) cutoff levels were accepted as 12 g/dL for women and 13 g/dL for men. Patients having anemia were further divided into three subgroups as severe anemia (Hb <8 g/dL for both genders), moderate anemia (Hb <10 g/dL for both genders), and mild anemia (Hb <13 g/dL for men and Hb <12 g/dL for women). Results: Forty of the subjects (44.4%) had anemia. Moderate anemia was detected in 14 out of 90 patients (15.5%) and severe anemia was found in only four of them (4.4%). Poor functional outcome (mRS 3-6) was similar in both anemic and non-anemic patients (37.5% vs. 38%, respectively, p = 0.08), but poor functional outcome was found to be statistically significant with severe anemic group (Hb <8 mg/dL) (p = 0.003). In multiple logistic regression analysis, moderate and severe anemia has been found to increase the mortality (p = 0.032). Conclusions: Our study demonstrated a poor functional outcome only in moderate to severe anemic patients. Clinicians should keep in mind the negative effect of moderate to severe anemia in the clinical course of acute stroke patients treated with mechanical thrombectomy.

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The Hemispheric Cerebrovascular Response to Hemodilution Is Attenuated by a Focal Cryogenic Brain Injury

Cited by 23 publications

References 46 publications

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

Anemia and stroke: Where do we stand?

Moderate to Severe Anemia Is Associated with Poor Functional Outcome in Acute Stroke Patients Treated with Mechanical Thrombectomy

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