scholarly journals Predictive Validity of Severity Grading for Cerebral Steno-Occlusive Arteriopathy in Recurrent Childhood Ischemic Stroke

2014 ◽  
Vol 10 (2) ◽  
pp. 213-218 ◽  
Author(s):  
Sally M. Sultan ◽  
Lauren A. Beslow ◽  
Arastoo Vossough ◽  
Mitchell S. V. Elkind ◽  
Scott E. Kasner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Predictive Validity ◽  
Severity Grading ◽  
Occlusive Arteriopathy

Early carotid endarterectomy in patients with a nondisabling ischemic stroke: Results of a retrospective analysis

VASA ◽  
2004 ◽  
Vol 33 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Wölfle ◽  
Pfadenhauer ◽  
Bruijnen ◽  
Becker ◽  
Engelhardt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Endarterectomy ◽  
Daily Living ◽  
Operative Mortality ◽  
Postoperative Outcome ◽  
Minor Stroke ◽  
Stroke Severity ◽  
Severity Grading ◽  
A Minor ◽  
Median Interval

Background: There are several recent recommendations not to delay carotid endarterectomy (CEA) for at least 4 weeks in patients experiencing a nondisabling ischemic stroke. Therefore, we re-examined if these patients could be safely operated on earlier: The aim of our study was to review the perioperative stroke and death rates of CEA performed within 30 days of stroke onset. Patients and methods: During a 4 year period until December 2001, in 66 neurologically stable patients suffering a nondisabling stroke ipsilateral to a carotid artery stenosis > 50% CEA was performed after a median interval of 10 (1–28) days. The modified Rankin scale (mRS) was applied to characterize the severity of impairment of daily living activities pre- and postoperatively: Any postoperative deterioration > 24 hours on the mRS was considered as a new stroke. Results: Operative mortality was 0%, and postoperative neurologic worsening > 24 hours occurred in 8/66 patients (12,1%). In 5/8 patients neurologic deterioration resolved within 5 days after surgery, only one stroke was permanent (1,5%). There was no correlation between timing of surgery or the presence of acute ipsilateral cranial CT defects with the occurrence of postoperative stroke. Stroke severity grading on admission according to the mRS, however, emerged to be a significant determinant of postoperative outcome: While 6/23 patients (26%) with an initial deficit ≥ 3 on the mRS developed neurologic worsening, this was the case in only 2/43 patients (4,6%) with a deficit ≤ 2 (Odds Ratio 7.2; 95% CI 1.32–39.49; two-sided p = 0.01). Conclusion: Our results suggest that selected patients with a minor stroke (mRS ≤ 2 on admission) can safely undergo early CEA.

The value of plasma fibrillin-1 level in patients with spontaneous cerebral artery dissection

Neurology ◽  
2018 ◽  
Vol 90 (9) ◽  
pp. e732-e737 ◽  
Author(s):  
Zhu Zhu ◽  
Weijun Tang ◽  
Liang Ge ◽  
Xiang Han ◽  
Qiang Dong
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Acute Stage ◽  
Artery Dissection ◽  
Class Iii ◽  
Severity Grading ◽  
Fibrillin 1 ◽  
Stroke Group ◽  
Healthy Participants ◽  
Cerebral Artery Dissection

ObjectiveTo explore the value of plasma fibrillin-1 levels in patients with spontaneous cerebral artery dissection (sCeAD).MethodsA single-center prospective cohort of 99 consecutive patients with sCeAD between February 2013 and December 2015 were age and sex matched with 115 patients with non-sCeAD ischemic stroke and 20 healthy participants undergoing routine physical examination. The plasma fibrillin-1 level was measured with ELISA and compared among the 3 groups. The associations of fibrillin-1 with site, acuity, and severity of dissection, as well as clinical and radiographic prognosis of patients, were analyzed.ResultsOne hundred nine plasma samples from 99 patients with sCeAD, 115 from disease control patients, and 20 from healthy participants were collected. The plasma fibrillin-1 level of the dissection group (mean 85.56 ng/mL [95% confidence interval 81.53–89.59]) was higher than that of non-sCeAD ischemic stroke group (77.13 ng/mL [73.64–80.63], p = 0.015) or healthy controls (73.04 ng/mL [65.94–80.13], p = 0.029). Such differences were most prominent in the acute stage (97.64 ng/mL [91.64–103.64], 74.39 ng/mL [68.95–79.84], and 73.04 ng/mL [65.95–80.13], respectively). A cutoff value of 88.455 ng/mL was determined to differentiate acute dissection from nondissection stroke with a sensitivity of 0.778 and a specificity of 0.800. Higher fibrillin-1 level was detected in patients with more severe dissection radiographically (p < 0.001), while patients with lower fibrillin-1 concentration at baseline achieved better morphologic recovery on follow-up imaging tests (p = 0.003).ConclusionPlasma fibrillin-1 is a promising biomarker for aiding the diagnosis of acute sCeAD and may have potential value in lesion severity grading and radiographic prognosis prediction.Classification of evidenceThis study provides Class III evidence that patients with sCeAD have significantly higher levels of plasma fibrillin-1 than patients with ischemic stroke attributable to a cause other than sCeAD.

scholarly journals Familial Presentation of Intracranial Occlusive Arteriopathy and Ischemic Stroke in Patients with Graves’ Hyperthyroidism

2015 ◽  
Vol 11 (02) ◽  
pp. 89
Author(s):  
Priyank Khandelwal ◽  
Nirav Shah ◽  
Tannvi Prakash ◽  
Gustavo Ortiz ◽  
◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Stenosis ◽  
Graves Disease ◽  
Intracranial Arterial Stenosis ◽  
Ischemic Event ◽  
First Report ◽  
Mother And Daughter ◽  
Occlusive Arteriopathy

Background:The comorbidity of intracranial occlusive arteriopathy and Graves’ disease (GD) is increasingly being reported.Methods:We describe two patients (mother and daughter) with GD, intracranial occlusive arteriopathy, and ischemic strokes.Results:Both patients were thyrotoxic at the time of the ischemic event, and the intracranial arterial stenosis was progressive while in thyrotoxic state. In one of the cases, there was no further progression of the disease after 1 year of follow up, once hyperthyroidism was well controlled.Conclusion:To the best of our knowledge, this is the first report of familial presentation of moyamoya-like vasculopathy in patients with GD in Latin population.

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