scholarly journals Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity

2017 ◽  
Vol 7 (3) ◽  
pp. 130-139 ◽  
Author(s):  
Thomas Marian ◽  
Jens Burchard Schröder ◽  
Paul Muhle ◽  
Inga Claus ◽  
Axel Riecker ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Sensory Feedback ◽  
Muscular Contraction ◽  
Sensory Deficit ◽  
Sensory Loss ◽  
Stroke Patients ◽  
Middle Cerebral Artery Infarction ◽  
Sensory Deficits

Background: Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction. Methods: Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique. Results: PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD. Conclusions: This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.

scholarly journals A hemispheric comparison of cognitive dysfunction and sleep quality impairment in Middle Cerebral Artery infarction

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Danyal Wahid ◽  
Hifza Rabbani ◽  
Ayesha Inam ◽  
Zuba'a Akhtar
Keyword(s):  
Sleep Quality ◽  
Middle Cerebral Artery ◽  
Cognitive Dysfunction ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Stroke Patients ◽  
Middle Cerebral Artery Infarction ◽  
Significant Difference ◽  
Ischemic Infarct ◽  
Left And Right

Objectives: To investigate the severity of cognitive dysfunction and sleep quality impairment in patients with middle cerebral artery (MCA) strokes across the left and right hemisphere. Moreover, it also study gender differences with respect to MCA strokes. Methods: The study was conducted from February 2019 - May 2019 at COMSATS University, Islamabad. A total sample size of N=55 middle cerebral artery ischemic infarct patients was selected with N=29 left middle cerebral artery ischemic infarct patients and N=26 right middle cerebral artery ischemic infarct patients. The sample was assessed on The Neurocognitive Assessment Battery for stroke patients (N-CABS) & The Pittsburgh Sleep Quality Index-Urdu (PSQI-U). Results: The mean age of the sample was 50.96 years. There was a significant difference among scores of cognitive dysfunction between Left MCA (M=47.28, SD=12.87) and Right MCA stroke patients (M=29.7, S=21.41), t (53) =-6.80, p<0.001. Similarly, there was significant difference among scores of sleep disturbance between Left MCA (M=6.90, SD=2.93) and Right MCA (M=10.35, SD=3.97), t (53) =-3.68, p<0.001. Gender comparisons reveal that there is no significant difference between males and females for both, cognitive dysfunction and sleep quality impairment. Conclusions: Cognitive dysfunction and sleep quality impairment due to MCA strokes is significant between left and right hemispheres respectively, regardless of gender, assessed with N-CABS and PSQI-U. Further studies are required to analyse other demographic correlates related to MCA strokes. doi: https://doi.org/10.12669/pjms.36.3.1385 How to cite this:Wahid D, Rabbani H, Inam A, Akhtar Z. A hemispheric comparison of cognitive dysfunction and sleep quality impairment in Middle Cerebral Artery infarction. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1385 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Early and Sustained Increases in Leukotriene B4 Levels Are Associated with Poor Clinical Outcome in Ischemic Stroke Patients

2019 ◽  
Vol 17 (1) ◽  
pp. 282-293 ◽  
Author(s):  
Su Jing Chan ◽  
Mary P. E. Ng ◽  
Hui Zhao ◽  
Geelyn J. L. Ng ◽  
Chuan De Foo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Infarct Volume ◽  
Prognostic Significance ◽  
Leukotriene B4 ◽  
Stroke Patients ◽  
Middle Cerebral Artery Infarction ◽  
Post Stroke ◽  
Stroke Models

Abstract Leukotriene B4 (LTB4) has been implicated in ischemic stroke pathology. We examined the prognostic significance of LTB4 levels in patients with acute middle cerebral artery (MCA) infarction and their mechanisms in rat stroke models. In ischemic stroke patients with middle cerebral artery infarction, plasma LTB4 levels were found to increase rapidly, roughly doubling within 24 h when compared to initial post-stroke levels. Further analyses indicate that poor functional recovery is associated with early and more sustained increase in LTB4 rather than the peak levels. Results from studies using a rat embolic stroke model showed increased 5-lipoxygenase (5-LOX) expression in the ipsilateral infarcted cortex compared with sham control or respective contralateral regions at 24 h post-stroke with a concomitant increase in LTB4 levels. In addition, neutrophil influx was also observed in the infarcted cortex. Double immunostaining indicated that neutrophils express 5-LOX and leukotriene A4 hydrolase (LTA4H), highlighting the pivotal contributions of neutrophils as a source of LTB4. Importantly, rise in plasma LTB4 levels corresponded with an increase in LTB4 amount in the infarcted cortex, thereby supporting the use of plasma as a surrogate for brain LTB4 levels. Pre-stroke LTB4 loading increased brain infarct volume in tMCAO rats. Conversely, administration of the 5-LOX-activating protein (FLAP) inhibitor BAY-X1005 or B-leukotriene receptor (BLTR) antagonist LY255283 decreased the infarct volume by a similar extent. To conclude, targeted interruption of the LTB4 pathway might be a viable treatment strategy for acute ischemic stroke.

Abstract 58: Prediction of Malignant Edema Formation After Endovascular Treatment for Middle Cerebral Artery Infarction: The Added Value of Intracranial Cerebrospinal Fluid Volume

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Frans Kauw ◽  
Marie Louise E Bernsen ◽  
Hugo W de Jong ◽  
L. Jaap Kappelle ◽  
Birgitta K Velthuis ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Extended Model ◽  
Stroke Patients ◽  
Middle Cerebral Artery Infarction ◽  
Edema Formation ◽  
Contrast Ct

Introduction: Prediction models may guide decisions in the management of patients at risk for malignant middle cerebral artery infarction. The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a predictor of malignant edema in ischemic stroke patients treated with intravenous thrombolysis. The added predictive value in stroke patients who received endovascular treatment is unknown. Methods: Patients with available thin-slice non-contrast CT data on admission were selected from the MR CLEAN Registry, which is a prospective national multicenter registry of patients with large vessel occlusion who were treated with endovascular treatment between 2014 and 2017. Baseline characteristics and CT imaging data were collected. The CSF/ICV ratio was automatically measured on baseline thin-slice non-contrast CT. The primary outcome was the formation of malignant edema based on clinical and imaging features on follow-up. A previously built logistic regression model was fitted and included the following baseline predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, poor collateral filling and reperfusion. An extended model with the CSF/ICV ratio was compared to the previous model by using the likelihood ratio test. Odds ratios (OR), areas under the receiver operating characteristic curve (AUROC) and 95% confidence intervals (CI) were reported. Results: Of the included 683 patients 40 (6%) developed malignant edema. The CSF/ICV ratio of the group with malignant edema (mean 9±5%) was lower than the group without malignant edema (mean 14±6%, P<0.001). In the extended model, the CSF/ICV ratio was associated with the formation of malignant edema (per one percent decrease OR 1.2, 95% CI 1.1-1.3, P<0.001). In addition, the discriminative performance of the model with the CSF/ICV ratio (AUROC 0.87, 95% CI 0.82-0.91) was higher than that of the model without the CSF/ICV ratio (AUROC 0.84, 0.78-0.89, P<0.001). Conclusions: The CSF/ICV ratio improves the prediction of malignant edema formation in ischemic stroke patients who received endovascular treatment.

scholarly journals Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

2015 ◽  
Vol 36 (4) ◽  
pp. 743-754 ◽  
Author(s):  
Wieland H Sommer ◽  
Christine Bollwein ◽  
Kolja M Thierfelder ◽  
Alena Baumann ◽  
Hendrik Janssen ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Symptom Onset ◽  
Ct Perfusion ◽  
Clinical Factors ◽  
Middle Cerebral Artery Infarction ◽  
Whole Brain ◽  
Crossed Cerebellar Diaschisis ◽  
Brain Ct ◽  
Cerebellar Diaschisis

We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.

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