Journal of Stroke & Cerebrovascular Diseases最新文献

Background: The presence of a large physiologic shunt, defined as >20 left atrial microbubbles within 3 cardiac cycles on transesophageal echocardiography (TEE), is a randomized trial-validated indication for patent foramen ovale (PFO) closure in patients with otherwise cryptogenic ischemic stroke. The frequency with which this information is available to treating physicians from clinical TEE reports has not been well-delineated.

Methods: Among consecutive ischemic stroke patients, clinical TEE report shunt size characterizations were abstracted and compared to transcranial Doppler (TCD) formal shunt grades in the same patients and to central Core Lab TEE quantified assessments.

Results: Among 77 patients, median age was 64 (IQR 56-73), and 33 (43%) female. On TEE, shunt presence was assessed by bubble study in 60 (78%), direct Doppler alone in 5 (7%), and neither in 12 (16%). Among bubble study patient, a right-to-left shunt (RLS) potentially due to PFO was present in 25 (42%). RLS severity was quantified on the clinical report in 4 (16%) patients and only with informal descriptive terms in 21 (84%) - "small/mild/trace" (13 cases), "moderate/medium" (6), and "large" (1). In the 19 patients also undergoing TCD, RLS severity was quantified in all clinical reports. Shunt severity agreement between clinical TEE reports and TCD quantification was 100% (3/3) for formally quantified TEE shunts but poor (3/15, 20%) for the15 TEE reports using informal descriptions. For presence of a large shunt, an indication for PFO closure, clinical TEE with informal descriptions and TCD were incongruent in 5/15 (33%) of patients.

Conclusions: Quantified, evidence-based ratings of PFO shunt severity were present in less than 1 of every 6 TEE reports, and unquantified, informal size estimates correlated poorly with TCD quantification of shunt severity. Patient management would be aided by inclusion of formal PFO shunt size quantification in all clinical stroke patient TEE reports.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a relatively uncommon but high mortality form of stroke that can result in long-lasting disability. A better understanding of key neuroinflammatory changes during the early phase (<72 hours) may provide potential avenues of treatment.

Methods: In an attempt to understand these early changes, we recruited 7 aSAH patients for profiling of longitudinal plasma and cerebrospinal fluid (CSF) proteins at up to 72 hours post injury. We additionally compared this to control plasma obtained previously from healthy elderly volunteers. Using the Alamar Biosciences NULISAseq platform, we obtained a comprehensive picture of early peripheral and central inflammatory changes after injury.

Results: This study demonstrated very early plasma changes across 107 inflammatory proteins, 22 of which showed significant correlations between plasma and CSF. Of these, CXCL12, IL-15, and SAA1 are detectably elevated <24 hours in plasma, significantly correlated with CSF levels, and altered as a function of aSAH progression over time during this early phase.

Conclusion: This study demonstrates the feasibility of measuring a large number of inflammatory proteins in CSF and plasma from aSAH patients soon after injury. Despite the small sample size and limitations of the control group, we identified several previously reported "hits" that may offer prognostic utility and/or therapeutic potential for aSAH patients: CXCL12, IL-15, and SAA1.

Background: Mucosal-associated invariant T (MAIT) cells are innate-like T cells that rapidly produce cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-17 (IL-17) upon activation. The immune response is crucial in stroke-related injury. However, few studies have investigated the role of MAIT cells in ischemic brain injury. This study assessed the predictive value of circulating MAIT cells in acute ischemic stroke (AIS) and early neurological deterioration (END).

Methods: We prospectively and continuously enrolled AIS patients within 72 h of stroke onset and included controls. END was defined as a ≥2-point increase in the National Institutes of Health Stroke Scale score within the first 72 h. Receiver operating characteristic curves were used to evaluate the predictive value of MAIT cells for END.

Results: This study included 188 AIS patients and 135 controls, with 50 (26.6%) AIS patients experiencing END. After adjusting for all potential confounders, circulating MAIT cell frequencies were lower in AIS patients than in controls (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.70-0.97, P = 0.02). IL-17 and TNF-α levels were significantly higher in AIS patients and negatively correlated with MAIT cell frequencies (R = -0.26, P < 0.05; R = -0.19, P < 0.05). Multivariate logistic regression analysis revealed that MAIT cell frequencies were lower in patients with END compared to those without END (OR: 0.74, 95% CI: 0.55-0.96, P = 0.03). The area under the curve for MAIT cells in END prediction was 0.641 (95% CI: 0.548-0.725, P < 0.05).

Conclusions: MAIT cell frequency was reduced in AIS patients and may serve as a predictive marker for END. Modulating these cells could be a novel AIS treatment strategy.