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Silent cerebral ischemia

Giovanni B Forleo Md PhD, Domenico G Della Rocca Md, Carlo Lavalle Md, Massimo Mantica Md, Lida P Papavasileiou Md, Valentina Ribatti Md, Germana Panattoni Md, Luca Santini Md PhD, Andrea Natale Md PhD, Luigi Di Biase Md PhD
Silent brain lesions due to thrombogenicity of the procedure represent recognized side effects of atrial fibrillation (AF) catheter ablation. Embolic risk is higher if anticoagulation is inadequate and recent studies suggest that uninterrupted anticoagulation, ACT levels above 300 seconds and administration of a pre-transeptal bolus of heparin might significantly reduce the incidence of silent cerebral ischemia (SCI) to 2%. Asymptomatic new lesions during AF ablation should suggest worse neuropsychological outcome as a result of the association between silent cerebral infarcts and increased long-term risk of dementia in non-ablated AF patients...
February 2016: Journal of Atrial Fibrillation
Luis Prats-Sánchez, Pol Camps-Renom, Javier Sotoca-Fernández, Raquel Delgado-Mederos, Alejandro Martínez-Domeño, Rebeca Marín, Miriam Almendrote, Laura Dorado, Meritxell Gomis, Javier Codas, Laura Llull, Alejandra Gómez González, Jaume Roquer, Francisco Purroy, Manuel Gómez-Choco, David Cánovas, Dolores Cocho, Moises Garces, Sonia Abilleira, Joan Martí-Fàbregas
BACKGROUND AND PURPOSE: Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis with recombinant tissue-type plasminogen activator may be associated with cerebral amyloid angiopathy, although supportive data are limited. We aimed to investigate risk factors of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator. METHODS: This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator and were included in a multicenter prospective registry...
August 2016: Stroke; a Journal of Cerebral Circulation
Yorito Hattori, Masafumi Ihara
Silent information regulator 2 homolog 1 (SIRT1), a product of the so called "longevity gene", is a protein deacetylase that has been reported to suppress cardiovascular pathologies such as myocardial infarction, and neurodegenerative diseases such as Alzheimer's disease, amyotrophic lateral sclerosis, and Parkinson's disease via anti-apoptosis, anti-inflammation, or increasing mitochondrial biogenesis in model organisms. In addition, SIRT1 can counter cerebral hypoperfusion and ischemia through deacetylating anti-inflammatory and anti-apoptotic molecules and also through deacetylating endothelial nitric oxide synthase and inducing arterial dilation...
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
Antoine N Saliba, Ali T Taher
Patients with non-transfusion-dependent thalassemia (NTDT) experience a wide array of clinical complications despite their independence from frequent, regular red blood cell (RBC) transfusions. According to the current understanding of NTDT, these clinical complications stem from the interaction of multiple pathophysiological factors: ineffective erythropoiesis, iron overload, and hypercoagulability. The state of chronic anemia and hypoxia-resulting from ineffective erythropoiesis and hemolysis-leads to the expansion of the erythroid marrow and extramedullary hematopoiesis...
March 2016: Annals of the New York Academy of Sciences
George Mihai Bădescu, Mădălina Fîlfan, Ovidiu Ciobanu, DănuŢ Adrian Dumbravă, Aurel Popa-Wagner
Although neuropathological conditions differ in the etiology of the inflammatory response, cellular and molecular mechanisms of neuroinflammation are probably similar in aging, hypertension, depression and cognitive impairment. Moreover, a number of common risk factors such as obesity, hypertension, diabetes and atherosclerosis are increasingly understood to act as "silent contributors" to neuroinflammation and can underlie the development of disorders such as cerebral small vessel disease (cSVD) and subsequent dementia...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Huseyin Goksuluk, Sadi Gulec, Ozgur Ulas Ozcan, Menekse Gerede, Veysel Kutay Vurgun, Nil Ozyuncu, Cetin Erol
Increased plasma levels of neuron-specific enolase (NSE) are related to damage of neurons and neuroendocrine cells. We aimed to investigate elevation of NSE after elective percutaneous coronary intervention (PCI) on the prediction of silent cerebral infarct (SCI). Study population consisted of 2 groups of patients. Group 1 included 92 consecutive patients with normal coronary angiograms, whereas group 2 consisted of 89 patients who underwent elective coronary stenting. NSE levels were studied before and 12 hours after the procedure...
June 15, 2016: American Journal of Cardiology
V V Zakharov, N V Vakhnina, D O Gromova, A V Tarapovskaya
Chronic cerebral circulatory insufficiency (CCCI) is a result of cerebral microangiopathy, most commonly due to uncontrolled hypertension. In this case, the brain is affected due to recurrent silent infarcts and/or microbleedings without clinical manifestations of stroke and chronic brain ischemia. Progressive cognitive impairments with a preponderance of inadequate attention and lower rates of cognitive performance, with impaired planning and control abilities in relative preservation of memory serve as the main manifestation of chronic progressive non-stroke vascular lesion in the brain...
2016: Terapevticheskiĭ Arkhiv
Luigi Di Biase, David F Briceno, Chintan Trivedi, Sanghamitra Mohanty, Carola Gianni, J David Burkhardt, Prasant Mohanty, Rong Bai, Sampath Gunda, Rodney Horton, Shane Bailey, Javier E Sanchez, Amin Al-Ahmad, Patrick Hranitzky, G Joseph Gallinghouse, Yaruva Madhu Reddy, Jason Zagrodzky, Richard Hongo, Salwa Beheiry, Dhanunjaya Lakkireddy, Andrea Natale
BACKGROUND: Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable. OBJECTIVE: To evaluate whether TEE is necessary before AF ablation in patients treated with novel oral anticoagulants (NOACs). METHODS: We performed a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation on uninterrupted NOACs (apixaban and rivaroxaban)...
June 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
A J Fischer, P Lebiedz, M Wiaderek, M Lichtenberg, D Böse, S Martens, F Breuckmann
If myocardial infarction remains silent, only clinical signs of complications may unveil its presence. Life-threatening complications include myocardial rupture, thrombus formation, or arterial embolization. In the presented case, a 76-year-old patient was admitted with left-sided hemiparesis. In duplex sonography, a critical stenosis of the right internal carotid artery was identified and initially but retrospectively incorrectly judged as the potential cause for ischemia. During operative thromboendarterectomy, arterial embolism of the right leg occurred coincidentally, more likely pointing towards a cardioembolic origin...
2016: Case Reports in Emergency Medicine
Dan Wan, Yehan Zhou, Ke Wang, Yongying Hou, Ruihang Hou, Xiufeng Ye
Dysfunction of energy metabolism can be a significant and fundamental pathophysiological basis for strokes. In studies of both humans and rodents, resveratrol, a natural polyphenol, has been reported to provide protection from cerebral ischemic injury by regulating expression of silent mating type information regulation 2 homolog 1 (SIRT1). However, direct evidence demonstrating that resveratrol exerts neuroprotection from cerebral ischemia injury by decreasing energy consumption is still lacking. Therefore, the aim of this study was to elucidate the mechanisms and signaling pathways through which resveratrol regulates energy metabolism in the ischemic brain, and to identify potential targets of resveratrol...
March 2016: Brain Research Bulletin
Lea Krey, Fred Lühder, Kathrin Kusch, Bozena Czech-Zechmeister, Birte Könnecke, Tiago Fleming Outeiro, George Trendelenburg
Sirtuin-2 (Sirt2) is a member of the NAD(+)-dependent protein deacetylase family. Various members of the sirtuin class have been found to be involved in processes related to longevity, regulation of inflammation, and neuroprotection. Induction of Sirt2 mRNA was found in the whole hemisphere after experimental stroke in a recent screening approach. Moreover, Sirt2 protein is highly expressed in myelin-rich brain regions after stroke. To examine the effects of Sirt2 on ischemic stroke, we induced transient focal cerebral ischemia in adult male Sirt2-knockout and wild-type mice...
December 2015: Journal of Cerebral Blood Flow and Metabolism
Kevin B Koronowski, Kunjan R Dave, Isabel Saul, Vladimir Camarena, John W Thompson, Jake T Neumann, Juan I Young, Miguel A Perez-Pinzon
BACKGROUND AND PURPOSE: Prophylactic treatments that afford neuroprotection against stroke may emerge from the field of preconditioning. Resveratrol mimics ischemic preconditioning, reducing ischemic brain injury when administered 2 days before global ischemia in rats. This protection is linked to silent information regulator 2 homologue 1 (Sirt1) and enhanced mitochondrial function possibly through its repression of uncoupling protein 2. Brain-derived neurotrophic factor (BDNF) is another neuroprotective protein associated with Sirt1...
August 2015: Stroke; a Journal of Cerebral Circulation
Mauro Bergui, Davide Castagno, Federico D'Agata, Alessandro Cicerale, Matteo Anselmino, Federica Maria Ferrio, Carla Giustetto, Franck Halimi, Marco Scaglione, Fiorenzo Gaita
BACKGROUND AND PURPOSE: Endovascular procedures, including atrial fibrillation transcatheter ablation, may cause microembolization of brain arteries. Microemboli often cause small sized and clinically silent cerebral ischemias (SCI). These lesions are clearly visible on early postoperative magnetic resonance diffusion-weighted images. We analyzed SCI distribution in a population of patients submitted to atrial fibrillation transcatheter ablation. METHODS: Seventy-eight of 927 consecutive patients submitted to atrial fibrillation transcatheter ablation were found positive for acute SCI on a postoperative magnetic resonance...
July 2015: Stroke; a Journal of Cerebral Circulation
Hongdi Lv, Ling Wang, Jinchang Shen, Shaojun Hao, Aimin Ming, Xidong Wang, Feng Su, Zhengchen Zhang
Silent information regulator 1 (SIRT1), a histone deacetylase, has been suggested to be effective in ischemic brain diseases. Salvianolic acid B (SalB) is a polyphenolic and one of the active components of Salvia miltiorrhiza Bunge. Previous studies suggested that SalB is protective against ischemic stroke. However, the role of SIRT1 in the protective effect of SalB against cerebral ischemia has not been explored. In this study, the rat brain was subjected to middle cerebral artery occlusion (MCAO). Before this surgery, rats were intraperitoneally administrated SalB with or without EX527, a specific SIRT1 inhibitor...
June 2015: Brain Research Bulletin
Hongchao Yang, Youxiang Li, Yuhua Jiang, Xianli Lv
This study evaluated patients' preoperative platelet function and the relation between acute embolic or hemorrhagic complications in unruptured intracranial aneurysm patients undergoing stent treatment. From September 2013 to December 2013 we prospectively collected clinical data in all unruptured intracranial aneurysm patients undergoing stent-assisted coiling. All patients received a dual antiplatelet therapy (aspirin and clopidogrel) protocol. Diffusion-weighted 3-T MRI was performed for cerebral aneurysm patients within 24 hours after treatment...
February 2015: Interventional Neuroradiology
Luigi Di Biase, Dhanujaya Lakkireddy, Chintan Trivedi, Thomas Deneke, Martin Martinek, Sanghamitra Mohanty, Prasant Mohanty, Sameer Prakash, Rong Bai, Madhu Reddy, Carola Gianni, Rodney Horton, Shane Bailey, Elisabeth Sigmund, Michael Derndorfer, Anja Schade, Patrick Mueller, Atilla Szoelloes, Javier Sanchez, Amin Al-Ahmad, Patrick Hranitzky, G Joseph Gallinghouse, Richard H Hongo, Salwa Beheiry, Helmut Pürerfellner, J David Burkhardt, Andrea Natale
BACKGROUND: Periprocedural anticoagulation management with uninterrupted warfarin and a "therapeutic" international normalized ratio is the best approach for reducing both thromboembolic and bleeding complications in the setting of catheter ablation for atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to evaluate the safety and feasibility of uninterrupted apixaban in this setting. METHODS: This was a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation at 4 institutions in United States and Europe with uninterrupted apixaban...
June 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Charles T Quinn
Silent cerebral infarction (SCI) is a highly prevalent and morbid condition in sickle cell disease (SCD). SCI can occur beginning in the first year of life and becomes more common with increasing age. Potentially modifiable risk factors for SCI include anemia and blood pressure. Headache does not appear to be associated with SCI, so neurologically normal children with headache do not necessarily warrant screening MRI for SCI. SCI does affect cognition, but biological determinants of cognition are not more important than socioeconomic factors...
December 5, 2014: Hematology—the Education Program of the American Society of Hematology
Yorito Hattori, Yoko Okamoto, Kazuyuki Nagatsuka, Ryosuke Takahashi, Rajesh N Kalaria, Makoto Kinoshita, Masafumi Ihara
Silent information regulator 2 homolog 1 (SIRT1) is a protein deacetylase that has been reported to suppress neurodegenerative and cardiovascular pathologies in model organisms. We have recently reported that SIRT1 overexpression preserves cerebral blood flow (CBF) after bilateral common carotid artery stenosis (∼50% stenosis) by the deacetylation of endothelial nitric oxide synthase. This study was designed to determine whether cerebral SIRT1 expression would be effective in a more severe model of cerebral ischemia caused by bilateral common carotid artery occlusion (BCAO) in vivo...
February 11, 2015: Neuroreport
Thomas Deneke, Pierre Jais, Marco Scaglione, Rainer Schmitt, Luigi DI Biase, Georgios Christopoulos, Anja Schade, Andreas Mügge, Martin Bansmann, Karin Nentwich, Patrick Müller, Joachim Krug, Markus Roos, Phillip Halbfass, Andrea Natale, Fiorenzo Gaita, David Haines
Brain magnetic resonance imaging (MRI) has identified a high incidence of cerebral ischemia in asymptomatic patients after atrial fibrillation (AF) ablation (silent). Detection of cerebral ischemic events on MRI is based on acute hyperintense lesions on diffusion-weighted imaging. In the literature, the incidence is related to specifications of MRI and depends on the definition applied. In comparative studies, silent cerebral events (SCE, diffusion-weighted MRI [DWI] positive only) appear to be approximately 3 times more common compared to using a definition of silent cerebral lesions (SCL; without fluid attenuated inverse recovery sequence [FLAIR] positivity)...
April 2015: Journal of Cardiovascular Electrophysiology
Elena Gordillo-Escobar, Juan J Egea-Guerrero, Santiago R Leal-Noval
No abstract text is available yet for this article.
January 1, 2015: New England Journal of Medicine
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