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Hemorrhagic transformation

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https://www.readbyqxmd.com/read/28187798/critical-care-in-acute-ischemic-stroke
#1
M McDermott, T Jacobs, L Morgenstern
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28185970/risk-factors-for-hemorrhagic-transformation-following-intravenous-thrombolysis-in-acute-cerebral-infarction-a-retrospective-single-center-study
#2
Xiahong Xu, Changsong Li, Ting Wan, Xiaobo Gu, Wenxia Zhu, Junjie Hao, Huan Bao, Lian Zuo, Hui Hu, Gang Li
OBJECTIVE: To investigate the risk factors for the hemorrhagic transformation (HT) following intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute cerebral infarction. METHODS: Acute cerebral infarction patients receiving r-tPA thrombolysis in Shanghai Eastern Hospital were retrospectively studied. Based upon the cranial CT or MRI examination, after the intravenous thrombolysis, the patients were divided into two groups: HT group and non-HT group...
February 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28178410/strategies-to-extend-thrombolytic-time-window-for-ischemic-stroke-treatment-an-unmet-clinical-need
#3
REVIEW
Ike Dela Peña, Cesar Borlongan, Guofang Shen, Willie Davis
To date, reperfusion with tissue plasminogen activator (tPA) remains the gold standard treatment for ischemic stroke. However, when tPA is given beyond 4.5 hours of stroke onset, deleterious effects of the drug ensue, especially, hemorrhagic transformation (HT), which causes the most significant morbidity and mortality in stroke patients. An important clinical problem at hand is to develop strategies that will enhance the therapeutic time window for tPA therapy and reduce the adverse effects (especially HT) of delayed tPA treatment...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28174097/synthetic-2-aryl-3-piperidin-1-yl-ethyl-thiazolidin-4-ones-exhibit-selective-in%C3%A2-vitro-antitumoral-activity-and-inhibit-cancer-cell-growth-in-a-preclinical-model-of-glioblastoma-multiforme
#4
Elita F da Silveira, Juliana H Azambuja, Taíse Rosa de Carvalho, Alice Kunzler, Daniel S da Silva, Fernanda C Teixeira, Rodrigo Rodrigues, Fátima T Beira, Rita de Cássia Sant Anna Alves, Roselia M Spanevello, Wilson Cunico, Francieli M Stefanello, Ana P Horn, Elizandra Braganhol
Glioblastoma multiforme (GBM) is the worst form of primary brain tumor, which has a high rate of infiltration and resistance to radiation and chemotherapy, resulting in poor prognosis for patients. Recent studies show that thiazolidinones have a wide range of pharmacological properties including antimicrobial, anti-inflammatory, anti-oxidant and anti-tumor. Here, we investigate the effect antiglioma in vitro of a panel of sixteen synthetic 2-aryl-3-((piperidin-1-yl)ethyl)thiazolidin-4-ones where 13 of these decreased the viability of glioma cells 30-65% (100 μM) compared with controls...
February 4, 2017: Chemico-biological Interactions
https://www.readbyqxmd.com/read/28162169/-efficacy-of-intravenous-thrombolysis-in-acute-ischemic-stroke-with-hyperdense-middle-cerebral-artery-sign
#5
L Peng, Y Guo, Y Wang, Y N Lin, C H Zhang, H Y Wang, R M Yu, X P Sun
Objective: To observe the efficacy and safety of recombinant tissue-type plasminogen activator (rtPA) intravenous thrombolysis (IVT) in the treatment of acute cerebral infarction with hyperdense middle cerebral artery sign (HMCAS). Methods: Acute cerebral infarction patients with HMCAS from July 2010 to November 2015 at the First Affiliated Hospital of Dalian Medical University were collected.These patients were divided into two groups depending on whether they received IVT or not.The Nation Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to evaluate early and long-time therapeutic effects...
January 17, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28153531/a-selective-cb2r-agonist-jwh133-restores-neuronal-circuit-after-germinal-matrix-hemorrhage-in-the-preterm-via-cx3cr1-microglia
#6
Jun Tang, Hongping Miao, Bing Jiang, Qianwei Chen, Liang Tan, Yihao Tao, Jianbo Zhang, Fabao Gao, Hua Feng, Gang Zhu, Zhi Chen
Microglia play dual roles after germinal matrix hemorrhage, and the neurotrophic phenotype maybe neuroprotective. However, the phenotype transformation and the way by which neuron-microglia dialogue remain unclear. We raise the hypothesis that a cannabinoid receptor2 agonist (JWH133) accelerates the CX3CR1(+) microglia secreting neurotrophic factors and restores damaged neuronal circuit. Here, we report a novel function of JWH133 in transforming the microglia CX3CR1 positive that secrete brain-derived neurotrophic factor (BDNF), which triggers neuron proliferation and neuronal restoration...
January 30, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28140443/onset-and-duration-of-intravenous-and-intraosseous-rocuronium-in-hypovolemic-swine
#7
Miguel Nemeth, George N Williams, Debbie Prichard, Angie McConnico, Don Johnson, Michael Loughren
OBJECTIVE: Compare the onset and duration of rocuronium administered via the intravenous (IV), and intraosseous (IO) routes in a hypovolemic swine model. DESIGN: Prospective, between subjects, experimental study. SETTING: Vivarium. SUBJECTS: Yorkshire-cross swine (N = 8). INTERVENTION: Electromyography (EMG) amplitudes were recorded at baseline and for every 15 seconds after administering 1.2 mg/kg of rocuronium via IV or IO routes to hypovolemic swine...
October 2016: American Journal of Disaster Medicine
https://www.readbyqxmd.com/read/28131432/dominant-vertebral-artery-status-and-functional-outcome-after-endovascular-therapy-of-symptomatic-basilar-artery-occlusion
#8
Jun Young Chang, Seunguk Jung, Cheolkyu Jung, Hee-Joon Bae, Oki Kwon, Moon-Ku Han
BACKGROUND AND PURPOSE: To determine whether status of dominant vertebral artery could affect clinical outcome in patients with symptomatic basilar artery occlusion (BAO). METHODS: We reviewed patients with symptomatic BAO who underwent endovascular treatment at the institute between January 2007 and July 2014. Patients were categorized into 2 groups according to functional outcome and baseline characteristics, treatment related factors were compared. Variables including clinical and imaging parameters were also compared according to the dominant V1 lesion...
January 25, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28130682/therapies-for-hemorrhagic-transformation-in-acute-ischemic-stroke
#9
REVIEW
Joshua A Stone, Joshua Z Willey, Salah Keyrouz, James Butera, Ryan A McTaggart, Shawna Cutting, Brian Silver, Bradford Thompson, Karen L Furie, Shadi Yaghi
Hemorrhagic transformation occurs in about 10-15% of patients with acute ischemic stroke. The treatment of hemorrhagic conversion is complex and includes blood pressure management, reversing coagulopathy, and managing its complications including increased intracranial pressure. Future research should be directed on identifying indications to treat and use of appropriate homeostatic regimens to effectively reverse the different anticoagulants and thrombolytic agents in an attempt to improve outcomes of patients with hemorrhagic transformation...
January 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/28130211/plasma-kallikrein-mediates-brain-hemorrhage-and-edema-caused-by-tissue-plasminogen-activator-therapy-in-mice-after-stroke
#10
Fabrício Simão, Tuna Ustunkaya, Allen C Clermont, Edward P Feener
Thrombolytic therapy using tissue plasminogen activator (tPA) in acute stroke is associated with increased risks of cerebral hemorrhagic transformation and angioedema. While plasma kallikrein (PKal) has been implicated in contributing to both hematoma expansion and thrombosis in stroke, its role in the complications associated with the therapeutic use of tPA in stroke is not yet available. We investigated the effects of tPA on plasma prekallikrein (PPK) activation and the role of PKal on cerebral outcomes in a murine thrombotic stroke model treated with tPA...
January 27, 2017: Blood
https://www.readbyqxmd.com/read/28126975/-cerebral-autosomal-recessive-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-carasil
#11
Masahiro Uemura, Hiroaki Nozaki, Osamu Onodera
Cerebral small vessel disease (CSVD) is frequently observed among the elderly and is known to cause dementia and gait disturbance associated with white matter lesions, lacunar infarcts, and cerebral hemorrhage. Molecular mechanistic studies promise to provide new insights into the pathogenesis of hereditary CSVD. Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is one of the hereditary CSVDs caused by a mutation in the high-temperature requirement serine peptidase A1 (HTRA1) gene...
January 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28114647/clinical-characteristics-risk-factors-and-outcomes-associated-with-neonatal-hemorrhagic-stroke-a-population-based-case-control-study
#12
Lauran Cole, Deborah Dewey, Nicole Letourneau, Bonnie J Kaplan, Kathleen Chaput, Clare Gallagher, Jacquie Hodge, Amalia Floer, Adam Kirton
Importance: Hemorrhage into the brain of term newborns often results in major injury and lifelong disability. The clinical epidemiology of neonatal hemorrhagic stroke (NHS) remains undefined, hindering the development of strategies to improve outcomes. Objective: To characterize the incidence, types, presentations, associated factors, and outcomes of neonatal hemorrhagic stroke. Design, Setting, and Participants: Population-based, nested case-control study...
January 17, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28111008/primary-intraventricular-hemorrhage-clinical-characteristics-and-outcomes
#13
Rachel Weinstein, Kathryn Ess, Bilaal Sirdar, Sarah Song, Shawna Cutting
BACKGROUND: Primary intraventricular hemorrhage (IVH) in adults is a rare neurologic disorder. The typical course, etiology, complications, and outcomes have not been well established. MATERIALS AND METHODS: Consecutive patient records with a diagnosis of intracerebral hemorrhage admitted between May 2009 and June 2014 at a tertiary care center were retrospectively reviewed. Subjects were included in the study cohort if all neurologists and the radiology report agreed that the subject had an isolated IVH...
January 19, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28088349/stroke-biomarkers-in-clinical-practice-a-critical-appraisal
#14
REVIEW
Geelyn J L Ng, Amy M L Quek, Christine Cheung, Thiruma V Arumugam, Raymond C S Seet
Biomarkers provide critical mechanistic insights to key biologic processes that occur during cerebral ischemia which, when carefully applied, can improve clinical decision-making in acute stroke management. The translation of a blood-based biomarker in ischemic stroke to clinical practice is challenging, in part, due to the complexity of ischemic stroke pathogenesis and the presence of a blood-brain barrier that restricts the release of brain-specific markers into the circulation. The pathologic and clinical aspects of ischemic stroke are described in this review, where a non-exhaustive list of biomarkers that interrogate different aspects of ischemic stroke such as oxidative damage, inflammation, thrombus formation, cardiac function and brain injury are described...
January 11, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28076634/immediate-versus-delayed-treatment-for-recently-symptomatic-carotid-artery-stenosis
#15
Vladimir Vasconcelos, Nicolle Cassola, Edina Mariko Koga da Silva, José Carlos Costa Baptista-Silva
BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis...
November 2016: São Paulo Medical Journal, Revista Paulista de Medicina
https://www.readbyqxmd.com/read/28068330/loss-of-p53-induces-leukemic-transformation-in-a-murine-model-of-jak2-v617f-driven-polycythemia-vera
#16
T Tsuruta-Kishino, J Koya, K Kataoka, K Narukawa, Y Sumitomo, H Kobayashi, T Sato, M Kurokawa
As leukemic transformation of myeloproliferative neoplasms (MPNs) worsens the clinical outcome, reducing the inherent risk of the critical event in MPN cases could be beneficial. Among genetic alterations concerning the transformation, the frequent one is TP53 mutation. Here we show that retroviral overexpression of Jak2 V617F mutant into wild-type p53 murine bone marrow cells induced polycythemia vera (PV) in the recipient mice, whereas Jak2 V617F-transduced p53-null mice developed lethal leukemia after the preceding PV phase...
January 9, 2017: Oncogene
https://www.readbyqxmd.com/read/28059705/emergent-endovascular-management-of-long-segment-and-flow-limiting-carotid-artery-dissections-in-acute-ischemic-stroke-intervention-with-multiple-tandem-stents
#17
S A Ansari, A L Kühn, A R Honarmand, M Khan, M C Hurley, M B Potts, B S Jahromi, A Shaibani, M J Gounis, A K Wakhloo, A S Puri
BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4)...
January 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28057806/12-15-lipoxygenase-inhibition-or-knockout-reduces-warfarin-associated-hemorrhagic-transformation-after-experimental-stroke
#18
Yu Liu, Yi Zheng, Hulya Karatas, Xiaoying Wang, Christian Foerch, Eng H Lo, Klaus van Leyen
BACKGROUND AND PURPOSE: For stroke prevention, patients with atrial fibrillation typically receive oral anticoagulation. The commonly used anticoagulant warfarin increases the risk of hemorrhagic transformation (HT) when a stroke occurs; tissue-type plasminogen activator treatment is therefore restricted in these patients. This study was designed to test the hypothesis that 12/15-lipoxygenase (12/15-LOX) inhibition would reduce HT in warfarin-treated mice subjected to experimental stroke...
February 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28049196/refining-prognosis-for-intracerebral-hemorrhage-by-early-reassessment
#19
Matthew B Maas, Brandon A Francis, Rajbeer S Sangha, Bryan D Lizza, Eric M Liotta, Andrew M Naidech
BACKGROUND: Prognostic assessments, which are crucial for decision-making in critical illnesses, have shown unsatisfactory reliability. We compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias. METHODS: Patients enrolled in a prospective observational cohort study of spontaneous ICH underwent hourly Glasgow Coma Scale (GCS) assessment...
January 4, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28031392/dce-mri-blood-brain-barrier-assessment-in-acute-ischemic-stroke
#20
Kersten Villringer, Borja E Sanz Cuesta, Ann-Christin Ostwaldt, Ulrike Grittner, Peter Brunecker, Ahmed A Khalil, Kristina Schindler, Ole Eisenblätter, Heinrich Audebert, Jochen B Fiebach
OBJECTIVE: To quantitatively evaluate blood-brain barrier changes in ischemic stroke patients using dynamic contrast-enhanced (DCE) MRI. METHODS: We examined 54 stroke patients (clinicaltrials.gov NCT00715533, NCT02077582) in a 3T MRI scanner within 48 hours after symptom onset. Twenty-eight patients had a follow-up examination on day 5-7. DCE T1 mapping and Patlak analysis were employed to assess BBB permeability changes. RESULTS: Median stroke K(trans) values (0...
January 31, 2017: Neurology
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