Acute brain syndrome

BACKGROUND: Inflammatory mechanisms play an important role in acute brain ischemia, and they contribute to the functional outcome. The neutrophil-to-lymphocyte ratio (NLR) has recently been described as a predictor of clinical outcomes in patients with acute coronary syndrome. This study assessed the clinical significance of NLR as a new predictor of the outcome in patients with acute ischemic stroke. METHODS: The study included 371 patients diagnosed as acute ischemic stroke within 48 hours after the onset. All subjects were divided into three groups according to tertiles of the NLR in the initial blood test. Functional outcomes were divided into two groups at 3 months and 1 year after stroke onset: favorable (mRS 0~2) or unfavorable (mRS 3~6). RESULTS: The proportion of patients with mRS 0~2 (favorable outcome) decreased as the NLR increased from the first tertile to the third tertile at discharge (74%, 62.9 and 49.2, p<0.001) and at 3 months (74%, 66.9 and 42.7, p<0.001) and 1 year (67.5%, 64.5 and 41.1, p<0.001) after stroke. NLR was higher in patients with an unfavorable outcome than in those with a favorable outcome (3.88 vs. 2.27 at 3 months, p<0.01; 3.67 vs. 2.31 at 1 year, p<0.001). Multivariate analysis revealed that the significant predictors of an unfavorable outcome at 3 months were NLR in the highest tertile (OR 2.28, 95% CI 1.13~4.60), age (OR 1.04, 95% CI 1.01~1.07), and NIHSS score (OR 1.27, 95% CI 1.18~1.36) at admission. CONCLUSIONS: NLR at admission can be used as a predictor of functional outcome at 3 months after ischemic stroke.
Acute Coronary Syndrome ; Brain Ischemia ; Hematologic Tests ; Humans ; Lymphocytes ; Multivariate Analysis ; Neutrophils ; Prognosis ; Stroke

OBJECTIVE: Patients with acute coronary syndrome (ACS) are at an increased risk of suicide. It is well known that epigenetic mechanisms may explain the pathophysiology of suicidal behavior including suicidal ideation (SI), but no study has explored these mechanisms in ACS populations. METHODS: In total, 969 patients were initially recruited within 2 weeks of the acute coronary event and, 711 patients were successfully followed up 1 year after ACS. SI was evaluated using the relevant items on the Montgomery-Åsberg Depression Rating Scale and covariates potentially affecting SI were estimated. RESULTS: Brain-derived neurotrophic factor (BDNF) hypermethylation was associated with SI in both the acute and chronic phases of ACS, although the association was not statistically significant in the acute phase after applying Bonferroni’s correction. CONCLUSION: These results suggested that BDNF hypermethylation may have played a role in an epigenetic predisposition for SI in ACS patients, particularly during the chronic phase.
Acute Coronary Syndrome* ; Brain-Derived Neurotrophic Factor* ; Depression ; Epigenomics ; Humans ; Longitudinal Studies ; Methylation* ; Suicidal Ideation* ; Suicide

Posterior reversible encephalopathy syndrome (PRES) involves predominantly posterior subcortical white matter and cortex. PRES is associated with an abrupt and severe increase in blood pressure or administration of various immuno-suppresants. We present a 18-year-old female with PRES. She was admitted to our hospital with seizures. She had been suffering from acute hypertension (170/100 mmHg) associated with acute renal failure. Brain MRI showed reversible biparietal cortical and subcortical edema. We report a case of hypertension-induced PRES associated with acute renal failure. (J Korean Neurol Assoc 19(5):541~543, 2001)
Acute Kidney Injury ; Adolescent ; Blood Pressure ; Brain ; Edema ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Posterior Leukoencephalopathy Syndrome* ; Seizures

In the twenty-first century, high contagious infectious diseases such as SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome), FMD (Foot-and-Mouth Disease) and AI (Avian Influenza) have become very prevalent, causing treat harm to humans and animals in aspect of public health, and economical issues. The critical problem is that newly-reported infectious diseases that humans firstly experience are expected to continue to emerge, and these diseases will be spreading out rapidly. Therefore, rapid and safe supplies of effective vaccines are most pivotal to prevent the rapid prevalent of new infection, but international standards or assessing protocol the safety of urgent vaccines are not established well. In our previous study, since we established a module to assess the brain safety of urgent vaccines, therefore, it is necessary to verify that this established module for assessing brain safety could work effectively in commercially available two vaccines (one killed- and on live-vaccines). We compared the results of Evans blue (EB) assay and qPCR analysis by injection of two kinds of vaccines, PBS and Lipopolysaccharide (LPS) under the condition of the module previously reported. We confirmed that the brain safety test module for urgent vaccine we established is very reproducible. Therefore, it is believed that this vaccine safety testing method can be used to validate brain safety when prompt supply of a newly developed vaccines is needed.
Animals ; Brain ; Communicable Diseases ; Coronavirus Infections ; Equipment and Supplies ; Evans Blue ; Humans ; Methods ; Public Health ; Severe Acute Respiratory Syndrome ; Vaccines

OBJECTIVETo elucidate whether the plasma concentration of NT-proBNP in patients with acute coronary syndrome (ACS) correlated with severity of the diseases and whether NT-proBNP is a reliable biochemical marker correctly indicates the severity of ACS.

METHODSEighty-nine subjects came from CCU of Cardiology Department of People's Hospital Beijing University from October 2003 to June 2004 and aged 34-85 y (66.89 +/- 11.12 y). In this study the spectrum of ACS only included unstable angina pectoris (UA) and acute myocardial infarction (AMI). Patients with UA were separated into 3 groups by Braunwald classes and those with AMI were separated into 4 groups by Killip classes when their venous blood samples were collected. Plasma concentration of NT-proBNP was measured by enzyme linked immunoabsorbent assay. Data was estimated by SPSS.

RESULTSThe concentration of NT-proBNP in patients with ACS was dramatically correlative with the severity of the diseases: with the upgrading of Braunwald classes, the concentration of NT-proBNP in patients with UA increased gradually; in patients with AMI it also raised gradually with the upgrading of killip classes; furthermore, the plasma concentration of NT-proBNP in patients with AIM increased much more than that in patients with UA when they are at the similar NYHA functional class.

CONCLUSIONPlasma concentration of NT-proBNP in patients with ACS might be a reliable biochemical marker which can objectively indicate the degree of this diseases.

Acute Coronary Syndrome ; blood ; physiopathology ; Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

BACKGROUND AND OBJECTIVES: Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients. SUBJECTS AND METHODS: Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated. RESULTS: NT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393+/-4,022 pg/mL in the lean group (n=875), 1,506+/-3,074 pg/mL in the overweight group (n=724) and 1,100+/-1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01). CONCLUSION: NT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.
Acute Coronary Syndrome ; Body Mass Index ; Brain ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Korea ; Male ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Obesity ; Overweight ; Peptide Fragments ; Risk Factors

PURPOSE: The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. METHODS: We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups. RESULTS: The renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05). CONCLUSION: We conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.
Acute Kidney Injury ; Blood Pressure ; Brain ; Brain Diseases ; Child ; Glomerulonephritis ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Jeollabuk-do ; Leukemia, Promyelocytic, Acute ; Lupus Nephritis ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Pheochromocytoma ; Posterior Leukoencephalopathy Syndrome ; Renal Artery Obstruction ; Retrospective Studies ; Seizures ; Thyrotoxicosis

PURPOSE: Natriuretic peptide levels are known to be associated with cardiac output and ventricular function. Recently it has been suggested that N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is available as a prognostic marker for acute coronary syndrome patients. We compared NTpro- BNP levels between patients with and without major adverse cardiovascular events (MACEs) who visited the emergency room due to acute coronary syndrome. METHODS: We designed a case-only study with study subjects recruited retrospectively by medical chart review. Patients who visited the emergency room from 1 May 2006 to 31 February 2007 and were diagnosed with acute coronary syndrome were enrolled. Subjects who did not receive bedside measurement of NT-proBNP levels were excluded. To analyze by subtype of acute coronary syndrome, we classified study subjects into the following group: ST elevation myocardial infarction, non-ST elevation myocardial infarction, or unstable angina. RESULTS: The level of NT-proBNP was 2,592+/-917 pg/ml in MACEs patients, and 1,289+/-1,261 pg/ml in patients without MACEs, a statistically significant difference (p<0.0001). The MACEs patients showed higher level of NT-proBNP than patients without MACEs in the ST elevation myocardial infarction group (p=0.439), the non-ST elevation myocardial infarction group (p=0.004), and the unstable angina group (p=0.009). CONCLUSION: Initial bedside NT-pro-BNP levels are higher in MACEs patients. Although the study size was small and the result should be carefully interpreted, it supports the hypothesis that NT-pro-BNP can as a marker to evaluate MACEs in acute coronary syndrome.
Acute Coronary Syndrome ; Angina, Unstable ; Biomarkers ; Cardiac Output ; Emergencies ; Humans ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Peptide Fragments ; Retrospective Studies ; Ventricular Function

Hemorrhagic fever with renal syndrome frequently found in Korea is a acute infectious disease caused by Hantaan virus. Its clinical manifestations include high fever, cardiovascular collapse, hemorrhagic tendency and acute renal failure. Many patients with hemorrhagic fever with renal syndrome show hemorrhagic tendency such as subconjunctival hemorrhage and mucocutaneous petechia. In vital organs such as lung, kidney, spleen, brain, and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. As a results, hematemesis, hemoptysis, melena and gross hematuria can be developed in some patients. Anemia and circulatory shock may result from large hematoma formed in third spaces like retroperitoneal and pleural space. But retroperitoneal hematoma and hemothorax was rarely reported. We report a case of hemorrhagic fever with renal syndrome complicated by retroperitoneal hematoma and hemothorax with review of literatures.
Acute Kidney Injury ; Anemia ; Brain ; Communicable Diseases ; Fever ; Hantaan virus ; Hematemesis ; Hematoma* ; Hematuria ; Hemoptysis ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Hemothorax* ; Humans ; Kidney ; Korea ; Lung ; Melena ; Shock ; Spleen