Cerebral Infarction ; blood ; Humans ; Interleukin-10 ; blood ; Interleukin-17 ; blood

OBJECTIVETo investigate the correlation between plasma fibrinogen level and cerebral infarction (CI) as well as the difference of fibrinogen among subtypes of CI.

METHODSA case-controlled study was conducted with 131 cases of CI and 148 controls. Plasma fibrinogen levels were detected by the Clauss method.

RESULTSHigh fibrinogen level (3.09 +/- 0.94 g/L) was correlated with CI (OR = 2.47, 95% CI: 1.51-4.04, P < 0.005) at the onset stage of the disease. Persistent high fibrinogen level (3.14 +/- 0.81 g/L) at 6-month after stroke onset was detected and correlated with CI (OR = 4.34, 95% CI: 1.80-10.51, P = 0.001). Higher fibrinogen level was correlated with total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), and posterior circulation infarction (POCI) (OR = 4.008, P < 0.001). Higher fibrinogen level was correlated with extracranial atherosclerosis (OR = 3.220, P < 0.05, but not with intracranial atherosclerosis.

CONCLUSIONFibrinogen level may be a risk factor of CI and probably correlates with subtypes of CI and distributions of atherosclerosis.

Aged ; Atherosclerosis ; blood ; Brain Infarction ; blood ; classification ; Case-Control Studies ; Cerebral Infarction ; blood ; classification ; Female ; Fibrinogen ; metabolism ; Humans ; Infarction, Anterior Cerebral Artery ; blood ; Infarction, Posterior Cerebral Artery ; blood ; Male ; Middle Aged

To establish a simple recirculation model in rats without craniectomy and to determine the recirculation time necessary to benefits the infarction area with restoration of the blood flow in a series of 30 adult rats, the authors induced irreversible ischemia(group I) in 15 rats through unilateral occlusion of the middle cerebral artery(MCA) by inserting a 16mm length of 4-0 nylon surgical thread through the internal carotid carotid artery(ICA). Reversible ischemia(group II) was induced by pullin the thread that occluded the MCA with hours recirculation in 5 rats. The author again divided the rats into 4 hours(Ia and Iia), 6 hours(Ib and Iib) and 12 hours(Ic and Iic) groups designated as according to the sacrifice time of rats in group I and the starting time of recirculation in group II following the MCA occlusion. The percentage of the infarction area to the total brain was calculated by a computer image analysis system, and the infarction size between reversible and irreversible groups were compared. The results showed that although the total average infarction sizes of irreversible ischemic groups were larger than those of reversible ischemic groups, the difference of the infarction size between each group o irreversible and reversible ischemia was not significant(group Ia Vs. Iia:7.78+/-8.37% Vs. 3.28+/-1.98%; group Ib Vs. Iib: 9.07+/-4.72% Vs. 6.61+/-3.19;group Ic Vs. Iic: 8.35+/-4.47% Vs. 6.90+/-6.07%. p>0.05, one-way ANOVA test). However, the degree of difference of the infarction size between irreversible and reversible ischemia decrease along with the prolongation of ischemic duration(difference between group Ia and IIa:4.5%;group Ib and Iib:2.46%;group Ic and Iic:.45%. The author concludes that ischemic brain injury may be decreased by making a restoration of the blood flow within 4 hours after occlusion of a blood vessel in rats, and this kind of reversible ischemic model may be useful in various studies on the focal cerebral ischemia without manipulation of the brain tissue and blood vessel.
Adult ; Animals ; Blood Vessels ; Brain ; Brain Injuries ; Brain Ischemia ; Cerebral Infarction* ; Humans ; Infarction* ; Infarction, Middle Cerebral Artery* ; Ischemia ; Middle Cerebral Artery* ; Nylons ; Rats*

BACKGROUND: Medical management of patients presenting with spontaneous intracerebral hemorrhage (ICH) is focused on blood pressure (BP) management. However, the BP goal to prevent ICH expansion remains controversial. Recent clinical trials have suggested that aggressive BP control is safe but may not have the previously thought benefits. CASE REPORT: We present an example of aggressive BP control in the setting of hypertensive ICH, in accordance to previously established protocols. This resulted in adverse effects in the form of acute kidney injury and watershed infarcts, which impeded the patients' recovery and prolonged his hospitalization. CONCLUSIONS: Hypertensive individuals have altered cerebral autoregulation curves shifted to the right and require higher arterial pressures to maintain adequate cerebral blood flow. Hence, aggressive BP reduction may result in cerebral hypoperfusion as well as other forms of end-organ damage.
Acute Kidney Injury ; Arterial Pressure ; Blood Pressure ; Cerebral Hemorrhage ; Cerebral Infarction ; Cerebrovascular Circulation ; Homeostasis ; Hospitalization ; Humans

PURPOSE: The purpose of this study was to evaluate the temporal pattern of blood volume change in cerebralinfarction and to provide guidelines for the interpretation of blood volume data known to vary according to thestage of infarction. MATERIALS AND METHODS: Thirteen patients with large infarctions attributable to proximalmiddle cerebral artery occlusion were studied at least twice after the onset of stroke using dynamiccontrast-enhanced T2*-weighted MR imaging and MR angiography. A total of 34 infarctions (11 in the acute stage[< or =7 days], 13 in the subacute stage [8-21 days], and 10 in the chronic stage [22-35 days]) were included. Afterblood volume maps were created on a pixel-by-pixel basis, blood volume ratios (blood volume of the infarctedregion divided by blood volume of the corresponding contralateral region) and findings of MR angiograms werecompared at different stages. RESULTS: A changing biphasic pattern of blood volume ratios was found: 0.73 in theacute stage, 1.45 in the subacute stage and 0.73 in the chronic stage (p < .01). Mean blood volume ratios ininfarctions with and without recanalization of occluded arteries were 1.37 and 0.42, respectively, a significantdifference (p <.001). Recanalization occurred during the acute stage in 45% of infarctions, and during the subacutestage in 77%. CONCLUSION: Blood volume that initially decreases in cerebral infarction increases during thesubacute stage, reflecting reperfusion hyperemia, and decreases again during the chronic stage. For correctinterpretation of blood volume data in cerebral infarction at various stages, the time interval between the onsetof stroke and MR examination and recanalization of arteries must be considered.
Angiography ; Arteries ; Blood Volume* ; Cerebral Arteries ; Cerebral Infarction* ; Follow-Up Studies* ; Humans ; Hyperemia ; Infarction ; Magnetic Resonance Imaging ; Reperfusion ; Stroke

BACKGROUND: Platelets play a key role in many occlusive vascular disorders and anti-platelet agents are the most important therapeutic strategy in preventing the recurrence of cerebral infarction. In order to know the platelet aggregability according to the strategy of anti-platelet agents, we measured platelet aggregability in patients who were taking anti-platelet agents for cerebral infarction. METHODS: Platelet aggregability in response to adenosine diphosphate (ADP) or collagen was measured in whole blood samples from 175 patients (48 females and 137 males). It was analyzed according to the type of cerebral infarction, vascular risk factors, and each anti-platelet agent. RESULTS: Platelet aggregability induced by ADP or collagen was significantly increased in patients with large artery atherosclerotic infarction compared to those with small vessel disease. Among anti-platelet regimens, combined therapy with aspirin and clopidogrel decreased platelet aggregability most effectively. CONCLUSIONS: These findings suggest that anti-platelet treatment should be tailored to the vascular status of each patient, and that combination therapy with aspirin and clopidogrel can effectively modulate platelet aggregability in preventing the recurrence of cerebral infarction.
Adenosine Diphosphate ; Arteries ; Aspirin ; Atherosclerosis ; Blood Platelets* ; Cerebral Arterial Diseases ; Cerebral Infarction* ; Collagen ; Female ; Humans ; Infarction ; Recurrence ; Risk Factors

PURPOSE: The presence of a perfusion-diffusion mismatch is a useful indicator for predicting the progression of acute cerebral infarction. However, not all the area of the perfusion-diffusion mismatch progresses to infarction and a large proportion survives with hypoperfusion. The purpose of this study was to assess 1) whether tissue viability can be predicted using quantitative perfusion values and 2) whether there is correlation between the perfusion value and the time that elapsed after the onset of symptoms. MATERIALS AND METHODS: Twenty-two patients with acute infarction in the middle cerebral artery territory within 12 hours after symptom onset were included in this study. We excluded those patients in whom thrombolysis was attempted or the lesion volume was less than 5 mL. Patients without perfusion-diffusion mismatch on the mean transit time (MTT) map were also excluded. We categorized the ischemic lesions into 3 areas: 1) the initial infarction, 2) the area that progressed to infarction, and 3) the hypoperfused but surviving area, based on the initial and follow up diffusion-weighted images and initial mean transit time (MTT) map. We obtained the relative cerebral blood volume (rCBV), the cerebral blood flow (rCBF) and the MTT in each area by comparing to the contralateral normal area. Statistical analysis was performed using one-way ANOVA to test whether there was a difference in perfusion values between each area. The threshold value was calculated between areas 2 and 3 using the receiver operating characteristics curve. We analyzed the correlation between the perfusion values of each area and the time that elapsed after the inset of symptoms. RESULTS: The perfusion values among each region were significantly different on the rCBV, rCBF and MTT maps. Between regions 2 and 3, the rCBV and rCBF maps showed a significant difference (Bonferroni post hoc analysis), but in case of rCBV, the mean perfusion values in each region approached to the normal level and it was difficult to differentiate between the two regions on the rCBV map. The rCBF in the regions 1, 2 and 3 was 0.40, 0.64, and 0.84, respectively. The difference of the threshold values of the rCBF between regions 2 and 3 was 0.75. There was no significant correlation between the time that elapsed after symptom onset and the perfusion values of each region on the rCBV, rCBF and MTT map. CONCLUSION: The perfusion values between the area of the initial infarction, the area that progressed to infarction and the hypoperfused but surviving area showed significant differences. The rCBF was the most useful parameter in differentiating between areas that progressed to infarction and the surviving areas. Quantitative measurement of the perfusion values may have a role in selecting the candidates for thrombolysis after they have suffered hyperacute stroke.
Blood Volume ; Cerebral Infarction ; Follow-Up Studies ; Humans ; Infarction* ; Middle Cerebral Artery ; Perfusion ; ROC Curve ; Stroke ; Tissue Survival*

Systemic air embolism is rare event that occurs when air bubbles enter into the multiple organs through blood circulation. We report a case of a 76-year-old man who developed systemic embolism in cerebral, coronary and renal artery after computed tomography guided trans-thoracic needle biopsy. It is assumed that cerebral infarction in the inferior branch of right middle cerebral artery and renal artery infarction might be occurred because of both the procedure performed in prone position and the physical characteristics of the air.
Aged ; Biopsy, Needle* ; Blood Circulation ; Cerebral Infarction ; Embolism ; Embolism, Air* ; Humans ; Infarction ; Middle Cerebral Artery ; Needles* ; Prone Position ; Renal Artery

Brain abscess following ischemic stroke is a very rare and dangerous condition that can have catastrophic results, and thus requires urgent and comprehensive evaluation. We report a case of a patient with brain abscess that developed at the lesion site of a previous cerebral infarction. The disruption of the blood-brain barrier in the infarcted lesion might facilitate abscess formation, making it a preferred target for infectious agents.
Abscess ; Blood-Brain Barrier ; Brain ; Brain Abscess ; Brain Infarction ; Cerebral Infarction ; Humans ; Stroke

BACKGROUND: Platelet activation has an important role in progression of atherosclerotic vascular events. To know the beneficial effects of clopidogrel loading dose about changes of platelet activation and clinical outcome in acute stage of atherosclerotic infarction, we performed a prospective randominized study. METHODS: Patients with large artery atherosclerotic infarction were randomized to clopidogrel loading dose (n=24) or intravenous heparin with low dose aspirin (n=28) during 7 days. We measured the surface expression of CD63 on platelets and the platelet aggregability for 7 days. The National Institute of Health Stroke Scale (NIHSS) score was recorded at 24 hours, 72 hours, and 7 days after stroke. Three-month outcome was recorded by the modified Barthel index (BI). RESULTS: As compared with intravenous heparin, the loading dose of clopidogrel was associated with significant reduction of the surface expression of CD63 on platelets, platelet aggregability, and NIHSS score. The clopidogrel loading dose-treated patients were more likely to have a very favorable outcome on BI index at 3 months. CONCLUSIONS: Our results showed that the clopidogrel loading dose has beneficial effects of clinical outcome of acute stage of large artery atherosclerotic infarction may be mediated by the platelet hyperactivity in these patients. Thus, this loading dose trial deserves further evaluation in clinical trial for treatment in large artery atherosclerotic infarction.
Arteries ; Aspirin ; Blood Platelets* ; Cerebral Infarction* ; Heparin ; Humans ; Infarction ; Platelet Activation* ; Prospective Studies ; Stroke