EFFECT OF ACUTE STROKE ON HEART FUNCTION

Background: There are contradictory data on how brain hemispheric localization/side influences the function of the heart. Our aim was to study the pathologic cardiological abnormalities in acute stroke patients without coronary heart disease or rhythm disturbances in the anamnesis. Methods: Between 1st of March, 2009 and 30th of September, 2009 at the Neurointensive Care Unit we monitorized 91 acute stroke patients’ parameters continuously for 24-36 hours: pulse, systolic, diastolic, mean blood pressure, 12 lead ECG. We were interested in the correlation of the above mentioned parameters and age, side and size of the cerebral lesion (by CT/MRI), type of stroke, mortality. Exclusion criteria were: fever, severe hyperglycemia, cardiac failure, myocardial infarct, pulmonary disorders, obstructive sleep apnoe, drug or metabolic caused rhythm disturbances, beta blocker usage. Results: The average age was 62,3±14,6 years. The left hemisphere was affected in 45%, the right in 38,5%, both hemispheres in 3,3%, and 13,2% suffered from VB syndrome. Ischemic stroke was in 74,7%, hemorrhage 14,3%, SAH 3,3%, TIA 7,7%. In the group where no heart disorder was known at admission, altogether 18% had repolarization abnormalities (10 patients had ST depression, 7 ST elevation). In addition, especially during the night, by 33% of the patients supraventricular (SVES) and ventricular extrasystoles (VES) were detected. 35% of patients had tachycardy and 23% bradycardy, both were significantly higher in the right sided lesions (p<0.05). VES was more frequent in left hemispherical lesions and VB syndrome (p<0.05). Less than 90 mmHg systolic pressure could be detected in 27% of patients, this was remarkable at dawn. Nine patients died, in 2 patients fatal rhythm disturbance caused death. Conclusion: Both sided hemispheric lesions and VB syndromes can cause cardiological and ECG abnormalities. Intensive monitoring is essential in acute stroke at least for 36 hours

Mannitol Use in Acute Stroke Case Fatality at 30 Days and 1 Year

Background and Purpose?Mannitol is used worldwide to treat acute stroke, although its efficacy and safety have not beenproven by randomized trials.Methods?In a tricenter, prospective study, we analyzed the 30-day and 1-year case fatality with respect to mannitoltreatment status in 805 patients consecutively admitted within 72 hours of stroke onset. Confounding factors werecompared between treated and nontreated patients.Results?Two thirds of the patients received intravenous mannitol as part of their routine treatment (mean dose, 47 22g/d; mean duration ,6 3 days). The case fatality was 25% versus 16% (P0.006) at 30 days and 38% versus 25%(P0.001) at 1 year in the-mannitol treated and nontreated groups, respectively. Mannitol treatment effect was adjustedfor age, stroke severity, fever in the first 3 days, and aspirin treatment (for ischemic strokes) in logistic regressionmodels. Depending on the factors entered into the model, either no effect or harm could be attributed to mannitol. Whenthe analysis was restricted to those admitted within 24 hours (n568), case fatality differed significantly only at 1 year(35% in treated and 26% in nontreated patients, P0.044). Although the prognostic scores of the ScandinavianNeurological Stroke Scale were similar in treated and nontreated patients, both in ischemic and hemorrhagic strokes, thepatient groups differed in several factors that might also have influenced survival.Conclusions?Based on the results of this study, no recommendations can be made on the use of mannitol in acute stroke,and properly randomized, controlled trials should be performed to come to a final conclusio