A prospective study about impact of renal dysfunction and morbidity and mortality on cardiovascular events after ischemic stroke

Background: The aim of our prospective study was to define the impact of renal dysfunction on future cardiovascular events and total mortality in 390 patients suffering from ischemic stroke. Methods: A quantitative measurement of neurologic deficit according to National Institutes of Health Stroke Scale (NIHSS) score was performed. Blood parameters were measured. Diabetes, hypertension and smoking habits were defined. Estimated glomerular filtration rate was calculated. Results: 153 (39.2%) patients had renal dysfunction. In the follow-up period in 36 (9.2%) patients acute coronary syndrome, in 102 (26.2%) recurrent ischemic stroke and in 44 (11.3%) peripheral arterial disease were documented. 191 (49%) patient died, 118 (30.3%) of whom died of cardiovascular events. Patients who died were older, had higher prevalence of renal dysfunction and NIHSS score. The Kaplan-Meier survival analysis showed that total mortality (p < 0.003) and cardiovascular mortality (p < 0.01) were higher in patients with renal dysfunction. According to Cox’s regression analysis, renal dysfunction was the predictor of cardiovascular events, cardiovascular and total mortality. Conclusions: Patients with ischemic stroke and renal dysfunction are at higher risk for long term cardiovascular and total mortality. The patients with ischemic stroke and renal dysfunction are also at higher risk of new cardiovascular morbidity. Renal dysfunction should be added to the other known prognostic factors in patients with ischemic stroke. Our results also emphasize the importance of identification and management of renal dysfunction in stroke patients.

Calcifications of Vertebrobasilar Arteries on CT: Detailed Distribution and Relation to Risk Factors in 245 Ischemic Stroke Patients

Introduction. Intracranial atherosclerosis is responsible for a substantial proportion of strokes worldwide but its detailed morphology in the vertebrobasilar arteries (VBA) is unknown.Subject and Methods. Cases with ischemic strokes were retrospectively sought from the hospital database. Native CT scans were assessed for vessel area and intracranial artery calcifications (ICACs) in VBA. The calcifications were classified as focal (FCs), crescent, and circular.Results. 245 patients (mean age:77.1±10.2years, 57.6% females) had visible ICACs. Calcifications were found in 75.9%, 63.3%, and 17.1% in the left vertebral artery (LVA), the right vertebral artery (RVA), and the basilar artery (BA), respectively. FCs were present in 91.0%, 90.3%, and 100.0%; crescents in 30.3%, 29.0%, and 7.1%, and circulars in 6.4%, 4.8%, and 0.0% of the RVA, LVA, and BA, respectively. FCs in dorsolateral quadrant were least prevalent in both vertebral arteries (VAs): 46 (29.8%) and 46 (27.4%) for RVA and LVA, respectively. Risk factors associated with vertical dispersion of ICACs were male gender (OR : 2.69, 1.38–5.28) and diabetes (OR : 2.28, 1.04–4.99).Conclusions. FCs in VAs are least prevalent in dorsolateral quadrants. The vertical dispersion of ICACs seems to be associated with the male gender and diabetes.</jats:p

Factors influencing daily treatment choices in multiple sclerosis:practice guidelines, biomarkers and burden of disease

At two meetings of a Central European board of multiple sclerosis (MS) experts in 2018 and 2019 factors influencing daily treatment choices in MS, especially practice guidelines, biomarkers and burden of disease, were discussed. The heterogeneity of MS and the complexity of the available treatment options call for informed treatment choices. However, evidence from clinical trials is generally lacking, particularly regarding sequencing, switches and escalation of drugs. Also, there is a need to identify patients who require highly efficacious treatment from the onset of their disease to prevent deterioration. The recently published European Committee for the Treatment and Research in Multiple Sclerosis/European Academy of Neurology clinical practice guidelines on pharmacological management of MS cover aspects such as treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and are based on expert consensus statements. However, the recommendations constitute an excellent framework that should be adapted to local regulations, MS center capacities and infrastructure. Further, available and emerging biomarkers for treatment guidance were discussed. Magnetic resonance imaging parameters are deemed most reliable at present, even though complex assessment including clinical evaluation and laboratory parameters besides imaging is necessary in clinical routine. Neurofilament-light chain levels appear to represent the current most promising non-imaging biomarker. Other immunological data, including issues of immunosenescence, will play an increasingly important role for future treatment algorithms. Cognitive impairment has been recognized as a major contribution to MS disease burden. Regular evaluation of cognitive function is recommended in MS patients, although no specific disease-modifying treatment has been defined to date. Finally, systematic documentation of real-life data is recognized as a great opportunity to tackle unresolved daily routine challenges, such as use of sequential therapies, but requires joint efforts across clinics, governments and pharmaceutical companies.</p

Management of multiple sclerosis patients in central European countries: current needs and potential solutions

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Predicting short-term (30-day) mortality in patients with ischemic stroke using the baseline score of the National Institutes of Health Stroke Scale: Lestvica NIHSS (National Institutes of Health Stroke Scale) in kratkoročna (30-dnevna) umrljivost bolnikov z ishemično možgansko kapjo

Purpose:&nbsp;The National Institutes of Health Stroke Scale (NIHSS) was developed to measure neurologic outcome and recovery in patients with stroke. The aim of our study was to establish the validity of the NIHSS on short-term (30-day) mortality in patients with ischemic stroke. Methods:&nbsp;All 402 patients (216 males) with acute ischemic stroke hospitalized over 1 year were included in the study. Information on the presence of diabetes mellitus and smoking habits was obtained by a questionnaire. Systolic and diastolic blood pressure was measured upon hospital admission. The body mass index was calculated. Laboratory data were assessed in the first 24h after stroke onset. The National Institutes of Health Stroke Scale (NIHSS) was employed upon hospital admission. Patients were then followed up for 30 days. Results:&nbsp;The mean age of patients was 70.89 years (range, 36–96 years). Women were older than men (P&lt;0.0001). There were 49 (12.2%) deaths in the first 30 days. Patients who died had a higher NIHSS score upon hospital admission (P=0.0001), were older (P=0.013), had higher high-sensitivity C-reactive protein (hsCRP) levels (P=0.0001) and lower albumin levels (P=0.016). With Cox multivariable regression analyses, NIHSS score (P=0.0001) as well as levels of total cholesterol (TC) (P=0.004) and low-density lipoproteincholesterol (LDL-C) (P=0.016) were predictors of 30-day mortality. After the addition of age as a variable, NIHSS score (P=0.0001) as well as levels of TC (P=0.006) and LDL-C (P=0.025) remained predictors of mortality. Conclusion:&nbsp;The NIHSS is a good predictor of outcome in short-term (30-day) mortality in patients with ischemic stroke.Lestvica NIHSS (National Institutes of Health Stroke Scale) in kratkoročna (30-dnevna) umrljivost bolnikov z ishemično možgansko kapjo Namen:&nbsp;Lestvica NIHSS (National Institutes of Health Stroke Scale) je bila razvita predvsem za napoved izhoda po možganski kapi. Cilj naše raziskave je bil ugotoviti uporabnost te lestvice za napoved kratkoročne (30-dnevne) umrljivosti pri bolnikih z ishemično možgansko kapjo. Metode:&nbsp;V raziskavo so bili vključeni vsi bolniki (n=402; 216 moških in 186 žensk), ki so bili v obdobju enega leta hospitalizirani zaradi akutne ishemične možganske kapi. Podatke o prisotnosti sladkorne bolezni in kajenju smo pridobili z vprašalnikom. Pri sprejemu so imeli vsi bolniki izmerjen sistolični in diastolični krvni tlak. Izračunali smo indeks telesne mase. Laboratorijske preiskave so bile opravljene vimpairprvih 24. urah. Ocena nevrološkega stanja ob sprejemu je bila opravljena z lestvico NIHSS. Bolnike smo nato sledili 30 dni. Rezultati:&nbsp;Povprečna starost v raziskavo vključenih bolnikov je bila 70,89 let (od 36 do 96 let). Ženske so bile starejše od moških (P&lt;0,0001). V 30-tih dnevih je umrlo 49 (12,2%) bolnikov. Bolniki, ki so umrli, so imeli ob sprejemu višjo oceno po lestvici NIHSS (P=0,0001), bili so starejši (P=0,013), imeli so višji hsCRP (P=0,0001) in nižje albumine (P=0,016). S pomočjo Cox multivariable regression analize so bili napovedniki 30 dnevne umrljivosti NIHSS (P=0,0001), celotni holesterol (P=0,004) in LDL holesterol (P=0,016). Ko smo dodali v analizo starost so NIHSS (P=0,0001), celotni holesterol (P=0,006) in LDL holesterol (P=0,025) ostali napovedniki umrljivosti. Zaključek:&nbsp;Lestvica NIHSS je dober napovednik kratkoročnega (30-dnevnega) izhoda pri bolnikih z akutno ishemično možgansko kapjo