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Biomedical subjects

A Shuaib

Publications and source records attributed to A Shuaib.

At least 109 records · Page 6Linked to original sources

Glutamate uptake and glutamate content in primary cultures of mouse astrocytes during anoxia, substrate deprivation and simulated ischemia under normothermic and hypothermic conditions.

During brain ischemia in vivo the extracellular concentration of the excitotoxic amino acid, glutamate, increases. This increase could be caused either by an enhanced formation rate of glutamate (from glutamine) or by an impaired re-uptake (or both). This re-uptake occurs to a large extent in astrocytes. In the present study we have determined glutamate uptake and the ability of the cells to maintain their glutamate content during exposure to anoxia, substrate deprivation and combined substrate deprivation and anoxia ('simulated ischemia') for a duration of up to 4 h. Isolated anoxia had no significant effect, whereas both substrate deprivation alone and 'simulated ischemia' reduced glutamate uptake and glutamate content by one-half after 2 h. Under hypothermic conditions (incubation at 32 degrees C), which in in vivo experiments exerts some protection against ischemic cell death in neurons, ischemia of intermediate duration (2 h) decreased glutamate uptake and glutamate content to a less extent than at 37 degrees C. Hypothermia did not have a similar effect during exposure to isolated substrate deprivation.

Animals↗

GABA agonist "muscimol" is neuroprotective in repetitive transient forebrain ischemia in gerbils.

The damaging effects from transient forebrain ischemia may be a result of excessive excitability or loss of inhibitory influences. In the brain, GABA acts as the major inhibitory neurotransmitter and its loss may be an important factor leading to delayed neuronal damage in the substantia nigra reticulata (SNr). In this study, we looked at the protective effects of muscimol, a GABA A agonist in a gerbil model of repetitive forebrain ischemia. For cerebral ischemia, we used three episodes of 2 min with a reperfusion period of 1 h between the insults. Histological evaluations were done 7 days after the insult using silver degeneration staining. Muscimol was infused into the third ventricle continuously for 7 days beginning just prior to the insult. There were a total of 20 animals, 12 treated with muscimol and the other 8 serving as controls. At 7 days, there was significant protection in the cortex (P = 0.007), hippocampus [CA1 (P = 0.01), CA4 (P = 0.015)], substantia nigra reticulata (P = 0.007), striatum (P = 0.049), and thalamus (P = 0.012). All statistical comparisons were done using nonparametric tests (Mann-Whitney U test). Our study shows that potentiation of inhibitory mechanisms may be important mechanisms of neuronal protection from the effects of repetitive ischemia and the effects are not limited to the SNr. Further studies are needed to better understand their mechanism of action.

Animals↗

Protective effect of hypothermia during ischemia in neural cell cultures.

Hypothermia offers protection from the effects of ischemia in small animals. We have recently shown that similar to small animals, hypothermia may also be protective in an astrocytic model of "simulated ischemia" in cell culture. This study was designed to look at the protective effects of hypothermia in cultures of cerebellar granular (glutamatergic) and cortical (GABAergic) neurons. We used LDH release into the medium as an indicator for neuron damage. Experiments were all done in sister cultures, in groups of six cultures at two temperatures (37 and 32 degrees Celsius). The duration of ischemia was three hours in cerebellar granular neuronal cell cultures and six hours in cortical neurons. LDH release was measured immediately after the insult. Hypothermia protected both granular and cortical neurons. In granular cells, LDH release was 62 +/- 18 at 32 degrees and 212 +/- 15 at 37 degrees (p = 0.02). Cortical neurons showed LDH release of 15 +/- 2 at 32 degrees and 32 +/- 2 at 37 degrees (p = 0.005). Our study suggests that similar to astrocytes, the protective effects of hypothermia are evident in neuronal cell cultures from the cerebellum and the cerebral cortex. Cell culture systems should prove useful techniques in understanding mechanisms of hypothermic protection during simulated ischemia in neurons from different sites.

Animals↗

CGS-19755 is neuroprotective during repetitive ischemia: this effect is significantly enhanced when combined with hypothermia.

In small animals the damaging effects of repetitive ischemia are more severe than a single insult of similar duration. Prolonged release of glutamate may correlate with the degree of damage. We report the protective effects of CGS-19755 (an N-methyl-D-aspartate receptor blocker), hypothermia or CGS-19755 in combination with mild hypothermia, in a gerbil model of repetitive ischemia. We used 3 min of forebrain ischemia and repeated it for a total of three times as 1-h intervals. Damage was assessed seven days after the insult. In the group where only CGS-19755 was used, significant neuronal protection was evident in the hippocampus (CA1 and CA3), striatum, and medial geniculate nucleus. With hypothermia significantly less damage was seen in the cerebral cortex, hippocampus (CA1 and CA4), and substantia nigra reticulata. When CGS-19755 was combined with mild hypothermia the effects of repetitive ischemia were completely abolished in all but one gerbil. Compared to hypothermia alone, significant protection was seen in the cerebral cortex, hippocampus (sibiculum, CA1 and CA4), striatum, medial geniculate nucleus, thalamus, and substantia nigra reticulata. The use of N-methyl-D-aspartate receptor blockers may protect the brain in repetitive ischemia. Combination with hypothermia may further enhance this protection.

Animals↗

Hypothermia protects astrocytes during ischemia in cell culture.

A mild decrease in temperature (2-3 degrees) can result in marked attenuation of ischemic neuronal damage in living animals. We now report the protective effects of hypothermia in an astrocyte with simulated ischemia in cell culture system. Hypothermia when used during ischemia showed significant reduction of damage. Brief episodes of post-ischemic hypothermia were not protective whereas more prolonged post-ischemic hypothermia showed moderate protection. Cell culture systems may prove to be useful tools to study the mechanisms of hypothermic protection during ischemia.

Animals↗

Gamma-vinyl GABA prevents hippocampal and substantia nigra reticulata damage in repetitive transient forebrain ischemia.

GABAergic inhibitory mechanisms may offer protection to neurons after global ischemia. We tested the effects of gamma-vinyl GABA, a GABA-transaminase inhibitor, via continuous infusion in the third ventricle (Alza pumps) in a gerbil model of repetitive forebrain ischemia. We used two episodes of 3 min duration with a 'reperfusion' interval of 1 h between the insults. Histological analysis was done with silver staining 5 days after the insult. Our results show that there is significant protection of the hippocampus CA1 region and substantia nigra reticulata in treated animals compared to controls. An increase in GABA levels, decrease in glutamate, or mild hypothermia, may be potential mechanisms for this protection. GABAergic agents may prove useful agents in repetitive ischemia.

4-Aminobutyrate Transaminase↗

Repetitive transient forebrain ischemia in gerbils: delayed neuronal damage in the substantia nigra reticulata.

Repetitive cerebral ischemia results in severe neuronal damage in multiple regions of the brain including the hippocampus, striatum, thalamus, medial geniculate nucleus and the substantia nigra reticulata (SNr). We postulated that the damage in the SNr was delayed, resulting from a loss of striatal inhibitory input. We used the gerbil model of repetitive ischemia (3 min times 2 and 3 min times 3) to evaluate the extent of neuronal damage at 2, 3, 5 and 7 days after the ischemic insult. Silver degeneration stain was used for histological evaluation. Our results indicate that damage in the SNr begins after 48 h and is maximum at 7 days. This delay in onset of damage offers a window for pharmacological protection.

Animals↗

Stroke involving the midbrain and thalamus and causing 'nonfocal' coma.

We have described two patients who had coma without focal findings and who were found to have an ischemic stroke involving the midbrain and the thalamus. In both cases metabolic encephalopathy or drug overdose was initially suspected, but recognition of abnormal vertical eye movements led to the proper diagnosis. Examination of vertical eye movements in drowsy or comatose patients may be helpful in arriving at the correct diagnosis early and may prevent unnecessary investigations.

Cerebral Infarction↗

Flunarizine is effective in prophylaxis of headache associated with scleroderma.

Migraine-like headaches may occasionally be seen in patients with scleroderma. The mechanism of these headaches is not well established but may be secondary to central "Raynaud's phenomenon". We report a patient with such headaches that responded dramatically to the centrally acting calcium channel blocker, flunarizine. We suggest that flunarizine should be considered in the management of patients with scleroderma and migraine-like headaches.

Female↗

The impact of magnetic resonance imaging on the management of acute ischemic stroke.

Despite rapid advances in imaging technology, the etiology of stroke remains unestablished in 40% of patients. MRI improves localization in acute stroke. However, it is not known whether "accurate localization" results in better management. We reviewed the hospital records of all patients admitted with a diagnosis of acute ischemic stroke and who had had cranial CTs and MRI within 10 days of admission. Between January 1987 and June 1990, 116 patients (69 men, 47 women; mean age, 66 years) were identified. Compared with CT localization, infarcts were better localized in nine of 39 patients with cerebral cortical lesions, in 20 of 22 patients with brainstem and cerebellar lesions, and in three of three patients with isolated cerebellar lesions. In 22 patients (18.9%), MRI showed multiple infarcts in two or more vascular territories, suggesting embolic disease and leading to anticoagulation. MRI also showed arterial occlusions in 11 patients (9.5%). Based on the information obtained with MRI, the clinical diagnosis was changed in 19 patients (16.3%), resulting in changes in the management of most of those patients. Thus, we confirm earlier reports that MRI improves localization after acute cerebral infarction and show that such information alters patient management.

Acute Disease↗

During repetitive forebrain ischemia, post-ischemic hypothermia protects neurons from damage.

In rodents damage from repetitive transient cerebral ischemia is more severe than that seen with a single ischemic insult of similar duration. Mild hypothermia has been shown to be very effective in protecting the brain during single ischemic insults. We tested the protective effects of hypothermia in repetitive ischemic insults. We used the gerbil model of repetitive ischemia (three minutes ischemia repeated at one hourly intervals three times) and histological evaluation was done using the silver staining technique. Our study reveals that a decrease in body and scalp temperature by 1-2 degrees Celsius can significantly reduce neuronal damage in the cerebral cortex, CA1 region of the hippocampus and substantia nigra reticulata during repetitive ischemia. As the hypothermia was induced after the initial insult, we believe this offers an opportunity for intervention in the clinical settings.

Animals↗

Medullary hemorrhage causing vertigo and gaze nystagmus.

Brainstem hematomas carry a poor prognosis. There are rare reports of excellent outcome with hemorrhages in the midbrain. We report a 43-year-old woman with vertigo and minimal neurological symptoms, whose symptoms were initially mistaken for "inner ear disease," but subsequent investigations revealed a medullary hemorrhage. Recovery was complete within two weeks. While rare, medullary hemorrhage should be considered in the differential diagnosis of vertigo.

Adult↗

Alteration of blood pressure regulation and cerebrovascular disorders in the elderly.

The objective of this study was to review the available data on the effects of management of hypertension on stroke in the elderly. MED-LINE was searched for articles published from 1967 to 1991 for articles on hypertension and hypotension. The following "key words" were used to limit our search to relevant studies: "stroke", "cerebrovascular disease", "elderly", "hypertension", "hypotension", "drug trials in hypertension", "complications of acute stroke", and "stroke management". Original articles with data related to the effects of hypertension management or complications of hypotension were reviewed in detail. Of about 900 papers reviewed, 121 were selected for this review. These papers specifically addressed the long-term prognosis of subjects treated with antihypertensive medications, the prognosis after TIA or stroke, and complications of aggressive antihypertensive therapy. The incidence of hypertension increases with age. Hypertension is the most important correctable risk factor for stroke. Most studies on stroke prevention in asymptomatic hypertension (primary prevention) have shown clear benefits (including management of systolic hypertension in the elderly). Data on stroke prevention in patients with TIAs (secondary prevention) is limited but suggests that management of hypertension will decrease the risk of stroke in such patients. Patients with completed stroke who are hypertensive should have very careful management of their hypertension as they may be at risk for hypotensive complications. Sudden reduction in blood pressure in the elderly (especially in the presence of pseudohypertension) increases the risk of symptomatic cerebral hypoperfusion and stroke. Management of hypertension in the elderly is effective in stroke prevention. Because of the real risk of a sudden decrease in cerebral perfusion, pressure reduction should be done slowly and with care.

Aged↗

Mechanisms and management of stroke in the elderly.

OBJECTIVE: To highlight the mechanisms, common causes and management of stroke in the elderly. DATA SOURCES: MEDLINE was searched for articles published from 1967 to 1990. The following key words were used: "stroke," "cerebrovascular disease," "elderly," "aging," "hypertension," "drug interactions," "etiology," "evaluation," "management" and "recovery of function." Original articles with large series of patients were reviewed in detail. STUDY SELECTION: Of about 750 original articles reviewed 116 were finally selected for detailed analysis. Those that dealt with cause, pathophysiologic features and management of stroke with emphasis on the elderly were chosen. DATA SYNTHESIS: With increasing age the incidence of stroke increases, cardiovascular reserve decreases, catecholamine responsiveness diminishes and cardiac arrhythmias become more common. Blood pressure, especially systolic, rises, and the benefits of its treatment become both more difficult to assess and less certain. In the elderly population embolic stroke, particularly that due to nonvalvular atrial fibrillation, is seen with increasing frequency. Because of postural hypotension, cardiac arrhythmias and overmedication, watershed infarction occurs more frequently with increasing age. Amyloid angiopathy now represents the most common cause of spontaneous intracerebral hemorrhage. CONCLUSIONS: Because of the altered drug metabolism and pharmacodynamics in the elderly the therapeutic armamentarium is growing, and so are the risks of such treatments. Stroke in the elderly poses unique problems that deserve distinctive solutions. Further research is needed to study the effect of cerebral ischemia to understand better how the older brain handles the stress of the ischemic insult.

Age Factors↗

Recurrent cerebral infarction during anticoagulation therapy in patients with mitral valve prolapse.

Mitral valve prolapse has been associated with an increased risk of transient or lasting ischemic events. Recurrence is uncommon after initiation of antiplatelet or anticoagulant therapy. In this communication we report two patients, both female, who had mitral valve prolapse as the major risk factor for cerebrovascular disease and who developed cerebral infarction despite anticoagulation. The cerebral infarctions were bilateral and extensive in one patient and led to the patient's death. In the second case, three infarctions resulted in moderate disability.

Adult↗

Benign brainstem hemorrhage.

Most patients with brainstem hemorrhage have a poor prognosis. There are occasional reports of a favorable outcome with hematomas restricted to the mid-brain region. We report two patients with hematomas within the lower brainstem (pons and medulla) who made a good recovery. Diagnosis was unsuspected until the cranial CT scan was done. Angiography was normal in both cases. Recovery was excellent in one and fair in the second patient. Patients with medullary hemorrhage are at risk for aspiration and may suddenly develop respiratory arrest and therefore should be carefully observed. Our review of the literature suggests that with some small brain-stem hemorrhages recovery is good to excellent and recurrences are rare.

Adult↗

Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients.

To compare the diagnostic yields of transesophageal and transthoracic echocardiography in the detection of potential cardiac sources of embolism, 63 patients (mean +/- SD age 63 +/- 15 [range 18-87] years) with transient ischemic attacks or stroke underwent both procedures. Transthoracic echocardiography revealed a potential cardiac source of embolism in 14% (nine) of the patients, all of whom had clinical evidence of heart disease. Transesophageal echocardiography revealed a potential cardiac source of embolism in 41% (26) of the patients; 27% (seven) of these patients had no clinical cardiovascular abnormalities. Abnormalities detected only by transesophageal echocardiography in the patients with unsuspected cardiac disease included atrial septal aneurysm in two, patent foramen ovale in two, left atrial appendage thrombus in one, and myxomatous mitral valve in two. The 26 patients with an identified cardiac source of embolism were older (67.5 versus 59.4 years, p = 0.04), more frequently in atrial fibrillation (62% [16] versus 8% [3], p less than 0.0001), had a larger left atrium (43 versus 37 mm, p = 0.01) and more commonly had left ventricular hypertrophy (62% [16] versus 32% [12], p less than 0.02) than the 37 patients in whom no cardiac source of embolism was identified. Thus, transesophageal echocardiography is more sensitive than transthoracic echocardiography in the detection of potential cardiac sources of embolism in patients with cerebral ischemic events.

Cerebrovascular Disorders↗

Stroke from other etiologies masquerading as migraine-stroke.

There has been a recent increase in the number of studies dealing with migraine-stroke. I describe five patients in whom migraine-stroke was the clinical diagnosis but in whom the subsequent clinical events or autopsy showed a different mechanism for the cerebral infarction. Three patients had arterial dissection (one proven at autopsy), one had marantic endocarditis that had been missed on two echocardiograms (proven at autopsy), and one had generalized atherosclerosis and diabetes. These patients demonstrate that important and different etiologies may produce what seems to be the migraine-stroke syndrome. The result may be failure to recognize specific therapeutic measures that could have vitally important benefit to the patient.

Adult↗