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Protective effect of anthocyanins in middle cerebral artery occlusion and reperfusion model of cerebral ischemia in rats.

Ischemic stroke results from a transient or permanent reduction in cerebral blood flow that is restricted to the territory of a major brain artery. The major pathobiological mechanisms of ischemia/reperfusion injury include excitotoxicity, oxidative stress, inflammation, and apoptosis. In the present report, we first investigated the protective effects of anthocyanins against focal cerebral ischemic injury in rats. The pretreatment of anthocyanins (300 mg/kg, p.o.) significantly reduced the brain infarct volume and a number of TUNEL positive cells caused by middle cerebral artery occlusion and reperfusion. In the immunohistochemical observation, anthocyanins remarkably reduced a number of phospho-c-Jun N-terminal kinase (p-JNK) and p53 immunopositive cells in the infarct area. Moreover, Western blotting analysis indicated that anthocyanins suppressed the activation of JNK and up-regulation of p53. Thus, our data suggested that anthocyanins reduced neuronal damage induced by focal cerebral ischemia through blocking the JNK and p53 signaling pathway. These findings suggest that the consumption of anthocyanins may have the possibility of protective effect against neurological disorders such as brain ischemia.

Animals↗

Early recurrent embolism associated with nonvalvular atrial fibrillation: a retrospective study.

Nonvalvular atrial fibrillation (NVAF) can be a source of cardiogenic brain embolism. We retrospectively reviewed the clinical features of 56 patients with acute brain infarction and NVAF. Based on clinical criteria, 35 infarcts (63%) were classified as probably embolic, 13 infarcts (23%) as probably nonembolic and 8 infarcts (14%) as of indeterminate pathogenesis. Among the 35 patients with presumed embolic infarcts, 12 patients were immediately anticoagulated without hemorrhagic complications. Of 23 patients who did not receive immediate anticoagulation, three (13%) experienced recurrent embolism (one each to brain, kidney and leg) within 10 days of initial embolism. There were no early recurrent emboli in patients receiving immediate anticoagulation or patients in the nonembolic or indeterminate category. Five additional patients experienced probable brain or systemic emboli within the 11 days prior to the marker stroke event. Including these patients, 20% (8 of 40) of all NVAF patients who were not immediately anticoagulated experienced recurrent embolism within 11 days of the initial embolus. Early recurrent emboli are common in NVAF patients who experience embolic stroke.

Adult↗

Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke.

The aim of this study was to identify the frequency and possible pathogenic mechanisms of early neurological deterioration in patients with acute small non-lacunar infarction. We studied 46 patients (35 men, 11 women; age, 70.3+/-10.4 years) with acute small non-lacunar infarction. Small non-lacunar infarction was diagnosed using diffusion-weighted magnetic resonance imaging (DWI) as being <15 mm in diameter and located in the cortex and centrum ovale in the middle cerebral artery territory. The patients were divided into two groups; Group D (n=6) had neurological deterioration within 7 days after symptom onset, while Group N (n=40) did not have any neurological deterioration. In Group D, the interval from symptom onset to clinical deterioration was 3.3+/-1.5 days (range 2-6 days). Blood pressure on admission was higher in Group D than in Group N (p<0.05). In Group D, four of these five patients with follow-up DWI had new acute small ischemic lesions in addition to the initial lesions, indicating recurrent attacks of brain infarction. Neurological deterioration occurred within 7 days after symptom onset in 13% of patients. Neurological deterioration was frequently caused by recurrent infarction detected by DWI.

Acute Disease↗

Magnetic resonance imaging studies on the effect of the fibrinogen-lowering agent ancrod on cerebral lesions in two rat models of acute stroke.

In vivo magnetic resonance imaging was used to study the effect of ancrod (CAS 9046-56-4, Arwin), a plasma fibrinogen level lowering agent, on brain lesion in two rat models of acute focal cerebral ischaemia. Total lesion volume was determined by multislice T2-weighted magnetic resonance imaging 24 h after permanent middle cerebral artery occlusion. Intravenous infusion of ancrod starting 30 min after middle cerebral artery occlusion at dosages of 10, 30, 50 or 70 IU/kg (n = 9/group) significantly diminished cerebral lesion volume by 20 to 33% as compared to vehicle-infused controls (n = 12). None of the ancrod-treated rats showed evidence of intracerebral bleeding on T2-weighted magnetic resonance images taken after 24 h. In photochemically induced (rose bengal) unilateral thrombotic cortical infarction brain damage was displayed by multislice diffusion-weighted magnetic resonance imaging after 24 h. Again, post treatment with ancrod reduced total volume of cerebral lesion dose-dependently from 142 +/- 28 mm3 in the controls (n = 10) to 121 +/- 28 mm3 (n = 10) and 111 +/- 20 mm3 (n = 11, p < 0.05) in rats treated with 10 and 30 IU/kg ancrod, respectively (means +/- S.D.). These results suggest cerebroprotection in focal cerebral ischaemia by improvements in the cerebral microcirculation which may offer a potential and safe approach for therapy of acute stroke.

Acute Disease↗

The encephalopathy of sepsis.

Twelve fatal cases of encephalopathy associated with sepsis were examined in a ten-year retrospective study. The sources of infection and organisms isolated were variable. Six of the patients had focal neurologic signs; five had seizures. The level of consciousness varied from drowsiness to deep coma, and electroencephalograms revealed diffuse or multifocal abnormalities. Computed tomographic head scans and cerebrospinal fluid examinations were usually unremarkable. Eight patients had disseminated microabscesses in the brain at autopsy. Four patients had proliferation of astrocytes and microglia in the cerebral cortex, a feature associated with metabolic encephalopathies. Additional findings included cerebral infarcts, brain purpura, multiple small white matter hemorrhages, and central pontine myelinolysis. Although sepsis may cause encephalopathy by producing disturbances in cerebral synaptic transmission and cerebral energy production through a toxic mechanism, bacterial invasion of the brain with the formation of disseminated microabscesses is also an important cause.

Adult↗

Differential diagnosis between Alzheimer's disease and vascular dementia: evaluation of common clinical methods.

A prospective series of consecutively admitted demented patients were examined in order to evaluate the role of common clinical methods in the differential diagnosis between Alzheimer's disease (AD) and vascular dementia. Patients fulfilling the DSM-III criteria for vascular dementia were divided into multi-infarct dementia (MID) and probable vascular dementia (PVD), the latter including also cases with combined vascular and degenerative dementia. The series consisted of 68 patients with AD, 79 with MID and 46 with PVD. These groups did not differ in regard to sex, age or degree of dementia. Absence of cardio- and cerebrovascular diseases differentiated AD from MID and PVD. Also absence of corticospinal tract signs and gait disorders differentiated AD from MID and PVD and that of bulbar signs AD from MID. Infarcts and white matter low attenuation on CT differentiated MID and PVD from AD. Altogether 88.6% of the MID patients and 41.3% with PVD had brain infarct on CT, but only one with AD. Ischemic scores seemed also to be useful in the differential diagnosis between AD and vascular dementia. Quantitative neuropsychology, EEG, routine cerebrospinal fluid and other laboratory investigations, including serum glucose and plasma lipids, seem to be less valuable.

Aged↗

Rodent models of cerebral ischemia.

The use of physiologically regulated, reproducible animal models is crucial to the study of ischemic brain injury--both the mechanisms governing its occurrence and potential therapeutic strategies. Several laboratory rodent species (notably rats and gerbils), which are readily available at relatively low cost, are highly suitable for the investigation of cerebral ischemia and have been widely employed for this purpose. We critically examine and summarize several rodent models of transient global ischemia, resulting in selective neuronal injury within vulnerable brain regions, and focal ischemia, typically giving rise to localized brain infarction. We explore the utility of individual models and emphasize the necessity for meticulous experimental control of those variables that modulate the severity of ischemic brain injury.

Animals↗

Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging.

BACKGROUND AND PURPOSE: This study was designed to analyze whether early diffusion-weighted imaging (DWI) provides reliable quantitative information for the prediction of stroke patients at risk of malignant brain infarct. METHODS: We selected 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MRI angiography performed within 14 hours after onset (mean 6.5+/-3.5 hours, median 5.2 hours). Of these, 10 patients developed malignant MCA infarct, whereas 18 did not. For the 2 groups, we compared the National Institutes of Health Stroke Scale (NIHSS) score at admission, site of arterial occlusion, standardized visual analysis of DWI abnormalities, quantitative volume measurement of DWI abnormalities (volume(DWI)), and apparent diffusion coefficient values. Univariate and multivariate discriminant analysis was used to determine the most accurate predictors of malignant MCA infarct. RESULTS: Univariate analysis showed that an admission NIHSS score >20, total versus partial MCA infarct, and volume(DWI) >145 cm(3) were highly significant predictors of malignant infarct. The best predictor was volume(DWI) >145 cm(3), which achieved 100% sensitivity and 94% specificity. Prediction was further improved by bivariate models combining volume(DWI) and apparent diffusion coefficient measurements, which reached 100% sensitivity and specificity in this series of patients. CONCLUSIONS: Quantitative measurement of infarct volume on DWI is an accurate method for the prediction of malignant MCA infarct in patients with persistent arterial occlusion imaged within 14 hours of onset. This may be of importance for early management of severe stroke patients.

Adult↗

Ischemic injury in experimental stroke depends on angiotensin II.

Since pharmacological interactions of the renin-angiotensin system appear to alter the neurological outcome of stroke patients significantly, we examined the effect of elevated levels of angiotensin II and the role of its receptor subtype AT1 in brain infarction in transgenic mice after focal cerebral ischemia. Angiotensinogen-overexpressing and angiotensin receptor AT1 knockout mice underwent 1 h or 24 h permanent middle cerebral artery occlusion (MCAO). The current study revealed a much smaller penumbra size, i.e., brain tissue at risk, in angiotensinogen-overexpressing animals compared with their wild-type subgroup after 1 h MCAO, but an enlarged infarct size after 24 h. In contrast, a smaller lesion area of energy failure and a much larger penumbral area were found in AT1 knockout mice compared with wild-type littermates. Lower perfusion thresholds for ATP depletion and protein synthesis inhibition after MCAO in AT1-deficient mice and reduced cell damage in an in vitro model using embryonic neurons of AT1 knockout mice suggest injury mechanisms independent of arterial blood pressure. Our data, therefore, demonstrate a direct correlation between brain angiotensin II and the severity of ischemic injury in experimental stroke.

Angiotensin II↗

Effect of head positioning on intracranial blood flow velocities in acute ischemic stroke: a pilot study.

Current nursing practice for the care of patients with ischemic stroke advocates routine elevation of the head of the bed (HOB) to 30 degrees. Evidence supporting this practice is lacking, and it may reflect inappropriate generalization of findings from studies conducted primarily on traumatic brain injury patients with associated increased intracranial pressure to the ischemic stroke population. We used a repeated measures design to conduct a pilot study of the effect of three HOB positions on middle cerebral artery mean flow velocities (MCA-MFV) in patients with acute ischemic stroke. Transcranial Doppler (TCD) sonography was used to measure MCA-MFV. Eleven patients were enrolled in the study; the mean age of the sample was 60 years, and the mean National Institutes of Health Stroke Scale score was 8.7. On average, a 9.2% increase in MCA-MFV was measured when the HOB was lowered to 15 degrees from the 30 degrees elevation standard (p = .02); MCA-MFV increased on average by 3.9% when the HOB was again lowered from the 15 degrees position to the 0 degrees (flat) position (p = not significant). Mean arterial pressure, heart rate, and pulse pressure remained stable without significant change throughout the positioning intervention and measurement period. The overall increase in MCA-MFV achieved from lowering the HOB position from 30 degrees to a flat position was 13.1% (p = .054). Our findings from this small sample suggest that patients with acute ischemic stroke may benefit from lower HOB positions, in particular flat positioning, to promote an increase in flow to ischemic brain tissue that may ultimately reduce brain infarct volume.

Adult↗

Astrocyte survival and HSP70 heat shock protein induction following heat shock and acidosis.

Although severe acidosis is an important mediator of brain infarction, recent evidence suggests that mild acidosis may protect ischemic cells. The HSP70 heat shock protein is induced by acidosis in cultured cells and in ischemic brain and protects cells against many types of injury. Therefore, this study determined whether induction of heat shock proteins protects cultured astrocytes against acidosis. Brief exposure of cultured cortical astrocytes to acid (pH 5.2 for 40 min) or heat shock (45 degrees C for 40 min) markedly induced hsp70 mRNA and HSP70 protein. HSP70 protein was detected with the C92 monoclonal antibody (Welch and Suhan: J Cell Biol 103:2035, 1986), which has been shown to recognize the protein product of the full-length rat hsp70 cDNA (Longo et al: J Neurosci Res 36:325, 1993). Heat shock of the cultured cortical astrocytes completely protected the astrocytes from an otherwise lethal heat exposure 24 h later (45 degrees C for 4 h). In contrast, heat pretreatment sensitized the astrocytes to injury from acidosis 24 h later. Acid pretreatment, which markedly induced the HSP70 protein without producing astrocytic cell death, similarly sensitized the cells to injury from acidosis 24 h later (60% survival following pH 5.2 for 3 h versus 90% survival in controls; P < 0.0001). Surprisingly, heat shock pretreatment protected astrocytes against exposure to acid 48 h later (P < 0.05, 1.5-3 h), whereas acid pretreatment had no effect on astrocyte survival 48 h later. Since heat shock did not protect against acidosis at 24 h when HSP70 induction was maximal but did protect at 48 h when HSP70 was markedly diminished, the protective effect of heat shock at 48 h may be related to stress proteins present at 48 h. It is concluded that induction of HSP70 and other heat shock proteins by heat shock protects astrocytes against subsequent lethal heat shock. However, heat shock and acid treatment increase the vulnerability of astrocytes to acidosis 24 h later in spite of the induction of HSP70 heat shock proteins. The finding that heat shock protected astrocytes against acidosis 2 days later may suggest that delayed induction of stress proteins partially protects the astrocytes against damage produced by high concentrations of hydrogen ions.

Acidosis↗

Expression of redox factor-1, p53-activated gene 608 and caspase-3 messenger RNAs following repeated unilateral common carotid artery occlusion in gerbils--relationship to delayed cell injury and secondary failure of energy state.

The temporospatial expression pattern of the nuclear DNA repair enzyme redox factor-1 (ref-1), the p53-activated gene (pag) 608 and the effector caspase-3 was examined by in situ hybridization histochemistry in gerbils subjected to two 10-min episodes of unilateral common carotid artery occlusion, separated by 5h. Gene responses were correlated with the metabolic state, as revealed by regional adenosine 5'-triphosphate bioluminescent imaging, and with the degree of histological damage, as assessed by haematoxylin-eosin staining and terminal deoxynucleotidyl transferase-mediated-dUTP nick end labeling (TUNEL), in order to evaluate the role of these genes in the maturation of injury. Focal infarcts developed in the dorsolateral cerebral cortex at the bregma level and the nucleus caudate-putamen within four days after repeated unilateral ischemia, as indicated by a secondary adenosine 5'-triphosphate loss after initial adenosine 5'-triphosphate recovery and by histomorphological signs of pannecrosis. The more caudal cortex at hippocampal levels and the hippocampus (CA1>CA3 area), however, exhibited selective neuronal injury without adenosine 5'-triphosphate depletion. TUNEL+ cells appeared starting 5h after repeated unilateral ischemia. TUNEL+ cells reached maximum levels in the caudate-putamen at 12-24h, but much later in the cortex and hippocampus at two days after ischemia. Remarkably few TUNEL+ cells were noticed in the thalamus, where adenosine 5'-triphosphate state did not recover after reperfusion. Following repeated unilateral ischemia, a transient elevation of ref-1 mRNA was detected after 5h in the cerebral cortex and hippocampal CA1 area. Ref-1 mRNA levels decreased within 12-24h, before the onset of tissue damage. Subsequently, pag608 and caspase-3 mRNA levels increased, closely in parallel with the appearance of DNA fragmented cells, but slightly prior to the deterioration of adenosine 5'-triphosphate state. In the caudate-putamen, pag608 and caspase-3 mRNAs reached maximum levels already 12-24h after repeated common carotid artery occlusion, when DNA fragmentation was most prominent, and declined thereafter. In the cortex and hippocampal CA1-3 areas, where DNA damage appeared more slowly, pag608 and caspase-3 mRNAs were induced starting 24h after ischemia, and remained elevated even after two to four days. The levels of pag608 and caspase-3 mRNAs were similar at rostral and caudal levels of the cortex, as well as in the hippocampal CA1 and CA3 area, although the degree of injury differed considerably between these structures. Notably, pag608 and caspase-3 mRNAs were not elevated in the thalamus after repeated unilateral ischemia. The present report shows a close temporal association between the induction of ref-1, pag608 and caspase-3 mRNAs, the manifestation of cell injury and the secondary adenosine 5'-triphosphate depletion in infarcting brain areas, suggesting (i) that de novo responses of these genes may be involved in the maturation of cell injury and (ii) that apoptotic programs and the secondary deterioration of cerebral energy state may interfere with each other after ischemia.

Adenosine Triphosphate↗

Computer-assisted carotid plaque analysis: characteristics of plaques associated with cerebrovascular symptoms and cerebral infarction.

OBJECTIVE: to correlate the echostructural characteristics of carotid plaques with neurological symptoms and cerebral infarcts. MATERIALS: one hundred and five plaques were studied in 74 patients by colour-flow duplex ultrasound: 39 were symptomatic and 37 were associated with brain infarction on CT scanning. METHODS: the images were digitalised for computer-assisted image standardisation and divided in homogenous (n=67) and heterogenous (n=38) groups. Parameters of the plaque image were analysed. RESULTS: global echogenicity was significantly lower in symptomatic and in CT(+)plaques (p<0.05). For homogenous plaques, an echogenic cap (EC) was visualised in 8.3% of symptomatic vs. 33.9% of asymptomatic (p<0. 05) and in 7.7% for plaques that were CT(+)vs. 37.7% for CT(-)(p<0. 05). Surface disruption was visualised in 50% of symptomatic vs. 8. 5% of asymptomatic (p=0.002) and in 46% of CT(+)vs. 9.4% of CT(-)plaques (p=0.002). For heterogenous plaques, the echolucent region was juxtaluminal in 67% of symptomatic and CT(+)plaques vs. 33% in asymptomatic and CT(-)(p<0.01). CONCLUSION: echolucent plaques are associated with a higher neurological risk. In homogenous plaques the absence of an echogenic cap and disruption of the plaque surface also correlates with symptoms. In heterogenous plaques, juxtaluminal location of the echolucent region is an additional marker of increased risk.

Adult↗

[Clinical diagnosis and stroke subtypes].

Sudden focal neurological symptoms are caused by stroke in 95%, either ischemic or hemorrhagic. Diagnosis and onset of treatment has to be rapid because the tolerance of the brain tissue to ischemia is lower than in any other tissue. First priority has stabilization of vital parameters such as maintenance of high blood pressure, rehydration, oxygen supply and correction of hyper-/hypoglycemia. Of equal importance is the prompt imaging of the brain to differentiate bleeding, complete brain infarction and early ischemic signs--only the latter permitting recanalization procedures by thrombolysis in a narrow time window of three hours. Distinct etiological diagnosis by Duplex scanning and echocardiography usually follows. This information determines the stroke subtype and the choice of secondary prevention measures.

Brain Ischemia↗

Thalassemia and learning: Neurocognitive functioning in children.

As more effective management and even cure of thalassemia become possible, attention is beginning to be directed to the potential neurologic and resulting neurocognitive effects of this illness on adults and children. Recent studies indicate that for adults with beta-thalassemia major and intermedia, and for children with sickle beta-thalassemia (Sbeta-thalassemia), there is a substantial risk for silent brain infarcts that may be associated with neurocognitive impairment similar to that reported for children with sickle cell anemia. Here the available literature in this area is reviewed and the limited outcomes are compared with those available from large, multicenter longitudinal studies of sickle cell anemia. On the basis of these comparisons, it is recommend that children with thalassemia be screened for specific neuropsychological impairments and that they be provided early intervention and special education access as available under the Individuals with Disabilities Education Act (IDEA) or the 504 Regulations of the Rehabilitation Act of 1973.

Adolescent↗

Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management.

Our review shows that a wide array of neurologic complications can occur after liver transplantation. Clinical correlation of the neuropathologic lesions may be difficult, as multiple lesions of variable etiologies may coexist, and significant systemic and metabolic complications may obscure the symptoms related to an underlying lesion in the central nervous system. Nevertheless, a reasoned approach to the recognition and diagnosis of these lesions is offered. In the early post-transplantation period, noninfectious lesions predominated. Of these, anoxic-ischemic changes and vascular events (hemorrhages and/or infarcts) occurred most frequently. Anoxic events occurred a mean of 10 days after transplantation and were often preceded by transient or varying degrees of hypotension. Hemorrhagic events and infarcts occurred a median of 27 and 5 days, respectively, after transplantation. It should be noted, however, that the projected onset of these events may vary somewhat, e.g., a brain infarct developed 47 days after liver transplantation in case 2. Although defects in coagulation may predispose to hemorrhagic lesions, a source for the infarct is usually not apparent. Central pontine myelinolysis is also an early-occurring lesion: most cases are seen within 10 days of transplantation. Extrapontine involvement frequently coexisted with or was present without pontine lesions. Hyponatremia or wide variations in serum sodium generally preceded the CNS lesion. Focal areas of high signal density by CT scan in the pons was highly suggestive of central pontine myelinolysis. Cyclosporine may cause white matter changes in the brain despite normal serum cyclosporine levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Simplified model of krypton laser-induced thrombotic distal middle cerebral artery occlusion in spontaneously hypertensive rats.

BACKGROUND AND PURPOSE: The effects of thrombotic occlusion of the middle cerebral artery on compromised ischemic tissue may be different from and more severe than those of cerebral ischemia induced by mechanical occlusion of the artery. Photothrombosis, which is based on photochemical damage to the endothelium and subsequent platelet aggregation, is an efficient method to induce thrombosis in vivo. This study aimed to improve and simplify this unique method for an ischemia model of middle cerebral artery occlusion in rats. METHODS: Male spontaneously hypertensive rats (5 to 6 months old, 300 to 450 g) were anesthetized with halothane, endotracheally intubated, and mechanically ventilated. A krypton laser operating at 568 nm was used to irradiate the exposed distal middle cerebral artery with an intact dura above the rhinal fissure. The photosensitizing dye rose bengal (20 mg/kg body wt) was administered intravenously over 90 seconds starting simultaneously with 4 minutes of laser irradiation at a power of 20 mW to cause thrombotic occlusion of this artery. RESULTS: The irradiated middle cerebral artery was completely occluded by intraluminal thrombi within 3 minutes after simultaneous laser irradiation and rose bengal infusion. Thrombosed materials were not stained by phosphotungstic acid-hematoxylin stain (ie, aggregated platelets lacked apparent fibrin). The mean volume of 3-day-old infarction, indicated by the lack of staining with 2,3,5-triphenyltetrazolium chloride, was 84.8 +/- 17.4 mm3 (mean +/- SD, n = 6). CONCLUSIONS: We demonstrated a reproducible and minimally traumatic model of brain infarction induced by the thrombotic distal middle cerebral artery occlusion in rats.

Animals↗

Arterial thoracic outlet syndrome with embolic cerebral infarction. Report of a case.

Cerebral embolism is a very rare but recognized manifestation of arterial complications of thoracic outlet syndrome, and is associated with retrograde embolization in the cerebral arteries. We herein report a case of embolic brain infarction due to arterial thoracic outlet syndrome while discussing the etiology, diagnosis, and surgery.

Cerebral Infarction↗