These results suggest a link between impaired cerebrovascular reactivity and the risk of ischemic events ipsilateral to severe asymptomatic carotid stenosis.

Background and Purpose-The aim of this study was to explore the possible contribution of alterations in cerebral hemodynamics to the evolution of cognitive impairment in patients with Alzheimer disease (AD). Method-Fifty-three patients with AD were investigated. The evolution of cognitive decline over 12 months was evaluated by means of changes in Mini Mental State Examination (MMSE) and AD Assessment Scale for Cognition (ADAS-Cog) scores. Demographic characteristics, vascular risk profile, pharmacological treatment, and presence of white matter lesions were assessed at entry. Further, a basal evaluation of cerebrovascular reactivity to hypercapnia was measured with transcranial Doppler ultrasonography using the breath-holding index (BHI). Results-Of all the variables considered, both MMSE and ADAS-Cog changes had the highest correlation with BHI, followed by age and diabetes. After subdividing both cognitive measures reductions into bigger and smaller-thanaverage decline (2 points for MMSE; 5 points for ADAS-Cog), multiple logistic regression indicated BHI as the sole significant predictor of cognitive decline. Conclusions-These results show an association between impaired cerebral microvessels functionality and unfavorable evolution of cognitive function in patients with AD. Further research is needed to fully establish whether altered cerebral hemodynamics may be considered an independent factor in sustaining cognitive decline progression or an effect of pathological processes involved in AD.

Background and Purpose-Evidence suggests that an alteration in cerebral hemodynamics plays a relevant role in the occurrence of stroke in patients with carotid occlusion. The purpose of the present study was to evaluate the relationships among baseline characteristics, type and number of collateral pathways, cerebral vasomotor reactivity (VMR), and outcome of patients with carotid occlusion. Methods-One hundred four patients with symptomatic or asymptomatic internal carotid artery occlusion were followed up prospectively for a median period of 24 months. Cerebral VMR to apnea was calculated with transcranial Doppler ultrasonography by means of the breath-holding index (BHI) in the middle cerebral arteries. The patency of the 3 major intracranial collateral vessels was also evaluated. Results-During the follow-up period, 18 patients experienced an ischemic stroke ipsilateral to internal carotid artery occlusion. Among factors considered, only older age, number of collateral pathways, and BHI values in the middle cerebral artery ipsilateral to the occluded side were significantly associated with the risk of ipsilateral stroke (PϽ0.001, Pϭ0.008, and PϽ0.001, respectively; multiple Cox regression analysis). A normal VMR and favorable prognosis characterized patients with full collateral development; in this group, no patient experienced an ischemic event. On the other hand, an impaired VMR and increased probability of experiencing a stroke were found in patients without collateral pathways; the annual risk of ipsilateral stroke in this group was 32.7%. Patients with 1 or 2 collateral pathways showed a different VMR ranging from normal to strongly reduced BHI values. The ipsilateral stroke event risk was 17.5% in patients with 1 collateral vessel and 2.7% in patients with 2 collateral pathways. In this case, the risk of cerebrovascular events occurring during the follow-up period was significantly related to VMR. Conclusions-These data suggest that cerebral hemodynamic status in patients with carotid occlusive disease is influenced by both individual anatomic and functional characteristics. The planning of strategies to define the risk profile and any attempt to influence patients' outcome should be based on the evaluation of the intracranial hemodynamic adaptive status, with particular attention to the number of collateral vessels and the related VMR. (Stroke. 2001;32:1552-1558.)

S pontaneous intracerebral hemorrhage (ICH) accounts for 10% to 30% of all strokes and is characterized by high rates of mortality and disability. The inflammatory response contributes to the ICH-induced secondary brain injury although the mechanisms are unknown. 1 The aim of this study was to evaluate the relationships between the total and differential leukocyte counts and the neutrophil-to-lymphocyte ratio (NLR) at admission with the 3-month outcome in ICH patients. Methods Participants and Study OutcomeWe retrospectively identified consecutive patients hospitalized at the Stroke Unit of the Marche Polytechnic University, Ancona, Italy from January 2008 to September 2015 for stroke syndrome caused by acute spontaneous ICH who underwent admission routine blood sampling and cranial computed tomographic neuroimaging within 24 hours from symptom onset. Demographics, medical history, admission/discharge National Institutes of Health Stroke Scale 2 scores, baseline ICH topography and volume, 3 admission blood pressure and 24-hour blood pressure variability by means the coefficient of variation 4 were considered. Total white blood cells (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and erythrocyte sedimentation rate were collected from admission blood work. The outcome measure was the 3-month functional status: poor outcome was the occurrence of death or major disability (modified Rankin Scale score, ≥3). 5 Statistical AnalysisValues are presented as mean±SD, median (interquartile range) or number (%) of subjects. Comparisons were made through the Student t test, Mann-Whitney U test or χ 2 test. Spearman correlation was used to correlate continuous variables. The associations between the WBC, ANC, ALC, NLR, and the study end point were determined using the logistic regression; the variables with P<0.05 from comparison of baseline characteristics and selected variables (age, sex, initial National Institutes of Health Stroke Scale score, baseline volume, location, and intraventricular extension of ICH) 6 were forced into the multivariate analysis. The analysis was performed after categorization of the WBC, ANC, and ALC values into higher and lower groups with respect to the normal reference ranges. 7 The receiver operating characteristic analysis evaluated the ability of the WBC, ANC, ALC, and NLR to predict the outcome. Results were significant for P<0.05 (2 sided). Analysis was performed using STATA/IC 13.1 (StataCorp LP, TX). Standard Protocol ApprovalsThe local ethical committee approved this study. The board allowed the study to be conducted without patients' consent because of the retrospective nature of the study. ResultsA total of 177 patients were recruited, whose 94 (53.1%) had a modified Rankin Scale score of ≥3 at 3 months (Table 1). The poor outcome patients had higher WBC, ANC, and NLR and lower ALC (Table I in the online-only Data Supplement); no difference was found in the admission erythrocyte sedimentation rate values (28±2 versus 26±2 mm/h for good and poor outcome, respec...