IntroductionThe impact of choroid plexus with its blood–cerebrospinal fluid barrier in the ischemic stroke pathology is poorly explored. Transthyretin (TTR) is a protein synthesized in liver and just in choroid plexus.ObjectivesThe current study was designed to assess the prognostic value of serum TTR for functional outcome (at the time of hospital discharge) and long-term (one-year) overall mortality in ischemic stroke patients.Patients and methodsWe conducted a prospective observational study. Patients (n = 81) with acute (< 24 hours of symptoms onset) ischemic stroke consecutively admitted to Stroke Unit were included. An unfavorable outcome was defined as a modified Rankin Scale (mRS) score ≥ 3. The relationships between serum TTR levels and clinical outcome were analyzed using multivariate analysis. One-year mortality was analyzed by Kaplan–Meier survival curves stratified by mean value of TTR.ResultsCompared with patients with mRS <3, patients with an unfavorable outcome at hospital discharge had significantly lower TTR levels on admission (P < 0.0001). In non-survivals serum TTR levels were significantly lower compared with patients who survive one year of observation (P = 0.009). Using multivariate analysis, transthyretin emerged as an independent predictor for unfavorable outcome at the day of hospital discharge (adjusted odds ratio = 0.96; 95% CI: 0.9–0.99, P <0.05). A one-year mortality of patients with the lower TTR levels was significantly higher than in patients with TTR levels above mean value (P = 0.02).ConclusionsSerum level of TTR at admission was a predictor of functional outcome after ischemic stroke and was also associated with one-year mortality in stroke survivals.

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In the last few years, there has been a rapid increase in patients being treated with various anticoagulation and antiplatelet agents. In clinical neurology, these drugs are administered for primary and secondary stroke prevention or to avoid the consequences of immobilization of severe stroke patients. Additionally, thrombolytic intravenous therapy and, recently, intra-arterial therapy for stroke have been increasingly employed all over the world. These therapies are associated with an increased risk of hemorrhage, including the most dangerous, intracranial hemorrhage. The knowledge of the standards for the treatment of hemorrhagic complications in the central nervous system is crucial for doctors in neurology and stroke units as well as in emergency rooms. Therefore, we conducted a review of various guidelines and recommendations, including manufacturers' opinions contained in the summaries of product characteristics (Polish and British or European versions), in Guidelines of the Polish Neurological Society and in international and American guidelines i.e., European Stroke Organization (ESO) and American Heart Association/American Stroke Association (AHA/ASA). In addition, we compared these guidelines with expert opinions published in recent manuscripts and manuals on intensive care in neurology.