Environmental enrichment is a widespread neuroprotective strategy during development and also in the mature nervous system. Several research groups have described that enriched environment in adult rats has an impact on the progression of Parkinson’s disease (PD). The aim of our present study was to examine the effects of early, postnatal environmental enrichment after 6-hydroxydopamine-induced (6-OHDA) lesion of the substantia nigra in adulthood. Newborn Wistar rats were divided into control and enriched groups according to their environmental conditions. For environmental enrichment, during the first five postnatal weeks animals were placed in larger cages and exposed to intensive complex stimuli. Dopaminergic cell loss, and hypokinetic and asymmetrical signs were evaluated after inducing PD with unilateral injections of 6-OHDA in three-month-old animals. Treatment with 6-OHDA led to a significant cell loss in the substantia nigra of control animals, however, postnatal enriched circumstances could rescue the dopaminergic cells. Although there was no significant difference in the percentage of surviving cells between 6-OHDA-treated control and enriched groups, the slightly less dopaminergic cell loss in the enriched group compared to control animals resulted in less severe hypokinesia. Our investigation is the first to provide evidence for the neuroprotective effect of postnatal enriched environment in PD later in life.

Background Neuroinflammation plays an important role in the pathogenesis of acute ischemic stroke (AIS) and peripheral leukocyte counts have proved to be independent predictors of stroke severity and outcomes. Clinical significance of large vessel occlusion (LVO) in AIS is increasing, as these patients are potential candidates for endovascular thrombectomy and likely to have worse outcomes if not treated urgently. The aim of our study was to assess the relationship between on admission leukocyte counts and the presence of LVO in the early phase of AIS. Methods We have conducted a cross-sectional, observational study based on a registry of consecutive AIS patients admitted up to 4.5 h after stroke onset. Blood samples were taken at admission and leukocyte counts were measured immediately. The presence of LVO was verified based on the computed tomography angiography scan on admission. Results Total white blood cell (WBC) and neutrophil counts were significantly higher in patients with LVO than those without LVO (P < 0.001 respectively). After adjustment for potential confounders total WBC counts (adjusted OR: 1.405 per 1 × 109/L increase, 95% CI: 1.209 to 1.632) and neutrophil counts (adjusted OR: 1.344 per 1 × 109/L increase, 95% CI: 1.155 to 1.564) were found to have the strongest associations with the presence of LVO. Total WBC and neutrophil counts had moderate ability to discriminate an LVO in AIS (AUC: 0.667 and 0.655 respectively). No differences were recorded in leukocyte counts according to the size of the occluded vessel and the status of collateral circulation in the anterior vascular territory. However, total WBC and neutrophil counts tended to be higher in patients with LVO in the posterior circulation (p = 0.005 and 0.010 respectively). Conclusion Higher admission total WBC and neutrophil counts are strongly associated with the presence of LVO and has moderate ability to discriminate an LVO in AIS. Detailed evaluation of stroke-evoked inflammatory mechanisms and changes according to the presence of LVO demands further investigation.

It was previously reported that diabetes mellitus (DM) and admission hyperglycemia (aHG) were associated with poor clinical outcomes in patients with acute ischemic stroke (AIS) who were treated with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT). Our study aimed to assess the prognostic effect of DM and aHG (≥7.8 mmol/L) on clinical outcomes in patients treated with recanalization therapies (IVT and MT). Our multicentric study was based on data from the prospective STAY ALIVE stroke registry between November 2017 and January 2020. We compared the demographic data, clinical parameters and time metrics between recanalized DM and non-DM groups, and we analyzed the impact of DM and aHG on 90-day functional outcome, 90-day mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. Statistical analyses were also performed in two subgroups: (1) patients treated with IVT alone and (2) patients treated with MT. Altogether, we included 695 patients from the three participating stroke centers in Hungary. Regarding the overall population, patients with diabetes were older (72 vs. 67 years, p < 0.001) and comorbidities were more frequent. There were significant differences in the 90-day good functional outcome (48.9% vs. 66.7%, p < 0.001), 90-day mortality (21.9% vs. 11.6%, p < 0.001) and the rate of symptomatic intracranial hemorrhaging (sICH) (7.8% vs. 2.2%, p < 0.001) between the groups. Diabetes and aHG were independently associated with a poor clinical outcome (OR 2.02, 95% CI 1.31–3.11, p = 0.001; OR 2.09, 95% CI 1.39–3.14, p < 0.001) and mortality at 3 months (OR 2.45, 95% CI 1.35–4.47, p = 0.003; OR 2.42, 95% CI 1.37–4.28, p = 0.002) and sICH (OR 4.32, 95% CI 1.54–12.09, p = 0.005; OR 4.61, 95% CI 1.58–13.39, p = 0.005) in the overall population. However, the presence of DM and aHG was not correlated with successful reperfusion (OR 0.39, 95% CI 0.09–1.67, p = 0.205; OR 0.42, 95% CI 0.09–1.97, p = 0.274) after MT. Our study revealed that diabetes and hyperglycemia on admission were correlated with poor clinical outcomes at 3 months in patients with acute stroke regardless of the recanalization method. In addition, the variables were also associated with sICH after recanalization therapies. However, successful recanalization was not associated with DM and aHG in patients who underwent MT.

A stroke világszerte a harmadik leggyakoribb halálok, a szívinfarktus és a daganatos betegségek után, funkcionális kimenetele pedig valamennyi betegség közül a legrosszabb. A koleszterin, különösen az LDL-C-szint kulcsszerepet játszik az érelmeszesedésben, a plakkok kialakulásában. Az elmúlt években bebizonyosodott, hogy az LDL-C-szint növekedésével arányosan emelkedik a cerebrovascularis betegségek incidenciája és halálozása. A statinterápia egyér-telműen csökkenti a stroke-rizikót, de a más módszerekkel elért lipidszintcsökkentő kezelésnek eddig nem volt igazoltan szignifikáns hatása. A magasabb dózisú statinkezelés preventív hatása egyértelmű, ugyanakkor az ilyen dózis alkalmazása fokozott óvatosságot igényel korábbi intracerebralis vérzést elszenvedett betegeknél, és kockáztathatjuk az új keletű diabetes kialakulását is. A közelmúltban közzétett IMPROVE-IT vizsgálat elsőként igazolta, hogy a statinterápia mellé adott nem statin típusú ezetimibbel az LDL-C-szint tovább csökkenthető, ezzel párhuzamosan tovább mérséklődik a cardio-és cerebrovascularis események incidenciája, a mellékhatások számának növekedése nélkül. Ezek az eredmények újra megerősítették a minél nagyobb mértékű LDL-C-szint-csökkentés jelentőségét. A statin-ezetimib kombináció révén a célértékek elérése alacsony és közepes statindózissal is lehetséges, csökkentve ezáltal a magas dózisú statinkezelés mellékhatásainak veszélyét. Orv. Hetil., 2016Hetil., , 157(52), 2059Hetil., -2065 Kulcsszavak: LDL-koleszterin, stroke, statinok, ezetimib Lipids and cerebrovascular disease -New therapeutic options in lowering LDL-cholesterolStroke is the third most common cause of death worldwide following myocardial infaction and malignancies, furthermore, its functional outcome is the worst of all conditions. Cholesterol, especially LDL-cholesterol plays a key role in the formation of atherosclerotic plaques. It has been verified recently that escalating incidence and mortality of cerebrovascular diseases are proportional to increased levels of LDL-cholesterol. Statin therapy undeniably reduces the risk of stroke, however other methods for decreasing lipid levels have not been proved significantly effective. Preventive effect of high-dose statin treatment is without doubt, although administration of such high dosage might require special precautions for patients with prior intracerebral hemorrhage and it also risks development of incident diabetes. The recently published IMPROVE-IT study is the first to prove that the addition of ezetimibe as a nonstatin type drug, to statin treatment contributes to further reduction of LDL-cholesterol. The combination treatment results in additional decrease in the incidence and mortality of cerebrovascular events, without any expansion in the number or adverse effects. These results confirm the importance of any further reduction of LDL-cholesterol levels. Achieving target values with statin-ezetimibe combination allows administration of low to moderate dose of statin, which decreases risks of adverse effects related to hig...

Introduction: Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15–20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. We sought to assess the efficacy and safety of EVT in tandem lesions, particularly the EICA stenting management. Methods: We retrospectively analyzed all patients with anterior circulation stroke associated with EICA lesion and receiving EVT in the three participated stroke centers between November 2017 and December 2020. Patients’ data were collected from our prospective stroke registry (STAY ALIVE). Patients enrolled in our study were divided into two groups depending on whether acute carotid stenting (ACS) or balloon angioplasty only (BAO) technique was used. Our primary outcome was the 90-day functional outcome assessed by modified Rankin scale (mRS). Mortality at 90 days and symptomatic intracranial hemorrhage (sICH) were considered as secondary outcomes. Results: A total of 101 patients (age: 67 ± 10 years, 38.6% female) were enrolled in our study, including 29 (28.3%) BAO cases, and 72 (71.3%) patients treated with ACS. Patients in the BAO group were slightly older (70 ± 9 years vs. 66 ± 10 years, p = 0.054), and had higher prevalence of comorbidities such as hypertension (100.0% vs. 59.4%, p < 0.001). There was no significant difference in favorable outcomes (51.7% vs. 54.4%, p = 0.808) between the groups. However, we observed a trend towards higher rates of sICH (8.3% vs. 3.4%, p = 0.382) and 90-day mortality (23.5% vs. 13.8%, p = 0.278) with significantly higher frequency of distal embolization (39.1% vs. 17.9%, p = 0.043) in patients with ACS. In the overall population age (p = 0.013), atrial fibrillation (AF) (p = 0.008), National Institutes of Health Stroke Scale (NIHSS) baseline (p = 0.029), and successful recanalization (p = 0.023) were associated with favorable outcome. Conclusion: Endovascular approach of EICA in addition to MT was safe and effective in tandem occlusion of anterior circulation. Furthermore, our results suggest that balloon angioplasty technique without acute stenting shows a comparable favorable outcome rate to ACS with moderately less hemorrhagic events and mortality rates.