Cerebral Edema Associated With Large Hemispheric Infarction

Liebeskind, David S; Jüttler, Eric; Shapovalov, Yuriy; Yegin, Ashley; Landen, Jaren W.; Jauch, Edward C.

doi:10.1161/strokeaha.118.024766

Cited by 72 publications

(62 citation statements)

References 82 publications

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“…Differences in the use of ICP-lowering and anticoagulant drugs could be related to the different AIS pathogeneses. In PHOTAR patients, AIS was likely related to haemodynamic changes, affected a larger area and tended to cause oedema, while in the PUFH group, AIS was likely associated with atherosclerosis and thrombosis, where patients presented with more progressive stroke [26].…”

Section: Treatmentmentioning

confidence: 99%

Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study

Zhuoga

Jin

et al. 2020

BMC Neurol

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Background Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing. Methods This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis. Results In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P < 0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P < 0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P < 0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases. Conclusion In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

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Section: Treatmentmentioning

confidence: 99%

Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study

Zhuoga

Jin

et al. 2020

BMC Neurol

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“…Ischemiareperfusion may result in reperfusion injury, which manifests as hemorrhagic transformation, brain edema, infarct progression, and neurologic worsening (Choi and Pile-Spellman, 2018). Most of these changes are caused by the energy exhaustion of neurons, followed by Ca 2+ entry (Stegner et al, 2019), cell edema (Liebeskind et al, 2019) and excitotoxicity (Lai et al, 2014), neuroinflammation (Jayaraj et al, 2019), apoptosis (Chen et al, 2020), and autophagy (Yan et al, 2013;He et al, 2020). While irretrievable neuronal loss occurs after a series of spatiotemporal pathological changes, especially in the infarct core area where blood flow drops quickly, the surrounding hypoperfused penumbra region (peri-infarct area) is at risk of delayed cell death.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Ischemia-Reperfusion Is Associated With Upregulation of Cofilin-1 in the Motor Cortex

Yin

Cheng

et al. 2021

Front. Cell Dev. Biol.

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Cerebral ischemia is one of the leading causes of death. Reperfusion is a critical stage after thrombolysis or thrombectomy, accompanied by oxidative stress, excitotoxicity, neuroinflammation, and defects in synapse structure. The process is closely related to the dephosphorylation of actin-binding proteins (e.g., cofilin-1) by specific phosphatases. Although studies of the molecular mechanisms of the actin cytoskeleton have been ongoing for decades, limited studies have directly investigated reperfusion-induced reorganization of actin-binding protein, and little is known about the gene expression of actin-binding proteins. The exact mechanism is still uncertain. The motor cortex is very important to save nerve function; therefore, we chose the penumbra to study the relationship between cerebral ischemia-reperfusion and actin-binding protein. After transient middle cerebral artery occlusion (MCAO) and reperfusion, we confirmed reperfusion and motor function deficit by cerebral blood flow and gait analysis. PCR was used to screen the high expression mRNAs in penumbra of the motor cortex. The high expression of cofilin in this region was confirmed by immunohistochemistry (IHC) and Western blot (WB). The change in cofilin-1 expression appears at the same time as gait imbalance, especially maximum variation and left front swing. It is suggested that cofilin-1 may partially affect motor cortex function. This result provides a potential mechanism for understanding cerebral ischemia-reperfusion.

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“…Acute ischemic stroke accounts for about 80% of all types of stroke (2). Large hemispheric infarction (LHI) is defined as affecting the majority of or complete middle cerebral artery (MCA) territory with or without anterior cerebral artery and posterior cerebral artery involvement (3). It is a disastrous subtype of acute ischemic stroke, which may lead to life-threatening swelling (4).…”

Section: Introductionmentioning

confidence: 99%

“…It is a disastrous subtype of acute ischemic stroke, which may lead to life-threatening swelling (4). Furthermore, LHI patients with malignant edema (ME) develop a mortality rate of nearly 40 ∼ 80% under standard treatment, while mortality of those without ME is nearly 5 ∼ 25% (3,5,6). It has been demonstrated by previous studies that timely decompressive craniotomy may reduce the mortality of LHI patients with ME (7,8).…”

Section: Introductionmentioning

confidence: 99%

Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

Sun

Luo

et al. 2021

Front. Neurol.

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Background and purpose: Previous studies have demonstrated that Net Water Uptake (NWU) is associated with the development of malignant edema (ME). The current study aimed to investigate whether NWU calculated in standardized and blindly outlined regions of the middle cerebral artery can predict the development of ME.Methods: We retrospectively included 119 patients suffering from large hemispheric infarction within onset of 24 h. The region of the middle cerebral artery territory was blindly outlined in a standard manner to calculate NWU. Patients were divided into two groups according to the occurrence of ME, which is defined as space-occupying infarct requiring decompressive craniotomy or death due to cerebral hernia in 7 days from onset. The clinical characteristics were analyzed, and the receiver operating characteristic curve (ROC curve) was used to assess the predictive ability of NWU and other factors for ME.Results: Multivariable analysis showed that NWU was an independent predictor of ME (OR 1.168, 95% CI 1.041–1.310). According to the ROC curve, NWU≥8.127% identified ME with good predictive power (AUC 0.734, sensitivity 0.656, specificity 0.862).Conclusions: NWU calculated in standardized and blindly outlined regions of the middle cerebral artery territory is also a good predictor for the development of ME in patients with large hemispheric infarction.

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Cerebral Edema Associated With Large Hemispheric Infarction

Cited by 72 publications

References 82 publications

Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study

Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study

Cerebral Ischemia-Reperfusion Is Associated With Upregulation of Cofilin-1 in the Motor Cortex

Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

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