Long term prognosis after occlusion of middle cerebral artery.

Sacquegna, T.; Carolis, P. De; Andreoli, A.; Ferrara, Raffaele; Limoni, P.; Testa, Claudio; Lugaresi, E

doi:10.1136/bmj.288.6429.1490

Cited by 13 publications

(4 citation statements)

References 12 publications

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“…The MCA is the most commonly affected vessel in stroke (Mohr et al, ), and its occlusion is associated with late‐onset seizures and epilepsy (De Carolis et al, ; Sacquegna et al, ). The MCA occlusion model of stroke has been used to investigate whether the initial ischemic injury is followed by an epileptogenesis phase and eventually by recurrent spontaneous seizures in rats (Karhunen et al, , ; Pitkanen et al, ; Kelly et al, ; Miller et al, ).…”

Section: Poststroke Epileptogenesismentioning

confidence: 99%

Prospects of modeling poststroke epileptogenesis

Reddy

Bhimani

Kuruba

et al. 2016

J of Neuroscience Research

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This article describes the current status of post-stroke epilepsy (PSE) with an emphasis on post-stroke epileptogenesis modeling for testing new therapeutic agents. Stroke is a leading cause of epilepsy in an aging population. Late-onset “epileptic” seizures were reported in up to 30% cases after stroke. Nevertheless, the overall prevalence of PSE is 2–4%. Rodent models of stroke have contributed to our understanding of the relationship between seizures and the underlying ischemic damage to neurons. To understand whether acutely generated stroke events lead to a chronic phenotype more closely resembling PSE with recurrent seizures, a limited variety of approaches emerged in early 2000s. These limited methods of causing an occlusion in mice and rats show different infarct size and neurological deficits. The most employed procedure for inducing focal ischemia is the middle cerebral artery occlusion. This mimics the pathophysiology seen in humans, in terms of extent of damage to cortex and striatum. Photothrombosis and endothelin-1 models can similarly evoke episodes of ischemic stroke. These models are well suited to studying mechanisms and biomarkers of epileptogenesis or optimizing novel drug discoveries. However, modeling of PSE is tedious, highly variable, and lacks validity; therefore, is not widely implemented in epilepsy research. Moreover, the relevance of ischemic models to specific forms of human stroke remains unclear. Stroke modeling in young male rodents lacks clinical relevance to elderly population and especially women, due likely to sex differences. Nevertheless, owing to the neuronal damage and epileptogenic insult that these models trigger, they are helpful tools used to study acquired epilepsy and prophylactic drug therapy.

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Section: Poststroke Epileptogenesismentioning

confidence: 99%

Prospects of modeling poststroke epileptogenesis

Reddy

Bhimani

Kuruba

et al. 2016

J of Neuroscience Research

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“…In severe MCAS the total length of stenosis was 6.8 mm (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and the length of maximal stenosis was 2.9 mm (0. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. An ulcer was suggested only in 5 of the 142 (4%) severely stenosed middle cerebral artery where this finding could be evaluated (76%).…”

Section: Angiographk Featuresmentioning

confidence: 99%

Atherosclerotic disease of the middle cerebral artery.

Bogousslavsky¹,

Barnett²,

Aj³

et al. 1986

Stroke

200

107

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SUMMARY Three hundred and fifty-two patients with atherosclerotic middle cerebral artery stenosis (MCAS, 53%) or occlusion (MCAO, 47%) have been systematically studied. The study involved all patients entered into the EC/IC Bypass Study with isolated MCA disease or a tandem lesion predominating in the MCA ipsilateral to the ischemic events (18 patients with a tandem lesion of greater magnitude in the internal carotid artery were not included). The Asian patients represented 58% of all Asians entered into the EC/IC Bypass Study, whereas the white patients represented 18% of all whites and the black patients 34% of all blacks. Isolated TIAs were less frequent in MCAO (12%) than in MCAS (34%). Warning TIAs before a stroke occurred in one third of the cases. Presentation with stroke or isolated TIA was not influenced by sex, age, level of MCA obstruction, collateral circulation nor associated carotid disease. In MCAS, no major difference in presentation was found between severe and moderate stenosis. Pure motor hemiparesis occurred in 15% and pure sensory stroke in 2% of the patients with stroke and 30% of the MCA territory infarcts were small and limited to the lentkulocapsular area, confirming that so-called lacunar infarcts may be due to large vessel disease.During follow-up (42 months) of 164 medically-treated patients, further cerebrovascular events (TIA and stroke) occurred in 11.7% of the patients per year. In MCAO the stroke rate was 10.1 % per patient-year and the ipsilateral infarct rate was 7.1% per patient-year. In MCAS, the stroke rate was 9.5% per patientyear and the ipsilateral stroke rate was 7.8% per patient-year. The location and severity of lesion did not influence the occurrence of ipsilateral ischemic events during follow-up. Reopening of an artery-to-artery embolic occlusion of the MCA, with subsequent embollc reocclusion, may explain some of the ipsilateral ischemic events during follow-up. The annual death rate was 3.3% in MCAS and 2.6% in MCAO. Less than 15% of the survivors were severely disabled at the end of follow-up and nearly two-thirds were able to resume previous activities both hi MCAO and MCAS. The type of delayed ischemic events tended to be the same as that of the presenting event, but no factor could significantly predict the occurrence of stroke or death. This study suggests that long-term prognosis of patients with MCA occlusion, who present with TIA or non-devastating stroke, is reasonable.

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“…Different factors appear to predict PSE. The two most common factors are large infarct size (Hauser et al ., 1984; Fish et al ., 1988; Faught et al ., 1989; Kotila and Waltimo, 1992; Giroud et al ., 1994; Heuts‐van Raak et al ., 1996) and cortical involvement (Silverstein and Hollin, 1965; Gilmore and Brenner, 1981; Hauser et al ., 1984; Sacquegna et al ., 1984; Berger et al ., 1988; Fish et al ., 1988; Shinton et al ., 1988; Daniele et al ., 1989; Faught et al ., 1989; Sung and Chu, 1989; Kilpatrick et al ., 1990; Weisberg et al ., 1991; Davalos et al ., 1992; Kotila and Waltimo, 1992; Lancman et al ., 1993; Giroud et al ., 1994).…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors for post‐stroke epilepsy. A prospective controlled trial. The Akershus stroke study

Lossius

Rønning

Mowinckel

et al. 2002

Euro J of Neurology

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The aim of the study was to assess the incidence and identify predictors for post-stroke epilepsy (PSE), in particular the possible influence of treatment in a stroke unit (SU). Patients with PSE were identified between 4 weeks and 1 year after the stroke. Different parameters were studied as possible predictors. Twelve patients (2.5%) developed PSE during 12 months. Four of the patients (33%) were treated in an SU and eight of the patients (67%) were treated in general medical wards (GMWs) (P=0.50). Mean age in those with PSE was 75 and 76 in those without (P=0.57). Four out of 363 patients (1.1%) with minor stroke [Scandinavian Stroke Scale (SSS)-score >30] developed PSE. Seven out of 104 patients (6.3%) with severe stroke developed PSE (P=0.004). In the multivariate analysis SSS-score scores below 30 was a significant predictor for incidence of PSE (odds ratio=6.1, P=0.003). At 12 months the incidence of PSE was 2.5%. SSS-score below 30 was a significant predictor for PSE, whilst age and treatment in SU versus GMW were not.

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Long term prognosis after occlusion of middle cerebral artery.

Cited by 13 publications

References 12 publications

Prospects of modeling poststroke epileptogenesis

Prospects of modeling poststroke epileptogenesis

Atherosclerotic disease of the middle cerebral artery.

Incidence and predictors for post‐stroke epilepsy. A prospective controlled trial. The Akershus stroke study

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