尿激酶溶栓并用局部亚低温治疗急性脑梗死的临床研究

目的：研究局部亚低温对急性脑梗死大剂量尿激酶溶栓后临床疗效的影响。方法：分别对发病3h以内及3－6h两组急性脑梗死患，大剂量尿激酶溶栓治疗同时，并用病灶侧局部亚低温治疗。结果：发病后治疗时间不同的两低温组在治疗后神经功能缺失评分水平均明显高于治疗前（P＜0．05）；在治疗后30d、90d随访时两低温组神经功能缺失评分水平均明显高于对照组（P＜0．05）；发病3h以内给予治疗的低温组明显高于发病3－6h的治疗低温组（P＜0．05）；局部亚低温治疗前、后患的体温、血压、脉搏及鼻咽温测定无明显变化（P＞0．05）。结论：大剂量尿激酶溶栓并用局部亚低温治疗是急性脑梗死有效的治疗方法之一。     

高血压性脑出血病人收缩压与不良预后的关系

目的 探讨高血压性脑出血病人收缩压（SBP）与预后、血肿扩张及心肾不良事件的关系。方法 回顾性分析2015年10月至2018年10月收治的550例高血压性脑出血的临床资料。入院24 h内静脉注射盐酸乌拉地尔进行降血压治疗,采用无创24 h动态心电监护仪监测SBP,根据平均每小时SBP值为分5组（<125、125~135、135~145、145~155、≥155 mmHg）,根据平均每小时最低SBP分为5组（<120、120~130、130~140、140~150、≥150 mmHg）;采用CT评估血肿扩张;心肾不良事件为治疗后7 d内发生心脏和肾脏并发症;采用电话随访方式收集出院90 d生存状态。采用多因素logistic回归分析检验SBP与不良事件的关系。结果 平均每小时SBP>155 mmHg与发病90 d内死亡（OR=1.38;95% CI 1.07~3.04）和血肿扩张（OR=1.13;95% 1.02~1.28）风险呈正相关。平均每小时最低SBP≥150 mmHg病人发病90 d内死亡风险升高（P<0.05）;平均每小时最低SBP≥140 mmHg时血肿扩张风险较高（P<0.05）。平均每小时最低SBP降低幅度越大,血肿扩张风险、发病90 d内死亡风险越低（P<0.05）,但心肾严重不良事件呈明显增高（P<0.05）。结论 高血压性脑出血病人发病24 h平均每小时最低SBP降低幅度越大,血肿扩张和发病90 d内死亡风险越低,但心肾不良事件风险明显增加。     

纤维化指标与急性缺血性脑卒中患者血管内治疗后症状性颅内出血风险的相关性

目的 探讨纤维化指标与急性缺血性脑卒中(AIS)患者血管内治疗(EVT)后症状性颅内出血(sICH)风险的相关性。方法 回顾性纳入2018-03—2023-04于东南大学附属中大医院接受EVT治疗的358例AIS患者,入院24 h内收集患者的年龄、性别、体重指数(BMI)、血压、既往史等人口统计资料,闭塞部位、卒中程度、FIB-4指数、EVT相关信息及术后sICH情况等临床资料,采用多因素Logistic回归分析FIB-4指数与EVT后sICH的相关性。结果 根据FIB-4临界值1.30与2.67,将患者分为FIB-4<1.30组(n=138)、FIB-4 1.30～2.67组(n=149)以及FIB-4>2.67组(n=71),3组性别、年龄、BMI、收缩压、糖尿病、高血压、高脂血症、大血管闭塞、术后sICH、90 d神经功能预后及基线NIHSS评分对比差异均有统计学意义(P<0.05)。术后未发生与发生sICH患者的高脂血症、FIB-4评分、FIB-4<1.30及FIB-4>2.67对比差异均有统计学意义(P<0.05)。90 d神经功能预后良好...     

武汉地区脑梗死患者住院天数的影响因素分析

目的探讨武汉地区脑梗死患者住院天数及其影响因素。方法收集本院近5年间出院脑梗死患者的病例772份,排除院内感染及并发症患者。采取回顾性分析方法,按住院天数分为5~10d组,11~14d组,15~20d组三组,选取性别、意识状态、糖尿病史、心脏病史、脑卒中史、遗传倾向、中医治疗、神经康复等因素,进行Ridit统计分析,并对相关因素行住院天数的非条件logistic回归分析。结果 （1）不同性别、糖尿病史、入院时患者意识清楚与否、是否神经康复治疗患者的住院天数差异具有统计学意义（P〈0.05）;（2）既往是否有心脏病史,脑梗死病史、脑卒中遗传倾向及住院期间是否接受过中医药治疗患者的住院天数上虽有差异,但无统计学意义;（3）糖尿病史和神经康复因素进入回归方程,二者均有统计学意义。结论脑梗死患者的住院天数与不同性别、糖尿病史、入院时不同的意识状态及神经康复治疗与否有关。其中糖尿病史和康复治疗可能为影响武汉地区脑梗死患者住院天数的重要因素。     

亚低温治疗自发性脑出血的临床疗效和安全性

目的 探讨亚低温治疗自发性脑出血的疗效和安全性。方法 2015年1月至2017年3月收治急性自发性脑出血78例,按术后体温控制方法分为低温组（n=39）和常温组（n=39）。均采用急诊手术清除血肿。低温组术后采用全身物理降温,将直肠温度维持于34~35 ℃,3 d后缓慢复温,复温速率不超过0.5 ℃/6 h。常温组病人维持正常体温（36~37 ℃）。结果 低温组病人低温维持时间3~7 d,平均（4.7±1.6）d。低温启动前,两组各项指标无明显差异（P>0.05）。随治疗时间的延长,低温组病人心率、动脉pH值、动脉剩余碱和血清钾离子浓度显著低于常温组（P<0.05）。术后24~120 h,亚低温组病人颅内压、脑脊液胶质纤维酸性蛋白和泛素C末端水解酶L1水平均明显低于常温组（P<0.05）。低温组病人肺部感染发生率和低钾血症发生率较常温组明显增高（P<0.05）。发病后6个月,低温组病死率（30.8%）明显低于常温组（53.8%;P<0.05）,低温组预后良好率（GOS评分4~5分,46.2%）明显高于常温组（20.5%;P<0.05）。结论 亚低温可降低自发性脑出血病人颅内压,保护脑组织,改善临床结局,但是治疗期间应注意早期防治并发症。     

气温变化与自发性脑出血的发病关系探讨

目的分析自发性脑出血气候发生学特点,探讨气温与自发性脑出血患者发病影响关系。方法将716例自发性脑出血患者分为三组,高血压性脑出血组、继发性脑出血组和不明原因性脑出血组,统计自发性脑出血在不同季节及不同气候下的发病人数。结果自发性脑出血发生时间上存在着显著的季节差异性（P〈0．05或P〈0．01）,高血压组差异最显著,在另外两组则差异不显著（P〉0．05）,高血压组老年人较年轻人更具有季节的显著差异性,越低气温发病人数越多。结论自发性脑出血多发于冬季和低温时节,老年人发病的气候规律性更为明显。     

急性后循环大血管闭塞性脑梗死桥接治疗与直接血管内治疗的疗效和安全性对比研究

目的 探讨桥接治疗和直接血管内治疗对急性后循环大血管闭塞性脑梗死患者的安全性和有效性。方法 本研究采用回顾性、多中心研究方法，应用Epidata数据库，收集2020年1月—2021年12月江苏省4家医疗中心急性后循环大血管闭塞性脑梗死患者动脉取栓数据，根据治疗方式分为桥接治疗组（急诊血管内治疗前给予阿替普酶静脉溶栓）和直接血管内治疗组。收集患者一般基线数据和结局指标，比较两组患者基线特征和治疗后预后情况。使用术后90 d mRS评分评估患者预后，0～2分为预后良好，3～6分为预后不良；主要有效性结局指标为90 d mRS评分和90 d血管性死亡率；主要安全性指标为术后48 h内出现症状性颅内出血（symptomatic intracerebral hemorrhage，sICH）、再灌注损伤、造影剂渗漏。采用logistic回归分析影响后循环取栓术预后的独立危险因素。 结果 共纳入125例急性后循环大血管闭塞性脑梗死患者，其中接受桥接治疗28例，直接血管内治疗97例。入院时，桥接治疗组丙氨酸转氨酶（alanine aminotransferase，ALT）[13.9（11.3～23.2）U/L vs. 20.0（13.0～27.8）U/L，P=0.024]低于直接取栓组。桥接治疗组和直接血管内治疗组的单因素分析发现，桥接治疗组发病到医院的时间[120（82.5～180.0）min vs. 270（180.0～360.0）min，P<0.001]、发病到血管内治疗的时间[232（180.0～363.8）min vs. 334（255.0～443.5）min，P<0.013]、穿刺至灌注的时间[67.5（44.3～95.0）min vs. 90（60.0～137.5）min，P=0.009]、发病至灌注的时间[348.5（272.5～421.3）min vs. 460（335.0～577.5）min，P=0.002]均短于直接取栓组；而入院至动脉穿刺的时间，桥接治疗组的时间延误较长[117.5（70.0～160.0）min vs. 60（25.0～120.0）min，P=0.002]。桥接治疗组90 d预后良好比例高于直接取栓组（57.1% vs. 28.9%，P=0.006）。sICH（7.1% vs. 17.5%，P=0.178）、再灌注损伤（25.0% vs. 41.2%，P=0.118）、造影剂渗漏（10.7% vs. 15.5%，P=0.528）和90 d血管性死亡率（28.6% vs. 43.3%，P=0.161），桥接治疗组均低于直接取栓组，差异无统计学意义。结论 桥接治疗可明显改善急性后循环大血管闭塞性脑梗死患者90 d的临床预后，疗效显著优于直接血管内治疗组，且不增加症状性颅内出血的发生风险。     

利培酮治疗首发精神分裂症的临床疗效观察

目的：观察利培酮治疗首发精神分裂症的疗效，副反应及最佳剂量。方法：首次使用可变剂量的利培酮治疗首发精神分裂症8周，使用阳性和阴性症状量表（PANSS）及不良反应症状量表（TESS）分别评定疗效和副反应。结果：全部病例完成8周治疗。治疗前后PANSS减分率比较，差异有极显著性（P＜0．001），显效率为81．63％，有效率达95．92％，起效时间在第2－4周，最佳剂量≤4mg/d，低剂量组（≤4mg/d)PANSS减分率大于高剂量组（＞4mg/d)，较多见副反应为EPS（20．41％），结论：低剂量利培酮（≤4mg/d)治疗首发精神分裂症安全，有效，病人依从性好。     

脑白质疏松与老年急性脑梗死静脉溶栓患者症状性颅内出血及功能预后的关系研究

目的 探讨脑白质疏松与老年急性脑梗死静脉溶栓患者症状性颅内出血（symptomatic intracranial hemorrhage，sICH）及功能预后的关系。 方法 纳入2016年1月1日-2018年12月31日连续就诊于北京怀柔医院的老年急性脑梗死静脉溶栓 患者。根据入院头颅CT，采用改良Van Swieten量表进行脑白质疏松分级。应用多因素Logistic回归模型， 分析脑白质疏松与溶栓后24 h sICH和3个月不良功能预后（mRS＞2分）的关系。 结果 共纳入125例患者，平均年龄73.2±8.4岁，男性84例（67.2%），有脑白质疏松82例（65.6%）。 有脑白质疏松、无脑白质疏松患者溶栓后24 h sICH发生率分别为12.2%（10/82）、4.7%（2/43）， P =0.298；3个月不良功能预后比例分别为70.7%（58/82）、34.9%（15/43），P ＜0.001。多因素 Logistic回归分析显示，脑白质疏松与老年急性脑梗死静脉溶栓患者24 h sICH不相关（OR 0.320， 95%CI 0.056～1.846，P =0.203）；与3个月不良功能预后独立相关（OR 4.392，95%CI 1.514～12.744， P =0.006）。 结论 脑白质疏松症与老年急性脑梗死静脉溶栓患者sICH不相关，但与静脉溶栓治疗后3个月不良 功能预后独立相关。     

玻璃化法和低温冷冻法保存兔股动脉活性的差异

背景：异体血管保存常用的低温冷冻法会不可避免地形成大量冰晶，因此所保存的血管活性有限。玻璃化法可避免冰晶所造成的挤压损伤和冻融效应，尤其适合于活性组织的保存。 目的：比较玻璃化法和低温冷冻法保存兔股动脉组织结构和收缩舒张能力的差异。 设计、时间及地点：组织形态学及力学水平的随机对照实验，于2002-09/2006-08在解放军总医院骨科研究所完成。 材料：纳入新西兰兔18只，按随机数字法分为3组，玻璃化法保存组、低温冷冻法保存组及新鲜血管组各6只，每组取12条股动脉。 方法：切取股动脉标本，置于平衡液中备用。玻璃化法保存组血管在4 ℃条件下经25%，50%和100%梯度玻璃化溶液浸泡后，直接投入液氮中。低温冷冻法保存组血管由常温状态下，经过0，-20，-70 ℃梯度降温，平衡60 min，直接投入液氮中。将新鲜动脉作为对照，样本在液氮中保存14 d 以上。 主要观察指标：对动脉组织进行细胞培养和鉴定，测定动脉环张力随去甲肾上腺素和硝普钠剂量的变化。 结果：3组动脉培养均为平滑肌细胞，玻璃化法保存组生长速度与新鲜血管组相近，而优于低温冷冻法保存组。玻璃化法保存组与新鲜血管组动脉环最大收缩力差异无显著性意义（P > 0.05），玻璃化法保存组、新鲜血管组动脉环最大收缩力显著大于低温冷冻法保存组（P < 0.01）。当去甲肾上腺素剂量为10-6 mol/L时，动脉开始明显收缩；当去甲肾上腺素剂量为10-4 mol/L时，动脉收缩力达到最大。玻璃化法保存组、低温冷冻法保存组及新鲜血管组动脉环最大舒张程度差异无显著性意义（P > 0.05）。当硝普钠剂量为10-7 mol/L时，动脉开始产生明显的舒张反应；当硝普钠剂量为10-4 mol/L时，动脉基本达到最大舒张程度。 结论：玻璃化法保存的动脉较低温冷冻法具有更多的活性平滑肌细胞，尽管玻璃化法保存的动脉在对去甲肾上腺素的收缩能力方面优于低温冷冻法保存的动脉，但是对硝普钠的舒张能力上二者之间没有差别。     

脑白质疏松程度与急性脑梗死患者静脉溶栓治疗后症状性脑出血转化的相关性研究

目的探讨脑白质疏松(LA)程度与急性脑梗死患者静脉应用重组人组织型纤溶酶原激活剂(rt-PA)溶栓治疗后症状性脑出血(sICH)转化的相关性。方法连续选取急性颈内动脉系统脑梗死患者117例,符合溶栓治疗指征者采用静脉rt-PA以0.9 mg/kg足量溶栓治疗,其余则给予普通安慰剂治疗。所有患者根据Wahlund改良LA分级量表(ARWMC)评分对LA严重程度进行分级:轻度(1~5分),中度(6~10分),重度(10分)。溶栓后24~36 h复查头CT,判定是否出现sICH转化。比较不同程度LA患者中溶栓组和安慰剂组sICH转化率。结果本研究组中,溶栓治疗者49例,安慰剂使用者68例;LA轻度45例,LA中度25例,LA重度47例。本研究共有10例患者(8.5%)发生s ICH转化,其中溶栓治疗者7例,安慰剂使用者3例;LA轻度2例,LA中度2例,LA重度6例。在LA轻度及中度患者中,溶栓组患者sICH转化率略高于较安慰剂组(P=0.052,P=0.650)。而在LA重度患者中,溶栓组患者s ICH转化率明显高于安慰剂组(P=0.043)。Pearson相关性分析结果显示,溶栓组患者ARWMC评分与其静脉溶栓治疗后sICH转化率呈正相关(r=0.476,P=0.0005)。结论重度LA可增加急性脑梗死患者rt-PA静脉溶栓后sICH转化的风险。了解患者的LA程度有助于对临床溶栓决策的选择和对患者预后的判断。     

External validation of TICI-ASPECTS-glucose score as a predictive model for symptomatic intracranial hemorrhage following mechanical thrombectomy

IntroductionThe indication for mechanical thrombectomy for acute ischemic stroke (AIS) secondary to large vessel occlusion has substantially increased in the past few years, but predictors of symptomatic intracranial hemorrhage (sICH) remain largely unstudied. A recent study assessing these predictors, led to the development of the TICI-ASPECTS-glucose (TAG) score, an internally validated model to predict sICH following thrombectomy.MethodsTo externally validate this scoring system and identify other potential risk factors for hemorrhagic conversion following endovascular therapy for AIS, 420 consecutive patients treated with mechanical thrombectomy from 2014-2017 were retrospectively reviewed. Data were collected pertaining to admission factors, procedural metrics, and functional outcomes. The components comprising the TAG score consist of modified thrombolysis in cerebral infarction (mTICI) score (mTICI 0-2a=2 points; 2b-3=0 points), Alberta stroke program early CT (ASPECTS) score (<6=4 points, 6-7=2 points, ≥8=0 points), and glucose (≥150 mg/dL=1 point, <150 mg/dL=0 points). Statistical analyses including univariate analysis, logistic regression analysis, and area under the receiver-operating curve (AUROC) were performed to validate the predictive capability of the model.ResultsThe patients with sICH presented with lower ASPECTS (8.13±1.55 v 9.16±1.24, p < 0.001), but no significant correlation with mTICI scores and admission glucose was observed. Decreasing ASPECTS correlated with increased risk of sICH (OR 1.57, 95% CI 1.25-1.96, p < 0.001), and increasing TAG score was associated with increased sICH (OR 1.46, 95% CI 1.11-1.94, p < 0.01). AUROC of the model was 0.633. Stratifying patients into low (TAG 0-2), intermediate,^3,4 and high^5-7 risk groups identified similar results to the original study with sICH risks of 5.2%, 10.5%, and 33.3%, respectively.ConclusionThe TICI-ASPECTS-glucose (TAG) score adequately predicts sICH following mechanical thrombectomy, and appropriately stratifies individual patient risk. Further inclusion of additional predictors of sICH would likely yield a more robust model.     

低分子肝素预防脑出血后深静脉血栓有效性和安全性研究

目的 评估自发性脑出血（spontaneous intracerebral hemorrhage,sICH）患者早期皮下注射低分子肝素 （low molecular weight heparin,LMWH）预防深静脉血栓形成（deep vein thrombosis,DVT）的有效性。 方法 共104例急性sICH患者纳入研究,其中LMWH组51例,对照组53例。LMWH组在入院后第4天开始, 连续7 d皮下注射低分子肝素0.4 ml/d;对照组相对应给予下肢间断充气加压（intermittent pneumatic compression,IPC）措施。两组患者均于入院当天及LMWH治疗第7天检测溶血磷脂酸（lysophosphatidic acid,LPA）水平及抗凝血因子Ⅹa活性,并观察患者有无出血征象。 结果 治疗期间所有患者均未出现颅内血肿扩大及再出血事件,与对照组比较,治疗后LMWH组LPA 水平（11.74±5.30）ng/ml明显低于对照组（26.81±5.12）ng/ml,比较差异具有统计学意义（P＜0.05）。 治疗后LMWH组抗凝血因子Xa活性（25.96±7.97）ng/ml明显较对照组（8.06±1.32）ng/ml增高,比较 差异具有统计学意义（P＜0.05）。 结论 急性sICH住院患者为DVT的高发人群,sICH患者在急性期皮下注射低剂量LMWH预防DVT是有效 和安全的。     

血清淀粉样蛋白A与自发性脑出血预后的关系

目的探讨血清淀粉样蛋白A(AA)与自发性脑出血病人预后的关系。方法选取2014年1月至2016年1月接受钻孔引流术治疗的自发性脑出血78例,术前及术后1、3、5、7、14 d动态检测外周血AA水平。术后6个月采用GOS评估预后。结果78例中,预后良好56例(GOS评估4~5分),预后不良22例(GOS评分1~3分)。血清AA水平术后1 d达到高峰,之后逐渐下降,并于术后7 d逐渐降至正常水平。预后良好组血清AA水平较预后不良组明显降低(P0.05)。多因素Logistic回归分析显示术后再出血以及术后1 d血清AA水平是自发性脑出血不良预后的独立危险因素。结论术后1 d血清AA水平升高预示自发性脑出血病人预后不良,术后血清AA水平可作为自发性脑出血病人的预后评估指标。     

Ambient ozone concentration and emergency department visits for panic attacks

The effect of ambient air pollution on panic disorder in the general population has not yet been thoroughly elucidated, although the occurrence of panic disorder in workers exposed to organic solvents has been reported previously. We investigated the association of ambient air pollution with the risk of panic attack-related emergency department visits. Using health insurance claims, we collected data from emergency department visits for panic attacks in Seoul, Republic of Korea (2005–2009). Daily air pollutant concentrations were obtained using automatic monitoring system data. We conducted a time-series study using a generalized additive model with Poisson distribution, which included spline variables (date of visit, daily mean temperature, and relative humidity) and parametric variables (daily mean air pollutant concentration, national holiday, and day of the week). In addition to single lag models (lag1 to lag3), cumulative lag models (lag0–1 to lag0–3) were constructed using moving-average concentrations on the days leading up to the visit. The risk was expressed as relative risk (RR) per one standard deviation of each air pollutant and its 95% confidence interval (95% CI). A total of 2320 emergency department visits for panic attacks were observed during the study period. The adjusted RR of panic attack-related emergency department visits was 1.051 (95% CI, 1.014–1.090) for same-day exposure to ozone. In cumulative models, adjusted RRs were 1.068 (1.029–1.107) in lag0-2 and 1.074 (1.035–1.114) in lag0-3. The ambient ozone concentration was significantly associated with emergency department visits for panic attacks.     

Intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign: A meta-analysis

Hyperdense middle cerebral artery sign (HMCAS) on admitting to neuroimaging is reported to have prognostic value for poor outcomes after thrombolysis, while evidence from studies comprising a sufficiently large sample size is limited. To detect prognostic predictors after thrombolysis could help improve therapeutic clinical strategies for acute ischemic stroke. We included prospective and retrospective studies of stroke patients that were treated with intravenous thrombolysis, in which functional outcomes (ie, a modified Rankin scale [mRS]) and systematic intracranial hemorrhage (sICH) were assessed in relation to HMCAS during pretreatment head CT. Random-effects models were used to calculate pooled risk ratios (RR) of poor outcomes and sICH for HMCAS patients as compared to patients without HMCAS. Eleven studies permitted identification of 11 818 patients. The risk of poor outcome at 3 months in the HMCAS-positive group was 1.56-fold the negative group (RR, 1.56; 95% CI 1.50-1.62; P < .001). The sICH risk when comparing both groups was found to be non-significant. Sensitivity analysis regarding studies performing thrombolysis within 3 hours also exhibited significant differences in their functional outcomes (RR, 1.56, 95% CI 1.49-1.62; P < .001) in patients with HMCAS as compared to non-HMCAS patients, although this was true for sICH risk. The presence of HMCAS on pretreatment CT predicts a poor outcome at 3 months after intravenous thrombolysis, while its relationship with the incidence of sICH was found to have no statistic value. Our study implies that more aggressive treatment should be considered for HMCAS patients.     

Lipid profile,statin use,and outcome after intravenous thrombolysis for acute ischaemic stroke

BACKGROUND: Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis. METHODS: The relation between admission lipid levels or statin use and both the development of symptomatic intracerebral haemorrhage (sICH) and 3-months functional outcome was assessed in a prospective hospital-based stroke registry comprising 252 patients treated with IV tissue plasminogen activator (tPA). The fasting status of the patients was unknown. Favourable outcome at 3 months was defined as a modified Rankin scale score 相似文献   

Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models

Objective: Thrombolytic therapy with intravenous alteplase (IV-rtPA) has a known risk of symptomatic intracerebral hemorrhage (sICH). We aim to identify factors with a significant association with the development of sICH post-IV-rtPA. We also aim to perform an external validation of sICH predicting scores in our patient population. Material and Methods: We performed a retrospective chart review of patients who received IV-rtPA at our tertiary care hospital. We excluded patients who underwent mechanical thrombectomy. We analyzed various factors recorded at presentation such as presenting mean arterial pressure (MAP), blood glucose, National Institutes of Health Stroke Scale (NIHSS) score, verify Aspirin, verify Plavix, age, sex, platelet count, international normalized ratio, prothrombin time, partial thromboplastin time, hemoglobin A1c, low-density lipoprotein, onset to treatment time, weight, sex, and early infarct signs on computed tomography (CT) head and compared them between sICH and non-sICH groups. For validation of sICH scores, we used documented variables to calculate the following scores for each patient: stroke prognostication using age and NIH stroke scale-100 (SPAN-100), DRAGON, CUCCHIARA, hemorrhage after thrombolysis (HAT), SEDAN, totaled health risks in vascular events, and safe implementation of thrombolysis in stroke-symptomatic intracerebral hemorrhage. Results: sICH rate in our cohort of 89 patients was 5.62% according to the European-Australasian Cooperative Acute Stroke Study-II (ECASS-II) criteria and 7.86% according to the National Institute of Neurological Disorders and Stroke (NINDS) criteria. In the multivariate regression analysis, MAP (95% CI, .001-.01; P .002), blood glucose greater than or equal to 185 mg/dL (95% CI, .12-.45; P .001) and presence of early infarct signs (95% CI, .06-.25; P .002) had a significant association with the development of sICH with the ECASS-II definition of sICH post-IV-rtPA, whereas, only MAP (95% CI, 1.01-1.18; P .025) and verify Aspirin less than 500 (95% CI, .01-.80; P .032) had a significant association with the development of sICH with the NINDS definition of sICH post-IV-rtPA. Our study found that HAT (95% CI, .58-.96; P .044) and DRAGON (95% CI, .61-.96; P .012) scores had the highest area under the curve (AUC) with respect to ECASS-II and NINDS criteria of sICH, respectively. Conclusions: We found that presenting MAP, presence of early infarct signs on CT Head and blood glucose greater than or equal to 185 mg/dL upon a patient's presentation have a significant association with sICH post-IV-rtPA when the ECASS-II definition was used, while presenting MAP and verify Aspirin less than 500 upon a patient's presentation have a significant association with sICH post-IV-rtPA when the NINDS definition was used. Our study found that HAT and DRAGON scores had the highest AUC, and they were the most valid in predicting the development of sICH in our independent cohort. Patients with these risk factors should receive more intensive neurological monitoring.     

tPA treatment for acute ischaemic stroke in patients with leukoaraiosis

Background and Purpose: Whether leukoaraiosis on baseline CT is associated with an increased risk of symptomatic intracerebral haemorrhage (sICH) or poor outcome following tissue plasminogen activator (tPA) treatment for acute ischaemic stroke is still a matter of debate. Objective: To investigate the relationship between the presence and severity of leukoaraiosis on baseline CT and the risk of sICH and functional outcome after tPA treatment for acute ischaemic stroke. Methods: A single‐center observational cohort study with a retrospective analysis on consecutive patients with ischaemic stroke treated with tPA in the period 2002–2008. Outcome measures were the occurrence of sICH and functional outcome at 3 months. Results: Of the 400 patients, 24% had leukoaraiosis on their baseline CT. Eleven patients (11%) with leukoaraiosis versus thirteen (4%) patients without leukoaraiosis had a sICH [odds ratio (OR) 2.85 95%‐CI 1.23–6.60, P = 0.02]. Multivariate analysis showed a non‐significant trend towards an association of leukoaraiosis and sICH (OR 1.9, 95%‐CI 0.78–4.68, P = 0.16). Leukoaraiosis was independently associated with poor functional outcome (OR 2.39, 95%‐CI 1.21–4.72, P = 0.01). No difference was observed in the outcome measures amongst patients with moderate or severe leukoaraiosis. Conclusion: Our study demonstrates that patients treated with tPA and leukoaraiosis on their baseline CT are at greater risk of sICH and have a worse functional outcome compared to patients without leukoaraiosis. It is important to note that these results should not lead to exclusion of patients with leukoaraiosis for tPA treatment.     

Effects of meteorological factors on the onset of subarachnoid hemorrhage: A time-series analysis

Previous studies have suggested a possible association between meteorological factors and the onset of subarachnoid hemorrhage (SAH). We aimed to investigate the relationship between the onset of SAH and meteorological factors based on an hourly time-series analysis. We collected hourly data on transportation of patients with SAH using the ambulance records of the Tokyo Fire Department from January 1 to December 31, 2005. We also collected hourly meteorological data for Tokyo from the Japan Meteorological Agency during the same period. We performed a time-series analysis using the autoregressive integrated moving average (ARIMA) model to control for autocorrelations in the time-series data. There were 1729 patients with SAH (mean age 63.3 years; 60.2% women). We identified two circadian patterns in the onset of SAH: a daily peak at 10 am (p<0.001) and a seasonal peak in February (p<0.001). Based on the ARIMA time-series analysis, significant risk factors associated with the onset of SAH included: low temperature on the previous day (lag time 17h; p=0.005) and on the onset day (lag time 0h; p<0.001); high barometric pressure on the onset day (lag time 0h; p=0.001). Humidity was not associated with the onset of SAH. Among meteorological factors, low temperature and high barometric pressure may be risk factors for the onset of SAH.