Who does well after a stroke? The Sydney Stroke Study

Research addressing positive outcomes one year after stroke has been limited. The sample comprised 125 participants with complete Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Mini-Mental State Examination (MMSE) scale scores at baseline (～4 months after ischaemic stroke) and at follow-up (1 year later), 31 persons were defined as having a favourable outcome (an MMSE score of ≥28/30 and combined ADL/IADL score equal to 14/14 at follow-up) and 94 as having a poorer outcome. Predictors of a favourable outcome following stroke included being younger, having higher premorbid IQ, no atrial fibrillation, no dementia, less apathy and fewer intercurrent cerebrovascular events. We conclude that people can have good outcomes in the year after stroke except if they experience further cerebrovascular events and/or have risk factors for cerebrovascular disease. Brain reserve appears to be protective.     

Hippocampal size and dementia in stroke patients: the Sydney stroke study

BACKGROUND: Hippocampal atrophy is an early feature of Alzheimer's disease (AD) but it has also been reported in vascular dementia (VaD). It is uncertain whether hippocampal size can help differentiate the two disorders. METHODS: We assessed 90 stroke/TIA patients 3-6 months after the event, and 75 control subjects, with neuropsychological tests, medical and psychiatric examination and brain MRI scans. A diagnosis of VaD, vascular mild cognitive impairment (VaMCI) or no cognitive impairment (NCI) was reached by consensus on agreed criteria. T1-weighted MRI was used to obtain total intracranial volume (TICV), gray and white matter volume, CSF volume, hippocampus and amygdala volumes, and T2-weighted scans for white matter hyperintensity (WMH) ratings. RESULTS: Stroke/TIA patients had more white matter hyperintensities (WMHs), larger ventricle-to-brain ratios and smaller amygdalae than controls, but hippocampus size and gray and white matter volumes were not different. WMHs and amygdala but not hippocampal volume distinguished stroke/TIA patients with VaD and VaMCI and without NCI and amygdala volumes. Right hippocampus volume significantly correlated with new visual learning. CONCLUSIONS: Stroke/TIA patients and patients with post-stroke VaMCI or mild VaD do not have hippocampal atrophy. The amygdala is smaller in stroke/TIA patients, especially in those with cognitive impairment, and this may be accounted for by white matter lesions. The hippocampus volume relates to episodic memory, especially right hippocampus and new visual learning. A longitudinal study of these subjects will determine whether hippocampal atrophy is a late development in VaD.     

Development of samarium [P] phosphate colloid for radiosynoviorthesis applications: Preparation, biological and preliminary clinical studies experience

A new therapeutic radio colloid for radiosynoviorthesis (RS) applications is reported. The method of preparation involves the reaction of SmCl₃ carrier with carrier added [³²P]H₃PO₄ in the presence of gelatin. The pure colloid was recovered by dialysis purification leading to radiochemical yield of around 90%. The radiochemical purity of the pure colloid formulated in isotonic saline was over 98%, for the usage period of 14 days, as assessed by paper chromatography. Ninety percent of colloid particles were in the size of 1–10 μm as evident from the laser diffraction particle size analysis, ideally suitable for the intended end use. Animal studies revealed complete retention of the radio colloid in the rabbit knee joint. The results of clinical trials in humans are satisfactory and encouraging, satisfactory retention of the colloid in the knee joint and negligible leakage into the systemic circulation.