Showing papers by "Alex Rovira published in 2005"

A Matrix Metalloproteinase Protein Array Reveals a Strong Relation Between MMP-9 and MMP-13 With Diffusion-Weighted Image Lesion Increase in Human Stroke

Abstract: Background and Purpose— Matrix metalloproteinases (MMPs) are involved in tissue destruction produced by the neuroinflammatory response that follows ischemic stroke. In the present study we use an MMP array to investigate the blood levels of several MMPs in stroke patients and its relation with brain tissue damage and neurological outcome. Methods— Twenty-four patients with middle cerebral artery occlusion who received thrombolytic therapy were included. Blood samples were drawn before tissue plasminogen activator treatment and an MMP array (multiplex enzyme-linked immunosorbent assay [ELISA]) was performed including gelatinases (MMP-2 and MMP-9), collagenases (MMP-1, MMP-8, and MMP-13), stromelysines (MMP-3 and MMP-10), and MMP endogen inhibitors (TIMP-1 and TIMP-2). To assess tissue lesion a serial multimodal MRI study was performed (pretreatment and at 24 hours). Results— Neither initial diffusion lesion nor hypoperfused volume was associated with metalloproteinase expression within the first 3 hours af...

Safety and Efficacy of Intravenous Tissue Plasminogen Activator Stroke Treatment in the 3- to 6-Hour Window Using Multimodal Transcranial Doppler/MRI Selection Protocol

Abstract: Background— Growing data point toward intravenous tissue plasminogen activator (tPA) benefit after 3 hours in selected stroke patients. We aim to study safety and efficacy of tPA treatment in the 3- to 6-hour window using multimodal transcranial Doppler (TCD)/MRI selection criteria. Methods— We studied patients with acute middle cerebral artery (MCA) occlusion. Patients within 0 to 3 hours from symptom onset (A) were treated according to standard computed tomography criteria. Treatment within 3 to 6 hours (B) was decided according to TCD/MRI protocol. Continuous TCD assessed clot location and recanalization. National Institutes of Health Stroke Scale (NIHSS) at 24 hours assessed neurological improvement/worsening and modified Rankin score <3 functional independence at third month. Results— Of 135 patients, 56 were in the 3- to 6-hour window. Only 13 (23%) patients within 3 to 6 hours did not meet MRI inclusion criteria. Finally, 122 patients were treated with tPA: A, 79 (65%); B, 43 (35%). Median time to ...

Is optic neuritis more benign than other first attacks in multiple sclerosis

Abstract: Optic neuritis presentations are thought to have a better prognosis. The aim of our study was to compare conversion to multiple sclerosis on the different topographies of CISs. We prospectively evaluated 320 patients with CISs (123 with optic neuritis, 78 with brainstem syndromes, 89 with spinal cord syndromes, and 30 with other topographies) who were observed for a median of 39 months. Patients underwent brain MRI within 3 months of their first attack and again 12 months later. Conversion to multiple sclerosis determined either clinically or by MRI was evaluated according to topography. Baseline MRI was normal in 49.2% of patients with optic neuritis compared with 24% in brainstem syndromes, 24% in spinal cord syndromes, and 18.5% in other syndromes. Optic neuritis behaved differently from the other CISs for lower conversion to clinically definite multiple sclerosis and smaller proportion of patients fulfilling MRI dissemination in space, time, or both. Nevertheless, when only patients with abnormal cranial MRI results at baseline were selected, no differences for clinical or MRI conversion were found. Optic neuritis has a smaller risk for conversion to multiple sclerosis. Nevertheless, MRI at baseline, not CIS topography, appears to be the crucial issue at multiple sclerosis presentation.

Distribution territories and causative mechanisms of ischemic stroke

Abstract: Ischemic stroke prognosis, risk of recurrence, clinical assessment, and treatment decisions are influenced by stroke subtype (anatomic distribution and causative mechanism of infarction). Stroke subtype diagnosis is better achieved in the early phase of acute ischemia with the use of multimodal MR imaging. The pattern of brain lesions as shown by brain MR imaging can be classified according to a modified Oxfordshire method, based on the anatomic distribution of the infarcts into six groups: (1) total anterior circulation infarcts, (2) partial anterior circulation infarcts, (3) posterior circulation infarcts, (4) watershed infarcts, (5) centrum ovale infarcts, and (6) lacunar infarcts. The subtype of stroke according to its causative mechanism is based on the TOAST method, which classifies stroke into five major etiologic groups: (1) large-vessel atherosclerotic disease, (2) small-vessel atherosclerotic disease, (3) cardioembolic source, (4) other determined etiologies, and (5) undetermined or multiple possible etiologies. The different MR imaging patterns of acute ischemic brain lesions visualized using diffusion-weighted imaging and the pattern of vessel involvement demonstrated with MR angiography are essential factors that can suggest the most likely causative mechanism of infarction. This information may have an impact on decisions regarding therapy and the performance of additional diagnostic tests.

Angiogenesis in Symptomatic Intracranial Atherosclerosis. Predominance of the Inhibitor Endostatin Is Related to a Greater Extent and Risk of Recurrence

Abstract: Background and Purpose— Angiogenesis may be beneficial in chronic myocardial and limb ischemia, but its role in intracranial atherosclerosis remains unknown. We aimed to investigate the relationship between the pro-angiogenic vascular endothelial growth factor (VEGF) and the anti-angiogenic endostatin, and the extent and risk of recurrence of symptomatic intracranial atherosclerosis. Methods— Of a total of 94 consecutive patients with symptomatic intracranial stenoses, 40 fulfilled all inclusion criteria. Intracranial stenoses were confirmed by magnetic resonance angiography. Magnetic resonance imaging (MRI) including diffusion-weighted sequences was conducted. Plasmatic VEGF and endostatin were determined from blood samples obtained 3 months after stroke onset, and patients were followed-up thereafter. Results— A total of 144 intracranial stenoses were confirmed (median number per patient=3). Endostatin/VEGF ratio gradually augmented with the increasing number of intracranial stenoses (r=0.35, P=0.02). D...

Pronóstico funcional tras un año de seguimiento en pacientes con infarto cerebral de causa desconocida y foramen oval permeable

Abstract: Fundamento y objetivo La presencia de foramen oval permeable (FOP) y aneurisma del septo auricular (ASA) se ha descrito como factor de riesgo en ictus criptogenicos. Los pacientes con ictus de origen desconocido y FOP tienen una menor gravedad comparado con el resto de ictus criptogenicos. El objetivo fue valorar la situacion clinica de los ictus con FOP al cabo de 1 ano, y que factores predicen mejor pronostico. Pacientes y metodo De 1.118 ictus isquemicos de pacientes entre 18 y 70 anos, 223 fueron clasificados como criptogenicos. El protocolo incluia Doppler transcraneal, ecocardiograma transesofagico (ETE) y resonancia magnetica (RM) craneal. La situacion clinica en fase aguda se valoro mediante la escala de ictus de la NIH (National Institute of Health) y la funcional al ano mediante la escala de Rankin modificada. Resultados Cumplian todos los criterios de inclusion 117 pacientes; 66 (56,4%) tenian FOP y 51 (43,2%) no. Se observo en los FOP una menor edad, un mayor porcentaje de sexo femenino (el 48,4% en los FOP frente al 25,5% en los no FOP) y menos factores de riesgo, excepto la migrana (el 24,6% en FOP frente al 5,9% en los no FOP; p = 0,01). Los FOP presentaban menor gravedad inicial (mediana NIHSS de 3 en los FOP frente a 5 en los no FOP; p = 0,010) y un menor porcentaje de secuelas al cabo del ano (p = 0,024). La peor situacion funcional se relaciono con el sexo masculino, la valoracion neurologica inicial (NIHSS) y la presencia de ASA. Con la regresion logistica solo la gravedad neurologica inicial y la presencia de ASA se asociaban con las secuelas. Conclusiones Los pacientes con FOP presentan una menor gravedad clinica y mejor situacion funcional en el seguimiento. El deficit neurologico inicial y la presencia de ASA predicen la situacion clinica al ano.