Clinical Study Of Progressive Ischemic Stroke

Objective: Progressive ischemic stroke (PIS) is gradually noted by people as an important ischemic cerebral stroke subtype. PIS refers to a kind of ischemic stroke that neurological function will deteriorate whether being treated or not after 6 hours after onset of ischemic stroke. Progression increases mortality and survivors have more permanent neurological deficits and functional disabilities. This study was designed to determine the possible cause of PIS and identify potential predictors and risk factors associated with PIS through 206 ischemic stroke in-patients. Patients were studied by analyzing the clinical,biochemical,neuroimaging and brain electrical activity mapping(BEAM) in order to instruct clinical treatment and select efficiently therapy , and give some guidance to ischemic stroke to reduce the mortality and improve the patients'life qualities.Methods: To select 206 in-patients in department of neurology of the first people′-s hospital of Chen Zhou from May 2005 to October 2006 including 64 progressive ischemic stroke patients and 142 nonprogressive ischemic stroke patients to study. All patients were matched with diagnosis by clinical standards referred to the fourth national cerebrovascular diseases meeting in 1995. We evaluated general parameters (including sex,age,temperature,blood pressure,NIHSS in admission,histories of other diseases),biochemical parameters (including blood glucose,lipoprotein,hemorheolegy),serum folic acid and vitamin B12,plasma Homocysteine(Hcy),neuroimaging,BEAM between acute progressive ischemic stroke group and acute nonprogressive ischemic stroke group . All patients on admission were examined by conventional CT/MRI. Patients without abnormality in the first examination were re-examinated after 48 hours. As for PIS patients, The CT/MRI examination was repeated on peak of neurological deterioration. Part of patients were examined by BEAM. It had 21 electrodes lying according to international 10/20 system. We traced EEG 5 minutes with the earlobes as reference electrodes, and 30 seconds EEG without confusion was input computer to FTT exchange to obtain power ofα,β,θ,δdistribution images. The university analyses were performed using SPSS for Windows version 13.0.Results:1 general parameters : university analysis showed , in 64 progressive ischemic stroke patients, having diabetes mellitus was 26 patients(40.63%),NIHSS in admission was 10.38±3.80; while in 142 no progressive ischemic stroke patients, having Diabetes mellitus was 20 patients(14. 08%), NIHSS in admission was 6.30±3.49. There were all significant differences between two groups(P<0.05). There were no significant differences in sex,age,temperature,blood pressure,smoking,histories of hypertension and ischemic heart disease .2 laboratory parameters: There were significant differences in hemorheoloy,fibrinogen between progressive ischemic stroke and no progressive ischemic stroke, fibrinogen (4.67±1.16g/L) in progressive group was much higher than no progressive group. In lipoprotein, HDL(1.31±0.32mmol/L)and APOA(1.36±027g/l) in progressive group were lower than HDL(1.48±0.32mmol/L)and APOA(1.47±026g/l) in no progressive group, there were significant differences(P < 0.05 ). Blood glucose in progressive group was 7.10±2.75mmol/L, which was higher than no progressive group(5.34±1.17mmol/L). There were significant differences (P< 0.05 =.3 The mean fast plasma Hcy concentration in case A and B group were35.46±8.37μmol/l and 21.39±4.81μmol/l respectively, there were significant differeences between A and B (P<0.05). The serum folic acid concentration of A and B group were 3.77±2.18ng/ml and 4.87±2.31ng/ml respectively, and the serum vitamin B12 concentration of A and B group were 342.24±112.34 pg/ml and 454.51±121.43pg/ml respectively. there were significant differences between A and B (P<0.05). 4.According to Spearman correlative analysis and Logistic-regression analysis and Stepwise method ,the concentration of the serum Hcy had a negative non-longitudinal correlation with those of serum folic acid and vitamin B12 respectively and the HHcy was an independent risk factors for PIS. The odds ratios (OR) of HHcy for stroke were 10.49(95% CI 1.592 to 5.057).5 neuroimaging parameters: During 24 hours after ischemic stroke onset, positive rate(84.4%) of conventional CT in progressive group was higher than no progressive group(60.6%), there were significant differences(P<0.05). In 64progressive patients, the repeated CT/MRI showed: 10 patients had hemorrhage transformation, 32 patients'infarction volume had enlarged, 6 pateints had new infarction, and 16 patients had not significant change.6 BEAM: 140 patients were examined by BEAM including 56 progressive patients and 84 no progressive patients. 128 patients had the abnormal BEAM. During 24 hours after ischemic stroke onset, positive rate of BEAM was 91.4%, conventional CT is 68.0%. There were significant differences. Mean power ofδin progressive group was higher than no progressive group. The abnormal range ofδdistribution in progressive group was wider than no progressive group. There were significant differences(P<0.05=Conclusions:1 Diabetes mellitus,high blood glucose,hemorheoloy,fibrinogen and low HDL,APOA might be risk factors of PIS.2 The deficiency of serum folic acid and vitamin B12 maybe result to plasma Hcy level and the cause HHcy; it might be risk factors of PIS;3 NIHSS on admission reflect the damage of brain; it was a predictive factor of PIS.4 An early CT abnormal might a predictive factor of PIS. 5 BEAM was sensitive to detection of PIS; the power and the range ofδmight a predictive factor of PIS.