This is Your Brain on LVAD
The utilization and duration of left ventricular assist device (LVAD) support has increased steadily over the last decade and recent changes in the UNOS heart allocation system, implemented in October 2018, portend a further increase in the duration of mechanical circulatory support for many patients (1). Though four-year survival rates have improved to 60% following LVAD implantation, the leading cause of death in these patients is neurological injury, specifically ischemic and hemorrhagic stroke (spontaneous subarachnoid hemorrhage or intraparenchymal hemorrhage [IPH]) (2).
AbstractOxidative stress is a key component of the pathological cascade in subarachnoid hemorrhage (SAH). Fucoxanthin (Fx) possesses a strong antioxidant property and has shown neuroprotective effects in acute brain injuries such as ischemic stroke and traumatic brain injury. Here, we investigated the beneficial effects of Fx against SAH-induced oxidative insults and the possible molecular mechanisms. Our data showed that Fx could significantly inhibit SAH-induced reactive oxygen species production and lipid peroxidation, and restore the impairment of endogenous antioxidant enzymes activities. In addition, Fx supplementati...
Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), usually presents as a respiratory illness. Neurological manifestations can be seen in 36.4% of patients.1 Patients with vascular risk factors (VRFs), including history of stroke, tend to have worse prognosis.2 COVID-19 triggers a robust inflammatory response which leads to hypercoagulability and thromboembolism.3 Reports of stroke in patients with COVID-19 are mostly limited to small case series or case reports of ischemic stroke (IS), though intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) have also been reported.
In conclusion, our results revealed the critical role of TREM-1 in neuroinflammation following SAH, suggesting that TREM-1 inhibition might be a potential therapeutic approach for SAH.
Subarachnoid haemorrhage (SAH) accounts for 5% –10% of strokes and its prognosis may be influenced by different complications, including delayed cerebral ischaemia (DCI). The pathophysiology of DCI is complex and still unknown. Many different mechanisms may contribute to the occurrence of DCI. Arterial stiffness (AS), a well-known risk factor for cardiovascular events, also associated to the development and rupture of cerebral aneurysms, may represent a novel contributing risk factor. The aim of our study was to investigate a possible link between AS and DCI after SAH.
Cerebral ischemia occurs in conditions such as ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury. Nitric oxide (NO) plays a widely accepted role in ischemia.1 –5 The ability to provide sensitive, timely detection of cerebral ischemia from NO metabolite changes in mixed venous blood samples could be of significant clinical utility.
Phospholipids and sphingolipids are cell membrane components, that participate in signaling events and regulate a wide variety of vital cellular processes. Sphingolipids are involved in ischemic stroke pathophysiology. Throughout cleavage of membrane sphingomyelin by sphingomyelinase in stroke patients, it results in increased Ceramide (Cer) levels in brain tissue. Different studies showed the evidence that sphingomyelinase with Cer production induces expression of interleukin (IL)-6 and have vasoconstrictive proprieties.
We report five cases of COVID-19 presenting to the ER with acute neurological symptoms, over the course of 1 month. This includes two cases of ischemic stroke, one with large-vessel occlusion and one with embolic infarcts. The remainders of the cases include acute tumefactive demyelination, isolated cytotoxic edema of the corpus callosum with subarachnoid hemorrhage, and posterior reversible encephalopat hy syndrome (PRES).
An increasing body of evidence suggests that the coronavirus disease 2019 (SARS-CoV2) may be associated with cerebrovascular disease, although most cases have been ischemic strokes related to occlusion of major intracranial vessels [1 –3]. Intracranial hemorrhages in the setting of SARS-CoV2 infection are exceedingly rare. To the best of our knowledge, only two cases has been reported in detail, one with a massive parenchymal brain hemorrhage and the other with an aneurysmal subarachnoid hemorrhage [4,5].
CONCLUSION: The Tigertriever offers a safe and effective treatment option in ischemic stroke due to LVOs with reperfusion rates and a safety profile similar to alternative devices. The Tigertriever is a promising bail-out tool in complex cases. Its role as a first line device has to be evaluated in further prospective studies. PMID: 32529306 [PubMed - as supplied by publisher]
CONCLUSIONS: Patients with diabetes mellitus were vulnerable to hemorrhagic transformation, whereas those who underwent several attempts of thrombectomy were susceptible to isolated subarachnoid hemorrhage. Both hemorrhage types worsened the functional outcome. Treatment with the stent retriever was significantly associated with postprocedural isolated subarachnoid hemorrhage. PMID: 32475194 [PubMed - as supplied by publisher]