Clinical Neuroimaging Peculiarities and Functional Consequences of Ischemic Stroke in Patients with MS
The objective of the research was to study the peculiarities of post-stroke period in patients with metabolic syndrome (MS), functional consequences, cognitive impairment, to identify structural brain changes on the basis of MRI results; to perform correlation analysis between the brain volumetric test results and cognitive deficit.
Materials and methods. The study involved 116 patients, aged 51 to 81, with ischemic stroke, 79 patients – main group – during the early and late recovery periods after ischemic stroke related to MS. The control group included 37 patients in the early and late recovery periods after acute cerebrovascular accident (ACVA) without MS. To determine the functional consequences of ischemic stroke after 12 weeks and 1 year after it, the examination was conducted and the results were evaluated according to modified Rankine scale (MSHR) and Barthel Index (BI). We determined patients’ mortality rate within 1 year after the ischemic stroke. Their condition of cognitive functions was measured according to MMSE, MOSA and FAB scales. The volume of cortex and white matter of the cerebral hemispheres, temporal and frontal lobes were measureed (cm³) by applying MRI scanner Toshiba Vantage Titan 1,5. Workstation Vitrea was used for images post-processing.
Results. Patients with MS had more common significant signs (p<0.05) of neurological status functional disorders, delayed recovery and disability. Within a year, in the main group mortality rate because of recurrent stroke was 5.06%, which was significantly higher than in the control group, where the mortality rate was 2.7%. Within a year, the process of lost functions restoring according to MSHR occurred in both groups, but in the main group, this rate was significantly lower in comparison to the control group. Patients with MS were determined to have a significant impairment of cognitive functions according to cognitive scales. However, a year later cognitive performance did not differ significantly in the main and control groups, although they declined in both groups. Volumetric parameters were determined: the volume of cortex and white matter of the cerebral hemispheres, temporal and frontal lobes (cm³). Results obtained: reduced total volume of the brain, of the temporal and frontal lobes in patients of the main group (p<0.05). Patients of both study groups were determined to have cognitive functions impairment - reduced volume of the cortex in the frontal and temporal lobes according to MMSE scale. The correlation index between cortex indicators of frontal and temporal lobes volume and the results of cognitive functions according to MMSE scale was: r = 0,62 - temporal and r = 0,59 frontal lobes indicators. Modules of correlation coefficients were within the average strength.
Conclusions. Patients who have suffered from primary ischemic stroke related to MS restored their lost functions slower and the mortality rate among them was significantly higher (p<0.05) within the first year after stroke than in patients without MS. Patients had cognitive deficits related to cortex atrophy in the frontal and temporal lobes after the primary ischemic stroke. Atrophy in these areas of the cortex was more distinct (p<0.05) than in patients without MS. Positive correlation relationship was determined between cognitive performance and the degree of cortex atrophy in the frontal (r = 0.59) and temporal (r = 0.62) lobes of patients with ischemic stroke related to MS.
Leys D. Atherothrombosis: a major health burden. Cerebrovasc Dis. 2001; 11 (2): 1-4.
Khobzey NK, Mishchenko TS, Golik VA. Stroke Epidimiology, clinical and expert aspects in Ukraine. Sudynni zakhvoriuvannia holovnoho mozku. 2010; 4: 2-5.
Voloshin PV, Mishchenko TS. Prevention of stroke. Zdorovia Ukrainy. 2002; 5:14.
Argentine C, Prencipe M. The burden of stroke: a need for prevention. In: Prevention of Ischemic Stroke. Eds. C. Fieschi, M. Fisher. London: Martin Dunitz. 2000; 1-5.
Vinychuk SM, Prokopiv MN. Acute ischemic stroke. Kyiv. Naukova dumka. 2006. 286 .
Voloshin PV, Yavorskaya YV, Flomyn YV et al. Modern assistance in stroke management: educational programs, active intervention in acute period and proper rehabilitation. Sudynni zakhvoriuvannia mozku. 2006; 5:19-41.
Recommendation for stroke management: Update 2003. European Stroke Initiative (EUSI). Cerebrovasc Dis. 2004; 17 (2):1–46.
Mishchenko TS. Epidemiology of cerebrovascular diseases in Ukraine. Sudynni zakhvoriuvannia holovnoho mozku.2006; 1:3-8.
Smith T. Growth hormone – induced insulin resistance: rile of the insulin receptor, IRS1, GLUT1. Am J Physiol. 1997; 272:1071-1079.
Third report of the National Cholesterol Education Programm (NCEP) Expert Panel on Detection. Evalution and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III). JAMA. 2001, 285:2447-2486.
Chazova IE, Michka VB. Metabolic syndrome. Moscow. Media Medica. 2004; 47-49.
J. Wang, S. Ruotsalainen, L. Moilanen [et al.] The metabolic syndrome predicts incident stroke: a 14-year follow-up study in elderly people in Finland. Stroke. 2008; 39 (4):1078-1083.
Boden-Albala B et al. Metabolic syndrome and ischemic stroke risk. Stroke. 2008; 39:30-35.
Park K, Yasuda N, Toyonaga S [et al.] Significant associations of metabolic syndrome and its components with silent lacunar infarction in middle aged subjects. Journal of Neurology, Neurosurgery and Psychiatry. 2008; 79 (6): 719-721.
Cherdak MA, Yahno NN. Poststroke cognitive disorders. Zhurnal nevrolohii imeni B.M. Mankovskoho. 2013;1: 31-37.
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