Risk factors and stroke subtypes: results of five consecutive years of the Perugia Stroke Registry.

To understand the etiopathogenetic mechanisms of stroke and to target prevention, we need to know how risk factors differ among etiological subtypes. Our aims were to determine the different profile of risk factors for ischemic and hemorrhagic stroke subtypes in our cohort from the Perugia Hospital-Based Stroke Registry. We analyzed the characteristics and the different risk factors of 2,395 first-ever consecutive stroke patients admitted to the Perugia Hospitals in the period between January 1, 1998 and December 31, 2002.

Outcome in patients with stroke associated with internal carotid artery occlusion.

Background: The clinical outcome in patients with stroke associated with internal carotid artery (ICA) occlusion is poor, although a minority may recover without dependency. The purposes of this study were (1) to assess the predictive factors of adverse outcome in patients with stroke associated with an occlusion of the ICA and (2) to evaluate the rate of spontaneous recanalization of an occluded ICA.

Methods: A total of 177 consecutive patients with first-ever ischemic stroke associated with ICA occlusion were prospectively examined from the Perugia Stroke Registry.

Dysphagia following Stroke.

Background: Dysphagia is common after stroke. We aimed to study the prognosis of dysphagia (assessed clinically) over the first 3 months after acute stroke and to determine whether specific neurovascular-anatomical sites were associated with swallowing dysfunction.

Methods: We prospectively examined consecutive patients with acute first-ever stroke.

Recanalization of cervical artery dissection: influencing factors and role in neurological outcome.

Background And Purpose: Generally, the prognosis for cervical artery dissection (CAD) is uncertain. The recanalization rate of CAD can be up to 85% within 3 months. This study evaluates the variables that might affect recanalization and the role of recanalization as a predictor for neurological outcome.

Selection of thrombogenetic antiphospholipid antibodies in cerebrovascular disease patients.

The association between anticardiolipin antibodies (aCL) and thrombosis is well recognized, but its role as an independent risk factor for stroke is not. The study's aim was to investigate the presence of antiphospholipid antibodies (aPL) and ischemic vascular events by using both traditional means the estimation of aCL and glycoprotein (beta(2)GP1) antibodies. Additionally both aCL/beta(2)GP1 and aPLmix/beta(2)GP1 antibodies were measured.

Is ultrasound examination sufficient in the evaluation of patients with internal carotid artery severe stenosis or occlusion?

Background And Purpose: Carotid endarterectomy (CE) has been shown to be beneficial in patients with symptomatic high-grade internal carotid artery (ICA) stenosis. Some authors have suggested that when ultrasound shows a stenosis 70-99%, CE can be performed without further imaging study. However, ultrasound findings that suggest an ICA occlusion, not confirmed by angiography but which instead show a near-occlusion usually benefit from CE.

The very acute stroke treatment: fibrinolysis and after.

Thrombolytic therapy with rt-PA given within 3 h after stroke onset to patients with ischemic stroke significantly improves outcome after stroke. There are some evidences that thrombolysis may also work up to 6 h after stroke onset in carefully identified patients, but the three most important trials, which used 0-6 h time-windows, combined with CT-scans to define the ischemic areas, failed individually to produce statistical benefits for the rt-PA-treated patients. In order to enlarge the time-window there is a need for additional information about the functionality of the affected brain area.

Phospholipid autoantibodies: time for a new immuno-assay?

Antiphospholipid (aPL) antibodies are a wide and heterogeneous group of closely related immunoglobulins that have specificity for a number of phospholipids (PLs), PL-binding proteins, including beta2 glycoprotein I (beta2GP1), prothrombin, and PL-protein complexes. Antiphospholipid antibodies are currently detected by a standard solid-phase immunoassay such as anticardiolipin (aCL) antibodies. Although the association between aCL antibodies and thrombosis is well recognized, their role in stroke pathogenesis, and the possibility that they are an independent stroke risk factors in the general stroke population, remains to be determined.

Hyperhomocyst(e)inemia: a risk factor for cerebrovascular disease.

Many case-control and cohort studies have identified a strong, independent and dose-related association between moderate hyperhomocyst(e)inemia and atherosclerotic vascular disease, with respect to the pathogenetic link between hyperhomocyst(e)inemia and stroke, the possible role in inducing an endothelial wall damage deserves special attention. Some prospective cohort studies have failed to demonstrate a positive association between elevated homocyst(e)ine (Hcy) levels and stroke. Further studies are needed, in order to better characterize the association between Hcy concentrations and risk of stroke.