http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Wed, 12 Jun 2013 09:23:19 +0000 http://www.hindawi.com/journals/srt/2013/651958/ Subarachnoid hemorrhage (SAH) is the subtype of stroke with one of the highest mortality rates and the least well-understood pathophysiologies. One of the very early events which may occur after SAH is a significant decrease of cerebral perfusion pressure (CPP) caused by the excessive increase of intracranial pressure during the initial bleeding. A severely decreased CPP results in global cerebral ischemia, an event also occurring after cardiac arrest. The aim of the current paper is to review the pathophysiological events occurring in experimental models of SAH and global cerebral ischemia and to evaluate the contribution and the importance of global cerebral ischemia for the pathophysiology of SAH. Nikolaus Plesnila Copyright © 2013 Nikolaus Plesnila. All rights reserved. Thu, 16 May 2013 14:35:09 +0000 http://www.hindawi.com/journals/srt/2013/510481/ Given recent advances in diagnostic modalities and revascularization capabilities, clinicians are not only able to rapidly and accurately identify acute ischemic stroke, but may also be able to aggressively intervene to minimize the extent of infarction. In those cases where revascularization cannot occur and/or the extent of infarction is large, there are multiple strategies to prevent secondary decompensation as the stroke evolves, for instance, if malignant cerebral edema should develop. In this paper, we will review the indications for specialized ICU care for an ischemic stroke patient, the treatment principles, and strategies employed by neurointensivists to minimize secondary neuronal injury, the literature in support of such strategies (and the questions to be addressed by future studies), all with the ultimate goal of increasing the likelihood of favorable neurologic outcomes in our ischemic stroke population. Vineeta Singh and Nancy J. Edwards Copyright © 2013 Vineeta Singh and Nancy J. Edwards. All rights reserved. Tue, 30 Apr 2013 13:20:29 +0000 http://www.hindawi.com/journals/srt/2013/128641/ Motor recovery after stroke is related to neural plasticity, which involves developing new neuronal interconnections, acquiring new functions, and compensating for impairment. However, neural plasticity is impaired in the stroke-affected hemisphere. Therefore, it is important that motor recovery therapies facilitate neural plasticity to compensate for functional loss. Stroke rehabilitation programs should include meaningful, repetitive, intensive, and task-specific movement training in an enriched environment to promote neural plasticity and motor recovery. Various novel stroke rehabilitation techniques for motor recovery have been developed based on basic science and clinical studies of neural plasticity. However, the effectiveness of rehabilitative interventions among patients with stroke varies widely because the mechanisms underlying motor recovery are heterogeneous. Neurophysiological and neuroimaging studies have been developed to evaluate the heterogeneity of mechanisms underlying motor recovery for effective rehabilitation interventions after stroke. Here, we review novel stroke rehabilitation techniques associated with neural plasticity and discuss individualized strategies to identify appropriate therapeutic goals, prevent maladaptive plasticity, and maximize functional gain in patients with stroke. Naoyuki Takeuchi and Shin-Ichi Izumi Copyright © 2013 Naoyuki Takeuchi and Shin-Ichi Izumi. All rights reserved. Sun, 28 Apr 2013 14:19:03 +0000 http://www.hindawi.com/journals/srt/2013/692137/ Introduction. Improvement of postural stability is an important goal during poststroke rehabilitation. Since weight-bearing asymmetry (WBA) towards the nonparetic leg is common, training of weight-bearing symmetry has been a major focus in post-stroke balance rehabilitation. It is assumed that restoration of a more symmetrical weight distribution is associated with improved postural stability. Objective. To determine to what extent WBA is associated with postural instability in people after stroke. Methods. Electronic databases were searched (Cochrane, MEDLINE, EMBASE, and CINAHL) until March 2012. Main Eligibility Criteria. (1) Participants were people after stroke. (2) The association between WBA and postural stability was reported. Quality of reporting was assessed with the STROBE checklist and a related tool for reporting of confounding. Results. Nine observational studies met all criteria. Greater spontaneous WBA was associated with higher center of pressure (COP) velocity and with poorer synchronization of COP trajectories between the legs (two and one studies, resp.). Evidence for associations between WBA and performance on clinical balance tests or falls was weak. Conclusion. Greater WBA after stroke was associated with increased postural sway, but the current literature does not provide evidence for a causal relationship. Further studies should investigate whether reducing WBA would improve postural stability. Jip F. Kamphuis, Digna de Kam, Alexander C. H. Geurts, and Vivian Weerdesteyn Copyright © 2013 Jip F. Kamphuis et al. All rights reserved. Sun, 14 Apr 2013 09:28:08 +0000 http://www.hindawi.com/journals/srt/2013/946056/ Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age years, days after stroke) were assigned to 30 days of ROBO-FES (), ROBO (), or control () in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped % during robot training. In 52% of controls mean arterial pressure decreased by %. ROBO-FES increased leg strength by points, ROBO by more than control (, ). CBFV increased in both robotic groups more than in controls (). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone. Alexey N. Kuznetsov, Natalia V. Rybalko, Vadim D. Daminov, and Andreas R. Luft Copyright © 2013 Alexey N. Kuznetsov et al. All rights reserved. Thu, 04 Apr 2013 09:46:03 +0000 http://www.hindawi.com/journals/srt/2013/954279/ Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures. Åsa G. Andersson, Åke Seiger, and Peter Appelros Copyright © 2013 Åsa G. Andersson et al. All rights reserved. Thu, 04 Apr 2013 09:43:55 +0000 http://www.hindawi.com/journals/srt/2013/362961/ Haemorrhagic transformation (HT) of recently ischaemic brain is a feared complication of thrombolytic therapy that may be caused or compounded by ischaemia-induced activation of matrix metalloproteinases (MMPs). The tetracycline antibiotic minocycline inhibits matrix MMPs and reduces macroscopic HT in rodents with stroke treated with tissue plasminogen activator (tPA). The West Australian Intravenous Minocycline and TPA Stroke Study (WAIMATSS) aims to determine the safety and efficacy of adding minocycline to tPA in acute ischaemic stroke. The WAIMATSS is a multicentre, prospective, and randomised pilot study of intravenous minocycline, 200 mg 12 hourly for 5 doses, compared with standard care, in patients with ischaemic stroke treated with intravenous tPA. The primary endpoint is HT diagnosed by brain CT and MRI. Secondary endpoints include clinical outcome measures. Some illustrative cases from the early recruitment phase of this study will be presented, and future perspectives will be discussed. David J. Blacker, David Prentice, Anthony Alvaro, Timothy R. Bates, Michael Bynevelt, Andrew Kelly, Lay Kun Kho, Edith Kohler, Graeme J. Hankey, Andrew Thompson, and Taryn Major Copyright © 2013 David J. Blacker et al. All rights reserved. Wed, 03 Apr 2013 10:47:03 +0000 http://www.hindawi.com/journals/srt/2013/869327/ In this study, we used a model of a hemorrhagic stroke in a motor zone of the cortex in rats at the age of 3 months The report shows that cortical neurons can fuse with oligodendrocytes. In formed binuclear cells, the nucleus of an oligodendrocyte undergoes neuron specific reprogramming. It can be confirmed by changes in chromatin structure and in size of the second nucleus, by expression of specific neuronal markers and increasing total transcription rate. The nucleus of an oligodendrocyte likely transforms into a second neuronal nucleus. The number of binuclear neurons was validated with quantitative analysis. Fusion of neurons with oligodendrocytes might be a regenerative process in general and specifically following a stroke. The appearance of additional neuronal nuclei increases the functional outcome of the population of neurons. Participation of a certain number of binuclear cells in neuronal function might compensate for a functional deficit that arises from the death of a subset of neurons. After a stroke, the number of binuclear neurons increased in cortex around the lesion zone. In this case, the rate of recovery of stroke-damaged locomotor behavior also increased, which indicates the regenerative role of fusion. Alexander Paltsyn, Svetlana Komissarova, Ivan Dubrovin, and Aslan Kubatiev Copyright © 2013 Alexander Paltsyn et al. All rights reserved. Tue, 26 Mar 2013 16:49:26 +0000 http://www.hindawi.com/journals/srt/2013/840265/ One-third of stroke and transient ischemic attack (TIA) are cryptogenic, and paroxysmal atrial fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Multiple studies have recently evaluated long-term cardiac rhythm monitoring with good yield for PAF. The duration of monitoring varies between studies as well as the qualifying event definition. Moreover, the clinical significance of very brief atrial fibrillation events is unclear in the literature. This paper provides an overview of current advances in the detection of paroxysmal atrial fibrillation, the clinical and genetic factors predictive of arrhythmia detection, and the therapeutic dilemma concerning this approach. Muhib Khan and Daniel J. Miller Copyright © 2013 Muhib Khan and Daniel J. Miller. All rights reserved. Tue, 26 Mar 2013 14:29:55 +0000 http://www.hindawi.com/journals/srt/2013/562506/ Background. Assessing poststroke cognitive impairment is complex. A subscale of the NIHSS, the Cog-4, has been proposed as a quick test of “cognitive impairment.” but a study of its properties in a larger dataset is lacking. Methods. Data from 9,147 patients with acute stroke from the VISTA archive was used to generate Cog-4 scores. The statistical properties of Cog-4, its relationship with baseline clinical characteristics, and other functional outcome measures at day 90 were assessed. Results. Mean age of patients was 69.2 years and 45.8%, were females. Day-90 Cog-4 was highly positively skewed (skewness 0.926). Patients with left hemispheric stroke had higher day-90 Cog-4 score (). Age, stroke severity, and previous stroke were significant predictors of Cog-4. Cog-4 was significantly correlated with dependency (modified Rankin Scale, ), and disability (Barthel Index, ). Conclusions. The Cog-4 scale at day 90 cannot be considered a useful test of cognition since it only superficially measures cognition. It is heavily dependent on the side of stroke, is inevitably associated with functional outcome (being a subset of the NIHSS), and suffers from a profound “floor” effect. Specific and validated measures are more appropriate for the assessment of poststroke cognition than Cog-4. Sandeep Ankolekar, Cheryl Renton, Nikola Sprigg, and Philip M. W. Bath Copyright © 2013 Sandeep Ankolekar et al. All rights reserved. Mon, 25 Mar 2013 11:11:58 +0000 http://www.hindawi.com/journals/srt/2013/425281/ Subarachnoid hemorrhage and transient global cerebral ischemia result in similar pathophysiological changes in the cerebral microcirculation. These changes include microvascular constriction, increased leukocyte-endothelial interactions, blood brain barrier disruption, and microthrombus formation. This paper will look at various animal and preclinical studies that investigate these various microvascular changes, perhaps providing insight in how these microvessels can be a therapeutic target in both subarachnoid hemorrhage and transient global cerebral ischemia. Michael K. Tso and R. Loch Macdonald Copyright © 2013 Michael K. Tso and R. Loch Macdonald. All rights reserved. Sun, 24 Mar 2013 19:20:43 +0000 http://www.hindawi.com/journals/srt/2013/948783/ Vascular endothelial growth factor (VEGF) stimulating angiogenesis was shown to be a potential novel therapeutic approach for the treatment of ischemic vascular diseases. The goal of the present study was to examine whether transfection of VEGF before occurrence of major stroke (part I) and cerebral vasospasm after experimental subarachnoid hemorrhage (SAH; part II) develops neuroprotective qualities. A total of 25 (part I) and 26 (part II) brains were analyzed, respectively. In part one, a significant reduction of infarct volume in the VEGF-treated stroke animals (43% reduction, ) could be detected. In part two, significant vasospasm was induced in all hemorrhage groups . Analyzing microperfusion, a significant higher amount of perfused vessels could be detected , whereas no significant effect could be detected towards macroperfusion. Histologically, no infarctions were observed in the VEGF-treated SAH group and the sham-operated group. Minor infarction in terms of vasospasm-induced small lesions could be detected in the control vector transduced group and saline-treated group . The present study demonstrates the preconditioning impact of systemic intramuscular VEGF injection in animals after major stroke and induced severe vasospasm after SAH. Sven Oliver Eicker, Moritz Hoppe, Nima Etminan, Stephan Macht, Jason Perrin, Hans-Jakob Steiger, and Daniel Hänggi Copyright © 2013 Sven Oliver Eicker et al. All rights reserved. Thu, 21 Mar 2013 15:15:53 +0000 http://www.hindawi.com/journals/srt/2013/105937/ We sought to determine the prevalence of fetal posterior cerebral artery (fPCA) and if fPCA was associated with specific stroke etiology and vessel territory affected. This paper is a retrospective review of prospectively identified patients with acute ischemic stroke from July 2008 to December 2010. We defined complete fPCA as absence of a P1 segment linking the basilar with the PCA and partial fPCA as small segment linking the basilar with the PCA. Patients without intracranial vascular imaging were excluded. We compared patients with complete fPCA, partial fPCA, and without fPCA in terms of demographics, stroke severity, distribution, and etiology and factored in whether the stroke was ipsilateral to the fPCA. Of the 536 included patients, 9.5% () had complete fPCA and 15.1% () had partial fPCA. Patients with complete fPCA were older and more often female than partial fPCA and no fPCA patients, and significant variation in TOAST classification was detected across groups (). Patients with complete fPCA had less small vessel and more large vessel strokes than patients with no fPCA and partial fPCA. Fetal PCA may predispose to stroke mechanism, but is not associated with vascular distribution, stroke severity, or early outcome. Amir Shaban, Karen C. Albright, Amelia K. Boehme, and Sheryl Martin-Schild Copyright © 2013 Amir Shaban et al. All rights reserved. Wed, 13 Mar 2013 11:00:06 +0000 http://www.hindawi.com/journals/srt/2013/819340/ Aneurysmal subarachnoid hemorrhage (SAH) has devastating consequences on brain function including profound effects on communication between neurons and the vasculature leading to cerebral ischemia. Physiologically, neurovascular coupling represents a focal increase in cerebral blood flow to meet increased metabolic demand of neurons within active regions of the brain. Neurovascular coupling is an ongoing process involving coordinated activity of the neurovascular unit—neurons, astrocytes, and parenchymal arterioles. Neuronal activity can also influence cerebral blood flow on a larger scale. Spreading depolarizations (SD) are self-propagating waves of neuronal depolarization and are observed during migraine, traumatic brain injury, and stroke. Typically, SD is associated with increased cerebral blood flow. Emerging evidence indicates that SAH causes inversion of neurovascular communication on both the local and global level. In contrast to other events causing SD, SAH-induced SD decreases rather than increases cerebral blood flow. Further, at the level of the neurovascular unit, SAH causes an inversion of neurovascular coupling from vasodilation to vasoconstriction. Global ischemia can also adversely affect the neurovascular response. Here, we summarize current knowledge regarding the impact of SAH and global ischemia on neurovascular communication. A mechanistic understanding of these events should provide novel strategies to treat these neurovascular disorders. Masayo Koide, Inna Sukhotinsky, Cenk Ayata, and George C. Wellman Copyright © 2013 Masayo Koide et al. All rights reserved. Tue, 12 Mar 2013 15:52:42 +0000 http://www.hindawi.com/journals/srt/2013/418627/ Method sensitivity is critical for evaluation of poststroke motor function. Skilled walking was assessed in horizontal, upward, and downward rung ladder walking to compare the demands of the tasks and test sensitivity. The complete step sequence of a walk was subjected to analysis aimed at demonstrating the walking pattern, step sequence, step cycle, limb coordination, and limb interaction to complement the foot fault scoring system. Rats (males, ) underwent unilateral photothrombotic lesion of the motor cortex of the forelimb and hind limb areas. Locomotion was video recorded before the insult and at postischemic days 7 and 28. Analysis of walking was performed frame-by-frame. Walking along the rung ladder revealed different results that were dependent on ladder inclination. Horizontal walking was found to discriminate lesion-related motor deficits in forelimb, whereas downward walking demonstrates hind limb use most sensitively. A more frequent use of the impaired forelimb that possibly supported poststroke motor learning in rats was shown. The present study provides a novel system for a detailed analysis of the complete walking sequence and will help to provide a better understanding of how rats deal with motor impairments. Iwa Antonow-Schlorke, Julia Ehrhardt, and Marcel Knieling Copyright © 2013 Iwa Antonow-Schlorke et al. All rights reserved. Sun, 10 Mar 2013 15:22:48 +0000 http://www.hindawi.com/journals/srt/2013/846732/ Objective. This analysis focuses on the effect of depression on the cost of hospitalization of stroke patients. Methods. Data on 17,010 stroke patients (primary diagnosis) were extracted from 2008 Tennessee Hospital Discharge Data System. Three groups of patients were compared: (1) stroke only (, ), (2) stroke + depression (, ), and (3) stroke + other mental health diagnoses (, ). Results. Of all adult patients, 4.3% were diagnosed with stroke. Stroke was more prevalent among blacks than whites (4.5% versus 4.2%, ) and among males than females (5.1% versus 3.7%, ). Nearly one-quarter of stroke patients (23.3%) were diagnosed with depression/anxiety. Hospital stroke cost was higher among depressed stroke patients () compared to stroke only () patients ($77,864 versus $47,790, ), and among , cost was higher for black males compared to white depressed males ($97,196 versus $88,115, ). Similar racial trends in cost emerged among females. Conclusion. Depression in stroke patients is associated with increased hospitalization costs. Higher stroke cost among blacks may reflect the impact of comorbidities and the delay in care of serious health conditions. Attention to early detection of depression in stroke patients might reduce inpatient healthcare costs. Baqar Husaini, Robert Levine, Linda Sharp, Van Cain, Meggan Novotny, Pamela Hull, Gail Orum, Zahid Samad, Uchechukwu Sampson, and Majaz Moonis Copyright © 2013 Baqar Husaini et al. All rights reserved. Thu, 07 Mar 2013 19:07:29 +0000 http://www.hindawi.com/journals/srt/2013/862978/ Background. Depression after stroke may have great burden on the likelihood of functional recovery and long-term outcomes. Objective. To estimate the association between depression after stroke and subsequent mortality. Methods. A systematic search of articles using PubMed and Web of Science databases was performed. Odds ratios (ORs) and hazard ratios (HRs) were used as association measures for pooled analyses, based on random-effects models. Results. Thirteen studies, involving 59,598 subjects suffering from stroke (6,052 with and 53,546 without depression), had data suitable for meta-analysis. The pooled OR for mortality at followup in people suffering from depression after stroke was 1.22 (1.02–1.47). Subgroups analyses highlighted that only studies with medium-term followup (2–5 years) showed a statistically significant association between depression and risk of death. Four studies had data suitable for further analysis of pooled HR. The meta-analysis revealed a HR for mortality of 1.52 (1.02–2.26) among people with depression after stroke. Conclusions. Despite some limitations, this paper confirms the potential role of depression on post stroke mortality. The relationship between depression and mortality after stroke seems to be related to the followup duration. Further research is needed to clarify the nature of the association between depression after stroke and mortality. Francesco Bartoli, Nicoletta Lillia, Annamaria Lax, Cristina Crocamo, Vittorio Mantero, Giuseppe Carrà, Elio Agostoni, and Massimo Clerici Copyright © 2013 Francesco Bartoli et al. All rights reserved. Thu, 07 Mar 2013 15:02:15 +0000 http://www.hindawi.com/journals/srt/2013/263974/ Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH). Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest) met the review criteria (103 published, 39 ongoing). The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%), while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study. Jennifer A. Frontera Copyright © 2013 Jennifer A. Frontera. All rights reserved. Wed, 06 Mar 2013 13:15:52 +0000 http://www.hindawi.com/journals/srt/2013/276540/ The risk of ischemic stroke increases substantially with age, making it the third leading cause of death and the leading cause of long-term disability in the world. Numerous studies demonstrated that genes, RNAs, and proteins are involved in the occurrence and development of stroke. Current studies found that microRNAs (miRNAs or miRs) are also closely related to the pathological process of stroke. miRNAs are a group of short, noncoding RNA molecules playing important role in posttranscriptional regulation of gene expression and they have emerged as regulators of ischemic preconditioning and ischemic postconditioning. Here we give an overview of the expression and function of miRNAs in the brain, miRNAs as biomarkers during cerebral ischemia, and clinical applications and limitations of miRNAs. Future prospects of miRNAs are also discussed. Yang Wang, Yongting Wang, and Guo-Yuan Yang Copyright © 2013 Yang Wang et al. All rights reserved. Sun, 03 Mar 2013 14:54:49 +0000 http://www.hindawi.com/journals/srt/2013/410972/ The availability of proper tests for gait evaluation following cerebral ischemia in rats has been limited. The automated, quantitative CatWalk system, which was initially designed to measure gait in models of spinal cord injury, neuropathic pain, and peripheral nerve injury, is said to be a useful tool for the study of motor impairment in stroke animals. Here we report our experiences of using CatWalk XT with rats subjected to transient middle cerebral artery occlusion (MCAO), during their six-week followup. Large corticostriatal infarct was confirmed by MRI in all MCAO rats, which was associated with severe sensorimotor impairment. In contrast, the gait impairment was at most mild, which is consistent with seemingly normal locomotion of MCAO rats. Many of the gait parameters were affected by body weight, walking speed, and motivation despite the use of a goal box. In addition, MCAO rats showed bilateral compensation, which was developed to stabilize proper locomotion. All of these interferences may confound the data interpretation. Taken together, the translational applicability of CatWalk XT in evaluating motor impairment and treatment efficacy remains to be limited at least in rats with severe corticostriatal infarct and loss of body weight. Saara Parkkinen, Francisco J. Ortega, Kristina Kuptsova, Joanna Huttunen, Ina Tarkka, and Jukka Jolkkonen Copyright © 2013 Saara Parkkinen et al. All rights reserved. Thu, 28 Feb 2013 14:08:34 +0000 http://www.hindawi.com/journals/srt/2013/394036/ Early brain injury (EBI) has become an area of extreme interest in the recent years and seems to be a common denominator in the pathophysiology of global transient ischemia and subarachnoid hemorrhage (SAH). In this paper, we highlight the importance of cerebral hypoperfusion and other mechanisms that occur in tandem in both pathologies and underline their possible roles in triggering brain injury after hemorrhagic or ischemic strokes. Mohammed Sabri, Elliot Lass, and R. Loch Macdonald Copyright © 2013 Mohammed Sabri et al. All rights reserved. Wed, 27 Feb 2013 17:23:50 +0000 http://www.hindawi.com/journals/srt/2013/170256/ Transcranial direct current stimulation (tDCS) is a promising technique to treat a wide range of neurological conditions including stroke. The pathological processes following stroke may provide an exemplary system to investigate how tDCS promotes neuronal plasticity and functional recovery. Changes in synaptic function after stroke, such as reduced excitability, formation of aberrant connections, and deregulated plastic modifications, have been postulated to impede recovery from stroke. However, if tDCS could counteract these negative changes by influencing the system’s neurophysiology, it would contribute to the formation of functionally meaningful connections and the maintenance of existing pathways. This paper is aimed at providing a review of underlying mechanisms of tDCS and its application to stroke. In addition, to maximize the effectiveness of tDCS in stroke rehabilitation, future research needs to determine the optimal stimulation protocols and parameters. We discuss how stimulation parameters could be optimized based on electrophysiological activity. In particular, we propose that cortical synchrony may represent a biomarker of tDCS efficacy to indicate communication between affected areas. Understanding the mechanisms by which tDCS affects the neural substrate after stroke and finding ways to optimize tDCS for each patient are key to effective rehabilitation approaches. Andrea Gomez Palacio Schjetnan, Jamshid Faraji, Gerlinde A. Metz, Masami Tatsuno, and Artur Luczak Copyright © 2013 Andrea Gomez Palacio Schjetnan et al. All rights reserved. Wed, 27 Feb 2013 11:34:14 +0000 http://www.hindawi.com/journals/srt/2013/546093/ Background. Long-term splinting, using static orthoses to prevent contractures, is widely accepted in stroke patients with paresis of the upper limb. A number of stroke patients complain about increased pain and spasticity, which leads to the nonuse of the orthosis and a risk of developing a clenched fist. Objectives. Evaluating long-term use of static hand-wrist orthoses and experienced comfort in chronic stroke patients. Methods. Eleven stroke patients who were advised to use a static orthosis for at least one year ago were included. Semistructured telephone interviews were conducted to explore the long-term use and experienced comfort with the orthosis. Data were analyzed using descriptive statistics. Results. After at least one year, seven patients still wore the orthosis for the prescribed hours per day. Two patients were unable to wear the orthosis 8 hours per day, due to poor comfort. Two patients stopped using the orthosis because of an increase in spasticity or pain. Conclusions. These pilot data suggest that a number of stroke patients cannot tolerate a static orthosis over a long-term period because of discomfort. Without appropriate treatment opportunities, these patients will remain at risk of developing a clenched fist and will experience problems with daily activities and hygiene maintenance. Aukje Andringa, Ingrid van de Port, and Jan-Willem Meijer Copyright © 2013 Aukje Andringa et al. All rights reserved. Wed, 27 Feb 2013 10:31:16 +0000 http://www.hindawi.com/journals/srt/2013/659374/ Hypoxic-ischemic neonatal encephalopathy and ensuing brain damage is still an important problem in modern perinatal medicine. In this paper, we would like to share some of the results of our recent studies on neuroprotective therapies in animal experiments, as well as some literature reviews. From the basic animal studies, we have now obtained some possible candidates for therapeutic measures against hypoxic-ischemic neonatal encephalopathy. For example, they are hypothermia, rehabilitation, free radical scavenger, neurotrophic factors and growth factors, steroid, calcium channel blocker, vagal stimulation, some anti apoptotic agents, pre- and post conditioning, antioxidants, cell therapy with stem cells, modulators of K(+)-ATP channels, and so on. Whether combination of these therapies may be more beneficial than any single therapy needs to be clarified. Hypoxia-ischemia is a complicated condition, in which the cause, severity, and time-course are different in each case. Likewise, each fetus has its own inherent potentials such as adaptation, preconditioning-tolerance, and intolerance. Therefore, further extensive studies are required to establish an individualized strategy for neuroprotection against perinatal hypoxic-ischemic insult. Hiroshi Sameshima and Tsuyomu Ikenoue Copyright © 2013 Hiroshi Sameshima and Tsuyomu Ikenoue. All rights reserved. Tue, 26 Feb 2013 08:41:03 +0000 http://www.hindawi.com/journals/srt/2013/715380/ The aims of this study were (i) to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii) to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed ( and , resp.). Undetermined causes decreased over 5-year period of study (). The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8%) was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases. L. Tancredi, F. Martinelli Boneschi, M. Braga, I. Santilli, C. Scaccabarozzi, P. Lattuada, M. Sessa, L. Fumagalli, S. Iurlaro, I. Neromante, M. L. De Lodovici, D. V. Roccatagliata, G. Giacalone, M. Arnaboldi, V. Crespi, E. Agostoni, G. C. Comi, C. Ferrarese, and R. Sterzi Copyright © 2013 L. Tancredi et al. All rights reserved. Sun, 24 Feb 2013 10:39:03 +0000 http://www.hindawi.com/journals/srt/2013/159105/ Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke. Myriam Villeneuve and Anouk Lamontagne Copyright © 2013 Myriam Villeneuve and Anouk Lamontagne. All rights reserved. Sun, 24 Feb 2013 09:48:09 +0000 http://www.hindawi.com/journals/srt/2013/424769/ Background. Frontal lobe atrophy (FLA) is associated with late life depression. However, the role that FLA plays in the development of depression after stroke (DAS) remains unknown. This study thus examined the association between FLA and DAS. Methods. A convenience sample of 705 Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all patients and made a diagnosis of DAS three months after the index stroke. Results. Eighty-five (12.1%) patients were diagnosed with DAS. In univariate analysis, the DAS patients were more likely to have severe FLA (14.1% versus 5.6%). Severe FLA remained an independent predictor of DAS in multivariate analysis, with an odds ratio of 2.6 (95% confidence intervals = 1.2–5.9). Conclusions. The results suggest that FLA may play a role in the pathogenesis of DAS, which supports the hypothesis that cumulative vascular burden may be important in predicting DAS. Further investigations are needed to clarify the impact of FLA on the clinical presentation, treatment response, and outcome of DAS in stroke survivors. W. K. Tang, Y. K. Chen, J. Y. Lu, V. C. T. Mok, Winnie C. W. Chu, Gabor S. Ungvari, and K. S. Wong Copyright © 2013 W. K. Tang et al. All rights reserved. Tue, 19 Feb 2013 16:51:43 +0000 http://www.hindawi.com/journals/srt/2013/560305/ Delayed cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) remain severe complications after subarachnoid hemorrhage (SAH). Although focal changes in cerebral metabolism indicating ischemia are detectable by microdialysis, routinely used biomarkers are missing. We therefore sought to evaluate a panel of possible global markers in serum and cerebrospinal fluid (CSF) of patients after SAH. CSF and serum of SAH patients were analyzed retrospectively. In CSF, levels of inhibitory, excitatory, and structural amino acids were detected by high-performance liquid chromatography (HPLC). In serum, neuron-specific enolase (NSE) and S100B level were measured and examined in conjunction with CVS and DCI. CVS was detected by arteriography, and ischemic lesions were assessed by computed tomography (CT) scans. All CSF amino acids were altered after SAH. CSF glutamate, glutamine, glycine, and histidine were significantly correlated with arteriographic CVS. CSF glutamate and serum S100B were significantly correlated with ischemic events after SAH; however, NSE did not correlate neither with ischemia nor with vasospasm. Glutamate, glutamine, glycine, and histidine might be used in CSF as markers for CVS. Glutamate also indicates ischemia. Serum S100B, but not NSE, is a suitable marker for ischemia. These results need to be validated in larger prospective cohorts. Carla S. Jung, Bettina Lange, Michael Zimmermann, and Volker Seifert Copyright © 2013 Carla S. Jung et al. All rights reserved. Thu, 14 Feb 2013 11:08:37 +0000 http://www.hindawi.com/journals/srt/2013/612458/ Despite the importance of regaining independent ambulation after stroke, the amount of daily walking completed during in-patient rehabilitation is low. The purpose of this study is to determine if (1) walking-related heart rate responses reached the minimum intensity necessary for therapeutic aerobic exercise (40%–60% heart rate reserve) or (2) heart rate responses during bouts of walking revealed excessive workload that may limit walking (>80% heart rate reserve). Eight individuals with subacute stroke attending in-patient rehabilitation were recruited. Participants wore heart rate monitors and accelerometers during a typical rehabilitation day. Walking-related changes in heart rate and walking bout duration were determined. Patients did not meet the minimum cumulative requirements of walking intensity (>40% heart rate reserve) and duration (>10 minutes continuously) necessary for cardiorespiratory benefit. Only one patient exceeded 80% heart rate reserve. The absence of significant increases in heart rate associated with walking reveals that patients chose to walk at speeds well below a level that has meaningful cardiorespiratory health benefits. Additionally, cardiorespiratory workload is unlikely to limit participation in walking. Measurement of heart rate and walking during in-patient rehabilitation may be a useful approach to encourage patients to increase the overall physical activity and to help facilitate recovery. Sanjay K. Prajapati, Avril Mansfield, William H. Gage, Dina Brooks, and William E. McIlroy Copyright © 2013 Sanjay K. Prajapati et al. All rights reserved. Sun, 20 Jan 2013 09:21:38 +0000 http://www.hindawi.com/journals/srt/2013/815814/ Marco Iosa, Stefan Hesse, Antonio Oliviero, and Stefano Paolucci Copyright © 2013 Marco Iosa et al. All rights reserved.