Tolga D Dittrich, MD
@to_dittrich

Mun KT, Hinman JD. Inflammation and the Link to Vascular Brain Health: Timing Is Brain. Stroke. 2022;53:427–436.

Over the past years, research has yielded several interesting new insights into the role of inflammation in the different stages of cerebrovascular injury. The development of therapeutic approaches is still in its beginning. It ranges from broadly effective anti-inflammatory agents to very specific drugs that interfere with the signaling pathways of the inflammatory cascade. This comprehensive article by Mun and Hinman presents the current state of knowledge on fundamental inflammatory mechanisms associated with cerebrovascular injury and illustrates the role of inflammation as a therapeutic target.

The immunological mechanisms underlying cerebrovascular injury are incredibly complex. Both intravascular and parenchymal inflammatory processes are driven by the invasion of inflammatory cells (e.g., neutrophil granulocytes) and the release of humoral factors (e.g., cytokines, complement factors, and acute-phase proteins) and may lead to the formation of microvascular thrombi and vascular leaks.

Ammad Mahmood, MBChB
@AMahmoodNeuro

Vemuri P, Decarli C, Duering M. Imaging Markers of Vascular Brain Health: Quantification, Clinical Implications, and Future Directions. Stroke. 2022;53:416–426.

Small vessel disease is a common finding on brain imaging which is increasingly identified with the widespread use of MRI. The clinical significance of this finding remains an area requiring further research. This review begins by defining the components and patterns of abnormalities that are encompassed by the term “small vessel disease,” which is widely used but ambiguous in its meaning. Techniques which identify earlier structural and functional changes in the brain in response to vascular risk factors are then discussed. Finally, the clinical implications of these findings and further opportunities for research in this area are highlighted.

Ayush Agarwal, MD, DM, DNB
@drayushagarwal

Qureshi AI, Huang W, Lobanova I, Chandrasekaran PN, Hanley DF, Hsu CY, Martin RH, Steiner T, Suarez JI, Yamamoto H, Toyoda K. Effect of Moderate and Severe Persistent Hyperglycemia on Outcomes in Patients With Intracerebral Hemorrhage. Stroke. 2021.

The optimal management of hyperglycaemia in ICH continues to be a grey area with precise guidelines yet to be framed. This multi centric study sought to answer this query and evaluated the effect of persistent hyperglycaemia on the 90-day functional outcome (mRS) in patients with ICH, enrolled within 4.5 hours of symptom onset with hematomas<60ml and GCS>5. Moderate hyperglycaemia was defined as serum glucose concentrations between 140-180mg/dl and severe hyperglycaemia as beyond 180mg/dl. Blood sugar monitoring was done for 3 days (upon admission and successively at 24, 48 and 72 hours). 

The study found that moderate and severe persistent hyperglycaemia was associated with statistically significant worse outcomes (higher 90-day death or disability). These were mirrored in non-diabetic patients with ICH. However, statistical significance was not attained in the previously diagnosed diabetic group. The calculated risk was adjusted for Glasgow coma scale score, hematoma volume, intraventricular hemorrhage, hypertension, hyperlipidemia and cigarette smoking to rule out potential bias and confounding. No glycemic association with hematoma expansion was found.