Stroke, a major cause of death and disability, is described as interruption or severe reduction of blood flow in cerebral arteries. Oxidative stress plays an important role in the pathogenesis of atherosclerosis and carotid atherosclerosis is a risk factor for stroke. Combination of multiple environmental and genetic risk factors is thought to increase susceptibility to the development of this disease. Therefore, investigation of the polymorphisms of drug metabolizing enzymes is of crucial importance to determine the molecular etiology of the disease. The main objective of this study was to investigate the possible association between polymorphisms of enzymes causing oxidative stress (CYP2E1, FMO3 and NOS3) and enzymes protecting against oxidative stress (GST and NQO1), and the pathogenesis of atherosclerosis and ischemic stroke risk. The study population consisted of 245 unrelated ischemic stroke patients and 145 healthy control subjects. There was no statistically difference between the patient and control groups in terms of age and gender. Hypertension, diabetes, smoking and obesity were found to be at least 2 times more common in stroke patients than controls. While total cholesterol, triglyceride and LDL-cholesterol level were higher in stroke patients, HDL-cholesterol level was lower in stroke patients when compared to controls. In the case-control analyses for the risk of ischemic stroke, CYP2E1*5B mutant allele, *5B was found to be associated with the development of disease (Odds Ratio / OR=7.876, 95%CI=1.025-60.525, P=0.019). In addition, significant difference was observed between stroke patients and controls with respect to CYP2E1*5B genotype distribution (OR=0.869, 95%CI=1.044-62.339, P=0.017). On the other hand, in the NQO1*2 polymorphism, together with NQO1 heterozygote (*1*2), NQO1 homozygote mutant (*2*2) genotype was found protective against ischemic stroke (OR=0.627, 95%CI=0.414-0.950, P=0.027). The risk of hypertensive individuals having stroke was highest in the FMO3 472GA group (OR=6.110, P=0.000). In diabetics, GSTP1 313AG genotype was found to be the highest risk factor for stroke (OR=3.808 P=0.001). On the other hand, NQO1 *1*2 heterozygote genotype was associated with 5 times increased risk for stroke in smokers (OR=5.000, P=0.000). In addition GSTM1 present genotype constituted 8 times increased stroke risk in obese individuals (OR=8.068, P=0.001). Logistic regression analysis revealed that hypertension, diabetes mellitus, obesity and smoking were significant risk factors for stroke. On the other hand, HDL-cholesterol and having NQO1 *1*2 heterozygote genotype were found to be protective factors against stroke.

The roles of the vascular architecture and blood flow in response to neurovascular diseases are important in predicting physiological outcomes. Observing these parameters chronically with optical imaging techniques provides insight into the neurovascular recovery process. We develop and deploy optical imaging systems for monitoring the progression of vascular structure, perfusion, and functional blood response after ischemic stroke in a chronic rodent model to observe vascular dynamics of the cortex under normal and diseased pathologies. Specifically, we monitor the progression of the vascular structure and cerebral blood flow (CBF) over a chronic period in the rodent cortex after photo-thrombotic occlusion. Multi-Exposure Speckle Imaging (MESI) provides surface measurements of microvascular flow dynamics while Two-Photon Fluorescence Microscopy offers direct visualization of the microvascular structure. We observe the occurrence of vascular reorientation in the sub-surface microvascular structure over a 35 day post-occlusion period. We also correlate MESI flow estimates in the parenchyma with sub-surface microvascular volume fractions from two-photon microscopy to assess how vascular density influences the surface-integrated MESI measurements. Next, we develop and validate a MESI technique for measuring absolute changes of the functional blood flow response to forepaw stimulation in rodents, termed FA MESI. The optimal camera exposures for capturing the CBF response to forepaw stimulation are extracted from a training set of animal data and the feasibility of the technique is demonstrated in a testing animal set by comparing functional response results between new and existing techniques. We then deploy this system in a chronic study monitoring the progression of hemodynamic parameters after ischemic stroke within the functionally responding area of the cortex. The progression of the regional CBF perfusion and absolute changes in the magnitude of the functional blood flow response are monitored chronically after photo-thrombotic occlusion. We compare the differences between absolute and relative measurements of the functional blood flow responses, and validate FA MESI by comparing baseline measurements to 15-exposure MESI over the sampled flow distributions. We demonstrate the differences measured between the functional outcomes and the regional CBF perfusion over a three week post-occlusion time period. / text

Cleaved fragments of the extracellular matrix protein perlecan have been shown to promote neuroprotection and repair after ischemic stroke. The cysteine proteases cathepsin B and L as well as the metalloprotease bone morphogenic protein 1 (BMP-1) are capable of releasing the biologically active C-terminal laminin-like globular domain (LG3) of perlecan. Exercise, a known method of reducing stroke risk and severity, has been shown to increase the expression of some proteases associated with perlecan processing. Using a transient distal middle cerebral artery occlusion (MCAo) model for focal ischemic stroke we show that while 7 days of running only slightly decreased infarct volume, BMP1 and perlecan (HSPG2) RNA expression in skeletal muscle was significantly increased in 3-month-old male wild type C57/BL6 mice. Moreover, elevated levels of BMP1 RNA were still detectable after 3 days of detraining, suggesting a prolonged effect of exercise on BMP1 expression. Levels of LG3 in the blood were below the limit of detection in the current study, however it is likely that a more sensitive method would enable analysis of serum. These preliminary findings suggest that LG3 could be a molecular mediator of neuroprotection afforded by exercise though further studies are required.

The goal of this thesis was to describe cognitive profile of mild cognitive impairment (MCI) in patients witch ischemic stroke (IST). The theoretical introduction focuses on IST, the concept of MCI, and neuropsychological test of cognitive deficits related to IST. The empirical part of the thesis describes the research results. 64 patients with various types of brain lesions after first-ever stroke were examined within 3-6 months after hospital admission. The cognitive performance was assessed across five cognitive domains: memory, attention, executive functions, visuospacial abilities, and language. All cognitive domains were impaired to the similar extend; the impairment quite severe, and ranged from 1.5 to 2.0 SD below the mean of the control group. The results showed that right hemisphere lesions were associated with visuospacial impairment whereas left hemisphere lesions were associated with language impairment. Also, it was examined which combination of tests differentiates best between patients from the experimental groups and the control group, and among individual experimental groups. It is necessary to develop and use sensitive and valid tests that can detect mild cognitive deficits in patients after ischemic stroke, which could be useful for rehabilitation planning. Keywords: mild...

Thermal imaging is a non-invasive and marker-free approach for intraoperative measurements of small temperature variations. In this work, we demonstrate the abilities of active dynamic thermal imaging for analysis of tissue perfusion state in case of cerebral ischemia. For this purpose, a NaCl irrigation is applied to the exposed cortex during hemicraniectomy. The cortical temperature changes are measured by a thermal imaging system and the thermal signal is recognized by a novel machine learning framework. Subsequent tissue heating is then approximated by a double exponential function to estimate tissue temperature decay constants. These constants allow us to characterize tissue with respect to its dynamic thermal properties. Using a Gaussian mixture model we show the correlation of these estimated parameters with infarct demarcations of post-operative CT. This novel scheme yields a standardized representation of cortical thermodynamic properties and might guide further research regarding specific intraoperative diagnostics.

L’AVC représente la première cause d’handicap acquis chez l’adulte. L’AVC ischémique, représentant 87% des AVCs, est une pathologie complexe dont le premier facteur de risque aggravant est l’hypertension artérielle. À l’heure actuelle les seuls traitements disponibles sont la thrombolyse et la thrombectomie. Cependant, ces traitements présentent de nombreuses contre-indications et effets secondaires limitant leurs applications chez les patients. L’objectif des travaux menés dans cette thèse est l’évaluation d’un traitement pharmacologique, le RGTA (ReGeneraTing Agent), combiné ou non à un traitement cellulaire utilisant les cellules souches mésenchymateuses (CSMs), chez des rats normo- et hyper-tendus. Les résultats obtenus dans cette thèse montrent qu’à la suite d’une ischémie cérébrale, les traitements évalués offrent une neuroprotection et une récupération fonctionnelle persistantes, chez les animaux noromo- et hyper-tendus. Cette récupération est expliquée par la réduction du volume lésionnel, par une meilleure plasticité cérébrale (angiogenèse, neurogenèse), ainsi par la potentialisation de l’effet des CSMs par le RGTA. En conclusion, nos études démontrent l’efficacité d’une thérapie robuste de neurorprotection chez le rongeur à la suite d’une ischémie cérébrale. / Stroke is the leading cause worldwide of adult severe disability. The limited available treatments for ischemic stroke, which accounts for 87% of strokes, makes it necessary to develop new therapeutical approaches. Stroke is a complex pathology and chronic hypertension (CAH) represents the first aggravating risk factor for ischemic stroke. At the present time, the only two available treatments for ischemic stroke, thrombolysis and thrombectomy, present several side effects limiting their clinical use. Here we evaluate the effect of a molecular RGTA (ReGeneraTing Agent) based therapy combined or not to a cellular therapy based on the use of mesenchymal stem cells (MSCs) for the treatment of ischemic stroke in normo- and hyper-tensive rats. The results demonstrate that the evaluated therapies confer a long lasting neuroprotection accompanied by animals’ functional recovery. Further analysis suggest that RGTA enhances brain plasticity (angiogenesis, and neurogenesis), protects the extracellular matrix structure, and potentiates MSCs’ beneficial effects. In conclusion, our studies demonstrate the efficacy of a molecular and cellular combined therapy conferring a persistent neuroprotection and functional recovery for the treatment of ischemic stroke.

Brain lesions are regions of abnormal or damaged tissue in the brain, commonly due to stroke, cancer or other disease. They are diagnosed primarily using neuroimaging, the most common modalities being Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). Brain lesions have a high degree of variability in terms of location, size, intensity and form, which makes diagnosis challenging. Traditionally, radiologists diagnose lesions by inspecting neuroimages directly by eye; however, this is time-consuming and subjective. For these reasons, many automated methods have been developed for lesion delineation (segmentation), lesion identification and diagnosis. The goal of this thesis is to improve and develop automated methods for delineating brain lesions from multimodal MRI scans. First, we propose an improvement to existing segmentation methods by exploiting the bilateral quasi-symmetry of healthy brains, which breaks down when lesions are present. We augment our data using nonlinear registration of a neuroimage to a reflected version of itself, leading to an improvement in Dice coefficient of 13 percent. Second, we model lesion volume in brain image patches with a modified Poisson regression method. The model accurately identified the lesion image with the larger lesion volume for 86 percent of paired sample patches. Both of these projects were published in the proceedings of the BIOSTEC 2020 conference. In the last two chapters, we propose a confidence-based approach to measure segmentation uncertainty, and apply an unsupervised segmentation method based on mutual information.

Cerebral ischemia leading to an ischemic stroke is a possible complication of a transcatheter aortic valve replacement (TAVR) procedure. This is because embolic debris can become dislodged and travel through the aortic arch, where they either continue to the descending aorta and join the systemic circulation or travel into the cerebral vasculature through the three daughter vessels that branch off the top of the aortic arch. These three vessels are the brachiocephalic artery, the left subclavian artery, and the left common carotid artery. These three vessels lead either directly or indirectly to the cerebral vasculature, where the diameter of vessels become very small. If a large enough embolus travels into the cerebral vasculature, it can become stuck in the small cerebral vessels, blocking blood flow and cutting off the supply of oxygen to brain cells. The purpose of this study is to expand upon previous work in order to 1) create a more accurate physics simulation of blood and debris flow through the aortic arch 2) report on embolic debris distribution through the aortic arch and 3) analysis on which physical parameters affect embolic debris distribution. The physical parameters analyzed were particle diameter and particle density. This study was performed by creating a finite element model in COMSOL Multiphysics™ using a SolidWorks model of an aortic arch, with dimensions taken from a patient’s CT scan. Computational fluid dynamics was performed using a pulsatile pressure waveform throughout the aortic arch with a non-constant viscosity model. Once the velocity profile through the aortic arch matched with value ranges from literature, the particle tracing study was implemented. Both a pulsatile pressure waveform and a constant pressure model were analyzed, as well as a constant viscosity model and a non-constant viscosity model. The pulsatile pressure waveform influenced particle distribution and is recommended for future studies since this model leads to pulsatile flow, which is representative of flow through the aorta. It was seen that the non-constant viscosity model did not have a large effect on the velocity profile, but more than doubled the surface average value of viscosity. It also had an effect on the particle distribution through the aortic arch. Small diameter emboli were more likely to flow into the descending aorta, the brachiocephalic artery, and the left subclavian artery; larger emboli were more likely to flow into the left common carotid. Lower density emboli were more likely to flow into the descending aorta and the brachiocephalic artery. Averaging all densities and sizes, it was determined 44.8% of emboli flow into the three daughter vessels, but ultimately only 30.61% of emboli flow into the cerebral vasculature and have the potential to cause an ischemic stroke.

Background: Early differentiation between transient ischemic attack (TIA) and minor ischemic stroke (MIS) impacts on the patient’s individual diagnostic work-up and treatment. Furthermore, estimations regarding persisting impairments after MIS are essential to guide rehabilitation programs. This study evaluated a combined clinical- and serum biomarker-based approach for the differentiation between TIA and MIS as well as the mid-term prognostication of the functional outcome, which is applicable within the first 24 h after symptom onset. Methods: Prospectively collected data were used for a retrospective analysis including the neurological deficit at admission (National Institutes of Health Stroke Scale, NIHSS) and the following serum biomarkers covering different pathophysiological aspects of stroke: Coagulation (fibrinogen, antithrombin), inflammation (C reactive protein), neuronal damage in the cellular [neuron specific enolase], and the extracellular compartment [matrix metalloproteinase-9, hyaluronic acid]. Further, cerebral magnetic resonance imaging was performed at baseline and day 7, while functional outcome was evaluated with the modified Rankin Scale (mRS) after 3, 6, and 12 months. Results: Based on data from 96 patients (age 64 ± 14 years), 23 TIA patients (NIHSS 0.6 ± 1.1) were compared with 73 MIS patients (NIHSS 2.4 ± 2.0). In a binary logistic regression analysis, the combination of NIHSS and serum biomarkers differentiated MIS from TIA with a sensitivity of 91.8% and a specificity of 60.9% [area under the curve (AUC) 0.84]. In patients with NIHSS 0 at admission, this panel resulted in a still acceptable sensitivity of 81.3% (specificity 71.4%, AUC 0.69) for the differentiation between MIS (n = 16) and TIA (n = 14). By adding age, remarkable sensitivities of 98.4, 100, and 98.2% for the prediction of an excellent outcome (mRS 0 or 1) were achieved with respect to time points investigated within the 1-year follow-up. However, the specificity was moderate and decreased over time (83.3, 70, 58.3%; AUC 0.96, 0.92, 0.91). Conclusion: This pilot study provides evidence that the NIHSS combined with selected serum biomarkers covering pathophysiological aspects of stroke may represent a useful tool to differentiate between MIS and TIA within 24 h after symptom onset. Further, this approach may accurately predict the mid-term outcome in minor stroke patients, which might help to allocate rehabilitative resources.

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