Scientific Program

Conference Series LLC Ltd invites all the participants across the globe to attend 8th International Conference on Stroke and Cerebrovascular Diseases Park Inn by Radison Stockholm Hammarby Sjostad, Midskeppsgatan 6 SE-120 66 Stockholm, Sweden.

Day 1 :

Keynote Forum

Anne L. Foundas

Brain Institute of Lousiana, USA

Keynote: Early Intervention In Vascular Cognitive Impairment
European Stroke Conference 2019 International Conference Keynote Speaker  Anne L. Foundas photo
Biography:

Anne L. Foundas, M.D., FAAN completed her Medical Degree from the LSU School of Medicine (LSU-SOM) in New Orleans, and her Neurology Resdiency and Postdoctoral training at the Univisity of Florida School of Medicine. She is the Executive Director of the Brain Institute of Lousiana, a premier institute that promotes brain health through medical resaearch and education. She has worked as Professor of Neurology at Tulane University, Vice-Chair of Clinical Research at the LSU-SOM, and Chair of Neurology at UMKC-SOM. She has published more than 200 papers and has supervised the training of over 200 physicians, clinical researchers, and educators.

Abstract:

Vascular dementia (VaD) is one dementia subtype that occurs with increasing age. This diagnosis is found in about 20% of people with dementia. The world population is aging. It is estimated that by 2050 there will be over 1.6 billion people worldwide aged 65 and over (17% of the world’s population). The greatest risk for VaD is a history of vascular risk factors (e.g., hypertension, hyperlipidemia) and increasing age. These vascular risks are associated with microvascular disease and stroke. Many people with neurodegenerative diseases, like Alzheimer’s disease, also have microvascular disease and, therefore, have a mixed-type of dementia. These mixed-dementia patients often have a more malignant disease progression. Our clinical and research progrms focus on early intervention in individuals with vascular cognitive impairment, including innovative treatment approaches to change the trajectory of cognitive decline. This talk will include an overview of the clinical and pathological heterogeneity of VaD. The second part will emphasize clusters of patients with vascular cognitive impairment, including major cognitive markers that seem to be prevalent across clinical subtypes. In the third part preliminary data will be presented that highligts our clinical approach that includes the innovative use of neural stimulation and photobiomodulation. Our clinical research team uses a two-pronged approach to: (1) improve communication skills and functional independence in patients with a cognitive decline, and (2) facilitate early identification and treatment of at risk individuals. This discussion will focus on our innovative treatment approaches designed to enhance functional independence, improve communication skills, and reduce caregiver burden..

 

Keynote Forum

Ming-Hsiu, Wu

Chi Mei Medical Center, Liouying, Tainan, Taiwan

Keynote: E-BABE-Adiponectin Axis and Ischemic Stroke
European Stroke Conference 2019 International Conference Keynote Speaker Ming-Hsiu, Wu photo
Biography:

Ming-Hsiu, Wu received his M.D. degree at Kaohsiung Medical University, Taiwan and Ph.D. degree at National Chen Kung University, Taiwan. He is now the director of Division of Neurology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan. His major interests are relationship among adiponectin axis, obesity, and ischemic stroke. For caring dementia patients, he also pays his attention to the overlap between ischemic stroke and Alzheimer’s disease. He published a couple of papers regarding adiponectin axis and its therapeutic trial in cerebral ischemia, and clinical stroke care.

 

Abstract:

Adiponectin (APN) axis is composed of adiponectin and its receptors (ARs). Adiponectin, an adipokine which weights 30 kDa, is almost exclusively secreted by adipocytes. It exists as oliogmeric multimers, and a globular fragment (gAd). Aiponectin receptors is composed of type 1 and 2, and is responsible for adiponectin signaling.

Physiologically, adiponectin is mainly involved in insulin sensitivity and regulation of metabolism of glucose and lipids. Obesity decreased its circulating level for increased oxidative stress in accumulated fat.

Adiponectin exerts multiple protective mechanisms against cerebral ischemic injury including eNOS-dependent mechanism, anti-inflammation, anti-apoptosis, anti-oxidation, anti-apoptosis, and promotion of angiogenesis.

The results of recent meta-analysis studies about adiponectin and risk of stroke are inconsistent. Two studies reported no association of circulating adiponectin levels and risk of stroke, while another reported hyperadiponectinemia increased risk of ischemic stroke. Results from studies in assessing circulating adiponectin levels and the risk of stroke mortality are conflicting and inconsistent in its relationship with functional outcome.

Although many laboratory studies reported beneficial effects of adiponectin in the protection against cerebral ischemic injury, some in vitro evidence showed that activation of AR1 might render neurons vulnerable to ischemic death. Our study showed adiponectin was protective against cerebral ischemic injury through down-regulation of AR1 expression and up-regulation of AR2 expression and p38-mediated anti-apoptosis.

Finally, we believe that, with better understandings of adiponectin axis in cerebral ischemia basically and ischemic stroke clinically, adiponectin has the great potential to be applied in the future care and treatment of ischemic stroke.

European Stroke Conference 2019 International Conference Keynote Speaker Jiangang Shen photo
Biography:

Dr. Shen Jiangang is Professor in School of Chinese Medicine, University of Hong Kong. He also serves as Associate Director (Research) and Chair of Department of Research Postgraduate Students Committee in the School. Dr. Shen’s major research interests focus on molecular regulations of oxidative stress and redox signaling in brain damage and brain repair in post-stroke and neurodegenerative diseases. He is also interested in the experimental and clinical studies on Chinese herbal medicine for cerebral and cardiovascular diseases. His studies have been supported by many prestigious research funds from Hong Kong, Mainland China and others. He has published more than 150 peer-reviewed papers in prestigious academic journals and 14 book chapters. He received many academic and research awards and appointed as honor professorship 15 universities from China and USA. He serves as the editorial board members for many international academic journals including Toxicology and Applied Pharmacology, Scientific Reports and others.

 

Abstract:

Free radicals, including reactive oxygen species (ROS) and reactive nitrogen species (RNS), play important roles in ischemic brin injury. However, both ROS and RNS at low concentration could be redox signaling to maintain biological functions. Although antioxidant therapy revealed neuroprotective effects in stroke animal models, no promising neuroprotective effect has been reported in clinical trials on stroke patients. Thus, the efficacy of antioxidant therapy for stroke treatment is still a puzzle. Peroxynitrite, a representative RNS, is produced from the rapid reaction of NO and O2-. , but it has higher cytotoxic effects than its parent free radicals. Peroxynitrite could increase blood brain barrier (BBB) disruption and aggravate ischemic brain damage. We have explored the molecular targets of RNS in mediating the BBB disruption and brain damage in experimental rat models of cerebral ischemia-reperfusion injury. We found that RNS down-regulated caveolin-1 (Cav-1) in the ischemic brains. Importantly, the loss of Cav-1 activated nitric oxide synthase (NOS), amplified RNS production and activated matrix metalloproteinases (MMP), subsequently inducing the BBB disruption and aggravating cerebral ischemia-reperfusion injury. The feedback interaction of RNS/Cav-1/MMPs provides an amplifying mechanism for aggravating ischemic brain damage. Furthermore, we tested the potentials of targeting the RNS/Cav-1/MMP pathway for drug discovery and found that that medicinal plant compounds, such as glycyrrhizin and baicalin, could regulate the RNS/Cav-1/MMP signaling cascades and attenuate cerebral ischemia-reperfusion injury. Moreover, glycyrrhizin and baicalin revealed to scavenge RNS, inhibit MMPs activation and reduced the BBB damages and hemorrhagic transformation in ischemic stroke animal model with delayed thrombolytic treatment. Therefore, targeting the RNS/Cav-1/MMP pathway could be a promising therapeutic strategy for protecting against cerebral ischemia-reperfusion injury. On the other hand, peroxynitrite at low concentration could be a cellular redox signaling for promoting neural stem cell (NSCs) proliferation, self-renewal and neuronal differentiation in ischemic/hypoxic NSCs. Therefore, antioxidant therapy at early phage of ischemic brain injury might be benefit for reducing RNS-mediated brain damage. Whether the antioxidant therapy could be benefit for brain repair without affecting the redox regulations remain to be further investigated. The detrimental or benefit effects of RNS in brain damage or brain repair could depend on their concentrations and their microenvironments in the ischemic brain

European Stroke Conference 2019 International Conference Keynote Speaker Asem Ali photo
Biography:

Dr Asem Ali, Consultant physician in stroke medicine; Site: Diana, Princess of Wales Hospital UK

Abstract:

MRI brain with diffusion weighted imaging has become the best modality over last decade in the diagnosis management of acute stroke and mimics especially when done within 0 to 14 days. MRI studies in acute strokes are done retrospectively and they suggest 15-30% MRI negative stroke. MRI with DWI can be positive in few circumstances other than ischaemic stroke for example cerebral venous sinus thrombosis, epilepsy, hypoglycaemia, migraine, abscess, herpes simplex encephalitis, demyelinating disease, Mitochondrial encephalopathy lactic acidosis and stroke like episodes, and Posterior reversible encephalopathy.

Objectives: We surveyed the MRI scans of patients presenting with stroke like symptoms and analysed the incidence of MRI negative acute strokes and MRI positive non-strokes at our acute stroke service over 4-month period.

Methods: We collected data of patients admitted under seven stroke skilled consultants using patient case notes, MRI with DWI images and reports by radiologist, discharge letters and clinic follow up clinic letters.

Results:  We reviewed total of 180 patients (89 male and 91 female) using above methods. Overall 98% of the patients had MRI with DWI done within 14 days of admission and among those 90% of patients had MRI within 72 hours of presentation to acute stroke service. A total of 88 (49%) patients had positive MRI and 92 (51%) MRI was negative.

MRI positive Non-stroke:

Total of 8% patients had positive MRI but diagnosed as non-stroke patients. Six stroke physicians have given 100% stroke diagnosis in all MRI positive scans. 18.8% were patient diagnosed as MRI non-stroke by one stroke physician and 75% of these patients the diagnosis was changed to stroke on follow up clinics by second consultant physician.

MRI negative Stroke: Total of 9.7% of patients were labelled as stroke whereas MRI with diffusion weighted imaging was negative.  Five consultants diagnosed MRI negative scans patients 100% as non-stroke Only two physician diagnosed 16% (7 patients) and 5% (2 patients) of patients as MRI negative Stroke respectively. Among the group of 16% patients, second physician on follow up change the diagnosis to non-stroke in 70% (5 patients) to anxiety related symptoms, migraine with aura and Bell’s palsy, remaining 2 patients were followed up by the same physician and diagnosis not changes. In the other 5% group of patients, diagnosis remained the same given the persistence of symptoms on follow up and MRI done > 14 days later.

Conclusion: Our survey has challenged the previous studies which were conducted retrospectively. Survey concluded that most ischaemic stroke will show diffusion restriction on MRI DWI and MRI negative stroke are less than 5% if the scan is done within 10-14 days of acute symptoms. More prospective studies have to be done by Stroke physician in collaboration with the radiologists.We recommend that MDT approach to be taken in MRI negative stroke / MRI positive non-stroke patient history and examination to be reviewed.

 

European Stroke Conference 2019 International Conference Keynote Speaker Hans von Holst, photo
Biography:

Hans von Holst received his Medical Doctor´s degree in 1976 and specialist in Neurosurgery 1982 at Karolinska University Hospital.  In 1985 he earned his PhD and Associate Professorship in Neurosurgery, Clinical Neuroscience at Karolinska Institutet. During 1991-1996 he was appointed as Chairman of the Dept of Neurosurgery and Division Manager of the Neuroclinics at Karolinska University Hospital, respectively. He has been appointed as senior neurosurgeon from 1974 to 2015.  Between 1995-2015 he was appointed as Professor in Neuroengineering at the Royal Institute of Technology. He has published around 150 original papers in reputed journals, reviews and books and has been serving as an editorial board member in several journals.      

 

 

Abstract:

Cytotoxic brain tissue edema, which is found in both grey and white matter cells, is a complicated secondary consequence to ischemic injury following cerebral diseases such as stroke and traumatic brain injury (TBI). To some extent the pathophysiological mechanisms are known, however far from complete. A new hypothesis regarding the etiology to cytotoxic brain edema is presented. The hypothesis is that the internal energy of semi-static mechanical forces following stroke and external energy of dynamic impact due to TBI result in the disruption of non-covalent and covalent bonds in protein and nucleotide structures. The unfolded proteins attract water molecules while the disruption of nucleotides such as adenosine-tri-phosphates causes a dysfunction in ion hemostasis and which may tentatively explain the etiology to cytotoxic edema. Our studies using computer models show that the kinetic energy following an impact to the head has the potential to break the chemical bonds in the protein and nucleotide structures resulting in cytotoxic brain tissue edema. Since folding of mature proteins is very much dependent on normal energy supply, the protein synthesis cannot continue during the ischemic process. Under such conditions very little of the energy rich ATP can be produced and which may result in disturbance between extra- and intracellular ion metabolism. By using a folded protein in laboratory investigation the present hypothesis has the potential to be confirmed and, hence, develop new drugs for therapeutic use. 

Keynote Forum

Felipe Padilla-Vazquez

Instituto Nacional de Neurología y Neurocirugía, Mexico

Keynote: A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations

Time : TBA

European Stroke Conference 2019 International Conference Keynote Speaker Felipe Padilla-Vazquez photo
Biography:

Felipe Padilla Vazquez Specialist in Neurointervention, Neuropathic Endovascular Therapy, Cerebrovascular Diseases, Column Surgery, CNS Oncological Surgery, Headaches, Neuropathic Pain and present time he is Member of the Mexican Society of Neurological Surgery AC. 

Abstract:

Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs.

This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1–4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis.

A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061–0.188), 2 point OR = (0.227 95% CI; 0.153–0.338), 3 point OR = (3.292 95% CI; 2.325–4.661), and 4 point OR = (23.304 95% CI; 11.077–49.027).