OBJECTIVE To determine whether elevated urine erythrocyte (red blood cell) and leukocyte (white blood cell) counts, reflecting concomitant renal and cerebral emboli of cardiac origin, would be useful ...in discriminating cardioembolic (CE) from non-CE stroke in acute ischemic stroke. DESIGN Consecutive patients presenting within 24 hours of ischemic stroke over 3¾ years were studied. Patient medical history and urinalysis data, including white blood cell count, red blood cell count, specific gravity, and glucose and protein levels at admission, were analyzed and compared with the final determination of stroke subtype. Multivariate analysis (CE vs non-CE stroke) was performed using a classification and regression tree that included all 5 urine variables as potential predictors. Additional predictors entered into the classification and regression tree model were age, presence of urinary tract infection at admission, history of hypertension, history of diabetes mellitus, and serum creatinine level. RESULTS A total of 341 individuals met the study criteria. Their mean age was 68.6 years; 49.8% were female, 70.9% were white, and 38.7% had the CE stroke subtype. In bivariate analysis, age (P = .009), urine white blood cell count (P = .02), urine red blood cell count (P = .005), urine specific gravity (P = .02), and serum creatinine level (P = .02) were significantly higher in those with the CE vs the non-CE stroke subtype. In the classification and regression tree, 58.3% of those with CE stroke were correctly classified and 84.7% of those with non-CE stroke were correctly classified, for an overall accuracy of 71.5%. The best single predictor for the CE stroke subtype was a white blood cell count of greater than 14.5/μL, followed by a red blood cell count of greater than 41.7/μL and a serum creatinine level greater than 1.08 mg/dL (>95.5 μmol/L). Based on the distribution in the first 2 divisions in the tree, a patient could be placed into 1 of 4 categories that corresponded to 3 levels of CE stroke likelihood: low (25%), moderate (50%), and high (80%). CONCLUSION Urinalysis may have utility in the early identification of the CE stroke subtype in patients with acute ischemic stroke.Arch Neurol. 2007;64:667-670
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Neurosyphilis is caused by the spirochete Treponema pallidum. These organisms divide slowly, requiring long exposure to antibacterials for treatment success. In order for an antibacterial to be ...effective in the therapy of neurosyphilis, it must achieve treponemicidal concentrations in the CSF, have a long half-life and be given in a treatment regimen that favours compliance. Penicillin was first introduced for the treatment of syphilis in 1943, and despite interest in the use of amoxicillin, erythromycin, tetracycline, doxycycline, ceftriaxone and azithromycin, penicillin remains the only recommended antibacterial agent for neurosyphilis.
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