Grzegorz Kozera

• Professor
• Professor (Associate) at Medical University of Gdansk

Purpose Glial fibrillary acidic protein (GFAP) and neuroglobin (NGB) are important biomarkers of cerebral hypoxia. For this reason, an attempt was made to assess their concentrations in various time intervals and their impact on the severity of neurological symptoms and functional prognosis of thrombolytic ischemic stroke patients. Patients and Me...

Psoriasis induces systemic atherosclerosis, but its impact on cerebrovascular function remains unclear. However, stroke prevention must be considered in psoriasis, as it is commonly comorbid with classic cardiovascular risk factors. Thus, the aim of the study is to assess cerebral microvasculature function and its confounders in patients with psori...

(1) Background: Haemorrhagic strokes (HS), including intracerebral (ICH) and subarachnoid haemorrhages (SAH), account for approximately 10–15% of strokes worldwide but are associated with worse functional outcomes and higher rates of mortality, and financial burden than ischemic stroke. There is evidence that confirmed poor air quality may increase...

Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends...

It is well documented that in patients with type 1 diabetes (DM1), decreased levels of angiogenin are associated with the development of overt nephropathy. However, little is known about angiogenin levels and subclinical macrovascular organ damage in patients with DM1 and concomitant metabolic syndrome (MS). Therefore, we analyzed the relationship...

One of the key response mechanisms to brain damage, that results in neurological symptoms, is the inflammatory response. It triggers processes that exacerbate neurological damage and create the right environment for the subsequent repair of damaged tissues. RANTES (Regulated upon Activation, Normal T Cell Expressed and Presumably Secreted) chemokin...

Stroke remains one of the greatest health challenges worldwide, due to a high mortality rate and, despite great progress in its treatment, the significant disability that it causes. Studies conducted around the world show that the diagnosis of stroke in children is often significantly delayed. Paediatric ischaemic arterial stroke (PAIS) is not only...

(1) Background: More than 1.8 million people in the European Union die every year as a result of CVD, accounting for 36% of all deaths with a large proportion being premature (before the age of 65). There are more than 300 different risk factors of CVD, known and air pollution is one of them. The aim of this study was to investigate whether daily c...

One of the most common neurological disorders involving oxidative stress is stroke. During a stroke, the balance of redox potential in the cell is disturbed, and, consequently, protein oxidation or other intracellular damage occurs, ultimately leading to apoptosis. The pineal gland hormone, melatonin, is one of the non-enzymatic antioxidants. It no...

Stroke is a serious health problem all over the world and the second most common cause of death and permanent disability in people, after heart attacks. Oxidative stress plays an important role in the pathogenesis of acute ischemic stroke (AIS). The aim of our study was to evaluate the temporal profile of the melatonin metabolite 6-hydroxymelatonin...

During a stroke, a series of biochemical and metabolic changes occur which eventually lead to the death of cells by necrosis or apoptosis. This is a multi-stage process involving oxidative stress and an inflammatory response from the first signs of occlusion of a blood vessel until the late stages of regeneration and healing of ischemic tissues. Th...

Psoriasis is a severe inflammatory disease associated with a higher comorbidity of depression, cognitive dysfunction and brain atrophy. The association between psoriasis, magnetic resonance imaging (MRI) markers and cognitive impairment has rarely been investigated, and the existing results are conflicting. Methods: This study included 89 subject...

Introduction: Due to the widespread use of magnetic resonance imaging (MRI) in neurological diagnostics, the number of patients detected as having cerebral microbleeds (CMBs) continues to increase. However, their clinical impact still remains controversial, especially the question of whether CMBs significantly increase the risk of life-threatening...

Objective: The coronavirus disease 2019 (COVID-19) infection may alter a stroke course; thus, we compared stroke course during subsequent pandemic waves in a stroke unit (SU) from a hospital located in a rural area. Methods: A retrospective study included all patients consecutively admitted to the SU between March 15 and May 31, 2020 (“first wave”)...

Objective Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID-19 infection negatively modifies acute stroke procedures and, due to its pro-coagulative effect, may potentially impact on IVT outcome. Thus, short-term efficacy and safety of IVT were compared in...

Introduction: Transcutaneous oxygen pressure (tcPO2) is a non-invasive method of measuring skin oxygenation that may reflect its superficial perfusion. Skin microvasculature may be impaired in patients with late onset of type 1 diabetes (DM1). However, its condition in children has not been fully determined. Aim: To compare tcPO2 in children wit...

This article constitutes a summary of the knowledge on the involvement of the nervous system in COVID-19, concerning its general pathobiology, clinical presentation and neuropathological features as well as the future directions of investigation. Variable definitions, selection bias, mainly retrospective analyses of hospitalized patients and differ...

The Multilevel Educational and Motivational Intervention in Patients after Myocardial Infarction (MEDMOTION) project will be adopted to support adherence to the study treatment in the Evaluation Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome (ELECTRA-SIRIO 2) a randomized clinical trial....

Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observat...

Purpose We evaluated the relationship between pretreatment IL-6 and hsCRP levels, symptom severity and functional outcome of patients with acute ischemic stroke (AIS) treated with IV-thrombolysis. Patients and Methods IL-6 and hsCRP samples were obtained from 83 consecutively treated Caucasian patients with AIS prior to initiation of IV-thrombolys...

Autoimmune thyroiditis (AIT) frequently coexists with type 1 diabetes (DM1) and additionally increases the extent of microcirculatory complications due to DM1. We hypothesized that in pediatric patients with DM1, impairment of macrocirculation could be further augmented by a coexisting autoimmune process. Therefore, we investigated the influence of...

Background: The aim of the study was to assess the number of endothelial progenitor cells (EPCs) in patients with acute stroke due to cerebral microangiopathy and evaluate whether there is a relationship between their number and clinical status, radiological findings, risk factors, selected biochemical parameters, and prognosis, both in ischemic a...

Pulsatility index (PI) is defined as the difference between the peak systolic flow and minimum diastolic flow velocity, divided by the mean velocity recorded throughout the cardiac cycle. It is a non-invasive method of assessing vascular resistance with the use of Doppler ultrasonography. It was first introduced in 1974 by Gosling and King and is a...

Stroke is currently one of the most common causes of death and disability in the world, and its pathophysiology is a complex process, involving the oxidative stress and inflammatory reaction. Unfortunately, no biochemical factors useful in the diagnostics and treatment of stroke have been clearly established to date. Therefore, researchers are incr...

Background: Reduced aspirin response may result in a worse prognosis and a poor clinical outcome in ischemic stroke. The aim of this prospective pilot study was to assess the relationship between platelet reactivity and early and late prognosis, and the clinical and functional status in ischemic stroke, with the role of stroke etiology. Methods:...

Background: The aim of this prospective, a three-year follow-up study, was to establish the role of high on-treatment platelet reactivity (HTPR) in predicting the recurrence of vascular events in patients after cerebrovascular incidents, particularly in the aspect of stroke etiology. Methods: The study included 101 subjects with non-embolic cerebra...

Background: Excessive platelet activation and aggregation plays an important role in the pathogenesis of ischemic stroke. Correlation between platelet reactivity and ischemic lesions in the brain shows contradictory results and there are not enough data about the potential role of stroke etiology and its relationships with chronic lesions. The aim...

Microcirculation accounts for about 99% of blood vessels in adults and mediates between the arterial and venous parts of the cardiovascular system, both structurally and functionally. Skin microcirculation consists of two vascular plexuses: superficial and deep. Microcirculation includes vessels with a diameter of less than 150 μm, i.e. arteries, s...

Microcirculation accounts for about 99% of blood vessels in adults and mediates between the arterial and venous parts of the cardiovascular system, both structurally and functionally. Skin microcirculation consists of two vascular plexuses: superficial and deep. Microcirculation includes vessels with a diameter of less than 150 μm, i.e. arteries, s...

Stroke is a ma jor challenge for medicine in the 21st century. Despite modern diagnostics and even revolutionary methods of treatment, stroke is still the main cause of permanent disability and the second cause of death worldwide. Recent clinical trials have led to a breakthrough in the treatment of stroke. On their basis, many scientific societies...

Background and Purpose— Many patients with acute ischemic stroke are not eligible for thrombolysis or mechanical reperfusion therapies due to contraindications, inaccessible vascular occlusions, late presentation, or large infarct core. Sphenopalatine ganglion (SPG) stimulation to enhance collateral flow and stabilize the blood-brain barrier offers...

Giant cell arteritis is the most common systemic vasculitis. It selectively affects large- and medium-sized arteries. Arterial wall inflammation leads to luminal occlusion and tissue ischemia, which cause the clinical manifestations of this vasculitis. Susceptible sites include the vascular bed of the cranial nerves and scalp including the temporal...

Aim: Excessive activation and platelet aggregation play important roles in the aetiopathogenesis of cerebral ischaemia. The aim of this study was to assess the relationship between platelet reactivity, gender and vascular risk factors in cerebral ischaemia patients. Clinical rationale for the study: The research is useful because we found high r...

Pituitary apoplexy (PA) is a clinical syndrome caused by acute haemorrhage and/or infarction of the pituitary gland, generally within a frequently undiagnosed pituitary adenoma. The sudden increase in pituitary gland volume is responsible for typical symptoms: severe headache, nausea, vomiting, visual impairment, cranial nerve palsies, deterioratin...

Background: Heart failure (HF) is common among patients with ischemic stroke (IS), however its impact on outcome after iv-thrombolysis has not been fully determined. Moreover, definition of HF has been recently modified, but majority of stroke studies classified patients regarding an old HF criteria. Thus, the aim of our study was to evaluate the...

Introduction Ischemic stroke (IS) still constitutes a serious problem for public health worldwide. The data on its burden in Poland before 2009 is limited and came only from a few metropolitan areas. The aims of the study were To assess temporal trends in the hospital admissions, treatment, and outcomes of IS in Poland in 2009–2013, to identify ri...

Introduction: An increase in cerebral pulsatility index (PI), measured by transcranial Doppler, reflects the presence of cerebral microangiopathy. A decrease in distance between skin capillaries (DISTANCE) and an increase in the ratio between the area of capillaries and total area of examined skin (COVERAGE), revealed by capillaroscopy, reflects s...

Background: The presence of chronic kidney disease (CKD) is an indicator of a worse long-term prognosis in patients with ischemic stroke (IS). Unfortunately, not much is known about renal function in the population of post-IS subjects. The aim of our study was to assess the prevalence of renal damage and impaired renal function (IRF) in the popula...

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. Th...

Background and purpose: Intravenous thrombolysis (IVT) in ischemic stroke (IS) does not reduce three-month mortality; however, longer-term survival after IVT has not been clearly established. Thus, we aimed to compare three-year mortality after IS in IVT-treated vs non-treated patients and to indicate predictors of long-term mortality after IVT....

Objective: We aimed to assess a wide range of cognitive functions in patients with type 1 diabetes (DM1) compared with healthy control subjects and to evaluate the effects of statins on cognitive functions in DM1 patients. Materials and methods: The sample studied consisted of 55 DM1 patients (80.0% with hyperlipidemia, 20% with statin treatment...

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. Th...

Introduction. A decrease in vasomotor reactivity reserve (VMRr) or an increase in pulsatility index (PI) are the early signs of cerebral microangiopathy in type 1 diabetes. Cigarette smoking is a risk factor for microvascular complications of type 1 diabetes, but cigarette smokers are routinely excluded from studies on VMRr or PI in type 1 diabetes...

Introduction Patients with ischemic stroke undergoing intravenous (iv)-thrombolysis are routinely controlled with computed tomography on the second day to assess stroke evolution and hemorrhagic transformation (HT). However, the benefits of an additional computed tomography (aCT) performed over the next days after iv-thrombolysis have not been dete...

Piotr Sobolewski,1 Grzegorz Kozera,2 Wiktor Szczuchniak,1 Walenty M Nyka2 1Department of Neurology and Stroke, Unit of Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland; 2Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland Introduction: Patients with ischemic stroke undergoing intravenous (iv)-thrombolysis are rout...

Objectives: Current guidelines for the early management of patients with acute ischemic stroke recommend completion of an evaluation within 60 min of the patient's arrival at the emergency department (ED) because prolongation of ED length of stay (LOS) may reduce the efficacy of acute stroke treatment. Aim: To evaluate the LOS in EDs at the comm...

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specifi c brain structure, i.e. substantia nigra hyperechogenicity. T...

What is known and objectiveCerebral systemic thrombolysis (i.v. thrombolysis) with tissue-type plasminogen activator (rt-PA) is the only proven medical therapy for ischaemic stroke. The use of i.v. thrombolysis up to 4·5 h from stroke onset was approved in certain countries in 2008, but its safety and efficacy have not been fully determined to date...

The metabolic syndrome (MetS) is common in patients with acute ischemic stroke (IS); however, its impact on outcome after intravenous thrombolysis (iv-thrombolysis) remains unclear. Thus, we aimed at evaluating the relationship between MetS and functional long-term outcome, mortality, and the presence of hemorrhagic complications in patients with I...

Diabetic symmetric polyneuropathy (DSP) and cerebral microangiopathy are common complications of type 1 diabetes (T1DM). However, little is known about associations between DSP, cerebral microcirculation and macrovascular injury in T1DM. We aimed to assess relationships between those complications. We examined 42 patients (25 females; mean age 37.1...

Objective: Renal dysfunction (RD) increases risk for ischaemic stroke (IS). The impact of RD on the effects of iv-thrombolysis in the Caucasian population has not been fully determined. Aims: To evaluate the associations between RD and the outcome of iv-thrombolysis in Caucasian patients with IS. Methods: The observational, multicentre study i...

OBJECTIVE The aim of our study was to evaluate the vasodilatory effect of l-arginine infusion on the skin microcirculation and to assess the relationship between this effect and the presence of microangiopathy in patients with type 1 diabetes.RESEARCH DESIGN AND METHODS Capillaroscopy was performed before and after l-arginine infusion in 48 diabeti...

Background: Angiogenin levels are increased in children and adolescent patients with type 1 diabetes, regardless of the extent of diabetic microangiopathy. However, little is known about the angiogenin concentrations in adults with type 1 diabetes. Thus we studied its level in middle aged subjects with the presence of diabetic nephro-, retino and...

It is crucial to understand the reasons behind pre- and in-hospital delays to improve nationwide access to effective treatment for acute stroke. To evaluate the pre- and in-hospital delays and to compare the intravenous (IV) thrombolysis rates in the urban and rural areas of the Province of Pomerania, Poland. We evaluated the medical records of 213...

Cerebrovascular reactivity (CVR) impairment and cerebral white matter lesions (WMLs) are associated in elderly or patients with overt cerebral ischemia. Such association has not been confirmed for asymptomatic middle-aged individuals with risk factors for stroke. We assessed the relationship between the CVR and the presence of WMLs in a middle-aged...

Background. According to the research from 2004 about 4 thousand citizens of Pomeranian Province suffer from stroke every year. In 2009 the region was subject to a close epidemiological monitoring program as a part of Pomeranian Stroke Registry. The aim of this research is to present the update on epidemiological and clinical patients with acute ce...

Cerebrovascular reactivity impairment was reported as a marker of cerebral microangiopathy in long-term type 1 diabetes. Intima-media complex thickening reflects early stages of macroangiopathy in type 1 diabetes. The analysis of the relationship between these variables and other microangiopathic complications might serve as a beneficial indicator...

The imaging of early stroke changes in the posterior fosse is still one of the principle problems for neuroradiology, especially in case of outcomes of patients with vertebrobasilar occlusions are less favorable than of patients with cerebral infarctions occurring in the carotid arteries. The most commonly used methods in diagnostic imaging of the...

Various studies suggest that deficiency of magnesium and potassium may be associated with increased risk of ischemic stroke. However, single time-point serum measurements may not be suitable for assessing long-term tissue levels. We investigated Mg and K levels in hair of patients with acute ischemic stroke. The elements hair accumulation analysis...

A frequent condition affecting patients with stroke is venous thromboembolism (VTE), which consists of two components: deep vein thrombosis, and pulmonary embolism as its complication The main risk factors of VTE are: age over 65 years, motor deficit with immobilisation, heart failure, infection, obesity and coagulopathy Typical symptoms of deep ve...

The aim of this paper was to assess the risk for depression in a 6-month-long post stroke follow up period as related to the stroke variables (i.e. stroke localisation, haemodynamic parameters). The stroke localisation was determined with CT and/or MRI. Subsequently all the examined individuals underwent SPECT examination. The follow up examination...

Background. It is difficult to establish proper criteria for diagnosis of post - stroke depression which would accurately distinguish between neurological and psychiatric symptoms. Anxiety disorders, apathy (abulia), loss of psychic self-activation, pathological laughing and crying, catastrophe reaction, grief reaction and organic personality disor...

Prospective study of consecutive 60 right-handed individuals with unilateral brain lesion was performed to verify the hypothesis of the impact of regional cerebral blood flow SPECT (rCBF SPECT) asymmetry within the specific regions of interest on the incidence of post-stroke depression (PSD) in six-month-long follow-up period. Thirty-eight percent...

Background. Ischaemic stroke ia direct threat to life. High death rate and the disability rate embracing over 60% of all sick people is a significant medical problem. Modern therapy makes it possible to provide efficient help within three hours from the stroke. Such therapy window is referred to as "the golden three hours". A proper, quick diagnosi...