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Chen J, Zhang J, Xiang J, Yu J, Qiu F. Impact of intelligent convolutional neural network -based algorithms on head computed tomography evaluation and comprehensive rehabilitation acupuncture therapy for patients with cerebral infarction. J Neurosci Methods 2024; 409:110185. [PMID: 38851543 DOI: 10.1016/j.jneumeth.2024.110185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
This work was to evaluate the impacts of comprehensive rehabilitation acupuncture therapy on the recovery of neurological function in cerebral infarction (CI) patients and to utilize convolutional neural network (CNN) intelligent algorithms to optimize head computed tomography (CT) images and improve lesion localization accuracy. 98 CI patients were divided into a control group (Ctrl group) and an experimental group (Exp group), with 48 patients in each group. The patients in the Ctrl group received CT evaluation combined with comprehensive rehabilitation acupuncture therapy. While, those in the Exp group received CT evaluation with the use of CNN algorithms for optimization, along with comprehensive rehabilitation acupuncture therapy. Acupuncture therapy included selecting acupoints on the patient's head, selecting two horizontal needling needles from top to bottom at the acupoints on the front side of the lesion, and then horizontal needling along the top midline. The differences in treatment outcomes were compared between the two groups based on Fugl-Meyer upper limb assessment (FMA) scores, Barthel Index (BI) scores, National Institutes of Health Stroke Scale (NIHSS4) scores, Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scores, and hemodynamics. Simultaneously, the CT images were optimized using CNN intelligent algorithms to improve image quality and lesion localization accuracy. The results showed that the CI CT images processed by the CNN-based intelligent algorithm showed significant improvements in clarity and contrast compared to conventional CT images. The CNN-based intelligent algorithm demonstrated higher sensitivity (97.5 %, 93.8 %), higher PSNR (30.14 dB, 24.72 dB), and lower missed detection rate (0.52 %, 1.88 %) in detecting CI lesions. The total effective rate in the Exp group was 95.83 %, which was significantly higher than the 85.42 % in the Ctrl group (P < 0.05). The Exp group showed significantly higher levels in FMA and BI scores (P < 0.05). After treatment, the NIHSS4 and MESSS scores in the Exp group were lower than those in the Ctrl group (P < 0.05). Additionally, post-treatment, the plasma concentrations and whole-blood viscosity (low shear and high shear) in the Exp group were lower than those in the Ctrl group, and the plasma concentration and whole-blood viscosity (high shear) were also lower than those in the Ctrl group (P < 0.05). In conclusion, comprehensive rehabilitation acupuncture therapy had a positive impact on the recovery of neurological function in CI patients. By applying CNN-based intelligent algorithms to optimize head CT images, lesion localization accuracy can be improved, thereby guiding rehabilitation treatment more effectively.
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Affiliation(s)
- Jianlin Chen
- Department of Rehabilitation Medicine, Zhejiang Jinhua Guangfu Cancer Hospital, Jinhua, Zhejiang 321000, China
| | - Jinfeng Zhang
- Department of Rehabilitation Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Jingjing Xiang
- Department of Geriatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Jie Yu
- Department of Rehabilitation Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Fanghui Qiu
- Department of Rehabilitation Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
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Dortez S, Pacheco M, Gasull T, Crevillen AG, Escarpa A. A dual colorimetric-electrochemical microfluidic paper-based analytical device for point-of-care testing of ischemic strokes. LAB ON A CHIP 2024. [PMID: 39118539 DOI: 10.1039/d4lc00398e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
A novel microfluidic paper-based analytical device with dual colorimetric and electrochemical detection (dual μPAD) was developed for the assessment of transferrin saturation (TSAT) in samples from ischemic stroke patients. TSAT was calculated from the ratio between transferrin-bound iron, which was colorimetrically measured, and the total iron-binding capacity, which was electrochemically measured. To this end, a μPAD was smartly designed, which integrated both colorimetric and electrochemical detection reservoirs, communicating via a microchannel acting as a chemical reactor, and with preloading/storing capabilities (reagent-free device). This approach allowed the dual and simultaneous determination of both parameters, providing an improvement in the reliability of the results due to an independent signal principle and processing. The μPADs were validated by analyzing a certified reference material, showing excellent accuracy (Er ≤ 5%) and precision (RSD ≤ 2%). Then they were applied to the analysis of diagnosed serum samples from ischemic stroke patients. The results were compared to those provided by a free-interference method (urea-PAGE). Impressively, both methods exhibited a good correlation (r = 0.96, p < 0.05) and no significant differences were found between them (slope 1.0 ± 0.1 and the intercept 1 ± 4, p < 0.05), demonstrating the excellent accuracy of our approach during the analysis of complex samples from ischemic stroke patients, using just 90 μL of clinical samples and taking less than 90 min in comparison with the 18 hours required by the urea-PAGE approach. The developed fully integrated colorimetric-electrochemical μPAD is a promising ready to use reagent-free device for the point-of-care testing of TSAT, which can be used to assist physicians in the fast diagnosis and prognosis of ischemic strokes, where the decision-time is crucial for the patient's survival.
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Affiliation(s)
- Silvia Dortez
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, University of Alcala, 28802, Alcala de Henares, Madrid, Spain.
| | - Marta Pacheco
- Department of Chemistry in Pharmaceutical Sciences, Analytical Chemistry, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | - Teresa Gasull
- Cellular and Molecular Neurobiology Research Group, Department of Neurosciences, Germans Trias i Pujol Research Institute (IGTP), 08916, Badalona, Barcelona, Spain
| | - Agustín G Crevillen
- Department of Analytical Sciences, Faculty of Sciences, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain.
| | - Alberto Escarpa
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, University of Alcala, 28802, Alcala de Henares, Madrid, Spain.
- Chemical Research Institute "Andrés M. Del Río" (IQAR), University of Alcala, 28802, Alcala de Henares, Madrid, Spain
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Roeder HJ, Leira EC. The Role of the Vascular Neurologist in Optimizing Stroke Care. Neurol Clin 2024; 42:739-752. [PMID: 38937039 DOI: 10.1016/j.ncl.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
The article summarizes the training pathways and vocational opportunities within the field of vascular neurology. It highlights the groundbreaking clinical trials that transformed acute stroke care and the resultant increased demand for readily available vascular neurology expertise. The article emphasizes the need to train a larger number of diverse physicians in the subspecialty and the role of vascular neurologists in improving outcomes across demographic and geographic lines.
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Affiliation(s)
- Hannah J Roeder
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA
| | - Enrique C Leira
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA; Department of Epidemiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA.
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Matsumoto N, Ogawa T, Shibazaki K, Hishikawa N, Wakutani Y, Takao Y. Usefulness of magnetic resonance imaging in differentiation between status epilepticus and acute ischemic stroke. J Neurol Sci 2024; 462:123066. [PMID: 38824818 DOI: 10.1016/j.jns.2024.123066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/10/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Status epilepticus, characterized by the temporal neurological deficits, often mimics acute ischemic stroke. We investigated the usefulness of magnetic resonance imaging for differentiation of status epilepticus from acute ischemic stroke. METHODS A retrospective case series of patients with status epilepticus who underwent brain magnetic resonance imaging. For comparative analysis, a series of patients with acute ischemic stroke caused by unilateral middle cerebral artery occlusion was used. RESULTS Ten patients (4 females and 6 males) with status epilepticus who underwent brain magnetic resonance imaging were included. The median age at diagnosis was 82 years (age range, 70-90 years). In all ten patients, hyperintensities in diffusion-weighted imaging with decreased apparent diffusion coefficient values, decreased venous intensity in susceptibility-weighted imaging, and hyperperfusion in arterial spin labeling perfusion were detected in the cortex of the affected side. Four patients showed an additional diffusion restriction in the thalamus. The apparent diffusion coefficient value of the lesional area was 13.1% less than the contralateral, which was less than one-third as acute ischemic stroke. Status epilepticus patients showed no change in medullary venous intensity of the affected area in susceptibility-weighted imaging, whereas acute ischemic stroke patients showed increased cortical and medullary venous intensity in affected hemisphere. Seven of eight patients with status epilepticus who underwent magnetic resonance angiography showed dilation of the cerebral arteries in the ipsilateral side. CONCLUSIONS The combined use of diffusion-weighted imaging, susceptibility-weighted imaging, and arterial spin labeling perfusion may help accurate and prompt diagnosis of status epilepticus.
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Affiliation(s)
- Namiko Matsumoto
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Toshihide Ogawa
- Neuroradiology Center, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Kensaku Shibazaki
- Department of Stroke Medicine, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Nozomi Hishikawa
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan
| | - Yosuke Wakutani
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Yoshiki Takao
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
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Xia X, Liu J, Fang W, Chen Z, Wang J, Xu H. The association between ferritin levels and all-cause mortality in stroke patients. Front Neurol 2024; 15:1386408. [PMID: 38988599 PMCID: PMC11233758 DOI: 10.3389/fneur.2024.1386408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
Purpose The purpose of study was to describe the association between ferritin and all-cause mortality of cases with stroke. Methods Clinical data derived from Multiparameter Intelligent Monitoring in Intensive Care were analyzed. The primary endpoint was 30-day mortality. The potential prognostic roles of Ferritin L were analyzed by Cox proportional hazard models. The independent prognostic roles of Ferritin L in the cases were analyzed by smooth curve fitting. Results Concerning 30-day mortality, the HR (95% CI) for a high Ferritin (≥373) was 1.925 (1.298, 2.854; p = 0.00113), compared to a low ferritin (< 373). After adjusting for multiple confounders, the HR (95% CI) for a high Ferritin (≥373) was 1.782 (1.126, 2.820; p = 0.01367), compared to a low Ferritin (< 373). A non-linear association between Ferritin and 30-day mortality was found. Using recursive algorithm and two-piecewise linear regression model, inflection point (IP) was calculated, which was 2,204. On the left side of the IP, there was a positive relationship between Ferritin and 30-day mortality, and the effect size, 95% CI and p value were 1.0006 (1.0004, 1.0009) p < 0.0001, respectively. On the right of the IP, the effect size, 95% CI and p value were 1.0000 (1.0000, 1.0000) and 0.3107, respectively. Conclusion Ferritin was associated with increased risk of stroke; it is important to further examine the association if the increased uric acid would increase the outcome of stroke in a longitudinal study. The non-linear relationship between Ferritin and all-cause mortality of stroke was observed. Ferritin was a risk factor for the outcome of stroke when ferritin was <2204.
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Affiliation(s)
- Xuefen Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiongjiong Liu
- Department of General Practice, Fuyang Hospital Affiliated to Anhui Medical University, Anhui, China
| | - Wenqiang Fang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhibo Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Wang
- Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiqin Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Dvorníková K, Kunešová V, Ely M, Ostrý S, Čábal M, Reiser M, Machová L, Pavlínová M, Kondé A, Eliáš P, Jonszta T, Havelka J, Volný O, Bar M. The importance of multimodal CT examination in stroke mimics diagnosis: design of prospective observational multicentre study. Front Neurol 2024; 15:1365986. [PMID: 38895699 PMCID: PMC11184135 DOI: 10.3389/fneur.2024.1365986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/25/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Non-contrast computed tomography (CT) and CT angiography are the gold standard in neuroimaging diagnostics in the case of suspected stroke. CT perfusion (CTP) may play an important role in the diagnosis of stroke mimics (SM), but currently, it is not a standard part of the stroke diagnostic procedure. The project is a multicentre prospective observational clinical research focused on refining the diagnostics of stroke and stroke mimics (SM) in hospital care. Aim This study aimed to evaluate the degree of specificity and sensitivity of multimodal CT (NCCT, CTA, and CTP) in the diagnosis of SM versus stroke. Methodology In this study, we will include 3,000 patients consecutively admitted to the comprehensive stroke centres with a diagnosis of suspected stroke. On the basis of clinical parameters and the results of multimodal CT and magnetic resonance imaging (MRI), the diagnosis of stroke and SM will be established. To clarify the significance of the use of the multimodal CT scan, the analysis will include a comparison of the blinded results for each imaging scan performed by radiologists and AI technology and a comparison of the initial and final diagnosis of the enrolled patients. Based on our results, we will compare the economic indicators and costs that would be saved by not providing inadequate treatment to patients with SM. Conclusion The expected outcome is to present an optimised diagnostic procedure that results in a faster and more accurate diagnosis, thereby eliminating the risk of inadequate treatment in patients with SM. Clinical trial registration clinicaltrials.gov, NCT06045455.
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Affiliation(s)
| | - Veronika Kunešová
- Department of Imaging Methods, Faculty of Medicine, Ostrava of University, Ostrava, Czechia
- Cerebrovascular research program, International Clinical Research Center, Brno, Czechia
| | - Marcela Ely
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
- Cerebrovascular research program, International Clinical Research Center, Brno, Czechia
| | - Svatopluk Ostrý
- Hospital in České Budejovice A.S., České Budějovice, Czechia
| | - Martin Čábal
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
| | - Martin Reiser
- Hospital in České Budejovice A.S., České Budějovice, Czechia
| | - Linda Machová
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
| | | | - Adéla Kondé
- Department of the Deputy Director for Science, Research and Education, University Hospital in Ostrava, Ostrava, Czechia
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB – Technical University of Ostrava, Ostrava, Czechia
| | - Pavel Eliáš
- Department of Imaging Methods, Faculty of Medicine, Ostrava of University, Ostrava, Czechia
| | - Tomáš Jonszta
- Department of Imaging Methods, Faculty of Medicine, Ostrava of University, Ostrava, Czechia
| | - Jaroslav Havelka
- Department of Imaging Methods, Faculty of Medicine, Ostrava of University, Ostrava, Czechia
| | - Ondrej Volný
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
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Péčová M, Benko J, Péč MJ, Bolek T, Hurtová T, Sokol J, Staško J, Samoš M, Mokáň M. Unilateral upper and lower limb ischemia mimics stroke: a case report. J Med Case Rep 2024; 18:66. [PMID: 38308343 PMCID: PMC10837969 DOI: 10.1186/s13256-023-04240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/01/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Although stroke and acute limb ischemia seem easily distinguishable by anamnesis and physical examination, symptoms may overlap and sometimes mislead the examiner. Such a situation can arise in the occurrence of unilateral neurological symptoms affecting the upper and lower limbs at the same time. As timely diagnosis and a correct therapeutic intervention are crucial to prevent irreversible damage in both diseases, knowledge of the possibility of one disease mimicking the other is essential. We present a unique case of acute unilateral upper and lower limb ischemia mimicking an acute stroke. CASE PRESENTATION A 69-year-old Caucasian patient with known atherosclerotic risk factors was admitted to the emergency department with a suspected stroke with unilateral paresthesia. After a comprehensive examination of the patient with the need for repeated reevaluation and a negative brain computed tomography scan, acute left-sided upper and lower limb ischemia was eventually diagnosed. The patient underwent surgical revascularization of the upper and lower limbs with a satisfactory result and was discharged from the hospital after a few days. CONCLUSION It is of utmost importance to always stay alert for stroke mimics, as overlooking can lead to severe complications and delay adequate therapy. Our case shows that persistent diagnostic effort leads to successful treatment of the patient even on rare occasions, as is the acute unilateral upper and lower limb ischemia.
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Affiliation(s)
- Monika Péčová
- Oncology Centre, Teaching Hospital Martin, Kollárova 2, 036 01, Martin, Slovakia
- Department of Hematology and Transfusion Medicine, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Jakub Benko
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia.
- Department of Cardiology, Teaching Hospital Nitra, 950 01, Nitra, Slovakia.
| | - Martin Jozef Péč
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia.
| | - Tomáš Bolek
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Tatiana Hurtová
- Department of Infectology and Travel Medicine and Department of Dermatovenerology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Juraj Sokol
- Department of Hematology and Transfusion Medicine, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Ján Staško
- Department of Hematology and Transfusion Medicine, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
- Division of Acute and Interventional Cardiology, Department of Cardiology and Angiology II., Mid-Slovakian Institute of Heart and Vessel Diseases (SÚSCCH, a.s.), 974 01, Banská Bystrica, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
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Wischmann J, Kremer P, Hinske L, Tomasi R, Becker-Pennrich AS, Kellert L. The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters. Front Neurol 2023; 14:1306520. [PMID: 38162448 PMCID: PMC10756062 DOI: 10.3389/fneur.2023.1306520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background and objective Post-stroke delirium (PSD) is a common complication in acute stroke patients, and guidelines recommend routine screening and various preventive and treatment measures. However, there is a substantial lack of standardized approaches in diagnostic and therapeutic management of PSD. Here, we aimed to develop a new pragmatic and easily assessable screening tool to predict PSD based on early parameters, which are already integral to acute stroke diagnostics. Methods We enrolled acute stroke patients admitted to our stroke unit or intensive care unit and developed the scoring system using retrospective single-center patient data. The Confusion Assessment Method for the Intensive Care Unit was used for prospective score validation. Logistic regression models were employed to analyze the association of early clinical and paraclinical parameters with PSD development. Results N = 525 patients (median age: 76 years; 45.7% female) were enrolled, with 29.7% developing PSD during hospitalization. The resulting score comprises 6 items, including medical history, clinical examination findings, and non-contrast computed tomography results at admission. Scores range from -15 to +15 points, with higher values indicating a higher likelihood of PSD, ranging from 4% to 79%. The accuracy was 0.85, and the area under the curve was 0.89. Conclusion The new RAPID (Risk Assessment and PredIction of Delirium in acute stroke patients)-score shows high accuracy in predicting PSD among acute stroke patients and offers precise odds of PSD for each corresponding score value, utilizing routine early clinical and paraclinical parameters. It can identify high-risk populations for clinical study interventions and may be suitable to guide prophylactic PSD measures.
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Affiliation(s)
- Johannes Wischmann
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Pauline Kremer
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ludwig Hinske
- Department of Anesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Digital Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Roland Tomasi
- Department of Anesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andrea S. Becker-Pennrich
- Department of Anesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Faculty of Medicine, Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany
| | - Lars Kellert
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
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Zhang Z, He M. Thrombotic thrombocytopenic purpura presenting as stroke mimics with normal diffusion-weighted MRI. BMC Neurol 2023; 23:435. [PMID: 38082222 PMCID: PMC10712053 DOI: 10.1186/s12883-023-03489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a rare and fatal thrombotic microangiopathy-based hematologic disease. Stroke has been reported as atypical neurological manifestations of TTP in some cases. CASE PRESENTATION A 65-year-old male presented with typical acute ischemic stroke symptoms including sudden-onset dysarthria, right-sided facial paralysis and hemiplegia. However, his CT and MRI scans were negative without showing any new ischemic lesions. He was diagnosed with TTP with severe thrombocytopenia, mild anemia, increased LDH, and low ADAMTS-13 activity. The symptoms and positive signs were rapidly resolved after administrating the plasma exchange therapy. CONCLUSION Clinicians should consider the possibility of TTP when a patient presents with acute stroke-like symptoms and thrombocytopenia, especially in an emergency room, either with or without new stroke lesions on the brain CT and MRI.
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Affiliation(s)
- Ziyi Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Miao He
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Cortel-LeBlanc MA, Orr SL, Dunn M, James D, Cortel-LeBlanc A. Managing and Preventing Migraine in the Emergency Department: A Review. Ann Emerg Med 2023; 82:732-751. [PMID: 37436346 DOI: 10.1016/j.annemergmed.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/13/2023]
Abstract
Migraine is a leading cause of disability worldwide, and acute migraine attacks are a common reason for patients to seek care in the emergency department (ED). There have been recent advancements in the care of patients with migraine, specifically emerging evidence for nerve blocks and new pharmacological classes of medications like gepants and ditans. This article serves as a comprehensive review of migraine in the ED, including diagnosis and management of acute complications of migraine (eg, status migrainosus, migrainous infarct, persistent aura without infarction, and aura-triggered seizure) and use of evidence-based migraine-specific treatments in the ED. It highlights the role of migraine preventive medications and provides a framework for emergency physicians to prescribe them to eligible patients. Finally, it evaluates the evidence for nerve blocks in the treatment of migraine and introduces the possible role of gepants and ditans in the care of patients with migraine in the ED.
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Affiliation(s)
- Miguel A Cortel-LeBlanc
- Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; 360 Concussion Care, Ottawa, ON, Canada.
| | - Serena L Orr
- Departments of Pediatrics, Community Health Sciences, and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Maeghan Dunn
- Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Daniel James
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Achelle Cortel-LeBlanc
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; 360 Concussion Care, Ottawa, ON, Canada; Division of Neurology, Department of Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada
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Pirlog BO, Jacob AP, Rajan SS, Yamal JM, Parker SA, Wang M, Bowry R, Czap A, Bratina PL, Gonzalez MO, Singh N, Zou J, Gonzales NR, Jones WJ, Alexandrov AW, Alexandrov AV, Navi BB, Nour M, Spokoyny I, Mackey J, Silnes K, Fink ME, Pisarro Sherman C, Willey J, Saver JL, English J, Barazangi N, Ornelas D, Volpi J, Pv Rao C, Griffin L, Persse D, Grotta JC. Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study. Int J Stroke 2023; 18:1209-1218. [PMID: 37337357 DOI: 10.1177/17474930231185471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. AIM To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. METHODS Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. RESULTS Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2-5) and 793 were without PD (baseline mRS 0-1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. CONCLUSION PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm.
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Affiliation(s)
- Bianca O Pirlog
- Department of Neuroscience, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Asha P Jacob
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephanie A Parker
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mengxi Wang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ritvij Bowry
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexandra Czap
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Patti L Bratina
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Noopur Singh
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jinhao Zou
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole R Gonzales
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William J Jones
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne W Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrei V Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Babak B Navi
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - May Nour
- Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ilana Spokoyny
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Jason Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly Silnes
- University of Buckingham Medical School, Buckingham, UK
| | - Matthew E Fink
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Carla Pisarro Sherman
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Josh Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Joey English
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Nobl Barazangi
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - David Ornelas
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jay Volpi
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Chethan Pv Rao
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James C Grotta
- Mobile Stroke Unit, Memorial Hermann Texas Medical Center, Houston, TX, USA
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12
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Zhou Z, Zhang T, Xu P. Sudden onset of left hemiplegia. Eur J Intern Med 2023; 118:127-128. [PMID: 37666677 DOI: 10.1016/j.ejim.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Zhiwei Zhou
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi 563003, Guizhou, China
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, 149 Dalian Road, Huichuan District, Zunyi 563003, Guizhou, China.
| | - Ping Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi 563003, Guizhou, China.
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13
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Jacobsen E, Logallo N, Kvistad CE, Thomassen L, Idicula T. Characteristics and predictors of stroke mimics in young patients in the norwegian tenecteplase stroke trial (NOR-TEST). BMC Neurol 2023; 23:406. [PMID: 37968581 PMCID: PMC10647039 DOI: 10.1186/s12883-023-03425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group. METHODS Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with acute ischemic stroke. Patients diagnosed with either acute cerebral ischemia or transient ischemic attack were categorized as stroke group, and patients with any diagnosis other than ischemic stroke or transient ischemic attack as mimics group. Patients were grouped post-hoc into young (< 60 years) and old (≥ 60 years). Logistic regression analyses were performed with mimics vs. stroke as dependent variable to identify predictors of mimics. RESULTS Of the 1091 patients included in the trial, 211 patients (19.3%) were under the age of 60 years. Out of the 1091 patients, 434 (39.8%) were female, median age 77 years (18-99 years), and median NIHSS was 4. Sixty-nine patients (32.7%) out of the 211 patients under the age of 60 were diagnosed as mimic. Mimics were significantly more frequent among the young (OR = 3.3, 32.7% vs. 12.8%, p = < 0.001). The most frequent mimics diagnoses among patients under 60 years of age were migraine (11.8%), no definite diagnosis (11.4%) and peripheral vertigo (3.3%). Mimics were independently associated with age < 50 years (OR = 4.97, p = < 0.001), not currently working/studying (OR = 3.38, p = 0.002) and not having aphasia on admission (OR = 2.95, p = 0.025). None of the mimics under the age of 60 years had symptomatic or asymptomatic intracerebral hemorrhage as a complication to thrombolysis. CONCLUSION We found significantly more mimics in the young, of which migraine was the most predominant diagnosis. Thrombolysis with alteplase or tenecteplase did not cause ICH in any mimics under 60 years.
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Affiliation(s)
- Eskil Jacobsen
- Norwegian University of Science and Technology, Trondheim (NTNU), Trondheim, 7034, Norway.
| | - Nicola Logallo
- Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway
| | - Christopher Elnan Kvistad
- Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars Thomassen
- Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Titto Idicula
- Norwegian University of Science and Technology (NTNU), Trondheim, 7034, Norway
- Department of Neurology, St Olav University Hospital, Trondheim, Norway
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14
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Zhao BH, Ruze A, Zhao L, Li QL, Tang J, Xiefukaiti N, Gai MT, Deng AX, Shan XF, Gao XM. The role and mechanisms of microvascular damage in the ischemic myocardium. Cell Mol Life Sci 2023; 80:341. [PMID: 37898977 PMCID: PMC11073328 DOI: 10.1007/s00018-023-04998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023]
Abstract
Following myocardial ischemic injury, the most effective clinical intervention is timely restoration of blood perfusion to ischemic but viable myocardium to reduce irreversible myocardial necrosis, limit infarct size, and prevent cardiac insufficiency. However, reperfusion itself may exacerbate cell death and myocardial injury, a process commonly referred to as ischemia/reperfusion (I/R) injury, which primarily involves cardiomyocytes and cardiac microvascular endothelial cells (CMECs) and is characterized by myocardial stunning, microvascular damage (MVD), reperfusion arrhythmia, and lethal reperfusion injury. MVD caused by I/R has been a neglected problem compared to myocardial injury. Clinically, the incidence of microvascular angina and/or no-reflow due to ineffective coronary perfusion accounts for 5-50% in patients after acute revascularization. MVD limiting drug diffusion into injured myocardium, is strongly associated with the development of heart failure. CMECs account for > 60% of the cardiac cellular components, and their role in myocardial I/R injury cannot be ignored. There are many studies on microvascular obstruction, but few studies on microvascular leakage, which may be mainly due to the lack of corresponding detection methods. In this review, we summarize the clinical manifestations, related mechanisms of MVD during myocardial I/R, laboratory and clinical examination means, as well as the research progress on potential therapies for MVD in recent years. Better understanding the characteristics and risk factors of MVD in patients after hemodynamic reconstruction is of great significance for managing MVD, preventing heart failure and improving patient prognosis.
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Affiliation(s)
- Bang-Hao Zhao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Amanguli Ruze
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Ling Zhao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Qiu-Lin Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Jing Tang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Nilupaer Xiefukaiti
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Min-Tao Gai
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - An-Xia Deng
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Xue-Feng Shan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Xiao-Ming Gao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China.
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China.
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15
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Ren Z, Ye S, Nie Q, Feng J, Liu K, Li Q, Wen J. Application of digitization and visualization-based muscle strength measurement in ischemic stroke patients with motor dysfunction. Sci Rep 2023; 13:17507. [PMID: 37845368 PMCID: PMC10579306 DOI: 10.1038/s41598-023-44826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023] Open
Abstract
Ischemic stroke stands as a prevalent neurological ailment, where a paucity of methodologies exists for the assessment of functional outcomes post-stroke. Our objective was the development of a WeChat applet for the evaluation of muscle strength and the subsequent evaluation of its validity in ischemic stroke patients experiencing motor dysfunction. The assessment encompassed Lovett and NIHSS, followed by muscle strength values (MSV) and muscle strength ratios (MSR). These metrics were then scrutinized in relation to NIHSS and Lovett, followed by examination of their interrelationships. We enrolled a cohort of 157 patients, with an average age of 65 years, consisting of 96 males and 61 females. Lovett scores in the range of 2-4 and NIHSS scores spanning from 0 to 3 were found to correspond to specific values of MSV and MSR, respectively. Upon conducting correlation analysis, we noted that both MSV and MSR exhibited significant positive correlations with Lovett scores and NIHSS. Remarkably, the correlation of MSR with Lovett scores or NIHSS surpassed that of MSV. The WeChat applet offers a means of digitization and visualization of muscle strength. It correlates well with Lovett score and NIHSS, especially MSR. This bears potential significance in guiding the rehabilitation of stroke patients.
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Affiliation(s)
- Zhongyu Ren
- Nervous System Clinical Medicine Research Center, Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
- Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin, 541000, China
- Renmin Hospital of Wuhan University, Wuhan, 430000, China
| | - Shangrong Ye
- Nervous System Clinical Medicine Research Center, Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Qi Nie
- Nervous System Clinical Medicine Research Center, Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Junlin Feng
- Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin, 541000, China
| | - Kaixiang Liu
- Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin, 541000, China
| | - Qinghua Li
- Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin, 541000, China
| | - Jian Wen
- Nervous System Clinical Medicine Research Center, Affiliated Hospital of Guilin Medical University, Guilin, 541001, China.
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16
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De Lucia F, Boucquey D, Coolen T. A stroke mimic with left-hemispheric leptomeningeal vessel paucity and hypoperfusion. Radiol Case Rep 2023; 18:3438-3441. [PMID: 37502472 PMCID: PMC10369385 DOI: 10.1016/j.radcr.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
In the neuroimaging workup of a suspected ischemic stroke, the involvement of more than one arterial territory without an anatomical substrate should raise the suspicion of a stroke mimic. We report the case of a 61-year-old male with a new-onset headache and transient phasic disturbances who presented a pattern of vascular abnormalities characterized by left-hemispheric leptomeningeal vessel paucity and hypoperfusion.
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Affiliation(s)
- Federico De Lucia
- Department of Radiology, Centre Hospitalier Interrégional Edith Cavell (CHIREC), Site Delta, Brussels, Belgium
| | - Dominique Boucquey
- Department of Neurology, Centre Hospitalier Interrégional Edith Cavell (CHIREC), Site Delta, Brussels, Belgium
| | - Tim Coolen
- Department of Radiology, Centre Hospitalier Interrégional Edith Cavell (CHIREC), Site Delta, Brussels, Belgium
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17
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Tao J, Xie X, Luo M, Sun Q. Identification of key biomarkers in ischemic stroke: single-cell sequencing and weighted co-expression network analysis. Aging (Albany NY) 2023; 15:6346-6360. [PMID: 37418282 PMCID: PMC10373980 DOI: 10.18632/aging.204855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE At present, there is a lack of accurate early diagnostic markers for ischemic stroke. METHODS By using dimensionality reduction cluster analysis, differential expression analysis, weighted co-expression network analysis, protein-protein interaction network analysis, cell heterogeneity and key pathogenic genes were identified in ischemic stroke. Immunomicroenvironment analysis was used to explore the immune landscape and immune associations of key genes in ischemic stroke. The analysis platform we use is R software (version 4.0.5). PCR experiments were used to verify the expression of key genes. RESULTS Single cell sequencing data in ischemic stroke can be annotated as fibroblast cells, pre-B cell CD34, neutrophils cells, bone marrow (BM), keratinocytes, macrophage, neurons and mesenchymal stem cells (MSC). By the intersection of differential expression analysis and WGCNA analysis, 385 genes were obtained. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that these genes were highly correlated with multiple functions and pathways. Protein-protein interaction network analysis revealed that MRPS11 and MRPS12 were key genes, both of which were down-regulated in ischemic stroke. The Pseudo-time series analysis found that the expression of MRPS12 decreased gradually with the differentiation of pre-B cell CD34 cells in ischemic stroke, suggesting that the downregulation of MRPS12 expression may play an important role in ischemic stroke. At last, PCR showed that MRPS11 and MRPS12 were significantly down-regulated in peripheral blood of patients with ischemic stroke. CONCLUSIONS Our study provides a reference for the study of pathogenesis and key targets of ischemic stroke.
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Affiliation(s)
- Jiali Tao
- Department of Emergency Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, People’s Republic of China
| | - Xiaochen Xie
- Department of Respiratory Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, People’s Republic of China
| | - Man Luo
- Department of Emergency Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, People’s Republic of China
| | - Qingsong Sun
- Department of Emergency Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, People’s Republic of China
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18
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Mannismäki L, Martinez-Majander N, Sibolt G, Suomalainen OP, Bäcklund K, Abou Elseoud A, Järveläinen J, Forss N, Curtze S. Association of admission plasma glucose level and cerebral computed tomographic perfusion deficit volumes. J Neurol Sci 2023; 451:120722. [PMID: 37393736 DOI: 10.1016/j.jns.2023.120722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Hyperglycemia in acute ischemic stroke (AIS) is frequent and associated with worse outcome. Yet, strict glycemic control in AIS patients has failed to yield beneficial outcome. So far, the underlying pathophysiological mechanisms of admission hyperglycemia in AIS have remained not fully understood. We aimed to evaluate the yet equivocal association of hyperglycemia with computed tomographic perfusion (CTP) deficit volumes. PATIENTS AND METHODS We included 832 consecutive AIS and transient ischemic attack (TIA) patients who underwent CTP as a part of screening for recanalization treatment (stroke code) between 3/2018 and 10/2020, from the prospective cohort of Helsinki Stroke Quality Registry. Associations of admission glucose level (AGL) and CTP deficit volumes, namely ischemic core, defined as relative cerebral blood flow <30%, and hypoperfusion lesions Time-to-maximum (Tmax) >6 s and Tmax >10s, as determined with RAPID® software, were analyzed with a linear regression model adjusted for age, sex, C-reactive protein, and time from symptom onset to imaging. RESULTS AGL median was 6.8 mmol/L (interquartile range 5.9-8.0 mmol/L), and 222 (27%) patients were hyperglycemic (glucose >7.8 mmol/L) on admission. In non-diabetic patients (643 [77%]), AGL was significantly associated with volume of Tmax. >6 s (regression coefficient [RC] 4.8, 95% confidence interval [CI] 0.49-9.1), of Tmax >10s (RC 4.6, 95% CI 1.2-8.1), and of ischemic core (RC 2.6, 95% CI 0.64-4.6). No significant associations were shown in diabetic patients. CONCLUSION Admission hyperglycemia appears to be associated with both larger volume of hypoperfusion lesions and of ischemic core in non-diabetic stroke code patients with AIS and TIA.
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Affiliation(s)
- Laura Mannismäki
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
| | - Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Olli P Suomalainen
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Katariina Bäcklund
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Ahmed Abou Elseoud
- Helsinki Medical Imaging Centre, Helsinki University Hospital, Helsinki, Finland
| | - Juha Järveläinen
- Helsinki Medical Imaging Centre, Helsinki University Hospital, Helsinki, Finland
| | - Nina Forss
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
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19
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Ye W, Chen X, Li P, Tao Y, Wang Z, Gao C, Cheng J, Li F, Yi D, Wei Z, Yi D, Wu Y. OEDL: an optimized ensemble deep learning method for the prediction of acute ischemic stroke prognoses using union features. Front Neurol 2023; 14:1158555. [PMID: 37416306 PMCID: PMC10321134 DOI: 10.3389/fneur.2023.1158555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Background Early stroke prognosis assessments are critical for decision-making regarding therapeutic intervention. We introduced the concepts of data combination, method integration, and algorithm parallelization, aiming to build an integrated deep learning model based on a combination of clinical and radiomics features and analyze its application value in prognosis prediction. Methods The research steps in this study include data source and feature extraction, data processing and feature fusion, model building and optimization, model training, and so on. Using data from 441 stroke patients, clinical and radiomics features were extracted, and feature selection was performed. Clinical, radiomics, and combined features were included to construct predictive models. We applied the concept of deep integration to the joint analysis of multiple deep learning methods, used a metaheuristic algorithm to improve the parameter search efficiency, and finally, developed an acute ischemic stroke (AIS) prognosis prediction method, namely, the optimized ensemble of deep learning (OEDL) method. Results Among the clinical features, 17 features passed the correlation check. Among the radiomics features, 19 features were selected. In the comparison of the prediction performance of each method, the OEDL method based on the concept of ensemble optimization had the best classification performance. In the comparison to the predictive performance of each feature, the inclusion of the combined features resulted in better classification performance than that of the clinical and radiomics features. In the comparison to the prediction performance of each balanced method, SMOTEENN, which is based on a hybrid sampling method, achieved the best classification performance than that of the unbalanced, oversampled, and undersampled methods. The OEDL method with combined features and mixed sampling achieved the best classification performance, with 97.89, 95.74, 94.75, 94.03, and 94.35% for Macro-AUC, ACC, Macro-R, Macro-P, and Macro-F1, respectively, and achieved advanced performance in comparison with that of methods in previous studies. Conclusion The OEDL approach proposed herein could effectively achieve improved stroke prognosis prediction performance, the effect of using combined data modeling was significantly better than that of single clinical or radiomics feature models, and the proposed method had a better intervention guidance value. Our approach is beneficial for optimizing the early clinical intervention process and providing the necessary clinical decision support for personalized treatment.
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Affiliation(s)
- Wei Ye
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Xicheng Chen
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Pengpeng Li
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Yongjun Tao
- Department of Neurology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Zhenyan Wang
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Chengcheng Gao
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Jian Cheng
- Department of Radiology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Fang Li
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Dali Yi
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
- Department of Health Education, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Zeliang Wei
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Dong Yi
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Yazhou Wu
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
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20
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Wan B, Ma N, Zhou Z, Lu W. Modifiable risk factors that mediate the effect of educational attainment on the risk of stroke: a network Mendelian randomization study. Mol Brain 2023; 16:39. [PMID: 37170327 PMCID: PMC10173578 DOI: 10.1186/s13041-023-01030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Stroke is a common cerebrovascular disease with great danger to public health. Educational inequality is a universal issue that influences populations' stroke risk. This study aimed to investigate the causal relationship between education and stroke risk and the contributions of effects mediated by four modifiable factors. MATERIALS AND METHODS Public large-scale genome-wide association study (GWAS) summary data associated with educational attainment, hypertensive diseases, body mass index (BMI), smoking behavior, time spent on watching the television (TV), and stroke were obtained from European ancestry. The data were used to investigate the causal relationship among educational attainment, hypertensive disease, BMI, smoking, watching TV, and stroke risk. Inverse variance weighted (IVW) method was used as a primary algorithm for estimating causal direction and effect size in univariable and multivariable Mendelian randomization (MR) analyses. RESULTS Higher educational attainment was a causal protective factor, while hypertensive diseases, higher BMI, smoking, and longer time spent on watching the TV were all causal risk factors for the risk of stroke. Hypertensive disease, BMI, smoking, and watching TV were all mediators for linking the causal relationship between educational attainment and stroke risk. Hypertensive disease, BMI, smoking, and watching TV explained 47.35%, 24.74%, 15.72%, and 2.29% of the variance in educational attainment's effect on stroke risk, respectively. The explained proportion reached 69.32% after integrating the four factors. CONCLUSIONS These findings support the causal effect of educational attainment on the risk of stroke, with a substantial proportion mediated by modifiable risk factors. Interventions on these modifiable factors would lead to substantial reductions in stroke cases attributable to educational inequality.
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Affiliation(s)
- Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China.
- Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China.
| | - Ning Ma
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
| | - Zhi Zhou
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
| | - Weiying Lu
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China.
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21
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Kumar M, Hu S, Beyea S, Kamal N. Restricted access in the emergency department prevents MRI from being the workhorse for ischemic stroke care. J Neurol Sci 2023; 448:120637. [PMID: 37001414 DOI: 10.1016/j.jns.2023.120637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Affiliation(s)
- Mukesh Kumar
- Department of Industrial Engineering, Dalhousie University, Halifax, Canada.
| | - Sherry Hu
- Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada
| | - Steven Beyea
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada; IWK Health, Halifax, Canada
| | - Noreen Kamal
- Department of Industrial Engineering, Dalhousie University, Halifax, Canada; Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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22
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Høllesli LJ, Ajmi SC, Kurz MW, Tysland TB, Hagir M, Dalen I, Qvindesland SA, Ersdal H, Kurz KD. Simulation-based team-training in acute stroke: Is it safe to speed up? Brain Behav 2022; 12:e2814. [PMID: 36416494 PMCID: PMC9759129 DOI: 10.1002/brb3.2814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In acute ischemic stroke (AIS), rapid treatment with intravenous thrombolysis (IVT) is crucial for good clinical outcome. Weekly simulation-based team-training of the stroke treatment team was implemented, resulting in faster treatment times. The aim of this study was to assess whether this time reduction led to a higher proportion of stroke mimics (SMs) among patients who received IVT for presumed AIS, and whether these SM patients were harmed by intracranial hemorrhage (ICH). METHODS All suspected AIS patients treated with IVT between January 1, 2015 and December 31, 2020 were prospectively registered. In 2017, weekly in situ simulation-based team-training involving the whole stroke treatment team was introduced. To analyze possible unintended effects of simulation training, the proportion of SMs among patients who received IVT for presumed AIS were identified by clinical and radiological evaluation. Additionally, we identified the extent of symptomatic ICH (sICH) in IVT-treated SM patients. RESULTS From 2015 to 2020, 959 patients were treated with IVT for symptoms of AIS. After introduction of simulation training, the proportion of patients treated with IVT who were later diagnosed as SMs increased significantly (15.9% vs. 24.4%, p = .003). There were no ICH complications in the SM patients treated before, whereas two SM patients suffered from asymptomatic ICH after introduction of simulation training (p = 1.0). When subgrouping SMs into prespecified categories, only the group diagnosed with peripheral vertigo increased significantly (2.5% vs. 8.6%, p < .001). CONCLUSIONS Simulation training of the acute stroke treatment team was associated with an increase in the proportion of patients treated with IVT for a suspected AIS who were later diagnosed with peripheral vertigo. The proportion of other SM groups among IVT-treated patients did not change significantly. No sICH was detected in IVT-treated SM patients.
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Affiliation(s)
- Liv Jorunn Høllesli
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Soffien Chadli Ajmi
- Neurology Research Group, Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Martin W Kurz
- Neurology Research Group, Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Thomas Bailey Tysland
- Neurology Research Group, Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Morten Hagir
- Department of Radiology, Hospital of Southern Norway Kristiansand, Kristiansand, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Sigrun Anna Qvindesland
- Department of Research, Simulation Section, Stavanger University Hospital, Stavanger, Norway
| | - Hege Ersdal
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kathinka D Kurz
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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23
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Southey CC, Birns J, Sommerville P, Bhalla A. Transient unilateral weakness: is it a transient ischaemic attack? Br J Hosp Med (Lond) 2022; 83:1-7. [DOI: 10.12968/hmed.2022.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transient ischaemic attack is an emergency medical condition that causes brief negative focal neurological symptoms such as unilateral weakness. The symptoms herald a high risk of stroke and hence require urgent assessment. The challenge lies in the brevity and compendium of associated symptoms that can ‘mimic’ a plethora of other conditions. The result is a high rate of referrals to transient ischaemic attack clinics for these stroke mimics. This article highlights the diagnostic challenges in transient ischaemic attack with relevance to unilateral weakness.
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Affiliation(s)
- Charles C Southey
- Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan Birns
- Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Peter Sommerville
- Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Ajay Bhalla
- Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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24
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Brain Imaging in Epilepsy-Focus on Diffusion-Weighted Imaging. Diagnostics (Basel) 2022; 12:diagnostics12112602. [PMID: 36359445 PMCID: PMC9689253 DOI: 10.3390/diagnostics12112602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is a common neurological disorder; 1% of people worldwide have epilepsy. Differentiating epileptic seizures from other acute neurological disorders in a clinical setting can be challenging. Approximately one-third of patients have drug-resistant epilepsy that is not well controlled by current antiepileptic drug therapy. Surgical treatment is potentially curative if the epileptogenic focus is accurately localized. Diffusion-weighted imaging (DWI) is an advanced magnetic resonance imaging technique that is sensitive to the diffusion of water molecules and provides additional information on the microstructure of tissue. Qualitative and quantitative analysis of peri-ictal, postictal, and interictal diffusion images can aid the differential diagnosis of seizures and seizure foci localization. This review focused on the fundamentals of DWI and its associated techniques, such as apparent diffusion coefficient, diffusion tensor imaging, and tractography, as well as their impact on epilepsy in terms of differential diagnosis, epileptic foci determination, and prognosis prediction.
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25
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Będkowska N, Zontek A, Paprocka J. Stroke-like Episodes in Inherited Neurometabolic Disorders. Metabolites 2022; 12:metabo12100929. [PMID: 36295831 PMCID: PMC9611026 DOI: 10.3390/metabo12100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Stroke-like episodes (SLEs) are significant clinical manifestations of metabolic disorders affecting the central nervous system. Morphological equivalents presented in neuroimaging procedures are described as stroke-like lesions (SLLs). It is crucial to distinguish SLEs from cerebral infarction or intracerebral hemorrhage, mainly due to the variety in management. Another significant issue to underline is the meaning of the main pathogenetic hypotheses in the development of SLEs. The diagnostic process is based on the patient’s medical history, physical and neurological examination, neuroimaging techniques and laboratory and genetic testing. Implementation of treatment is generally symptomatic and includes L-arginine supplementation and adequate antiepileptic management. The main aim of the current review was to summarize the basic and actual knowledge about the occurrence of SLEs in various inherited neurometabolic disorders, discuss the possible pathomechanism of their development, underline the role of neuroimaging in the detection of SLLs and identification of the electroencephalographic patterns as well as histological abnormalities in inherited disorders of metabolism.
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Affiliation(s)
- Natalia Będkowska
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Aneta Zontek
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
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26
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Kalani M, Shinde P. Diabetic Retinopathy May Covariate With Stroke in Diabetes Mellitus. Cureus 2022; 14:e28227. [PMID: 36158371 PMCID: PMC9491626 DOI: 10.7759/cureus.28227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 12/01/2022] Open
Abstract
Diabetes mellitus is a chronic metabolic disorder with increasing prevalence per hour. Cataracts are one of the most common eye complications, and they affect all structures of the eye. The incidence of cataracts is increasing in patients with diabetes by several mechanisms. With the advancement of technology, cataract surgery is now a necessary procedure for diabetic patients. High-risk complications, like diabetic macular oedema, diabetic retinopathy (DR), phakic, postoperative cyst, and postoperative macular oedema, and macular oedema and endophthalmitis following surgery for a pseudocyst, could result in blindness. The importance of preoperative, intraoperative, and postoperative factors cannot be overestimated in managing complications and improving visual outcomes. DR can be a severe problem if it worsens and causes non-proliferative or proliferative DR or if fluid accumulation in the eye is diagnosed as macular oedema. A woman progressing to sight-threatening DR during childbearing age experiences distress and often requires ocular treatment. Diabetes that has been present for a more extended period, as well as more significant hyperglycaemia, hypertension, cardiovascular diseases, and elevated blood pressure, substantially predict the development of DR. Oxidative stress can be caused by hyperglycaemia, irregular metabolic processes, and people with DR developing neurodegeneration. Therefore, controlling postprandial hyperglycaemia is crucial for preventing DR. Femtosecond laser technology, multifocal intraocular lenses, and other surgical innovations are popularly referred to as surgical management; it will be engaged in the coming era to determine whether there will be a continued reduction in the complication of cataract surgery. This article aims to review the correlation of DR with stroke and its screening and to outline the critical management strategies.
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27
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Sjöö M, Berglund A, Sjöstrand C, Eriksson EE, Mazya MV. Prehospital stroke mimics in the Stockholm Stroke Triage System. Front Neurol 2022; 13:939618. [PMID: 36062015 PMCID: PMC9433744 DOI: 10.3389/fneur.2022.939618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction In 2017, Stockholm implemented a new prehospital stroke triage system (SSTS) directing patients with a likely indication for thrombectomy to the regional comprehensive stroke center (CSC) based on symptom severity and teleconsultation with a physician. In Stockholm, 44% of patients with prehospital code stroke have stroke mimics. Inadvertent triage of stroke mimics to the CSC could lead to inappropriate resource utilization. Aims To compare the characteristics between (1) triage-positive stroke mimics and stroke (TP mimics and TP stroke) and (2) triage-negative stroke mimics and stroke (TN mimics and TN stroke) and to (3) compare the distribution of stroke mimic diagnoses between triage-positive and triage-negative cases. Methods This prospective observational study collected data from October 2017 to October 2018, including 2,905 patients with suspected stroke who were transported by code-stroke ambulance to a Stockholm regional hospital. Patients directed to the CSC were defined as triage-positive. Those directed to the nearest stroke center were defined as triage-negative. Results Compared to individuals with TP stroke (n = 268), those with TP mimics (n = 55, median 64 vs. 75 years, P < 0.001) were younger and had lower NIHSS score (median 7 vs. 15, P < 0.001). Similarly, those with TN mimics (n = 1,221) were younger than those with TN stroke (n = 1,361, median 73 vs. 78 years, P < 0.001) and had lower NIHSS scores (median 2 vs. 4, P < 0.001). Functional paresis was more common in those with TP mimics than in those with TN mimics, 18/55 (32.7%) vs. 82/1,221 (6.7%), P < 0.001. Systemic infection was less common in those with TP mimics than in those with TN mimics, 1/55 (1.8%) vs. 160/1,221 (13.1%), P < 0.011. There was a trend toward “syncope, hypotension, or other cardiovascular diagnosis” being less common in those with TP mimics than in those with TN mimics, 1/55 (1.8%) vs. 118/1,221 (9.7%), P < 0.055. Conclusions In the SSTS, those with triage-positive and triage-negative stroke mimics were younger and had less severe symptoms than patients with stroke. All patients with TP mimics who had hemiparesis but overall exhibited less severe symptoms against true stroke but more severe symptoms than those with TN mimics were triaged to the nearest hospital. Over-triage of functional paresis to the CSC was relatively common. Meanwhile, a large majority of cases with minor symptoms caused by stroke mimics was triaged correctly by the SSTS to the nearest stroke center.
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28
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Garg R. Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis. Acta Neurol Scand 2022; 146:252-257. [PMID: 35652287 PMCID: PMC9541760 DOI: 10.1111/ane.13656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent national guidelines recommend alteplase treatment for ischemic stroke within 4.5 h of symptom-onset based on meta-analyses of randomized controlled clinical trials (RCT). A detailed description of missing outcome data (MOD) due to participant loss to follow-up has never been published. The objective of this study was to perform a methodlogical survey on missing outcome data in an alteplase for ischemic stroke meta-analysis. MATERIALS AND METHODS A methodological survey was performed on a chosen meta-analysis of alteplase for ischemic stroke RCTs that most closely aligns with recent national guideline recommendations. Data were collected to assess the number of participants lost to follow-up; differential lost to follow-up between allocation groups; baseline characteristics of those lost to follow-up; and the imputation methods used by individual trials and the chosen meta-analysis. The number of participants lost to follow-up was compared with the fragility index; and repeated for individually positive RCTs in the meta-analysis. RESULTS The methodological survey revealed a substantial degree of missing information regarding MOD in the chosen meta-analysis and in individual RCTs. Single imputation was exclusively used in all RCTs and in the meta-analysis. The number of participants lost to follow-up was greater than the fragility index in the chosen meta-analysis and individually positive component RCTs suggesting that MOD may impact the direction of the reported effect or effect size. CONCLUSION This methodological survey of an alteplase for ischemic stroke meta-analysis revealed MOD may be an important source of unrecognized bias. This survey highlights the need for sensitivity analyses using more robust methods of imputation.
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Affiliation(s)
- Ravi Garg
- Division of Neurocritical Care, Department of Neurology Loyola University Chicago Stritch School of Medicine Maywood Illinois USA
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29
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Molina-Gil J, Azofra J, González-Fernández L. Hereditary angio-oedema with C1 inhibitor deficiency type I, an unusual stroke mimic. BMJ Case Rep 2022; 15:e249040. [PMID: 35393279 PMCID: PMC8990707 DOI: 10.1136/bcr-2022-249040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/03/2022] Open
Abstract
Hereditary angio-oedema with C1 inhibitor deficiency (C1-INH-HAE) type I is a rare immune disorder characterised by a deficit of functional C1 esterase inhibitor (C1-INH). Recurrent C1-INH-HAE attacks typically present as generalised skin swelling and abdominal pain. Neurological involvement is very unusual, with a few reports of cephalea and recurrent dizziness. We describe a woman in her 30s diagnosed with C1-INH-HAE type I who was referred to the emergency department suffering from left hemisensory syndrome, with the initial suspicion of an ischaemic stroke. A few hours after hospital admission, she presented an acute attack of facial swelling and abdominal pain, receiving intravenous C1-INH concentrate with complete resolution of all symptoms, including neurological ones. A complete aetiological study ruled out a stroke. We pointed out that C1-INH-HAE attack can be an unusual stroke mimic that responds favourably to replacement therapy.
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Affiliation(s)
- Javier Molina-Gil
- Neurology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Julián Azofra
- Allergology and Immunology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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30
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Walter S, Audebert HJ, Katsanos AH, Larsen K, Sacco S, Steiner T, Turc G, Tsivgoulis G. European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management. Eur Stroke J 2022; 7:XXVII-LIX. [PMID: 35300251 PMCID: PMC8921783 DOI: 10.1177/23969873221079413] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/23/2022] [Indexed: 08/03/2023] Open
Abstract
The safety and efficacy of mobile stroke units (MSUs) in prehospital stroke management has recently been investigated in different clinical studies. MSUs are ambulances equipped with a CT scanner, point-of-care lab, telemedicine and are staffed with a stroke specialised medical team. This European Stroke Organisation (ESO) guideline provides an up-to-date evidence-based recommendation to assist decision-makers in their choice on using MSUs for prehospital management of suspected stroke, which includes patients with acute ischaemic stroke (AIS), intracranial haemorrhage (ICH) and stroke mimics. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and aggregated data meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements are provided where sufficient evidence was not available to provide recommendations based on the GRADE approach. We found moderate evidence for suggesting MSU management for patients with suspected stroke. The patient group diagnosed with AIS shows an improvement of functional outcomes at 90 days, reduced onset to treatment times and increased proportion receiving IVT within 60 min from onset. MSU management might be beneficial for patients with ICH as MSU management was associated with a higher proportion of ICH patients being primarily transported to tertiary care stroke centres. No safety concerns (all-cause mortality, proportion of stroke mimics treated with IVT, symptomatic intracranial bleeding and major extracranial bleeding) could be identified for all patients managed with a MSU compared to conventional care. We suggest MSU management to improve prehospital management of suspected stroke patients.
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Affiliation(s)
- Silke Walter
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
| | - Heinrich J Audebert
- Klinik und Hochschulambulanz für Neurologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Karianne Larsen
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, Paris, France
- INSERM U1266, Paris, France
- FHU Neurovasc, Paris, France
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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31
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Vieira AB, Fonseca AC, Ferro J, Oliveira AL. Using a Siamese Network to Accurately Detect Ischemic Stroke in Computed Tomography Scans. PROGRESS IN ARTIFICIAL INTELLIGENCE 2022. [DOI: 10.1007/978-3-031-16474-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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