1
|
Das AS, Mallick A, Mora SA, Keins S, Abramson JR, Castello JP, Pasi M, Kourkoulis CE, Rodriguez-Torres A, Warren AD, Gökçal E, Viswanathan A, Greenberg SM, Anderson CD, Rosand J, Biffi A, Gurol ME. Hypertension control after intracerebral hemorrhage among varying small vessel disease etiologies. Neurol Sci 2024; 45:4913-4921. [PMID: 38772978 DOI: 10.1007/s10072-024-07560-2] [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: 02/17/2024] [Accepted: 04/25/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) is attributable to cerebral small vessel disease (cSVD), which includes cerebral amyloid angiopathy (CAA) and hypertensive-cSVD (HTN-cSVD). HTN-cSVD includes patients with strictly deep ICH/microbleeds and mixed location ICH/microbleeds, the latter representing a more severe form of HTN-cSVD. We test the hypothesis that more severe forms of HTN-cSVD are related to worse hypertension control in long-term follow-up after ICH. METHODS From consecutive non-traumatic ICH patients admitted to a tertiary care center, we classified the ICH as CAA, strictly deep ICH/microbleeds, and mixed-location ICH/microbleeds. CSVD burden was quantified using a validated MRI-based score (range: 0-6 points). We created a multivariable (linear mixed effects) model adjusting for age, sex, race, year of inclusion, hypertension, and antihypertensive medication usage to investigate the association of average systolic blood pressure (SBP) during follow-up with cSVD etiology/severity. RESULTS 796 ICH survivors were followed for a median of 48.8 months (IQR 41.5-60.4). CAA-related ICH survivors (n = 373) displayed a lower median SBP (138 mmHg, IQR 133-142 mmHg) compared to those of strictly deep ICH (n = 222, 141 mmHg, IQR 136-143 mmHg, p = 0.04), and mixed location ICH/microbleeds (n = 201, 142 mmHg, IQR 135-144 mmHg, p = 0.02). In the multivariable analysis, mixed location ICH/microbleeds (effect: + 3.8 mmHg, SE: 1.3 mmHg, p = 0.01) and increasing cSVD severity (+ 1.8 mmHg per score point, SE: 0.8 mmHg, p = 0.03) were associated with higher SBP in follow-up. CONCLUSION CSVD severity and subtype predicts long-term hypertension control in ICH patients.
Collapse
Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry Medical Office Building, Ste 9A-05, Boston, MA, 02215, USA.
| | - Akashleena Mallick
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha A Mora
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sophia Keins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Jessica R Abramson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Juan Pablo Castello
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Marco Pasi
- Université de Tours, CHU Tours, Tours, France
| | - Christina E Kourkoulis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Axana Rodriguez-Torres
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew D Warren
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Elif Gökçal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Christopher D Anderson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| |
Collapse
|
2
|
Yang J, Wu C, Jin Y, Hu M, Lin Y, Yao Q, Zhu C. Long-term outcomes among ischemic stroke TOAST subtypes: A 12-year Cohort study in China. J Stroke Cerebrovasc Dis 2024; 33:107783. [PMID: 38896973 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107783] [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: 04/06/2024] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Disparities in short-term ischemic stroke (IS) prognosis among Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes were observed. Notably, little is known about the long-term prognosis of different subtypes in China. We aim to investigate the long-term outcome in IS patients and try to explore the potential interactive effects between IS subtypes and antithrombotic therapy. METHODS This is a prospective cohort of stroke survivors. Patients diagnosed with first-ever IS at the Department of Neurology, West China Hospital, Sichuan University from January 2010 to December 2019 were recruited. They were followed until September 2022 to assess recurrence, mortality, and functional recovery. The multivariate Fine-Gray model assessed stroke recurrence, while Cox regression estimated hazard ratios. Modified Rankin Scale scores(mRS) were analyzed using the generalized linear mixed effects model. RESULTS At baseline, 589 of 950 participants (62.00 %) were male. The longest follow-up was 150 months, the shortest was 1.5 months, and the median follow-up was 81.0 months. Cardio-embolism (CE) bore the highest mortality risk compared to large artery atherosclerosis (LAA) (HR=4.43,95 %CI 1.61-12.23). Among survivors on anticoagulant therapy, CE exhibited a reduced risk of mortality (HR = 0.18, 95 % CI 0.04-0.80). In function recovery, small artery occlusion (SAO) demonstrated more favorable prognostic outcomes (β=-2.08, P<0.01, OR=0.13,95 %CI 0.03-0.47). Among survivors taking antiplatelet drugs, SAO demonstrated a slower pace of functional recovery compared to LAA (β=1.39, P=0.05, OR=3.99,95 %CI 1.01-15.74). CONCLUSIONS Long-term outcomes post-first IS vary among TOAST subtypes. Anticoagulant therapy offers long-term benefits among patients of the CE. However, prolonged administration of antiplatelet drugs among SAO patients may be limited in improving function recovery. Physicians should carefully consider treatment options for different IS subtypes to optimize patient outcomes and stroke care effectiveness.
Collapse
Affiliation(s)
- Jing Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Chenyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China; Public Health Center, Tianfu New Area Disease Prevention and Control Center, Sichuan, PR China
| | - Yu Jin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Meijing Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Yidie Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China.
| |
Collapse
|
3
|
Abramovitz Fouks A, Yaghi S, Selim MH, Gökçal E, Das AS, Rotschild O, Silverman SB, Singhal AB, Kapur S, Greenberg SM, Gurol ME. Left atrial appendage closure in patients with atrial fibrillation and acute ischaemic stroke despite anticoagulation. Stroke Vasc Neurol 2024:svn-2024-003143. [PMID: 38862182 DOI: 10.1136/svn-2024-003143] [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: 01/23/2024] [Accepted: 04/14/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The occurrence of acute ischaemic stroke (AIS) while using oral anticoagulants (OAC) is an increasingly recognised problem among nonvalvular atrial fibrillation (NVAF) patients. We aimed to elucidate the potential role of left atrial appendage closure (LAAC) for stroke prevention in patients with AIS despite OAC use (AIS-despite-OAC). METHODS We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite-OAC and subsequently underwent endovascular LAAC, between January 2015 and October 2021. The primary outcome measure was the occurrence of AIS after LAAC, and the safety outcome was symptomatic intracerebral haemorrhage (ICH). RESULTS 29 patients had LAAC specifically because of AIS-despite-OAC. The mean age at the time of the procedure was 73.4±8.7, 13 were female (44.82%). The mean CHA2DS2-VASc score was 5.96±1.32, with an expected AIS risk of 8.44 per 100 patient-years. 14 patients (48%) had two or more past AIS-despite-OAC. After LAAC, 27 patients (93.10%) were discharged on OAC which was discontinued in 17 (58.62%) after transoesophageal echocardiogram at 6 weeks. Over a mean of 1.75±1.0 years follow-up after LAAC, one patient had an AIS (incidence rate (IR) 1.97 per 100 patient-years). One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC. CONCLUSIONS LAAC in AIS-despite-OAC patients demonstrated a low annual AIS recurrence rate in our cohort (1.97%) compared with the expected IR based on their CHA2DS2-VASc scores (8.44%) and to recent large series of AIS-despite-OAC patients treated with OAC/aspirin only (5.3%-8.9%). These hypothesis-generating findings support randomised trials of LAAC in AIS-despite-OAC patients.
Collapse
Affiliation(s)
| | - Shadi Yaghi
- Neurology, Brown University, Warren Alpert Medical School, Providence, RI, USA
| | - Magdy H Selim
- Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elif Gökçal
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alvin S Das
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
- Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ofer Rotschild
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott B Silverman
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aneesh B Singhal
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sunil Kapur
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven M Greenberg
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mahmut Edip Gurol
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Sadat Larijani M, Doroud D, Banifazl M, Karami A, Bavand A, Ashrafian F, Ramezani A. A landscape on disorders following different COVID-19 vaccination: a systematic review of Iranian case reports. Eur J Med Res 2023; 28:542. [PMID: 38008729 PMCID: PMC10676592 DOI: 10.1186/s40001-023-01531-7] [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: 04/28/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023] Open
Abstract
There have been massive studies to develop an effective vaccine against SARS-CoV-2 which fortunately led to manage the recent pandemic, COVID-19. According to the quite rapidly developed vaccines in a fast window time, large investigations to assess the probable vaccine-related adverse events are crucially required. COVID-19 vaccines are available of different platforms and the primary clinical trials results presented acceptable safety profile of the approved vaccines. Nevertheless, the long-term assessment of the adverse events or rare conditions need to be investigated. The present systematic review, aimed at classification of probable vaccine-related unsolicited adverse events in Iranian population through the data collection of the published case report studies.The related published case reports were explored via PubMed, Web of Science and Google scholar according to the available published data up to 14th Dec, 2022 using PRISMA guideline. Out of 437 explored studies, the relevant data were fully investigated which totally led to 40 studies, including 64 case reports with a new onset of a problem post-vaccination. The cases were then classified according to the various items, such as the type of adverse event and COVID-19 vaccines.The reported COVID-19 vaccines in the studied cases included BBIBP-CorV, ChAdOx1-S, Sputnik V and COVAXIN. The results showed that the adverse events presented in 8 different categories, including cutaneous involvements in 43.7% (n = 28), neurologic problems (n = 16), blood/vessel involvement (n = 6), cardiovascular involvement (n = 5), ocular disorders (n = 4), liver disorder/failure (n = 2), graft rejection (n = 2) and one metabolic disorder. Notably, almost 60% of the cases had no comorbidities. Moreover, the obtained data revealed nearly half of the incidences occurred after the first dose of injection and the median duration of improvement after the symptom was 10 days (range: 2-120). In addition, 73% of all the cases were either significantly improved or fully recovered. Liver failure following ChAdOx1-S vaccination was the most serious vaccine adverse event which led to death in two individuals with no related medical history.Although the advantages of COVID-19 vaccination is undoubtedly significant, individuals including with a history of serious disease, comorbidities and immunodeficiency conditions should be vaccinated with the utmost caution. This study provides a comprehensive overview and clinical implications of possible vaccine-related adverse events which should be considered in further vaccination strategies. Nevertheless, there might be a bias regarding potential under-reporting and missing data of the case reports included in the present study. Although the reported data are not proven to be the direct vaccination outcomes and could be a possible immune response over stimulation, the people the population with a medium/high risk should be monitored after getting vaccinated against COVID-19 of any platforms. This could be achieved by a carefull attention to the subjects ' medical history and also through consulting with healthcare providers before vaccination.
Collapse
Affiliation(s)
- Mona Sadat Larijani
- Clinical Research Department, Pasteur Institute of Iran, No: 69, Pasteur Ave, Tehran, 1316943551, Iran
| | - Delaram Doroud
- Quality Control Department, Production and Research Complex, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Banifazl
- Iranian Society for Support of Patients With Infectious Disease, Tehran, Iran
| | - Afsaneh Karami
- Department of Infectious Disease, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Anahita Bavand
- Clinical Research Department, Pasteur Institute of Iran, No: 69, Pasteur Ave, Tehran, 1316943551, Iran
| | - Fatemeh Ashrafian
- Clinical Research Department, Pasteur Institute of Iran, No: 69, Pasteur Ave, Tehran, 1316943551, Iran
| | - Amitis Ramezani
- Clinical Research Department, Pasteur Institute of Iran, No: 69, Pasteur Ave, Tehran, 1316943551, Iran.
| |
Collapse
|
5
|
Das AS, Gokcal E, Biffi A, Regenhardt RW, Pasi M, Abramovitz Fouks A, Viswanathan A, Goldstein J, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Mechanistic Implications of Cortical Superficial Siderosis in Patients With Mixed Location Intracerebral Hemorrhage and Cerebral Microbleeds. Neurology 2023; 101:e636-e644. [PMID: 37290968 PMCID: PMC10424843 DOI: 10.1212/wnl.0000000000207476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertensive cerebral small vessel disease (HTN-cSVD) is the predominant microangiopathy in patients with a combination of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH). We tested the hypothesis that cerebral amyloid angiopathy (CAA) is also a contributing microangiopathy in patients with mixed ICH with cortical superficial siderosis (cSS), a marker strongly associated with CAA. METHODS Brain MRIs from a prospective database of consecutive patients with nontraumatic ICH admitted to a referral center were reviewed for the presence of CMBs, cSS, and nonhemorrhagic CAA markers (lobar lacunes, centrum semiovale enlarged perivascular spaces [CSO-EPVS], and multispot white matter hyperintensity [WMH] pattern). The frequencies of CAA markers and left ventricular hypertrophy (LVH), a marker for hypertensive end-organ damage, were compared between patients with mixed ICH with cSS (mixed ICH/cSS[+]) and without cSS (mixed ICH/cSS[-]) in univariate and multivariable models. RESULTS Of 1,791 patients with ICH, 40 had mixed ICH/cSS(+) and 256 had mixed ICH/cSS(-). LVH was less common in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-) (34% vs 59%, p = 0.01). The frequencies of CAA imaging markers, namely multispot pattern (18% vs 4%, p < 0.01) and severe CSO-EPVS (33% vs 11%, p < 0.01), were higher in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-). In a logistic regression model, older age (adjusted odds ratio [aOR] 1.04 per year, 95% CI 1.00-1.07, p = 0.04), lack of LVH (aOR 0.41, 95% CI 0.19-0.89, p = 0.02), multispot WMH pattern (aOR 5.25, 95% CI 1.63-16.94, p = 0.01), and severe CSO-EPVS (aOR 4.24, 95% CI 1.78-10.13, p < 0.01) were independently associated with mixed ICH/cSS(+) after further adjustment for hypertension and coronary artery disease. Among ICH survivors, the adjusted hazard ratio of ICH recurrence in patients with mixed ICH/cSS(+) was 4.65 (95% CI 1.38-11.38, p < 0.01) compared with that in patients with mixed ICH/cSS(-). DISCUSSION The underlying microangiopathy of mixed ICH/cSS(+) likely includes both HTN-cSVD and CAA, whereas mixed ICH/cSS(-) is likely driven by HTN-cSVD. These imaging-based classifications can be important to stratify ICH risk but warrant confirmation in studies incorporating advanced imaging/pathology.
Collapse
Affiliation(s)
- Alvin S Das
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Elif Gokcal
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alessandro Biffi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert W Regenhardt
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Pasi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Avia Abramovitz Fouks
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua Goldstein
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lee H Schwamm
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
6
|
Neuroprotective effect of the calcium channel blocker nilvadipine on retinal ganglion cell death in a mouse ocular hypertension model. Heliyon 2023; 9:e13812. [PMID: 36879972 PMCID: PMC9984798 DOI: 10.1016/j.heliyon.2023.e13812] [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: 11/19/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
We investigated whether nilvadipine has a neuroprotective effect on retinal ganglion cells (RGCs) in a mouse model of ocular hypertension (OH) that expresses cyan fluorescein protein (CFP) in RGCs. OH was induced in the right eyes of Thy1-CFP transgenic mice using a laser. Nilvadipine or vehicle treatment began simultaneously with OH modeling and was administered intraperitoneally once daily for 8 weeks. Intraocular pressure (IOP) in both the laser- and non-treated eyes was measured weekly with the microneedle method, and calculations were performed to estimate the pressure insult in each eye. Using a retinal whole mount, the number of RGCs was counted at week 9. Laser-treated eyes showed a significant increase in IOP (p < 0.01), and the pressure insult did not differ between the drug-treated groups. Over time, laser treatment produced a significant decrease in the number of RGCs in the vehicle-treated groups, but this effect was attenuated by nilvadipine treatment. The pressure insult and RGC survival rate were significantly negatively correlated in the vehicle-treated group (y = -0.078 x + 107.8, r = 0.76, p < 0.001), but not in the nilvadipine-treated group (y = -0.015 x + 99.9, r = 0.43, p = 0.128). Nilvadipine was a potent neuroprotective agent for RGCs in our mouse model of OH and may have potential for protection against glaucoma. This model is useful as a screening tool for drugs with retinal protective effects.
Collapse
|
7
|
Das AS, Gokcal E, Regenhardt RW, Horn MJ, Schwab K, Daoud N, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Rost N, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage. Stroke Vasc Neurol 2023; 8:26-33. [PMID: 35981809 PMCID: PMC9985798 DOI: 10.1136/svn-2022-001653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluate whether non-haemorrhagic imaging markers (NHIM) (white matter hyperintensity patterns, lacunes and enlarged perivascular spaces (EPVS)) can discriminate cerebral amyloid angiopathy (CAA) from hypertensive cerebral small vessel disease (HTN-cSVD) among patients with isolated lobar intracerebral haemorrhage (isolated-LICH). METHODS In patients with isolated-LICH, four cSVD aetiologic groups were created by incorporating the presence/distribution of NHIM: HTN-cSVD pattern, CAA pattern, mixed NHIM and no NHIM. CAA pattern consisted of patients with any combination of severe centrum semiovale EPVS, lobar lacunes or multiple subcortical spots pattern. HTN-cSVD pattern consisted of any HTN-cSVD markers: severe basal ganglia PVS, deep lacunes or peribasal ganglia white matter hyperintensity pattern. Mixed NHIM consisted of at least one imaging marker from either pattern. Our hypothesis was that patients with HTN-cSVD pattern/mixed NHIM would have a higher frequency of left ventricular hypertrophy (LVH), which is associated with HTN-cSVD. RESULTS In 261 patients with isolated-LICH, CAA pattern was diagnosed in 93 patients, HTN-cSVD pattern in 53 patients, mixed NHIM in 19 patients and no NHIM in 96 patients. The frequency of LVH was similar among those with HTN-cSVD pattern and mixed NHIM (50% vs 39%, p=0.418) but was more frequent in HTN-cSVD pattern compared with CAA pattern (50% vs 20%, p<0.001). In a regression model, HTN-cSVD pattern (OR: 7.38; 95% CI 2.84 to 19.20) and mixed NHIM (OR: 4.45; 95% CI 1.25 to 15.90) were found to be independently associated with LVH. CONCLUSION Among patients with isolated-LICH, NHIM may help differentiate HTN-cSVD from CAA, using LVH as a marker for HTN-cSVD.
Collapse
Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Pavlovic A, Pekmezovic T, Mijajlovic M, Tomic G, Zidverc Trajkovic J. Is the female sex associated with an increased risk for long-term cognitive decline after the first-ever lacunar stroke? Prospective study on small vessel disease cohort. Front Neurol 2023; 13:1052401. [PMID: 36712431 PMCID: PMC9878188 DOI: 10.3389/fneur.2022.1052401] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background Sex is a significant determinant of survival and functional outcome after stroke. Long-term cognitive outcome after acute lacunar stroke in the context of sex differences has been rarely reported. Methods A cohort of small vessel disease (SVD) patients presenting with first-ever acute lacunar stroke and normal cognitive status has been evaluated 4 years after the qualifying event for the presence of cognitive impairment (CI) with a comprehensive neuropsychological battery. Differences in baseline clinical and neuroimaging characteristics were compared between sexes in relation to cognitive status. Results A total of 124 female and 150 male patients were analyzed. No difference was detected between the groups regarding age (p = 0.932) or frequency of common vascular risk factors (p > 0.1 for all). At the baseline assessment, women had more disabilities compared to men with a mean modified Rankin scale (mRS) score of 2.5 (1.5 in men, p < 0.0001). Scores of white matter hyperintensities (WMH) of presumed vascular origin and a total number of lacunes of presumed vascular origin on brain MRI were higher in women compared to men (p < 0.0001 for all). As many as 64.6% of patients had CI of any severity on follow-up, women more frequently (77.4%) than men (54.0%; p < 0.0001). Univariate logistic regression analysis showed that female sex, higher NIHSS and mRS scores, presence of depression, and increasing WMH severity were associated with an increased risk for CI. Multivariate regression analysis indicated that only depression (OR 1.74, 95%CI 1.25-2.44; p = 0.001) and WMH severity (OR 1.10, 95%CI 1.03-1.17; p = 0.004) were independently associated with the CI. Conclusion At the long-term follow-up, women lacunar stroke survivors, compared to men, more frequently had CI in the presence of more severe vascular brain lesions, but this association was dependent on the occurrence of depression and severity of WMH, and could not be explained by differences in common vascular risk factors.
Collapse
Affiliation(s)
- Aleksandra Pavlovic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia,Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia,*Correspondence: Aleksandra Pavlovic ✉
| | - Tatjana Pekmezovic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Milija Mijajlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Tomic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasna Zidverc Trajkovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
9
|
Das AS, Gökçal E, Regenhardt RW, Warren AD, Biffi A, Goldstein JN, Kimberly WT, Viswanathan A, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants. J Neurol 2022; 269:6589-6596. [PMID: 35997817 PMCID: PMC10947801 DOI: 10.1007/s00415-022-11333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) usage confers significant mortality/disability. We aimed to understand the clinical and neuroimaging features associated with developing ICH among DOAC users. METHODS Clinical and radiological data were collected from consecutive DOAC users with ICH (DOAC-ICH) and age-matched controls without ICH from a single referral center. The frequency/distribution of MRI markers of hemorrhage risk were assessed. Baseline demographics and neuroimaging markers were compared in univariate tests. Significant associations (p < 0.1) were entered into a multivariable regression model to determine predictors of ICH. RESULTS 86 DOAC-ICH and 94 ICH-free patients were included. Diabetes, coronary artery disease, prior ischemic stroke, smoking history, and antiplatelet usage were more common in ICH patients than ICH-free DOAC users. In the neuroimaging analyses, severe white matter hyperintensities (WMHs), lacunes, cortical superficial siderosis (cSS), and cerebral microbleeds (CMBs) were more common in the ICH cohort than the ICH-free cohort. In the multivariable regression, diabetes [OR 3.53 95% CI (1.05-11.87)], prior ischemic stroke [OR 14.80 95% CI (3.33-65.77)], smoking history [OR 3.08 95% CI (1.05-9.01)], CMBs [OR 4.07 95% CI (1.45-11.39)], and cSS [OR 39.73 95% CI (3.43-460.24)] were independently associated with ICH. CONCLUSIONS Risk factors including diabetes, prior stroke, and smoking history as well as MRI biomarkers including CMBs and cSS are associated with ICH in DOAC users. Although screening MRIs are not typically performed prior to initiating DOAC therapy, these data suggest that patients of high-hemorrhagic risk may be identified.
Collapse
Affiliation(s)
- Alvin S Das
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Elif Gökçal
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Robert W Regenhardt
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Andrew D Warren
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Alessandro Biffi
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Taylor Kimberly
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Lee H Schwamm
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Jonathan Rosand
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
| |
Collapse
|
10
|
Shen Y, Li F, Cao L, Wang Y, Xiao J, Zhou X, Tian T. Hip Osteoarthritis and the Risk of Lacunar Stroke: A Two-Sample Mendelian Randomization Study. Genes (Basel) 2022; 13:genes13091584. [PMID: 36140752 PMCID: PMC9498627 DOI: 10.3390/genes13091584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Whether hip osteoarthritis (OA) could increase the risk of lacunar stroke (LS) is not well understood. This two-sample Mendelian randomization (MR) study aimed to investigate in depth the effect of genetically predicted hip OA on LS risk. Hip OA-related instrumental variables (IVs) were selected from a genome-wide association study (GWAS) of 393,873 individuals. The summary data of LS were obtained from a GWAS meta-analysis, including 16,030 cases and 248,929 controls. We used the inverse-variance weighted (IVW) as the primary MR analysis method. Moreover, the weighted-median, MR-Egger regression, and the MR pleiotropy residual sum and outlier (MR-PRESSO) test were supplementary methods. The sensitivity analysis was performed using the leave-one-out test. We identified the positive causal relationship between hip OA and the risk of LS (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.07, 1.36; p = 0.002 using the IVW method). The weighted median method provided similar results. There was no evidence of directed pleiotropy, and sensitivity analysis results were stable, suggesting the robustness of our study. This study showed a causal effect of hip OA on the risk of LS, and more efforts should be made to explore the potential mechanisms in the future.
Collapse
Affiliation(s)
- Yi Shen
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Fuju Li
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Lina Cao
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Yunyun Wang
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Jing Xiao
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Xiaoyi Zhou
- Center for Disease Control and Prevention of Nantong, Nantong 226007, China
- Correspondence: (X.Z.); (T.T.); Tel.: +86-1891-439-6755 (X.Z.); +86-1599-655-5458 (T.T.)
| | - Tian Tian
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
- Correspondence: (X.Z.); (T.T.); Tel.: +86-1891-439-6755 (X.Z.); +86-1599-655-5458 (T.T.)
| |
Collapse
|
11
|
Shahali H, Farahani RH, Asgari A, Hazrati E. Thalamic hemi-chorea: a rare complication after receiving the adenoviral vector-based COVID-19 vaccine: a case report. Clin Exp Vaccine Res 2022; 11:217-221. [PMID: 35799877 PMCID: PMC9200646 DOI: 10.7774/cevr.2022.11.2.217] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/28/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022] Open
Abstract
Lacunar strokes occur when a branch of a large cerebral artery is blocked. The thalamus is often affected, causing uncontrollable motions. A 72-year-old previously healthy man presented with involuntary motions in the right limbs, which were present at rest, and exacerbated during voluntary actions. He had received the first dose of the adenoviral vector-based coronavirus disease 2019 vaccine (ChAdOx1 nCoV-19) 9 days ago. Severe thrombocytopenia and elevated levels of lactate dehydrogenase, ferritin, C-reactive protein, and D-dimer were found, without any evidence of connective tissue disease. Electromyography demonstrated typical choreiform movements, and the brain magnetic resonance imaging indicated a small high signal lesion on the left side of the thalamus. Detection of the immunoglobulin G antibodies against platelet factor 4 in the blood, negative heparin-induced platelet activation (HIPA) test, and positive modified HIPA test confirmed the thalamic stroke due to the vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). He was admitted to the intensive care unit and received nadroparin, sodium ozagrel, edaravone, methylprednisolone, and haloperidol. His hemi-chorea improved gradually over 2 weeks, and he was discharged after 21 days with rehabilitation advice. VIPIT due to the ChAdOx1 nCoV-19 is a novel immune-mediated response that needs clinicians' awareness and further investigations.
Collapse
Affiliation(s)
- Hamze Shahali
- Faculty of Aerospace and Sub-Aquatic Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ali Asgari
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- Department of Anesthesiology and Critical Care, Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Apiratwarakul K, Boonrod A, Piyawattanametha N, Ienghong K, Sripadungkul D, Tiamkao S, Cheung LW. The Role of Doctors in Ambulance Management of Stroke Patients in Emergency Medical Services. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Strokes are one of the most common of all neurological diseases and can be found in all genders and ages. Emergency medical services (EMS) are the first line of care with access to stroke patients from on the scene assessment to initial treatment. However, currently there are no studies regarding the role doctors play in initial ambulance contact to assess stroke patients.
AIM: To analyze the role of doctors in ambulances managing stroke patients in EMS.
METHODS: This was a retrospective study over a five-year period (2017-2021) at Srinagarind Hospital EMS units. The information from the EMS database was transferred completely into the data record form and imported into the computer system for further data analysis.
RESULTS: A total of 10,329 EMS operations were examined. The mean age of the patients was 52.10 ± 10.24 years. A total of 64.4% (n = 6650) of them were male. The afternoon shift was the most common time for EMS operations with doctors in the stroke group (42.9%) and non-stroke group (59.3%). The distance from hospital to the scene in the stroke group was 12.6 ± 3.2 km. The average response time for stroke group and non-stroke group were 7.05 minutes and 9.50 minutes, respectively
CONCLUSIONS: The role of doctors in the ambulance to manage stroke patients in EMS directly resulted in a decrease in time in arriving at the scene to diagnose, arriving at the laboratory, and arriving at the scene to activate the special team.
Collapse
|
13
|
Shahali H, Hamidi Farahani R, Hazrati P, Hazrati E. Acute vestibular neuritis: A rare complication after the adenoviral vector-based COVID-19 vaccine. J Neurovirol 2022; 28:609-615. [PMID: 35877063 PMCID: PMC9310685 DOI: 10.1007/s13365-022-01087-y] [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: 09/03/2021] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 01/13/2023]
Abstract
Vestibular neuritis was first reported in 1952 by Dix and Hallpike, and 30% of patients reporting a flu-like symptom before acquiring the disorder. The most common causes are viral infections, often resulting from systemic viral infections or bacterial labyrinthitis. Here we presented a rare case of acute vestibular neuritis after the adenoviral vector-based COVID-19 vaccination. A 51-year-old male pilot awoke early in the morning with severe vertigo, nausea, and vomiting after receiving the first dose of the ChAdOx1 nCoV-19 vaccine 11 days ago. Nasopharyngeal SARS-CoV-2 RT-PCR test and chest CT scan were inconclusive for COVID-19 pneumonia. Significant findings were a severe spontaneous and constant true-whirling vertigo which worsened with head movement, horizontal-torsional spontaneous nystagmus, abnormal caloric test, positive bedside head impulse tests, and inability to tolerate head-thrust test. PTA, MRI of the brain and internal auditory canal, and cerebral CT arteriography were normal. According to the clinical, imaging, and laboratory findings, he was admitted to the neurology ward and received treatment for vestibular neuritis. His vertigo increased gradually over 6-8 h, peaking on the first day, and gradually subsided over 7 days. Ten days later, the symptoms became tolerable; the patient was discharged with advice for home-based vestibular rehabilitation exercises. Despite the proper treatment and rehabilitation, signs of dynamic vestibular imbalances persisted after 1 year. Based on the Federal Aviation Administration (FAA) regulations, the Air Medical Council (AMC) suspended him from flight duties until receiving full recovery. Several cases of vestibular neuritis have been reported in the COVID-19 patients and after the COVID-19 vaccination. This is the first case report of acute vestibular neuritis after the ChAdOx1 nCoV-19 vaccination in a healthy pilot without past medical history. However, the authors believe that this is a primary clinical suspicion that must be considered and confirmed after complete investigations.
Collapse
Affiliation(s)
- Hamze Shahali
- Aerospace and Sub-Aquatic Medical Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Dept of Infectious and Tropical Diseases, Medical Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Parham Hazrati
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- Dept of Anesthesiology and Intensive Care, Medical Faculty, Aja University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Lacunar Syndromes, Lacunar Infarcts, and Cerebral Small-Vessel Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Zureigat H, Alhusban M, Cobia M. Mechanical Thrombectomy Outcomes in COVID-19 Patients With Acute Ischemic Stroke: A Narrative Review. Neurologist 2021; 26:261-267. [PMID: 34734904 PMCID: PMC8575107 DOI: 10.1097/nrl.0000000000000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been shown to associate with increased risk of thromboembolic events. Mechanical thrombectomy (MT) has long been used to effectively manage those with large-vessel occlusive (LVO) stroke and has similarly been implemented in the management of stroke in COVID-19 patients. REVIEW SUMMARY The COVID-19 pandemic took the health care sector by a storm. Thus, less is known about MT outcomes in this population and evidence suggesting poor outcomes postthrombectomy for COVID-19 patients is accumulating. We provide a narrative on some of the published studies on the outcomes of MT in COVID-19 patients with LVO between March 2020 and February 2021. A description of patient characteristics, risk factors, COVID-19 infection severity, stroke features and thrombectomy success in this population is also presented as data from several studies show that LVO in COVID-19 patients may have some distinguishing characteristics that make management more challenging. CONCLUSIONS The effect of COVID-19 on the long-term prognosis of stroke patients after thrombectomy is yet to be determined. The accumulating evidence from current studies indicates a negative impact of COVID-19 on outcomes in acute ischemic stroke patients who receive MT, irrespective of timely, successful angiographic recanalization. This review may help alert clinicians of some of the COVID-19-specific postthrombectomy challenges.
Collapse
Affiliation(s)
| | - Muna Alhusban
- School of Medicine, University of Jordan, Amman, Jordan
| | - Miles Cobia
- the Department of Neurology, Grandview Medical Center, Birmingham, AL
| |
Collapse
|
16
|
Vynckier J, Maamari B, Grunder L, Goeldlin MB, Meinel TR, Kaesmacher J, Hakim A, Arnold M, Gralla J, Seiffge DJ, Fischer U. Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology 2021; 97:e1437-e1446. [PMID: 34400585 DOI: 10.1212/wnl.0000000000012661] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the rate and predictors of early neurologic deterioration (END) in patients with lacunar strokes and its implications for management and outcome. METHODS We enrolled consecutive patients with MRI-defined lacunar stroke who presented within 12 hours after symptom onset from a prospective stroke database (2015-2019). END was defined as any persisting increase in NIH Stroke Scale (NIHSS) score of ≥2 points within 24 hours after admission and favorable outcome as modified Rankin Scale (mRS) score of 0 to 2 at 90 days. We assessed the association of END with clinical and imaging variables, acute treatment, and outcome using multivariable regression, calculating adjusted odds ratios (aORs). RESULTS Sixty-one of 365 (16.7%) patients with acute lacunar stroke (median age 71.8 years, 39.5% female, median NIHSS score on admission 3) had END. Lower NIHSS score on admission (per point, aOR 0.81, p = 0.006), capsular warning syndrome (aOR 7.00, p < 0.001), ventral pontine infarct (aOR 3.49, p = 0.008), and hypoperfusion lesion on imaging (aOR 2.13, p = 0.026) were associated with END. Acute dual antiplatelet therapy was associated with reduced risk of END (aOR 0.10, p = 0.04). Patients with END had less favorable outcome at 90 days (aOR 0.13 p < 0.001), but IV thrombolysis (IVT) was associated with favorable outcome at 90 days (aOR 3.95, p = 0.002). DISCUSSION One in 6 patients with lacunar stroke has END, and patients at high risk of END can be identified with radiologic and clinical variables. Targeted therapeutic trials for this population seem justified. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that early neurologic deterioration in patients with acute lacunar stroke predicts poorer functional outcome at 90 days as determined by the mRS.
Collapse
Affiliation(s)
- Jan Vynckier
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland.
| | - Basel Maamari
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Lorenz Grunder
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Martina Béatrice Goeldlin
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Thomas Raphael Meinel
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Johannes Kaesmacher
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Arsany Hakim
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Marcel Arnold
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Jan Gralla
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - David Julian Seiffge
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Urs Fischer
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| |
Collapse
|
17
|
Lecordier S, Manrique-Castano D, El Moghrabi Y, ElAli A. Neurovascular Alterations in Vascular Dementia: Emphasis on Risk Factors. Front Aging Neurosci 2021; 13:727590. [PMID: 34566627 PMCID: PMC8461067 DOI: 10.3389/fnagi.2021.727590] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 12/25/2022] Open
Abstract
Vascular dementia (VaD) constitutes the second most prevalent cause of dementia in the world after Alzheimer’s disease (AD). VaD regroups heterogeneous neurological conditions in which the decline of cognitive functions, including executive functions, is associated with structural and functional alterations in the cerebral vasculature. Among these cerebrovascular disorders, major stroke, and cerebral small vessel disease (cSVD) constitute the major risk factors for VaD. These conditions alter neurovascular functions leading to blood-brain barrier (BBB) deregulation, neurovascular coupling dysfunction, and inflammation. Accumulation of neurovascular impairments over time underlies the cognitive function decline associated with VaD. Furthermore, several vascular risk factors, such as hypertension, obesity, and diabetes have been shown to exacerbate neurovascular impairments and thus increase VaD prevalence. Importantly, air pollution constitutes an underestimated risk factor that triggers vascular dysfunction via inflammation and oxidative stress. The review summarizes the current knowledge related to the pathological mechanisms linking neurovascular impairments associated with stroke, cSVD, and vascular risk factors with a particular emphasis on air pollution, to VaD etiology and progression. Furthermore, the review discusses the major challenges to fully elucidate the pathobiology of VaD, as well as research directions to outline new therapeutic interventions.
Collapse
Affiliation(s)
- Sarah Lecordier
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Daniel Manrique-Castano
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Yara El Moghrabi
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Ayman ElAli
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| |
Collapse
|
18
|
Pavlovic AM. Cerebral small vessel disease and heart rate variability: A quest for nontraditional risk factors. J Clin Hypertens (Greenwich) 2021; 23:1810-1812. [PMID: 34418268 PMCID: PMC8678650 DOI: 10.1111/jch.14350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Aleksandra M Pavlovic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
19
|
Regenhardt RW, Rosenthal JA, Awad A, Martinez-Gutierrez JC, Nolan NM, McIntyre JA, Whitney C, Alotaibi NM, Dmytriw AA, Vranic JE, Stapleton CJ, Patel AB, Rost NS, Schwamm LH, Leslie-Mazwi TM. 'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model. J Neurointerv Surg 2021; 14:650-653. [PMID: 34326197 DOI: 10.1136/neurintsurg-2021-017819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Randomized trials have not demonstrated benefit from intravenous thrombolysis among patients undergoing endovascular thrombectomy (EVT). However, these trials included primarily patients presenting directly to an EVT capable hub center. We sought to study outcomes for EVT candidates who presented to spoke hospitals and were subsequently transferred for EVT consideration, comparing those administered alteplase at spokes (i.e., 'drip-and-ship' model) versus those not. METHODS Consecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pre-transfer CT angiography defined emergent large vessel occlusion and Alberta Stroke Program CT score ≥6 were identified from a prospectively maintained Telestroke database. Outcomes of interest included adequate reperfusion (Thrombolysis in Cerebral Infarction (TICI) 2b-3), intracerebral hemorrhage (ICH), discharge functional independence (modified Rankin Scale (mRS) ≤2), and 90 day functional independence. RESULTS Among 258 patients, median age was 70 years (IQR 60-81), median National Institutes of Health Stroke Scale (NIHSS) score was 13 (6-19), and 50% were women. Ninety-eight (38%) were treated with alteplase at spokes and 113 (44%) underwent EVT at the hub. Spoke alteplase use independently increased the odds of discharge mRS ≤2 (adjusted OR 2.43, 95% CI 1.08 to 5.46, p=0.03) and 90 day mRS ≤2 (adjusted OR 3.45, 95% CI 1.65 to 7.22, p=0.001), even when controlling for last known well, NIHSS, and EVT; it was not associated with an increased risk of ICH (OR 1.04, 95% CI 0.39 to 2.78, p=0.94), and there was a trend toward association with greater TICI 2b-3 (OR 3.59, 95% CI 0.94 to 13.70, p=0.06). CONCLUSIONS Intravenous alteplase at spoke hospitals may improve discharge and 90 day mRS and should not be withheld from EVT eligible patients who first present at alteplase capable spoke hospitals that do not perform EVT. Additional studies are warranted to confirm and further explore these benefits.
Collapse
Affiliation(s)
- Robert W Regenhardt
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA .,Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Rosenthal
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amine Awad
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Neal M Nolan
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joyce A McIntyre
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cynthia Whitney
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naif M Alotaibi
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dmytriw
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin E Vranic
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J Stapleton
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aman B Patel
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia S Rost
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thabele M Leslie-Mazwi
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Wang H, Fu X, Ju J, Meng D, Sun S, Guo C, Jia H, Sun Q. Acupuncture for patients recovering from lacunar infarction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26413. [PMID: 34160428 PMCID: PMC8238297 DOI: 10.1097/md.0000000000026413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lacunar infarction (LI) is the mild type in the classification of ischemic stroke, mostly occurs in the middle-aged and elderly, with mild hemiplegia and partial sensory disorder as the main manifestations. In the treatment of LI, acupuncture is often regarded as dominant therapy in the convalescence period. However, acupuncture for treatment of LI in the recovery period lacks high-quality reports and evidence-based medical evidence. Thus, we aim to evaluate the curative effect and safety of acupuncture for LI objectively. METHODS Pubmed, Cochrane Library, Web of Science, EBSCO, Springer, China National Knowledge Infrastructure, Chinese Scientific and Technical Journals Database (VIP), Wan-fang Database, Chinese Biomedical Literature Database, Chinese Science Citation Database, and other electronic databases will be retrieved from the inception to May, 2021. Randomized controlled trials related to this subject will be searched. The inclusion criteria are established and a detailed literature search strategy is designed through discussion. Article retrieval, screening, excluding repetitive studies, assessment of quality, and data processing will be conducted by 2 reviewers independently using EndNote (X9) and Review Manager (5.3.5). The outcome measures include primary outcome measures (total effective rate, National Institute of Health Stroke Scale score, and Fugl-Meyer Assessment score), secondary outcome measures (blood pressure, plasma glucose, and blood lipid), and safety outcome measures. We will perform a meta-analysis, descriptive analysis, and subgroup analysis based on data conditions. RESULTS The study of total effective rate, National Institute of Health Stroke Scale score, Fugl-Meyer Assessment score, blood pressure, plasma glucose, blood lipid, and adverse effects will provide evidenced outcome for high-quality synthesis and descriptive analysis. CONCLUSION This systematic review will kindly provide evidence of whether acupuncture is an effective and safe intervention for LI in the recovery period. INPLASY REGISTRATION NUMBER INPLASY202150060 (DOI:10.37766/inplasy2021.5.0060).
Collapse
Affiliation(s)
- Haoran Wang
- Department of Rehabilitation Medicine, The Second Hospital of Shandong University
| | - Xiaoyan Fu
- Department of Endocrinology, Jinan Huaiyin People's Hospital
| | - Jing Ju
- Shandong University of Traditional Chinese Medicine
| | - Dan Meng
- Shandong University of Traditional Chinese Medicine
| | - Shengming Sun
- Department of Traditional Chinese Medicine, Shandong Provincial Public Health Clinical Center
| | - Chenchen Guo
- Neck-Shoulder and Lumbocrural Pain Hospital Affiliated to Shandong First Medical University
| | - Hongling Jia
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qiangsan Sun
- Department of Rehabilitation Medicine, The Second Hospital of Shandong University
| |
Collapse
|
21
|
English SW, Landzberg DR, Bhatt NR, Frankel MR, Navalkele D. Safety of Ticagrelor in Moderate and Severe Acute Ischemic Stroke: A Single-Center Retrospective Review. J Stroke Cerebrovasc Dis 2021; 30:105767. [PMID: 33823462 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105767] [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: 01/16/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Ticagrelor may be superior to aspirin after minor ischemic stroke or TIA, particularly in patients with symptomatic atherosclerotic disease. However, there may be an increased risk of intracerebral hemorrhage in patients with moderate to severe ischemic stroke, and ticagrelor has not been studied in this patient population. Therefore, we sought to evaluate the safety of ticagrelor after moderate or severe ischemic stroke. MATERIALS AND METHODS Retrospective chart review of all patients admitted with acute ischemic stroke and NIHSS 6 or greater who were discharged on ticagrelor between January 2016 and December 2019. Patients who underwent angioplasty, stenting or carotid revascularization during the hospitalization were excluded. RESULTS Of 183 patients discharged on ticagrelor, 61 patients were included. Median age was 61 (IQR 52-68); 33 (54%) patients were men. Median NIHSS was 11 (IQR 8-15). Fourteen (23%) patients received IV alteplase and 35 (57%) patients received mechanical thrombectomy. Stroke mechanism was large artery atherosclerosis in 53 (87%) of patients, of which 40 (71%) were deemed intracranial atherosclerosis. Final infarct volume was greater than 10 mL in 32 (52%) patients. Follow-up information was available for 53 (87%) patients; median length of follow-up was 3 (IQR 2-6) months. Six (10%) patients experienced recurrent ischemic stroke. No patients experienced symptomatic intracerebral hemorrhage after initiation of ticagrelor. One (2%) patient experienced major bleeding. CONCLUSIONS This study provides preliminary evidence supporting the potential safety of ticagrelor following moderate or severe acute ischemic stroke. These findings support the need for future prospective studies.
Collapse
Affiliation(s)
| | - David R Landzberg
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA, USA.
| | - Nirav R Bhatt
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA, USA.
| | - Michael R Frankel
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA, USA.
| | - Digvijaya Navalkele
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA, USA.
| |
Collapse
|
22
|
Zheng L, Wang Z, Liu J, Yang X, Zhang S, Hao Z, Liu M, Wang D. Association between admission blood fibrinogen-to-albumin ratio and clinical outcomes after acute lacunar stroke. Biomark Med 2021; 15:87-96. [PMID: 33442997 DOI: 10.2217/bmm-2019-0537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 02/08/2023] Open
Abstract
Aim: We aimed to investigate the influence of admission fibrinogen-to-albumin ratio (FAR) on 3-month outcomes after acute lacunar stroke. Materials & methods: Consecutive patients with acute lacunar stroke were included and classified into two groups according to an optimized FAR cut-off value determined by receiver operating characteristic curve analysis. Results: Compared with those with low FAR (<0.077), patients from the high FAR group (≥0.077) had significantly higher risk for 3-month disability and the composite outcome of death/disability. After logistic regression adjustment, high FAR was still significantly associated with 3-month disability and death/disability. Conclusion: FAR ≥0.077 on admission might be an independent predictor of disability and death/disability at 3 months after lacunar stroke, which needs to be verified in future studies.
Collapse
Affiliation(s)
- Lukai Zheng
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zhetao Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xue Yang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shihong Zhang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zilong Hao
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Deren Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China
| |
Collapse
|
23
|
Gokcal E, Horn MJ, Gurol ME. The role of biomarkers and neuroimaging in ischemic/hemorrhagic risk assessment for cardiovascular/cerebrovascular disease prevention. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:345-357. [PMID: 33632452 DOI: 10.1016/b978-0-12-819814-8.00021-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stroke prevention in patients with atrial fibrillation is arguably one of the fastest developing areas in preventive medicine. The increasing use of direct oral anticoagulants and nonpharmacologic methods such as left atrial appendage closure for stroke prevention in these patients has increased clinicians' options for optimal care. Platelet antiaggregants are also commonly used in other ischemic cardiovascular and or cerebrovascular conditions. Long term use of oral anticoagulants for atrial fibrillation is associated with elevated risks of major bleeds including especially brain hemorrhages, which are known to have extremely poor outcomes. Neuroimaging and other biomarkers have been validated to stratify brain hemorrhage risk among older adults. A thorough understanding of these biomarkers is essential for selection of appropriate anticoagulant or left atrial appendage closure for stroke prevention in patients with atrial fibrillation. This article will address advances in the stratification of ischemic and hemorrhagic stroke risk among patients with atrial fibrillation and other conditions.
Collapse
Affiliation(s)
- Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
| |
Collapse
|
24
|
Das AS, Regenhardt RW, LaRose S, Monk AD, Castro PM, Sheriff FG, Sorond FA, Vaitkevicius H. Microembolic Signals Detected by Transcranial Doppler Predict Future Stroke and Poor Outcomes. J Neuroimaging 2020; 30:882-889. [PMID: 32648610 DOI: 10.1111/jon.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Although transcranial Doppler detects microembolic signals (MES) in numerous settings, the practical significance of such findings remains unclear. METHODS Clinical information from ischemic stroke or transient ischemic attack patients (n = 248) who underwent embolic monitoring from January 2015 to December 2018 was obtained. RESULTS MES were found in 15% of studies and ischemic recurrence was seen in 11% of patients (over 7 ± 6 days). Patients with MES had more lacunes than those without MES (1 ± 3 vs. 1 ± 2, P = .016), were more likely to have ischemic recurrence (37% vs. 6%, P < .001), undergo a future revascularization procedure (26% vs. 10%, P = .005), have a longer length of stay (9 vs. 4 days, P = .043), and have worse functional disability at discharge (modified Rankin Scale 3-6, 66% vs. 34%, P < .001). After controlling for several relevant cofactors, patients with MES were more likely to have ischemic recurrence (HR 4.90, 95% CI 2.16-11.09, P < .001), worse functional disability (OR 3.31, 95% CI 1.22-8.99, P = .019), and longer length of stays (β = .202, P < .001). CONCLUSIONS MES may help to risk stratify patients as their presence is associated with ischemic recurrence and worse outcomes.
Collapse
Affiliation(s)
- Alvin S Das
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarah LaRose
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew D Monk
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pedro M Castro
- Department of Neurology, Centro Hospital Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Faheem G Sheriff
- Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, IL
| | - Henrikas Vaitkevicius
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
25
|
Regenhardt RW, Takase H, Lo EH, Lin DJ. Translating concepts of neural repair after stroke: Structural and functional targets for recovery. Restor Neurol Neurosci 2020; 38:67-92. [PMID: 31929129 PMCID: PMC7442117 DOI: 10.3233/rnn-190978] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is among the most common causes of adult disability worldwide, and its disease burden is shifting towards that of a long-term condition. Therefore, the development of approaches to enhance recovery and augment neural repair after stroke will be critical. Recovery after stroke involves complex interrelated systems of neural repair. There are changes in both structure (at the molecular, cellular, and tissue levels) and function (in terms of excitability, cortical maps, and networks) that occur spontaneously within the brain. Several approaches to augment neural repair through enhancing these changes are under study. These include identifying novel drug targets, implementing rehabilitation strategies, and developing new neurotechnologies. Each of these approaches has its own array of different proposed mechanisms. Current investigation has emphasized both cellular and circuit-based targets in both gray and white matter, including axon sprouting, dendritic branching, neurogenesis, axon preservation, remyelination, blood brain barrier integrity, blockade of extracellular inhibitory signals, alteration of excitability, and promotion of new brain cortical maps and networks. Herein, we review for clinicians recovery after stroke, basic elements of spontaneous neural repair, and ongoing work to augment neural repair. Future study requires alignment of basic, translational, and clinical research. The field continues to grow while becoming more clearly defined. As thrombolysis changed stroke care in the 1990 s and thrombectomy in the 2010 s, the augmentation of neural repair and recovery after stroke may revolutionize care for these patients in the coming decade.
Collapse
Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Hajime Takase
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - David J Lin
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| |
Collapse
|
26
|
Xiang L, Lou Y, Liu L, Liu Y, Zhang W, Deng J, Guan Y, She M, You X, Liu M, Li H, Xu X, Liu F, Cai X. Gut Microbiotic Features Aiding the Diagnosis of Acute Ischemic Stroke. Front Cell Infect Microbiol 2020; 10:587284. [PMID: 33409158 PMCID: PMC7779606 DOI: 10.3389/fcimb.2020.587284] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
Increasing evidence suggests that features of the gut microbiota correlate with ischemic stroke. However, the specific characteristics of the gut microbiota in patients suffering different types of ischemic stroke, or recovering from such strokes, have rarely been studied, and potential microbiotic predictors of different types of stroke have seldom been analyzed. We subjected fecal specimens from patients with lacunar or non-lacunar acute ischemic infarctions, and those recovering from such strokes, to bacterial 16S rRNA sequencing and compared the results to those of healthy volunteers. We identified microbial markers of different types of ischemic stroke and verified that these were of diagnostic utility. Patients with two types of ischemic stroke, and those recovering from ischemic stroke, exhibited significant shifts in microbiotic diversities compared to healthy subjects. Cluster of Orthologous Groups of Proteins (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed reduced metabolic and transport-related pathway activities in ischemic stroke patients. We performed fivefold cross-validation using a Random Forest model to identify two optimal bacterial species (operational taxonomic units; OTUs) serving as markers of lacunar infarction; these were Lachnospiraceae (OTU_45) and Bacteroides (OTU_4), and the areas under the receiver operating characteristic curves (AUCs under the ROCs) were 0.881 and 0.872 respectively. In terms of non-lacunar acute ischemic infarction detection, the two optimal species were Bilophila (OTU_330) and Lachnospiraceae (OTU_338); the AUCs under the ROCs were 0.985 and 0.929 respectively. In post-ischemic stroke patients, the three optimal species were Pseudomonas (OTU_35), Sphingomonadaceae (OTU_303), and Akkermansia (OTU_9); the AUCs under the ROCs were 1, 0.897, and 0.846 respectively. Notably, the gut microbial markers were of considerable value for utility when diagnosing lacunar infarction, non-lacunar acute ischemic infarction, and post-ischemic stroke. This study is the first to characterize the gut microbiotic profiles of patients with lacunar or non-lacunar, acute ischemic strokes, and those recovering from stroke, and to identify microbiotic predictors of such strokes.
Collapse
Affiliation(s)
- Lei Xiang
- Department of Integrative Chinese and Western Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanfeng Lou
- Department of Dermatology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Lingyu Liu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Yuanling Liu
- Administrative Department, Guangdong Province Hospital for Women and Children Healthcare, Guangzhou, China
| | - Weizheng Zhang
- Clinical Laboratory, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianxin Deng
- Department of Endocrinology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen, China
| | - Yubin Guan
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Miaoqin She
- Research Section, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xinchao You
- Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Minqi Liu
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hongwei Li
- Institute of Biotherapy, Southern Medical University, Guangzhou, China
| | - Xiaosong Xu
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- *Correspondence: Xiangsheng Cai, ; Fang Liu, ; Xiaosong Xu,
| | - Fang Liu
- Department of Dermatology, Jinling Hospital, Southern Medical University, Nanjing, China
- *Correspondence: Xiangsheng Cai, ; Fang Liu, ; Xiaosong Xu,
| | - Xiangsheng Cai
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Center for Medical Experiments, University of Chinese Academy of Science-Shenzhen Hospital, Shenzhen, China
- *Correspondence: Xiangsheng Cai, ; Fang Liu, ; Xiaosong Xu,
| |
Collapse
|
27
|
Smith EE, Markus HS. New Treatment Approaches to Modify the Course of Cerebral Small Vessel Diseases. Stroke 2019; 51:38-46. [PMID: 31752610 DOI: 10.1161/strokeaha.119.024150] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Eric E Smith
- From the Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)
| | - Hugh S Markus
- Department of Clinical Neurosciences, Cambridge University, United Kingdom (H.S.M.)
| |
Collapse
|