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Kościołek D, Kobierecki M, Tokarski M, Szalbot K, Kościołek A, Malicki M, Wanibuchi S, Wiśniewski K, Piotrowski M, Bobeff EJ, Szmyd BM, Jaskólski DJ. The Anterior Inferior Cerebral Artery Variability in the Context of Neurovascular Compression Syndromes: A Narrative Review. Biomedicines 2024; 12:452. [PMID: 38398054 PMCID: PMC10887044 DOI: 10.3390/biomedicines12020452] [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: 01/24/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
The anterior inferior cerebellar artery (AICA) is situated within the posterior cranial fossa and typically arises from the basilar artery, usually at the pontomedullary junction. AICA is implicated in various clinical conditions, encompassing the development of aneurysms, thrombus formation, and the manifestation of lateral pontine syndrome. Furthermore, owing to its close proximity to cranial nerves within the middle cerebellopontine angle, AICA's pulsatile compression at the root entry/exit zone of cranial nerves may give rise to specific neurovascular compression syndromes (NVCs), including hemifacial spasm (HFS) and geniculate neuralgia concurrent with HFS. In this narrative review, we undertake an examination of the influence of anatomical variations in AICA on the occurrence of NVCs. Significant methodological disparities between cadaveric and radiological studies (CTA, MRA, and DSA) were found, particularly in diagnosing AICA's absence, which was more common in radiological studies (up to 36.1%) compared to cadaver studies (less than 5%). Other observed variations included atypical origins from the vertebral artery and basilar-vertebral junction, as well as the AICA-and-PICA common trunk. Single cases of arterial triplication or fenestration have also been documented. Specifically, in relation to HFS, AICA variants that compress the facial nerve at its root entry/exit zone include parabola-shaped loops, dominant segments proximal to the REZ, and anchor-shaped bifurcations impacting the nerve's cisternal portion.
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Affiliation(s)
- Dawid Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mateusz Kobierecki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Tokarski
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Konrad Szalbot
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Aleksandra Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Malicki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Sora Wanibuchi
- The Faculty of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Karol Wiśniewski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Michał Piotrowski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland
| | - Bartosz M. Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
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Ma Y, Lu Q, Wang X, Wang Y, Yuan F, Chen H. Establishment and validation of a nomogram for predicting new fractures after PKP treatment of for osteoporotic vertebral compression fractures in the elderly individuals. BMC Musculoskelet Disord 2023; 24:728. [PMID: 37700293 PMCID: PMC10496219 DOI: 10.1186/s12891-023-06801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND To investigate the risk factors for new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) and to create a nomogram to predict the occurrence of new postoperative fractures. METHODS This was a retrospective analysis of the clinical data of 529 OVCF patients who received PKP treatment in our hospital from June 2017 to June 2020. Based on whether there were new fractures within 2 years after surgery, the patients were divided into a new fracture group and a nonnew fracture group. Univariate and multivariate analyses were used to determine the risk factors for the occurrence of NVCFs after surgery. The data were randomly divided into a training set (75%) and a testing set (25%). Nomograms predicting the risk of NVCF occurrence were created based on the results of the multivariate analysis, and performance was evaluated using receiver operating characteristic curves (ROCs), calibration curves, and decision curve analyses (DCAs). A web calculator was created to give clinicians a more convenient interactive experience. RESULTS A total of 56 patients (10.6%) had NVCFs after surgery. The univariate analysis showed significant differences in sex and the incidences of cerebrovascular disease, a positive fracture history, and bone cement intervertebral leakage between the two groups (P < 0.05). The multivariate analysis showed that sex [OR = 2.621, 95% CI (1.030-6.673), P = 0.043], cerebrovascular disease [OR = 28.522, 95% CI (8.749-92.989), P = 0.000], fracture history [OR = 12.298, 95% CI (6.250-24.199), P = 0.000], and bone cement intervertebral leakage [OR = 2.501, 95% CI (1.029-6.082), P = 0.043] were independent risk factors that were positively associated with the occurrence of NVCFs. The AUCs of the model were 0.795 (95% CI: 0.716-0.874) and 0.861 (95% CI: 0.749-0.974) in the training and testing sets, respectively, and the calibration curves showed high agreement between the predicted and actual states. The areas under the decision curve were 0.021 and 0.036, respectively. CONCLUSION Female sex, cerebrovascular disease, fracture history and bone cement intervertebral leakage are risk factors for NVCF after PKP. Based on this, a highly accurate nomogram was developed, and a webpage calculator ( https://new-fracture.shinyapps.io/DynNomapp/ ) was created.
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Affiliation(s)
- Yiming Ma
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Qi Lu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Xuezhi Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Yalei Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Feng Yuan
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
| | - Hongliang Chen
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
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Ma Y, Lu Q, Yuan F, Chen H. Comparison of the effectiveness of different machine learning algorithms in predicting new fractures after PKP for osteoporotic vertebral compression fractures. J Orthop Surg Res 2023; 18:62. [PMID: 36683045 PMCID: PMC9869614 DOI: 10.1186/s13018-023-03551-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The use of machine learning has the potential to estimate the probability of a second classification event more accurately than traditional statistical methods, and few previous studies on predicting new fractures after osteoporotic vertebral compression fractures (OVCFs) have focussed on this point. The aim of this study was to explore whether several different machine learning models could produce better predictions than logistic regression models and to select an optimal model. METHODS A retrospective analysis of 529 patients who underwent percutaneous kyphoplasty (PKP) for OVCFs at our institution between June 2017 and June 2020 was performed. The patient data were used to create machine learning (including decision trees (DT), random forests (RF), support vector machines (SVM), gradient boosting machines (GBM), neural networks (NNET), and regularized discriminant analysis (RDA)) and logistic regression models (LR) to estimate the probability of new fractures occurring after surgery. The dataset was divided into a training set (75%) and a test set (25%), and machine learning models were built in the training set after ten cross-validations, after which each model was evaluated in the test set, and model performance was assessed by comparing the area under the curve (AUC) of each model. RESULTS Among the six machine learning algorithms, except that the AUC of DT [0.775 (95% CI 0.728-0.822)] was lower than that of LR [0.831 (95% CI 0.783-0.878)], RA [0.953 (95% CI 0.927-0.980)], GBM [0.941 (95% CI 0.911-0.971)], SVM [0.869 (95% CI 0.827-0.910), NNET [0.869 (95% CI 0.826-0.912)], and RDA [0.890 (95% CI 0.851-0.929)] were all better than LR. CONCLUSIONS For prediction of the probability of new fracture after PKP, machine learning algorithms outperformed logistic regression, with random forest having the strongest predictive power.
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Affiliation(s)
- Yiming Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004 Jiangsu China
| | - Qi Lu
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004 Jiangsu China
| | - Feng Yuan
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
| | - Hongliang Chen
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
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Corrêa DG, Hygino da Cruz LC, Freddi TDAL. The oculomotor nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 43:389-399. [DOI: 10.1053/j.sult.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wang A, Hu K, Yang Y, Yang B, Liu J, Chen X, Liu Y, Si Z. Susac syndrome with the typical clinical triad: A case report and literature review. J Neuroimmunol 2022; 367:577822. [DOI: 10.1016/j.jneuroim.2022.577822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/31/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
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Kešnerová P, Školoudík D, Herzig R, Netuka D, Szegedi I, Langová K. Peripheral Vascular Resistance in Cerebral Arteries in Patients With Carotid Atherosclerosis - Substudy Results of the Atherosclerotic Plaque Characteristics Associated With a Progression Rate of the Plaque and a Risk of Stroke in Patients With the Carotid Bifurcation Plaque Study (ANTIQUE). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:237-246. [PMID: 33792942 DOI: 10.1002/jum.15703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Transcranial color-coded duplex sonography (TCCS) enables to measure blood flow characteristics in cerebral vessels, including vascular resistance and pulsatility. The study aims to identify factors influencing pulsatility (PI) and resistance (RI) indices measured using TCCS in patients with carotid atherosclerosis. METHODS Self-sufficient patients with atherosclerotic plaque causing 20-70% carotid stenosis were consecutively enrolled to the study. All patients underwent duplex sonography of cervical arteries and TCCS with measurement of PI and RI in the middle cerebral artery, neurological, and physical examinations. Following data were recorded: age, gender, height, weight, body mass index, systolic and diastolic blood pressure, occurrence of current and previous diseases, surgery, medication, smoking, and daily dose of alcohol. Univariant and multivariant logistic regression analysis were used for identification of the factors influencing RI and PI. RESULTS Totally 1863 subjects were enrolled to the study: 139 healthy controls (54 males, age 55.52 ± 7.05 years) in derivation cohort and 1724 patients (777 males, age 68.73 ± 9.39 years) in validation cohort. The cut off value for RI was 0.63 and for PI 1.21. Independent factors for increased RI/PI were age (odds ratio [OR] = 1.108/1.105 per 1 year), occurrence of diabetes mellitus (OR = 1.767/2.170), arterial hypertension (OR = 1.700 for RI only), width of the carotid plaque (OR = 1.260 per 10% stenosis for RI only), and male gender (OR = 1.530 for PI only; P ˂.01 in all cases). CONCLUSIONS The independent predictors of increased cerebral arterial resistance and/or pulsatility in patients with carotid atherosclerosis were age, arterial hypertension, diabetes mellitus, carotid plaque width, and male gender.
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Affiliation(s)
- Petra Kešnerová
- Department of Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurology, Comprehensive Stroke Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Školoudík
- Department of Neurology, Comprehensive Stroke Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Center for Health Research, Ostrava University Medical Faculty, Ostrava, Czech Republic
- Department of Neurology, Stroke Center, Vítkovice Hospital, Ostrava, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - David Netuka
- Department of Neurosurgery, First Faculty of Medicine and University Military Hospital Prague, Prague-Střešovice, Czech Republic
| | - Istvan Szegedi
- Department of Neurology, Debrecen University Faculty of Medicine and University Hospital Debrecen, Debrecen, Hungary
| | - Kateřina Langová
- Department of Biophysics, Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký University, Olomouc, Czech Republic
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Elsebaie N, Abdelzaher A, Gamaleldin O. Atypical intracranial aneurysms: spectrum of imaging findings in computed tomography and magnetic resonance imaging. Clin Imaging 2021; 83:1-10. [PMID: 34915276 DOI: 10.1016/j.clinimag.2021.12.003] [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: 08/08/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
We aim to describe demographics, clinical presentation, and spectrum of CT and MRI features suggestive of atypical intracranial aneurysms. The imaging protocols used for the diagnosis of intracranial aneurysms were thoroughly reviewed, including different CT and MRI protocols. We classified atypical aneurysms according to their location, size, clinical presentation, and specific imaging features. Dissecting aneurysms are one of the causes of stroke in young adults that may show intimal flap and double lumen. Traumatic intracranial aneurysms are a rare but serious complication of head injuries. Mycotic aneurysms are small and multiple at distal branch points with a high risk of rupture. Aneurysms with vasculitis are fusiform with a wide neck at a non-branch point that may be associated with vessel wall enhancement. Atherosclerotic aneurysms are usually large fusiform that affect large arteries. Oncotic aneurysms are relatively rare. They were reported to occur in patients with left atrial myxoma. Our study represented a wide spectrum of atypical intracranial aneurysms with their detailed diagnostic imaging findings on MRI and CT including newly introduced MRI sequences, which greatly influenced early diagnosis and timely management.
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Affiliation(s)
- Nermeen Elsebaie
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt.
| | - Ahmed Abdelzaher
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Omneya Gamaleldin
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt
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Morgan R, Prosapio J, Kara S, Sonty S, Youssef P, Nedd K. Preliminary clinical diagnostic criteria for chronic traumatic encephalopathy: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abdel Razek AAK, Alksas A, Shehata M, AbdelKhalek A, Abdel Baky K, El-Baz A, Helmy E. Clinical applications of artificial intelligence and radiomics in neuro-oncology imaging. Insights Imaging 2021; 12:152. [PMID: 34676470 PMCID: PMC8531173 DOI: 10.1186/s13244-021-01102-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022] Open
Abstract
This article is a comprehensive review of the basic background, technique, and clinical applications of artificial intelligence (AI) and radiomics in the field of neuro-oncology. A variety of AI and radiomics utilized conventional and advanced techniques to differentiate brain tumors from non-neoplastic lesions such as inflammatory and demyelinating brain lesions. It is used in the diagnosis of gliomas and discrimination of gliomas from lymphomas and metastasis. Also, semiautomated and automated tumor segmentation has been developed for radiotherapy planning and follow-up. It has a role in the grading, prediction of treatment response, and prognosis of gliomas. Radiogenomics allowed the connection of the imaging phenotype of the tumor to its molecular environment. In addition, AI is applied for the assessment of extra-axial brain tumors and pediatric tumors with high performance in tumor detection, classification, and stratification of patient's prognoses.
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Affiliation(s)
| | - Ahmed Alksas
- Biomaging Lab, Department of Bioengineering, University of Louisville, Louisville, KY, 40292, USA
| | - Mohamed Shehata
- Biomaging Lab, Department of Bioengineering, University of Louisville, Louisville, KY, 40292, USA
| | - Amr AbdelKhalek
- Internship at Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Khaled Abdel Baky
- Department of Diagnostic Radiology, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Ayman El-Baz
- Biomaging Lab, Department of Bioengineering, University of Louisville, Louisville, KY, 40292, USA
| | - Eman Helmy
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Elgomheryia Street, Mansoura, 3512, Egypt.
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Esmael A, Elsherief M, Razek AAKA, El-Sayed NTM, Elsalam MA, Flifel ME, Shawki S. Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Reliable and acceptable biomarkers are needed to anticipate the outcome and cognitive impairment following ischemic stroke. The goal of this research is to examine the association of ASPECTS with cognitive decline, biomarkers of stroke, and acute ischemic stroke outcomes. This study included 120 patients with ischemic stroke in the middle cerebral artery region. The initial NIHSS, non-contrast CT brain assessed by ASPECTS, and the biomarkers of cognitive decline such as ESR, CRP, S100B, MMP9, and glutamate were investigated. The Montreal Cognitive Assessment and modified Rankin scale (mRS) were evaluated after 3 months. Correlations between ASPECTS, MoCA, biomarkers of cognitive impairment, and mRS were done by Spearman correlation.
Results
The incidence of cognitive impairment in our patients was 25.8%. Stroke biomarkers (ESR, CRP, S100B, MMP9, and glutamate) were significantly increased in cognitively disabled individuals with significantly lower mean MoCA scores than in cognitively intact patients. There was a strong direct correlation linking the initial ASPECTS and total MoCA test score after 3 months follow-up. Cases with unfavorable outcomes were older, more incidence of hypertension, and had higher average initial NIHSS (P < 0.05). While the average ASPECTS scores for the favorable outcome group of patients were significantly higher and there was a significant negative correlation between the initial ASPECTS and modified Rankin Scale score.
Conclusions
ASPECTS is a reliable scale to identify the extent of acute ischemic injury and could participate in assessing the outcome. ASPECTS and particular neurocognitive stroke biomarkers will enable the early detection of post-stroke cognitive impairment.
Trial registration Registration of Clinical Trial Research: ClinicalTrials.gov ID: NCT04235920
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Ozaki M, Mano T, Eura N, Horimoto K, Takano M, Ohbayashi C, Sugie K. Multiple cerebral infarctions associated with lung cancer-induced hypereosinophilia: a case report. BMC Neurol 2021; 21:397. [PMID: 34641815 PMCID: PMC8513168 DOI: 10.1186/s12883-021-02423-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023] Open
Abstract
Background Hypereosinophilia (HE) is caused by various conditions, including solid and hematologic tumors. Nonetheless, there exist no reports on cerebral infarctions caused by HE associated with lung cancer metastasis to the bone marrow. Case presentation We report a case of a 67-year-old man with multiple cerebral infarctions associated with HE. His white blood cell and eosinophil counts were 38,900/μL and 13,600/μL, respectively, at 4 weeks before admission. During treatment for HE, he presented with dysarthria and walking difficulties. Magnetic resonance imaging of the brain showed multiple small infarcts in regions such as the bilateral cortex, watershed area, and cerebellum. Chest computed tomography showed small nodes in the lung and enlargement of the left hilar lymph nodes. Bronchoscopic biopsy did not reveal a tumor; however, bone marrow biopsy showed infiltration of tumor cells. We considered a diagnosis of lung cancer metastasizing to the bone marrow, which induced HE and later caused cerebral infarctions. Conclusions This case report demonstrates that metastatic cancer in the bone marrow can induce HE, which can consequently cause multiple cerebral infarctions. Clinicians should consider HE as a cause of multiple cerebral infarctions in patients with cancer.
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Affiliation(s)
- Maki Ozaki
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Nobuyuki Eura
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kazuhide Horimoto
- Second Department of Internal Medicine, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masato Takano
- Department of Diagnostic Pathology, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Talerico R, Tosoni A, Pilato F, Addolorato G, Marrone G. Cerebral infarction following cyanoacrylate endoscopic therapy of duodenal varices in a patient with a patent foramen ovale: comment. Intern Emerg Med 2021; 16:2021-2022. [PMID: 33704676 DOI: 10.1007/s11739-021-02692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rosa Talerico
- Department of Internal Medicine and Hepatogastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Tosoni
- Department of Internal Medicine and Hepatogastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Pilato
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Addolorato
- Department of Internal Medicine and Hepatogastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Marrone
- Department of Internal Medicine and Hepatogastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Bando T, Ueno Y, Kuroyama T, Shimo D, Mikami K, Hori S, Tanaka Y, Hirai O. Histopathological diagnosis of clot tissues collected by mechanical thrombectomy provides understanding of cerebral infarction pathology in cancer associated thrombosis: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kamis MFAK, Yaakob MNM, Rahim EA, Muda AS, Noh MSFM. Spontaneous Middle Cerebral Artery (MCA) dissection and stenosis: Role of vessel wall imaging and 3D-RA endoluminal view as adjunct diagnostic tools in endovascular therapy. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Cognitive decline, psychological distress and brain atrophy in recovery and residual periods of aneurysmal subarachnoid hemorrhage. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Yamamuro S, Yazawa G, Shiokawa R, Kajiwara R, Negishi H, Sumi K, Yoshino A. Erroneous resection of a cerebellar infarction – Lesson learned. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Merli E, Romoli M, Gentile M, Forlivesi S, Borghi AM, Zaniboni A, Simonetti L, Zini A. Bulbar watershed ischemic stroke: the comma-shaped sign-a case series. Neuroradiology 2021; 63:1947-1950. [PMID: 34191099 DOI: 10.1007/s00234-021-02754-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
Watershed infarcts can involve the brainstem, with lesions distributed across the terminal supply from the vertebral and cerebellar arteries. Brain imaging can highlight a comma-shaped lesion at the edge of vertebral and posteroinferior cerebellar artery vascularization territory. Such peculiar MRI lesion shape might suggest a watershed hypoperfusion etiology and direct workup towards causes of hemodynamic impairment, including postural hypotension, cardiac failure, or vertebral artery origin occlusion.
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Affiliation(s)
- Elena Merli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Michele Romoli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.,Neurology Clinic, S. Maria della Misericordia Hospital - University of Perugia, Perugia, Italy
| | - Mauro Gentile
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Stefano Forlivesi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Anna Maria Borghi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Anna Zaniboni
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Luigi Simonetti
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Department of Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurology and Metropolitan Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.
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18
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Alis D, Yergin M, Alis C, Topel C, Asmakutlu O, Bagcilar O, Senli YD, Ustundag A, Salt V, Dogan SN, Velioglu M, Selcuk HH, Kara B, Oksuz I, Kizilkilic O, Karaarslan E. Inter-vendor performance of deep learning in segmenting acute ischemic lesions on diffusion-weighted imaging: a multicenter study. Sci Rep 2021; 11:12434. [PMID: 34127692 PMCID: PMC8203621 DOI: 10.1038/s41598-021-91467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
Abstract
There is little evidence on the applicability of deep learning (DL) in the segmentation of acute ischemic lesions on diffusion-weighted imaging (DWI) between magnetic resonance imaging (MRI) scanners of different manufacturers. We retrospectively included DWI data of patients with acute ischemic lesions from six centers. Dataset A (n = 2986) and B (n = 3951) included data from Siemens and GE MRI scanners, respectively. The datasets were split into the training (80%), validation (10%), and internal test (10%) sets, and six neuroradiologists created ground-truth masks. Models A and B were the proposed neural networks trained on datasets A and B. The models subsequently fine-tuned across the datasets using their validation data. Another radiologist performed the segmentation on the test sets for comparisons. The median Dice scores of models A and B were 0.858 and 0.857 for the internal tests, which were non-inferior to the radiologist’s performance, but demonstrated lower performance than the radiologist on the external tests. Fine-tuned models A and B achieved median Dice scores of 0.832 and 0.846, which were non-inferior to the radiologist's performance on the external tests. The present work shows that the inter-vendor operability of deep learning for the segmentation of ischemic lesions on DWI might be enhanced via transfer learning; thereby, their clinical applicability and generalizability could be improved.
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Affiliation(s)
- Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
| | - Mert Yergin
- Department of Software Engineering and Applied Sciences, Bahcesehir University, Istanbul, Turkey
| | - Ceren Alis
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cagdas Topel
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/Istanbul, Turkey
| | - Ozan Asmakutlu
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/Istanbul, Turkey
| | - Omer Bagcilar
- Radiology Department, Istanbul Silivri State Hospital, Istanbul, Turkey
| | - Yeseren Deniz Senli
- Cerrahpaşa Medical Faculty, Radiology Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Ustundag
- Cerrahpaşa Medical Faculty, Radiology Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vefa Salt
- Cerrahpaşa Medical Faculty, Radiology Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebahat Nacar Dogan
- Radiology Department, Istanbul Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Murat Velioglu
- Radiology Department, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Hakan Hatem Selcuk
- Radiology Department, Istanbul Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Batuhan Kara
- Radiology Department, Istanbul Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ilkay Oksuz
- Department of Software Engineering and Applied Sciences, Istanbul Technical University, Istanbul, Turkey
| | - Osman Kizilkilic
- Cerrahpaşa Medical Faculty, Radiology Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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19
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Wang Z, Miao J, Wang L, Liu Y, Ji H, Zhang X, Cui L. EGFR-mutant NSCLC presenting with stroke and massive systemic embolization as the first manifestation: case report. BMC Neurol 2021; 21:221. [PMID: 34107910 PMCID: PMC8188717 DOI: 10.1186/s12883-021-02236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022] Open
Abstract
Background Presentation with massive systemic embolization as the initial manifestation of occult malignancy is infrequent. The standard management of cancer-related arterial thromboembolism has not yet been established. Case presentation We described a case of Trousseau’s syndrome resulting in acute ischemic stroke concomitant with multiple embolizations in the spleen and kidney during oral administration of dabigatran for pulmonary embolism preceding the diagnosis of a malignant tumor. A cancer-related hypercoagulable state was suspected because the patient was admitted to the neurology department due to acute ischemic stroke with three territory infarcts on diffusion-weighted imaging (DWI) in the absence of identifiable conventional risk factors and brain vessel narrowing. The patient was subsequently diagnosed with epidermal growth factor receptor (EGFR) mutation–positive non-small-cell lung cancer (NSCLC) (stage IV) with pleural metastasis. Administration of low-molecular-weight heparin followed by long-term dabigatran under effective cancer therapy comprising gefitinib and subsequent chemotherapy did not cause stroke relapse during the 1-year follow-up. Conclusions This case suggests that cancer-related hypercoagulability should be considered an important etiology for stroke patients who develop unexplained disseminated acute cerebral infarction without conventional stroke risk factors, especially concomitant with multiple organ embolization. Novel oral anticoagulants may be an alternative therapy for the long-term management of cancer-related arterial thromboembolism under effective cancer therapy.
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Affiliation(s)
- Zheng Wang
- Department of Respiratory Medicine III, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiangyong Miao
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China.,Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Shijiazhuang, Hebei, China
| | - Lina Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China
| | - Ying Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China
| | - Hui Ji
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China
| | - Xiangjian Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China.,Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Shijiazhuang, Hebei, China
| | - Lili Cui
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China. .,Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Shijiazhuang, Hebei, China.
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20
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Wang HP, Sung SF, Yang HY, Huang WT, Hsieh CY. Associations between stroke type, stroke severity, and pre-stroke osteoporosis with the risk of post-stroke fracture: A nationwide population-based study. J Neurol Sci 2021; 427:117512. [PMID: 34082148 DOI: 10.1016/j.jns.2021.117512] [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: 01/07/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Background Recognizing the post-stroke fracture risk factors is crucial for targeted intervention and primary fracture prevention. We aimed to investigate whether stroke types, stroke severity, and pre-stroke osteoporosis are associated with post-stroke fracture. Methods In a nationwide cohort, we identified previously fracture-free patients who suffered from first-ever stroke, either acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH), between 2003 and 2015. Information regarding stroke severity, osteoporosis, comorbidity, and medication information was collected. The outcomes analyzed included hip fracture, spine fracture, and other fractures. Cumulative incidence functions (CIFs) were used to estimate the cumulative incidence of fractures over time after accounting for competing risk of death. Multivariable Fine and Gray models were used to determine the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results Of the 41,895 patients with stroke, the 5-year CIFs of any incident fracture, hip fracture, spine fracture, and other fractures were 8.03%, 3.42%, 1.87%, and 3.05%, respectively. The fracture risk did not differ between patients with AIS and ICH. While osteoporosis increased the risk of post-stroke fracture (adjusted HR [95% CI],1.42 [1.22-1.66]), stroke severity was inversely associated with post-stroke fracture (moderate, 0.88 [0.81-0.96] and severe, 0.39 [0.34-0.44], compared with mild stroke severity). Conclusions Stroke survivors had an over 8% fracture risk at 5 years after stroke. Mild stroke severity and osteoporosis were significantly associated with post-stroke fracture risk, whereas stroke type was not. Our results call for effective measures for bone health screening and fracture prevention in patients with stroke.
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Affiliation(s)
- Hung-Ping Wang
- Division of Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hsin-Yi Yang
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Wan-Ting Huang
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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21
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Zhu D, Zhang M, Li Q, Liu J, Zhuang Y, Chen Q, Chen C, Xiang Y, Zhang Y, Yang Y. Can perihaematomal radiomics features predict haematoma expansion? Clin Radiol 2021; 76:629.e1-629.e9. [PMID: 33858695 DOI: 10.1016/j.crad.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the association between perihaematomal radiomics features and haematoma expansion (HE). MATERIALS AND METHODS Clinical and radiological data were collected retrospectively. The 1:1 propensity score matching (PSM) method was used to balance the difference of baseline characteristics between patients with and without HE. Radiomics features were extracted from the intra- and perihaematomal regions. Top HE-associated features were selected using the minimum redundancy, maximum relevancy algorithm. Support vector machine models were used to predict HE. Predictive performance of radiomics features from different regions was evaluated by receiver operating characteristic curve and confusion matrix-derived metrics. RESULTS A total of 1,062 patients were enrolled. After PSM analysis, the propensity score-matched cohort (PSM cohort) included 314 patients (HE: n=157; non-HE: n=157). The PSM cohort was distributed into the training (n=218) and the validation cohorts (n=96). The predictive performance of intra- and perihaematomal features were comparable in the training (area under the receiver operating characteristic curve [AUC], 0.751 versus 0.757; p=0.867) and the validation cohorts (AUC, 0.724 versus 0.671; p=0.454). By incorporating intra- and perihaematomal features, the combined model outperformed the single intrahaematomal model in the training cohort (AUC, 0.872 versus 0.751; p<0.001). Decision curve analysis (DCA) further confirmed the clinical usefulness of the combined model. CONCLUSION Perihaematomal radiomics features can predict HE. The integration of intra- and perihaematomal signatures may provide additional benefit to the prediction of HE.
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Affiliation(s)
- D Zhu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - M Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Q Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - J Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Y Zhuang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Q Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - C Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Y Xiang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Y Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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22
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Zheng Q, Freeman CW, Hwang M. Sex-related differences in arterial spin-labelled perfusion of metabolically active brain structures in neonatal hypoxic-ischaemic encephalopathy. Clin Radiol 2021; 76:342-347. [PMID: 33579516 DOI: 10.1016/j.crad.2020.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
AIM To investigate the sex-related differences in arterial spin-labelled (ASL) perfusion of metabolically active brain structures in neonatal hypoxic-ischaemic encephalopathy (HIE). MATERIALS AND METHODS Seventy-three term neonates were identified for a retrospective case-control study following an institutional review board (IRB) approved protocol. The cerebral pulsed arterial spin labelling values were compared by permutation test to identify metabolically active brain structures with significant perfusion changes between 10 male controls and eight female controls, and between 31 HIE males and 24 HIE females. RESULTS In the perfusion comparison between HIE male and female neonates, significantly lower perfusion was found in the thalamus in males (p=0.02). The other brain clusters, including basal ganglia, hippocampus cluster, cingulate gyrus cluster, brainstem cluster, sensorimotor cortex cluster, and cerebellum and peduncle cluster, demonstrated no significant differences between HIE males and females. In the perfusion comparison between male and female controls, there were no significant perfusion changes in those brain clusters. CONCLUSION Brain perfusion in neonatal HIE differs between males and females in the thalamus, a metabolically active region within neonates, with males demonstrating lower perfusion. This difference in perfusion may reflect sex-related disparities in response to and recovery from hypoxic-ischaemic events.
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Affiliation(s)
- Q Zheng
- School of Computer and Control Engineering, Yantai University, Yantai, China
| | - C W Freeman
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - M Hwang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
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23
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Esmael A, Elsherief M, Eltoukhy K. Predictive Value of the Alberta Stroke Program Early CT Score (ASPECTS) in the Outcome of the Acute Ischemic Stroke and Its Correlation with Stroke Subtypes, NIHSS, and Cognitive Impairment. Stroke Res Treat 2021; 2021:5935170. [PMID: 33575025 PMCID: PMC7864728 DOI: 10.1155/2021/5935170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/03/2020] [Accepted: 01/16/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study is aimed at correlating ASPECTS with mortality and morbidity in patients with acute middle cerebral artery territory infarction and at determining the cutoff value of ASPECTS that may predict the outcome. METHODS 150 patients diagnosed with acute middle cerebral artery territory infarction were involved in this study. Risk factors, initial NIHSS, and GCS were determined. An initial or follow-up noncontrast CT brain was done and assessed by ASPECTS. Outcomes were determined by mRS during the follow-up of cases after 3 months. Correlations of ASPECTS and outcome variables were done by Spearman correlation. Logistic regression analysis and ROC curve were done to detect the cutoff value of ASPECTS that predicts unfavorable outcomes. RESULTS The most common subtypes of ischemic strokes were lacunar stroke in 66 patients (44%), cardioembolic stroke in 39 patients (26%), and LAA stroke in 30 cases (20%). The cardioembolic stroke had a statistically significant lower ASPECT score than other types of ischemic strokes (P < 0.05). Spearman correlation showed that lower ASPECTS values (worse outcome) were more in older patients and associated with lower initial GCS. ASPECTS values were inversely correlated with initial NIHSS, inpatient stay, inpatient complications, mortality, and mRS. The ASPECTS cutoff value determined for the prediction of unfavorable outcomes was equal to ≤7. The binary logistic regression analysis detected that patients with ASPECTS ≤ 7 were significantly associated with about fourfold increased risk of poor outcomes (OR 3.95, 95% CI 2.09-11.38, and P < 0.01). CONCLUSIONS ASPECTS is a valuable and appropriate technique for the evaluation of the prognosis in acute ischemic stroke. Patients with high ASPECTS values are more likely to attain favorable outcomes, and the cutoff value of ASPECTS is a strong predictor for unfavorable outcomes. This trial is registered with ClinicalTrials.gov NCT04235920.
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Affiliation(s)
- Ahmed Esmael
- Neurology Department, Faculty of Medicine, Mansoura University, Egypt
| | | | - Khaled Eltoukhy
- Neurology Department, Faculty of Medicine, Mansoura University, Egypt
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24
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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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25
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Di Pietro M, Di Stefano V, Cannella R, Di Blasio F, De Angelis MV. Fetal variant of posterior cerebral artery: just a physiologic variant or a window for possible ischemic stroke? Neurol Sci 2021; 42:2535-2538. [PMID: 33389246 DOI: 10.1007/s10072-020-05018-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BiND), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy.
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BiND), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy
| | - Francesco Di Blasio
- Urgent Neurology Clinic and Stroke Unit, Department of Emergency, Santo Spirito Hospital, Pescara, Italy
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26
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Wang C, Zhang X, Wu Y, Fu L, Fang Q. Clinical Predictors for Functional Independence After Tissue-Window Guided Endovascular Thrombectomy. World Neurosurg 2020; 146:e947-e954. [PMID: 33217590 DOI: 10.1016/j.wneu.2020.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Thrombectomy increases the survival rate of acute ischemic stroke patients corresponding to large vessel occlusion. This study aimed to determine clinical predictors for good outcomes in patients subjected to tissue window guided thrombectomy. METHODS This study was performed at the stroke center of the First Affiliated Hospital of SooChow University. Baseline characteristics and outcomes were retrospectively collected, 90 days after endovascular thrombectomy. Collection was done within 6-24 hours after a patient was last seen in good condition. Binary logistic regression was used to establish the clinical predictors for functional independence. Receiver operator characteristic curve analysis was performed to determine cutoff values for outcome predictors. P value <0.05 was considered to be statistically significant. RESULTS Forty-seven patients were enrolled in this study. Among them, 13 (27.7%) had last presenting stroke, 24 (51.1%) had wake-up stroke, and 10 (21.3%) had daytime unknown stroke onset. The median initial National Institutes of Health Stroke Scale (NIHSS) score, infarct core volume, and ischemic penumbra volume were 15 (interquartile range [IQR] 11-18), 20 (IQR 8-36) mL, and 115 (IQR 81-176) mL, respectively. Multivariate regression analysis showed that patients with a lower initial NIHSS score, smaller ischemic penumbra, and no hemorrhagic transformation were more likely to have good outcomes. As shown by the receiver operator characteristic curves, the optimal thresholds of initial NIHSS score, ischemic penumbra, and infarct core were 14.5 (AUC: 0.867; P < 0.001), 109 mL (AUC: 0.841; P < 0.001), and 12.5 mL (AUC: 0.681; P = 0.036), respectively. CONCLUSIONS A lower initial NIHSS score, smaller ischemic penumbra, and lack of hemorrhagic transformation are significant independent predictors for good outcomes after a tissue-window based thrombectomy.
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Affiliation(s)
- Can Wang
- Neurology Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianxian Zhang
- Neurology Department, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Yaya Wu
- Neurology Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Le Fu
- Neurology Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Neurology Department, The First Affiliated Hospital of Soochow University, Suzhou, China.
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27
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Tudor R, Iovanescu G, Reisz D, Cornea A, Potre-Oncu C, Tutelca A, Simu M. Additional factors to corelate with a more than 30% NIHSS score improvement in patients 7 days after fibrinolytic and/or endovascular treatment for ischemic stroke. BMC Neurol 2020; 20:417. [PMID: 33189130 PMCID: PMC7666450 DOI: 10.1186/s12883-020-01990-z] [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: 05/25/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Our objective was to find which additional factors can influence the favorable result in stroke patients after receiving fibrinolytic and/or endovascular treatment, quantified as a more than 30% improvement of the NIHSS score at 7 days. Methods This is a retrospective study to find factors that could influence a favorable evolution of patients with stroke that underwent fibrinolytic and or thrombectomy using the NIHSS score changes. At the admission in the hospital, blood glucose, blood count, coagulation time, INR, aPTT, PT, platelet count, NIHSS questionnaire and ASPECTS score were collected. NIHSS was assessed at the admission, after 1 h, after 2 h, after 24 h and after 7 days. Results As compared to the initial evaluation, at 7 days after admission 59% (72) of patients have improved with more than 30% the NIHSS. Higher levels of systolic blood pressure, glycemia and lower ASPECTS score at admission were observed in non-achievers. The value of INR contributed to model: for every unit increase of INR, the chance of better outcome decreases by 90,1%. High glycemia has also a negative impact: for every unit increase, the chance of better outcome decreases by 24%. Higher initial ASPECTS score is associated with better outcomes: each point increase of ASPECTS score at initial evaluation, increases the chance of better outcome by 154.2%. Conclusion Males, older age, diabetes, and hyperglycemia correlate with a worse outcome after cerebral stroke regardless of the benefit yielded fibrinolytic and/or thrombectomy therapy. In this study, patients with the above-mentioned factors did not improve more than 30% of baseline NIHSS score from admission to the 7th day.
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Affiliation(s)
- Raluca Tudor
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Gheorghe Iovanescu
- Department of Otorhinolaryngology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
| | - Daniela Reisz
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Amalia Cornea
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Cristina Potre-Oncu
- Department of Hematology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Adrian Tutelca
- Department of Interventional Radiology, Timis County Emergency Clinical Hospital "Pius Branzeu", Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
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Imaging of congenital cranial dysinnervation disorders: What radiologist wants to know? Clin Imaging 2020; 71:106-116. [PMID: 33189029 DOI: 10.1016/j.clinimag.2020.10.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/03/2020] [Accepted: 10/17/2020] [Indexed: 11/22/2022]
Abstract
We aim to review the imaging features of congenital cranial dysinnervation disorders. Characteristic imaging findings can define subtypes of these disorders through assessment of cranial nerves, extraocular muscles, orbital, and brain abnormalities. Duane retraction syndrome shows absent or hypoplasic 6th cranial nerve and preserved extraocular muscles (EOM). Mobius syndrome shows absent 7th and 6th cranial nerves, absence of facial colliculus, flattening of the dorsal aspect of the pons, hypoplasia of the pons and medulla, and flattening of the 4th ventricular floor. Congenital fibrosis of the extraocular muscles reveals unilateral or bilateral hypoplasia or aplasia of the 3rd cranial nerve, atrophy of superior rectus and levator palpebrae superioris muscles, and atrophy of the brainstem and cerebellar hemispheres. Horizontal gaze palsy and progressive scoliosis show characteristic split pons sign, butterfly medulla, absent facial colliculi, and spinal scoliosis. HOXA1 Mutations show a bilateral absence of 6th cranial nerves with the underdeveloped inner ear. Pontine Cap Tegmental Dysplasia shows ventral pontine hypoplasia, dorsal tegmental projection into the 4th ventricle, and variable cranial nerve deficits.
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Borgman CJ. Dorsolateral pontine syndrome and contralateral fourth nerve palsy in a post‐stroke patient. Clin Exp Optom 2020; 103:925-926. [DOI: 10.1111/cxo.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 10/27/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christopher J Borgman
- Advanced Care Ocular Disease Service, Southern College of Optometry, Memphis, Tennessee, USA,
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Yu Y, Wang B, Zheng S, Kou J, Gu X, Liu T. Carotid web and ischemic stroke: a CT angiography study. Clin Imaging 2020; 67:86-90. [DOI: 10.1016/j.clinimag.2020.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/04/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
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Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke. Neurol Sci 2020; 41:3307-3313. [PMID: 32417986 DOI: 10.1007/s10072-020-04397-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have revealed a relationship between chronic kidney disease (CKD) and white matter hyperintensities (WMH). However, studies on the WMH and CKD in acute stroke patients are rare, and the conclusion is consistent. Our study aimed to investigate the relationship between the severity of WMH and CKD in acute lacunar infarction patients. METHODS Consecutive acute lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to the severity of periventricular WMH (PVWMH) and deep WMH (DWMH). We dichotomized the severity of WMH (PVWMH and DWMH, separately) into mild group (Fazekas scores 0-1) and moderate-severe group (Fazekas scores 2-3). Estimated glomerular filtration rate (eGFR), proteinuria, vascular risk factors, and clinical features were compared between these two groups. Multivariable logistic regression analysis was used to investigate the association between the severity of WMH and risk factors. RESULTS A total of 993 acute lacunar infarction patients aged 25-95 years were enrolled. The proportions of participants presenting moderate-severe group PVWMH and DWMH were 46.6% and 38.6%, respectively. Patients with moderate-severe PVWMH had higher age (P < 0.001) and higher incidence of stroke history (P < 0.001) than those in mild group. The level of serum creatinine and the presence of CKD were significantly higher while the eGFR was significantly lower in patients with moderate-severe PVWMH than those with mild PVWMH. Patients with moderate-severe DWMH (n = 383) also had higher age (P < 0.001) and often had a history of stroke (P < 0.001). But the association between the severity of DWMH and eGFR was not found. Multivariable logistic regression analyses showed stage 2 CKD and stage 3 CKD were independently associated with moderate-severe PVWMH, but not DWMH. CONCLUSIONS Our study demonstrates that CKD was independently associated with moderate-severe PVWMH in patients with acute lacunar infarction, but not DWMH. PVWMH and DWMH may have distinct pathophysiology.
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Chen YS, Chen TS, Huang CW. Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency. Heliyon 2020; 6:e05376. [PMID: 33209999 PMCID: PMC7658694 DOI: 10.1016/j.heliyon.2020.e05376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/10/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022] Open
Abstract
Diagnosing non-convulsive seizures (NCSs) is a great challenge for most clinicians due to a wide spectrum of clinical presentations. The complexity of the disease course usually results in a delayed diagnosis or misdiagnosis so that timely and appropriate treatment is not given. Herein, we report a case with NCSs misdiagnosed as vertebrobasilar insufficiency (VBI), in which the patient suffered from episodes of prominent dizziness, vertigo, becoming transfixed, and worsening response within a day. Brain magnetic resonance image findings were unremarkable, however electroencephalography (EEG) showed rhythmic epileptiform discharges that appeared to originate from the right frontal area with ipsilateral hemispheric involvement. We prescribed intravenous valproate and the seizures ceased. Few studies have reported a patient with NCS misdiagnosed with VBI, a very different entity. It is thus important that clinicians should be aware of the trivial symptoms of NCSs, and to consider implementing early EEG studies and anti-epileptic drug therapy.
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Affiliation(s)
- Yu-Shiue Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsang-Shan Chen
- Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Wen H, Lv M. Correlation analysis between serum procalcitonin and infarct volume in young patients with acute cerebral infarction. Neurol Sci 2020; 42:3189-3196. [PMID: 33108576 DOI: 10.1007/s10072-020-04856-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To detect the serum procalcitonin (PCT) level and determine its relationship with the infarct volume in young patients with acute cerebral infarction. METHODS According to the infarct volume, young patients with acute cerebral infarction were divided into large group, intermediate group, and small group. The severity of clinical symptoms was determined according to the National Institute of Health Stroke Scale (NIHSS) score. Healthy young people were selected as the control group. Serum PCT levels were measured. The relationship among PCT, volume, and NIHSS score was analyzed. RESULTS PCT in observation group was significantly higher than that in control group (t = 6.879, P = 0.011), and PCT in severe group was significantly higher than in mild group (t = 6.978, P = 0.016). PCT in large cerebral infarction group was higher than that in intermediate and small-size infarct group (P = 0.0036 and P < 0.0001, respectively), and PCT in intermediate cerebral infarction group was higher than that in small-size infarct group (P = 0.0024). In observation group, the PCT level was positively correlated with both NIHSS (r = 0.793, P = 0.022) and infarction volume (r = 0.649, P = 0.007). CONCLUSION The level of PCT in young patients with acute cerebral infarction may be related to the inflammatory reaction of the cerebral artery and positively related to the volume of cerebral infarction and NIHSS score. To some extent, PCT concentration can predict the disease severity of acute cerebral infarction.
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Affiliation(s)
- Huijun Wen
- Department of Neurology, Baoji Municipal Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi, People's Republic of China
| | - Maikou Lv
- Department of Neurology, Baoji Municipal Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi, People's Republic of China.
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Ablefoni M, Ullrich S, Surov A, Hoffmann KT, Meyer HJ. Diagnostic benefit of high b-value computed diffusion-weighted imaging in acute brainstem infarction. J Neuroradiol 2020; 49:47-52. [PMID: 32987036 DOI: 10.1016/j.neurad.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) is a cornerstone in diagnostic of ischemic stroke. The aim of this study was to investigate the usefulness of high-b-value computed DWI (c-DWI) in comparison to standard DWI in patients with acute brainstem infarction. MATERIALS AND METHODS 56 patients with acute brainstem infarction were retrospectively analysed by two readers. DWI was obtained with the b-values 0, 500 and 1000 s/mm² on either a 1.5 or 3 T magnetic resonance imaging (MRI) scanner. c-DWI was calculated with a monoexponential model with high b-values 2000, 3000, 4000 and 5000 s/mm². All c-DWI series with high-b-values were compared to the standard DWI sequence at b-value of 1000 s/mm² in terms of image artifacts, lesion extent and contrast. RESULTS There was no statistically significant difference between 1.5 and 3 T MRI regarding the measured ischemic lesion size. There were no statistically significant differences between the ischemic lesion sizes on DWI at b-values of 1000 s/mm² and on c-DWI at higher b-values. Overall, the contrast between the lesion and the surrounding normal areas improved with increasing b-value on the isotropic DWIs: maximum at b = 5000, followed by that at b 2000 and b 1000 s/mm², in order. The best relation between artifacts and lesion contrast was identified for b 2000 s/mm². CONCLUSION High b-value DWI derived from c-DWI has a higher visibility for ischemic brainstem lesions compared to standard DWI without additional time cost. The b-2000 image is recommended to use in clinical routine, higher b-value images lead to more imaging artifacts, which might result in misdiagnosis.
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Affiliation(s)
- Maxime Ablefoni
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Sebastian Ullrich
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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Bilateral medullary infarct: the radiologist's point of view. Neuroradiology 2020; 63:15-16. [PMID: 32889580 DOI: 10.1007/s00234-020-02544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
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The impact of FLAIR vascular hyperintensity on clinical severity and outcome : A retrospective study in stroke patients with proximal middle cerebral artery stenosis or occlusion. Neurol Sci 2020; 42:589-598. [PMID: 32643132 DOI: 10.1007/s10072-020-04513-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The clinical significance of fluid-attenuated inversion recovery vascular hyperintensity (FVH) has not been clarified. The aim of this study was to clarify the effects of FVH on the clinical severity and long-term prognosis of patients with proximal middle cerebral artery (MCA) occlusion or severe stenosis. METHOD Because their clinical and imaging data is not accessible, we excluded the patients being treated with IV thrombolysis or mechanical thrombectomy. Clinical and imaging characteristics were documented in 282 consecutive AIS patients with proximal MCA occlusion or severe stenosis. We assessed clinical severity using the National Institutes of Health Stroke Scale (NIHSS) score and clinical outcomes using mRS scores. The average time interval between symptom onset and imaging was 16-18 h. The FVH score according to FVH-ASPECTS ranged from 0 to 7, based on the numbers of territories where FVH is positive. RESULTS FVH was observed in 235 (83.33%) of the AIS patients. The FVH(+) group tended to have more alcoholics (65 [27.66%] vs 6 [12.77%], P = 0.032), a higher NIHSS score on the 7th day (3 [1-6] vs 2 [1-3], P = 0.039), more instances of early neurological deterioration (END) (27 [11.4%] vs 1 [2.12%], P = 0.05), and more patients with MCA occlusion (94 [40.00%] vs 3 [6.38%]). Among the patients with positive FVH, a high FVH score represented severe clinical impairment (higher NIHSS score on admission [P = 0.009] and 7th day since admission [P = 0.02]) and poor clinical outcomes. Spearman's rank correlations showed that FVH scores were positively correlated with NIHSS scores on admission and NIHSS scores on the 7th day (P = 0.039; P = 0.017, respectively). CONCLUSION In patients with proximal middle cerebral artery (MCA) occlusion or stenosis ≥ 70%, a high FVH score represented severe clinical impairment and poor clinical outcomes. In acute ischemic stroke (AIS) patients with proximal MCA occlusion, a high FVH score represented favorable clinical outcomes.
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Attygalle UR, Hewawitharana G, Wijesinghe CJ. Migraine, attention deficit hyperactivity disorder and screen time in children attending a Sri Lankan tertiary care facility: are they associated? BMC Neurol 2020; 20:275. [PMID: 32640997 PMCID: PMC7341609 DOI: 10.1186/s12883-020-01855-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Headache and Attention Deficit Hyperactivity Disorder (ADHD) are two relatively common, neuropsychiatric conditions seen in children. Recent studies have shown an association between these two disorders, which are otherwise distinct conditions. This study aims to assess the association between migraine and ADHD, as well as the association between screen-time and these two conditions, among children attending a Sri Lankan tertiary care facility. Possible associations will have important implications in the clinical management of these conditions. METHODS This was a comparative cross-sectional study of 226 children aged 5-14 years, attending clinics at a tertiary care hospital in Galle, Sri Lanka. Of them, 141 had a diagnosis of migraine and 85 did not have migraine. The presence or absence of ADHD and the use of screen-time among the two groups was analysed. Chi-square test and Mann-Whitney U test was used to assess the associations between these variables. RESULTS Approximately 5% of the children with migraine had clinically diagnosed ADHD, compared to 3.5% of those without migraine (p = 0.862). The median SNAP-IV scores (inter-quartile range) of the children with migraine and without migraine were 0.60 (0.27-1.00) and 0.44 (0.16-0.80) respectively (p = 0.014). There was no significant difference in screen-time hours per day between children with and without clinically diagnosed ADHD. However, a significant difference in median screen-time (hours per day) was observed between children with and without migraine (2.0 h and 1.0 h respectively; p = 0.012). CONCLUSIONS Our findings suggest that children with migraine are more likely to show features of hyperactivity/impulsivity and inattentiveness than those without migraine. While no association was found between clinically diagnosed ADHD and screen-time, migraine was associated with longer daily screen use. Screening for ADHD in children diagnosed with migraine may be of benefit. Further studies are required to understand the possible benefits of reducing screen-time in children with migraine.
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Abstract
Neuronal and mixed glioneuronal tumors represent a group of neoplasms with varying degrees of neural and glial elements. Their age of presentation varies, but they are most commonly seen in children and young adults. With the exception of anaplastic ganglioglioma and other atypical variants, most lesions are low grade; however, they can have significant morbidity because of seizures, mass effect, or difficult to treat hydrocephalus. Although many tumors show overlapping clinical and imaging features, some have relatively distinctive imaging characteristics that may aid in narrowing the differential diagnosis. In this review, we discuss relevant clinical and pathologic characteristics of these tumors and provide an overview of conventional and advanced imaging features that provide clues as to the diagnosis.
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Lee HY, Park JH, Kim AR, Park M, Kim TW. Neurobehavioral recovery in patients who emerged from prolonged disorder of consciousness: a retrospective study. BMC Neurol 2020; 20:198. [PMID: 32434516 PMCID: PMC7238564 DOI: 10.1186/s12883-020-01758-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background We investigated the clinical course of patients with prolonged disorders of consciousness (PDoC), predictors of emergence from PDoC (EDoC), and the temporal dynamics of six neurobehavior domains based on the JFK Coma Recovery Scale-Revised (CRS-R) during the recovery. Methods A total of 50 traumatic and non-traumatic patients with PDoC were enrolled between October 2014 and February 2017. A retrospective analysis of the clinical findings and neurobehavioral signs was conducted using standardized methodology such as CRS-R. The findings were used to investigate the incidence and predictors of EDoC and determine the cumulative pattern of neurobehavioral recovery at 6 months, 1 year, and 2 years post-injury. Results The results showed that 46% of the subjects emerged from PDoC after 200 median days (64–1197 days) of injury onset. The significant predictors of EDoC included minimally conscious state (MCS) (vs. vegetative state), higher auditory, communication, arousal, total CRS-R scores, shorter lag time post-injury, and the absence of intra-axial lesions. In terms of cumulative recovery of motor and communication signs in patients who emerged from PDoC, 39 and 32% showed EDoC at 6 months post-injury, and 88 and 93% exhibited EDoC at 2 years post-injury, respectively. Conclusions Nearly half of the patients with PDoC recovered consciousness during inpatient rehabilitation. MCS, shorter lag time, the absence of intra-axial lesions, higher auditory, communication, arousal, and total CRS-R scores were important predictors for EDoC. Motor scores in the early stage of recovery and communication scores after prolonged intervals contributed to the higher levels of cumulative EDoC.
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Affiliation(s)
- Hoo Young Lee
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, 260, Jungang-ro, Dogok-ri, Yangpyeong-eup, Yangpyeong-gun, Gyeonggi-do, 12564, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, South Korea.,Department of Medicine, the Graduate School of Yonsei University, Seoul, South Korea
| | - Jung Hyun Park
- Department of Medicine, the Graduate School of Yonsei University, Seoul, South Korea.,Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Misun Park
- Department of Biostatistics, Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, 260, Jungang-ro, Dogok-ri, Yangpyeong-eup, Yangpyeong-gun, Gyeonggi-do, 12564, South Korea. .,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, South Korea.
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Susceptibility-weighted imaging and transcranial Doppler ultrasound in patients with cerebral small vessel disease. Neurol Sci 2020; 41:2853-2858. [DOI: 10.1007/s10072-020-04414-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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Pedersen KB, Madsen C, Sandgaard NC, Diederichsen AC, Bak S, Nybo M, Brandes A. Predictive Markers of Atrial Fibrillation in Patients with Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2020; 29:104643. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 12/22/2022] Open
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Abstract
We aim to review the imaging appearance of fulminant demyelinating disorders of central nervous system that have different pathological features, clinical course, clinical features, and imaging findings different from classic multiple sclerosis. Routine magnetic resonance imaging (MRI) can help in accurate localization of the lesions, detection of associated lesions, and monitoring of these patients. Advanced MRI combined with routine MRI can aid in differentiation fulminant demyelinating lesions from simulating malignancy. Tumefactive demyelination lesions are located in supratentorial white matter mainly frontal and parietal regions with incomplete rim enhancement. Baló concentric sclerosis shows characteristic concentric onion skin appearance. Schilder disease is subacute or acute demyelinating disorders with one or more lesions commonly involving the centrum semiovale. Marburg disease is the most severe demyelinating disorder with diffuse infiltrative lesions and massive edema involving both the cerebral hemisphere and brain stem.
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Pinter D, Gattringer T, Fandler-Höfler S, Kneihsl M, Eppinger S, Deutschmann H, Pichler A, Poltrum B, Reishofer G, Ropele S, Schmidt R, Enzinger C. Early Progressive Changes in White Matter Integrity Are Associated with Stroke Recovery. Transl Stroke Res 2020; 11:1264-1272. [PMID: 32130685 PMCID: PMC7575507 DOI: 10.1007/s12975-020-00797-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
Information on microstructural white matter integrity has been shown to explain post-stroke recovery beyond clinical measures and focal brain damage. Especially, knowledge about early white matter changes might improve prediction of outcome. We investigated 42 acute reperfused ischemic stroke patients (mean age 66.5 years, 40% female, median admission NIHSS 9.5) with a symptomatic MRI-confirmed unilateral middle cerebral artery territory infarction 24-72 h post-stroke and after 3 months. All patients underwent neurological examination and brain MRI. Fifteen older healthy controls (mean age 57.3 years) were also scanned twice. We assessed fractional anisotropy (FA), mean diffusivity (MD), axial (AD), and radial diffusivity (RD). Patients showed significantly decreased white matter integrity in the hemisphere affected by the acute infarction 24-72 h post-stroke, which further decreased over 3 months compared with controls. Less decrease in FA of remote white matter tracts was associated with better stroke recovery even after correcting for infarct location and extent. A regression model including baseline information showed that the modified Rankin Scale and mean FA of the genu of the corpus callosum explained 53.5% of the variance of stroke recovery, without contribution of infarct volume. Furthermore, early dynamic FA changes of the corpus callosum within the first 3 months post-stroke independently predicted stroke recovery. Information from advanced MRI measures on white matter integrity at the acute stage, as well as early dynamic white matter degeneration beyond infarct location and extent, improve our understanding of post-stroke reorganization in the affected hemisphere and contribute to an improved prediction of recovery.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | | | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Hannes Deutschmann
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | | | - Birgit Poltrum
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Gernot Reishofer
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
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Individualized intravenous thrombolytic strategy for acute ischemic stroke with large vessel occlusion on the era of mechanical thrombectomy: cases report. Neurol Sci 2020; 41:605-610. [PMID: 31728853 PMCID: PMC7039837 DOI: 10.1007/s10072-019-04098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/09/2019] [Indexed: 11/16/2022]
Abstract
Intravenous thrombolysis for acute ischemic stroke within 4.5 h after the onset of symptoms has become a standard therapy that is recommended by many trials and clinical guidelines. As on the era of mechanical thrombectomy for acute ischemic stroke with large vessel occlusions, whether intravenous thrombolysis (IVT) is still necessary, and how to choose the optimal dose are still controversy. Here, we reported two cases of acute ischemic stroke with large vessel occlusions that both achieved complete recanalization after IVT. Then, IVT was terminated in advance, and dynamic surveillance by DSA was performed to achieve individual treatment. However, both of the cases presented with hemorrhagic transformation. We analyzed the probable reasons and put forward thoughts from ourselves.
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Decreased visible deep medullary veins is a novel imaging marker for cerebral small vessel disease. Neurol Sci 2020; 41:1497-1506. [PMID: 31955350 DOI: 10.1007/s10072-019-04203-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Visibility of deep medullary veins (DMVs) seen at SWI is predictive of poor prognosis in ischemic stroke. Few attentions have been paid to DMVs in atherosclerotic cerebral small vessel disease (aCSVD) which is attributed to long-term imbalanced microhemodynamics. We conducted this retrospective study to explore the association between DMVs profiles and aCSVD risk factors, neuroimaging markers. METHODS Two hundred and two patients identified as aCSVD from January 2017 to March 2019 were included in the study. Their demographic, clinical, laboratory, and neuroimaging data were reviewed. The quantity and morphology of DMVs were assessed with a 5-grade (range 0~4) visual rating scale. Total CSVD burden was calculated with an ordinal "SVD score" (range 0~4). Spearman rank correlation and multivariable logistic regression analysis were performed to determine the association between DMV scale and CSVD markers. RESULTS DMV scale showed strong positive correlation with CSVD burden (rs = 0.629, P < 0.001). Age (OR 1.078, 95% CI 1.015-1.145, P = 0.015) and hypertension (OR 2.629, 95% CI 1.024-6.749, P = 0.045) were two demographic risk factors for high DMV scale. Among CSVD neuroimaging markers, periventricular WMH (OR 2.925, 95% CI 1.464-5.845, P = 0.002), deep WMH (OR 2.872, 95% CI 1.174-7.022, P = 0.021), lacunae (OR 1.961, 95% CI 1.181-3.254, P = 0.009), and cerebral atrophy (OR 2.046, 95% CI 1.079-3.880, P = 0.028) were associated with high DMV scale after adjusting for clinical and metabolic confounders. CONCLUSION Multifactorial association between DMV scale and epidemiological, radiological contributors of aCSVD suggests DMV's involved pathomechanism may participate in aCSVD development. Attach importance to DMV radiological profile in aCSVD will provide more neuroimaging information for diagnosis and prognosis.
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Bot JCJ, Mazzai L, Hagenbeek RE, Ingala S, van Oosten B, Sanchez-Aliaga E, Barkhof F. Brain miliary enhancement. Neuroradiology 2020; 62:283-300. [PMID: 31925469 PMCID: PMC7044143 DOI: 10.1007/s00234-019-02335-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.
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Affiliation(s)
- Joseph C J Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Linda Mazzai
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.,Institute of Radiology, Department of Medicine (DiMED), University of Padua, Padua, Italy
| | | | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Bob van Oosten
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Esther Sanchez-Aliaga
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.,Institute of Neurology and Healthcare Engineering, UCL, London, UK
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Monseur BC, Anastasio HB, Haddad A, Al‐Kouatly HB. Review of familial hemiplegic migraine, successful outcome in a pregnant patient. Clin Case Rep 2019; 7:2495-2499. [PMID: 31893087 PMCID: PMC6935667 DOI: 10.1002/ccr3.2513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/23/2019] [Accepted: 10/11/2019] [Indexed: 12/30/2022] Open
Abstract
As the field of neurogenetics is expanding rapidly and variant classification criteria evolve, genetic variants in databases are re-evaluated overtime allowing updated classifications of pathogenicity predication. When caring for patients with genetic disorders, it is important to obtain the original genetic report and also consider an updated reanalysis.
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Affiliation(s)
- Brent C. Monseur
- Department of Obstetrics and GynecologySidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Hannah B. Anastasio
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologySidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Andrew Haddad
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologyMedStar Washington Hospital CenterWashingtonDistrict of Columbia
| | - Huda B. Al‐Kouatly
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologySidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvania
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Invasiveness and Clinical Outcomes of Off-Hour Admissions in Patients with Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2019; 29:104505. [PMID: 31786043 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Whether time of hospital admission-during or outside regular working hours-affects functional outcome in intracerebral hemorrhage (ICH) is unestablished as previous analyses have focused on mortality only. We here investigate whether on- versus off-hour hospital admission in ICH is associated with levels of invasiveness and clinical outcomes. METHODS Based on the UKER registry (NCT03183167) we grouped ICH-patients according to on- versus off-hour hospital admission. Primary outcome measures was functional outcome after 3 months using the modified Rankin scale (mRS) dichotomized into favorable (mRS = 0-3) and unfavorable (mRS = 4-6). Multivariate regression analyses were used to adjust for baseline imbalances, and subgroup analyses were performed to explore associations of on- versus off-hour admission with invasiveness of therapeutic interventions. RESULTS A total of 438/1269 (34.5%) of ICH-patients were admitted during regular working hours. Mortality rates were not significantly different among patients with on- versus off-hour admission. On-hour patients showed a significantly larger proportion of patients with favorable outcome (on-hour: mRS = 0-3 after 3 months: 176/416 (42.3%) versus off-hour: 265/784 (33.8%); P = .004). Analysis of invasive therapeutic interventions revealed that likelihood of favorable outcome was significantly increased among on-hour admitted patients who did not require neurosurgical interventions (no external ventricular drain n = 349, OR: 1.67[1.13-2.48], P < .05; no hematoma evacuation surgery n = 423, OR: 1.51[1.07-2.14], P < .05). CONCLUSION This study verified an "off-hour effect" in ICH that relates to functional outcome, rather than mortality, and which may be linked to different levels of invasive therapeutic interventions in patients admitted during off-hour.
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