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Iov DE, Floria M, Tanase DM. Patent foramen oval and ESUS in cryptogenic stroke: Still a complex puzzle. Echocardiography 2024; 41:e15778. [PMID: 38353336 DOI: 10.1111/echo.15778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Diana-Elena Iov
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa,", Iasi, Romania
- Emergency Clinical Hospital "Saint Spiridon,", Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Mariana Floria
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa,", Iasi, Romania
- Emergency Clinical Hospital "Saint Spiridon,", Internal Medicine Clinic, Iasi, Romania
| | - Daniela Maria Tanase
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa,", Iasi, Romania
- Emergency Clinical Hospital "Saint Spiridon,", Internal Medicine Clinic, Iasi, Romania
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Low CE, Teo YN, Teo YH, Lim ICZ, Rana S, Lee YQ, Chen X, Fang JT, Lam HH, Ong K, Yang J, Kuntjoro I, Low TT, Lee EC, Sharma VK, Yeo LL, Sia CH, Tan BY, Lim Y. Propensity-score matched analysis of patent foramen ovale closure in real-world study cohort with cryptogenic ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107407. [PMID: 37804781 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023] Open
Abstract
INTRODUCTION Patent foramen ovale (PFO) occurs in 25% of the general population and in 40% of cryptogenic ischemic stroke patients. Recent trials support PFO closure in selected patients with cryptogenic stroke. We examined the outcomes of transcatheter PFO closure in a real-world study cohort with cryptogenic stroke. METHODS Consecutive ischemic stroke patients who were classified as cryptogenic on the TOAST aetiology and diagnosed with a PFO were included. All patients underwent either transcatheter PFO closure or medical therapy. A 2:1 propensity score matching by sex and Risk-of-Paradoxical-Embolism (RoPE) score was performed. Multivariable regression models adjusted for sex and RoPE score. RESULTS Our cohort comprised 232 patients with mean age 44.3 years (SD 10.8) and median follow-up 1486.5 days. 33.2% were female. PFO closure (n=84) and medical therapy (n=148) groups were well-matched with <10% mean-difference in sex and RoPE score. Two patients in the treated group (2.4%) and seven in the control group (4.7%) had a recurrent ischemic stroke event. Multivariable Cox regression demonstrated a hazard-ratio of 0.26 (95%CI 0.03-2.13, P=0.21) for PFO closure compared to control. The incidence of atrial fibrillation (AF) detected post-PFO closure was similar between the treated and control (1.19% vs 1.35%, multivariable logistic regression odds-ratio 0.90, 95%CI 0.04-9.81, P=0.94). There were no major periprocedural complications documented. The difference in restricted mean survival-time free from stroke at two years between treated and control was 26.2 days (95%CI 5.52-46.85, P=0.013). CONCLUSIONS In this Asian cohort, we report a low incidence of ischemic stroke recurrence and new-onset AF in patients who underwent PFO closure. When compared to the medical therapy group, there was no significant difference in the incidence of stroke recurrence and new-onset AF. Further studies involving larger real-world cohorts are warranted to identify patients who are more likely to benefit from PFO closure.
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Affiliation(s)
- Chen Ee Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Isis Claire Zy Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sounak Rana
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yong Qin Lee
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Xintong Chen
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Jun Tao Fang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hsin Hui Lam
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kathleen Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joanna Yang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Ting Ting Low
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Edward Cy Lee
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Yinghao Lim
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
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Wu Y, Jing Y, Li T, Che L, Sheng M, Jia L, Li H, Yu W, Weng Y. Impact of patent foramen ovale on short-term outcomes in children with biliary atresia undergoing living donor liver transplantation: a retrospective cohort study. BMC Anesthesiol 2023; 23:315. [PMID: 37715177 PMCID: PMC10503016 DOI: 10.1186/s12871-023-02268-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To investigate the impact of patent foramen ovale (PFO) on the short-term outcomes of living donor liver transplantation (LDLT) in children with biliary atresia. METHODS With the approval of the hospital ethics committee, 304 children with biliary atresia who underwent LDLT in our center from January 2020 to December 2021 were enrolled. According to the results of echocardiography before the operation, the subjects were divided into the PFO group (n = 73) and the NoPFO group (n = 231). The baseline characteristics; intraoperative recipient-related data and donor-related data; incidence of postreperfusion syndrome (PRS); postoperative mechanical ventilation time; ICU stay duration; postoperative hospital stay duration; liver function index; incidences of postoperative complications including acute renal injury (AKI), graft dysfunction, hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT); and one-year survival rate were compared between the two groups. RESULTS The median age in the PFO group was 6 months and that in the NoPFO group was 9 months (P < 0.001), and the median height (65 cm) and weight (6.5 kg) in the PFO group were significantly lower than those in the NoPFO group (68 cm, 8.0 kg) (P < 0.001). The preoperative total bilirubin level (247 vs. 202 umol/L, P = 0.007) and pediatric end-stage liver disease (PELD) score (21 vs. 16, P = 0.001) in the PFO group were higher than those in the NoPFO group. There were no significant differences in the intraoperative PRS incidence (46.6% vs. 42.4%, P = 0.533 ), postoperative mechanical ventilation time (184 vs. 220 min, P = 0.533), ICU stay duration (3.0 vs. 2.5 d, P = 0.267), postoperative hospital stay duration (22 vs. 21 d, P = 0.138), AKI incidence (19.2% vs. 24.7%, P = 0.333), graft dysfunction incidence (11.0% vs. 12.6%, P = 0.716), HAT incidence (5.5% vs. 4.8%, P = 0.762), PVT incidence (2.7% vs. 2.2%, P = 0.675) or one-year survival rate (94.5% vs. 95.7%, P = 0.929) between the two groups. CONCLUSION The presence of PFO has no negative impact on short-term outcomes in children with biliary atresia after LDLT.
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Affiliation(s)
- Yuli Wu
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China
| | - Yongle Jing
- Department of Cardiology, Tianjin First Central Hospital, 300192, Tianjin, China
| | - Tianying Li
- School of Medicine, Nankai University, 300071, Tianjin, China
| | - Lu Che
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China
| | - Mingwei Sheng
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China
| | - Lili Jia
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China
| | - Hongxia Li
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China.
| | - Yiqi Weng
- Department of Anesthesiology, Tianjin First Central Hospital, 300192, Tianjin, China.
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Ordille AJ, Antinori G, Mowdawalla C, McGeehan J. Expanding Medical Student Knowledge and Impacting Patient Outcomes Through a Student-Run Clinic: A Case-Based Reflection. Cureus 2023; 15:e39532. [PMID: 37366448 PMCID: PMC10290886 DOI: 10.7759/cureus.39532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Cryptogenic stroke is a debilitating condition that requires follow-up care and treatment that is appropriate for the underlying etiology. Here, we present the case of a 46-year-old uninsured patient with an undocumented immigration status who presented to our student-run clinic (SRC) for the management of her post-stroke care. She initially presented to an outside hospital with focal neurological deficits, was diagnosed with an acute stroke, and was told to follow up with a primary care provider. The patient established care at the Cooper Medical School of Rowan University's SRC one week following her stroke event. The SRC served as a conduit for access to healthcare services necessary for her recovery and secondary prevention of future strokes which otherwise would have been unattainable due to the patient's socioeconomic constraints. These services and treatments included specialist appointments, anticoagulation medications, physical and speech therapy, labs, placement of an internal heart rhythm monitor, and surgical closure of a patent foramen ovale. All services, medications, and procedures were provided free of charge. One year following her stroke, the patient is living without disability and has had no recurrence of a cerebrovascular ischemic event. This case highlights the dual-purposed value of SRCs in providing both meaningful clinical educational experiences to students and necessary health care to disadvantaged patients.
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Affiliation(s)
- Andrew J Ordille
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, USA
| | - Gianna Antinori
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, USA
| | - Cyrus Mowdawalla
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, USA
| | - John McGeehan
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, USA
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Lopez G, Cataldi F, Bellin G, Dunning J, Fernández-de-las-Peñas C, Galeno E, Meroni R, Maselli F, Mourad F. Physiotherapy Screening for Referral of a Patient with Patent Foramen Ovale Presenting with Neck Pain as Primary Complaint: A Case Report. Healthcare (Basel) 2023; 11:1165. [PMID: 37107999 PMCID: PMC10138410 DOI: 10.3390/healthcare11081165] [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: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Neck pain is a common musculoskeletal disorder encountered by physiotherapists. However, it may be the early manifestation of more alarming conditions, such as cardiovascular diseases mimicking musculoskeletal pain. Patent foramen ovale (PFO) is a congenital heart defect consisting of a small opening between the right and the left atrium. A 56-year-old male presented with neck pain and head heaviness as primary complaints. The cardiovascular profile and the behavioral symptoms led the physiotherapist to find an exaggerated blood pressure response during exercise; in addition to subtle neurological signs, this prompted the physiotherapist to make an urgent referral. At the emergency department a PFO was diagnosed. To the best of the authors' knowledge, this is the first case to describe a rare clinical presentation of a PFO presenting neck pain as primary complaint. This case report emphasizes the importance for physiotherapists to be able to triage patients for conditions outside their scope suggestive of further medical investigation.
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Affiliation(s)
- Giovanni Lopez
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Kinesis, Department of Physiotherapy, 70126 Bari, Italy
| | - Fabio Cataldi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Manual Therapy Laboratory—MTLab, Department of Physiotherapy, 70123 Bari, Italy
| | - Giuseppe Bellin
- Centro Diagnostico Veneto, Department of Physical Therapy, 36030 Vicenza, Italy
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL 36104, USA
- Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL 36104, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra de Clínica, Investigación y Docencia en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Erasmo Galeno
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
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Shi F, Sha L, Li H, Tang Y, Huang L, Liu H, Li X, Li L, Yang W, Kang D, Chen L. Recent progress in patent foramen ovale and related neurological diseases: A narrative review. Front Neurol 2023; 14:1129062. [PMID: 37051056 PMCID: PMC10084837 DOI: 10.3389/fneur.2023.1129062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Patent foramen ovale (PFO) is a common congenital cardiac abnormality when the opening of the interatrial septum is not closed in adulthood. This abnormality affects 25% of the general population. With the development of precision medicine, an increasing number of clinical studies have reported that PFO is closely related to various neurological diseases such as stroke, migraine, obstructive sleep apnea, and decompression syndrome. It has also been suggested that PFO closure could be effective for preventing and treating these neurological diseases. Therefore, increasing attention has been given to the prevention, diagnosis, and treatment of PFO-related neurological diseases. By reviewing existing literature, this article focuses on the pathogenesis, epidemiology, and clinical characteristics of PFO-related neurological diseases, as well as the prevention and treatment of different neurological diseases to discuss, and aims to provide current progress for this field and decision-making evidence for clinical practice.
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Affiliation(s)
- Fanfan Shi
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Leihao Sha
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Li
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Yusha Tang
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Litao Huang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Huizhen Liu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjie Yang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Deying Kang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Chen
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Hurford R, Siripurapu R, Emsley HCA, Lovett J, Werring D, Punter MNM. Uncommon causes of ischaemic stroke: how to approach the diagnosis. Pract Neurol 2023; 23:35-45. [PMID: 35863878 DOI: 10.1136/pn-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 02/02/2023]
Abstract
Stroke is a common neurological emergency and although most cases are associated with traditional vascular risk factors leading to cerebral ischaemia by well-recognised pathophysiological mechanisms, around 4% of ischaemic strokes are due to rare conditions. These are important to recognise due to their different management, which is often specific and effective, and due to their different prognosis from otherwise cryptogenic ischaemic strokes. We outline a practical approach to identifying uncommon causes of ischaemic stroke by highlighting diagnostic 'red flags' and propose a structured approach to investigating them.
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Affiliation(s)
- Robert Hurford
- Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rekha Siripurapu
- Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Joanna Lovett
- Neurology Department, Wessex Neurological Centre, Southampton, UK
| | - David Werring
- Stroke Research Group, UCL institute of neurology, London, UK
| | - Martin Nicholas Michael Punter
- Department of Medicine, University of Otago, Wellington, New Zealand .,Department of Neurology, Wellington Regional Hospital, Newtown, New Zealand
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Li Y, Shen Y, Cao Q, Cheng Y, Xu L, Tang Z. Effect of Interventional Therapy Unexplained Dizziness and Relationship Between Dizziness Handicap Inventory and Right-to-Left Shunt Grading. Int J Gen Med 2023; 16:803-811. [PMID: 36883122 PMCID: PMC9985875 DOI: 10.2147/ijgm.s401046] [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: 12/11/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
Objective Unexplained dizziness remains a clinical challenge. Our previous studies have shown that unexplained dizziness may be related to patent foramen ovale (PFO). This study aims to explore whether the degree of shunt is correlated with the degree of unexplained dizziness and looking for the possible clinical intervention for patients with unexplained dizziness. Methods This study was a large single-center, prospective, controlled study. From March 2019 to March 2022, patients with unexplained dizziness and explained dizziness and healthy controls were recruited. Contrast-enhanced transcranial Doppler sonography (c-TCD) was performed to detect the existence of right-to-left shunt (RLS) and shunt grading. The dizziness handicap inventory (DHI) was completed to evaluate the dizziness. Unexplained dizziness patients with large amount of PFO were volunteered to receive medication treatment and transcatheter PFO closure and followed up six months. Results A total of 387 patients (132 unexplained, 123 explained and 132 controls) were enrolled. There was a statistical difference in the RLS grading with three groups (p < 0.001). The Spearman correlation coefficient of RLS grading and DHI scores in unexplained dizziness patients (r=0.122, p=0.163) and explained dizziness patients (r=0.067, p=0.460). In the unexplained group, there were 49 cases with massive grading RLS. Of which 25 patients received percutaneous PFO closure treatment and 24 cases received medication treatment. Followed up six months after treatment, the amount of DHI scores change in patients who received the percutaneous PFO closure was significantly higher than that in the medication treatment group (p < 0.001). Conclusion RLS may play an important role in unexplained dizziness. For unexplained dizziness patients, PFO closure may contribute to better outcomes. In the future, large-scale randomized controlled studies are still needed.
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Affiliation(s)
- Yanping Li
- Department of Neuroelectrophysiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yingzhang Cheng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhenyu Tang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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Abreu Martins F, Sousa D. Leiomyoma as a cause of thrombotic events in different vascular territories. BMJ Case Rep 2022; 15:e252906. [PMID: 36357110 PMCID: PMC9660612 DOI: 10.1136/bcr-2022-252906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Pisani E, Gaudiano C, Petrone A, Stancati F, Siniscalchi A. Isolated tongue angioedema after alteplase infusion in acute ischemic stroke. Curr Drug Saf 2021; 17:75-77. [PMID: 34323196 DOI: 10.2174/1574886316666210728104331] [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: 11/24/2020] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Angioedema, like anaphylaxis, has been reported as a rare adverse event of alteplase infusion in acute ischemic stroke. OBJECTIVE We report the case of a patient with acute ischemic stroke who after treatment of alteplase developed angioedema. METHODS We report the case of an 81-year-old woman who presented to our observation with acute ischemic stroke. The patient was on therapy with 100 mg acetylsalicylic acid and a triple combination antihypertensive drug (perindopril 10 mg + 2.5 mg indapamide + 5 mg amlodipine). The patient was treated with alteplase infusion. RESULTS Five minutes after the end of the alteplase infusion (0.9 mg/kg for 1 hour) the patient developed isolated angioedema of the lips and tongue. CONCLUSION Although the incidence of alteplase-induced angiodema in these patients is rare, this case report suggests the need for routine inspection of the tongue in acute ischemic patient in treatment with alteplase infusion, especially in female patients in treatment with ACE inhibitors.
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Affiliation(s)
- Ermanno Pisani
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Carmen Gaudiano
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Alfredo Petrone
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Furio Stancati
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Antonio Siniscalchi
- Department of Neurology and Stroke Unit Annunziata Hospital of Cosenza Via F. Migliori, 1 87100 Cosenza, Italy
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Adamo D, Calabria E, Coppola N, Pecoraro G, Buono G, Mignogna MD. When orofacial pain needs a heart repair. Clin Exp Dent Res 2020; 7:263-267. [PMID: 33247554 PMCID: PMC8019759 DOI: 10.1002/cre2.359] [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: 07/25/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives The association of chronic orofacial pain (COFP) and congenital heart disease has never previously been reported. We report the first case of COFP secondary to a right‐to‐left shunt (RLS) due to asymptomatic patent foramen ovale (PFO) in a patient with prothrombotic states. Materials and methods A 48‐year‐old female patient presented with a 10‐month history of left‐sided facial pain who was initially diagnosed with persistent idiopathic facial pain (PIFP) on account of its similar characteristics. Magnetic resonance imaging (MRI) of the brain revealed gliosis and carotid siphon tortuosity; in addition, hyperhomocysteinaemia due to the homozygosis mutation for 5,10 MethyleneTetraHydroFolate Reductase was identified. Transcranial doppler ultrasonography was requested from a neurology consultant which revealed a high degree of RLS. Subsequently, a cardiological evaluation was performed; the specialist requested a transesophageal echocardiography that detected an interatrial septum aneurysm with PFO. Results Based on the analysis of the patient's high degree of RLS, prothrombotic state and gliosis in relation to age, the cardiological consultant chose to perform a percutaneous closure of the PFO to avoid the risk of a cryptogenic stroke. After PFO closure, a complete remission of the pain was obtained. Conclusions The disappearance of the pain supports the possible association between RLS and COFP. PFO with RLS has been suggested as a risk factor for cryptogenic stroke, especially in association with other thromboembolic risk factors. Therefore, the early detection, in this case, could be considered a possible lifesaver. Communication between different care providers is essential when the patient presents symptoms of facial pain which are of an atypical nature.
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Affiliation(s)
- Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Buono
- Department of Morphological and Functional Imaging, Haematology and Oncology Sciences, University Federico II of Naples, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
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Zhao E, Xie H, Zhang Y. A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure. Front Neurol 2020; 11:593074. [PMID: 33193059 PMCID: PMC7645229 DOI: 10.3389/fneur.2020.593074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/01/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: This study aimed to develop and validate a nomogram to predict cessation of patent foramen ovale (PFO) patients with migraine headache after percutaneous closure. Methods: A total of 247 eligible patients with PFO and migraine after percutaneous closure between May, 2016 and May, 2018 were divided into a development cohort (n = 149) and a validation cohort (n = 98). The primary end point was cessation of migraine at follow-up of 1 year after the procedure measured by the Migraine Disability Assessment Score (MIDAS). In the development cohort, the LASSO regression was used data dimension reduction. A multivariable logistic regression analysis was used to develop the predicting nomogram. The performance of the nomogram was assessed by concordance index (C-index), calibration and clinical usefulness. The results were validated in the validation cohort. Results: Migraine with aura, history of antiplatelet, and the right-to-left shunt (RLS) at rest were identified as significant predictors based on the analysis of multivariate logistic regression. The nomogram incorporating these variables showed good calibration and discrimination in the development cohort with C-index of 0.906 (95% CI: 0.847–0.965), which was confirmed using the validation cohort with C-index of 0.827 (95% CI: 0.751–0.903). The nomogram showed good agreement between prediction by nomogram and actual observation. Furthermore, the decision curve indicated that the novel nomogram was clinically useful. Conclusion: The novel nomogram showed favorable predictive accuracy for cessation of migraine among patients with PFO after percutaneous closure and might provide constructive guidance in clinical decision making.
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