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Bah MG, Dowlati E, Fleigner M, Koduri S, Pandey A, Lin LY, Chenevert TL, Troost J, Xi G, Keep R, Chaudhary N. MR Imaging-based Biomarker Development in Hemorrhagic Stroke Patients Including Brain Iron Quantification, Diffusion Tensor Imaging, and Phenomenon of Ultra-early Erythrolysis. Neuroimaging Clin N Am 2024; 34:215-224. [PMID: 38604706 DOI: 10.1016/j.nic.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This review article discusses the role of MR imaging-based biomarkers in understanding and managing hemorrhagic strokes, focusing on intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage. ICH is a severe type of stroke with high mortality and morbidity rates, primarily caused by the rupture of small blood vessels in the brain, resulting in hematoma formation. MR imaging-based biomarkers, including brain iron quantification, ultra-early erythrolysis detection, and diffusion tensor imaging, offer valuable insights for hemorrhagic stroke management. These biomarkers could improve early diagnosis, risk stratification, treatment monitoring, and patient outcomes in the future, revolutionizing our approach to hemorrhagic strokes.
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Affiliation(s)
- Momodou G Bah
- Michigan State University College of Human Medicine, Lansing, MI, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Max Fleigner
- Oakland University, William Beaumont School of Medicine, Detroit, MI, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Leanne Y Lin
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jonathan Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Otorhinolaryngology, University of Michigan, Ann Arbor, MI 48109, USA.
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Campos-Fernandez D, Rodrigo-Gisbert M, Abraira L, Quintana Luque M, Santafé M, Lallana S, Fonseca E, Toledo M, Gándara DF, Arikan F, Tomasello A, Sala Padró JX, Falip M, López-Ojeda P, Gabarrós A, Sánchez A, Santamarina E. Predictive Model for Estimating the Risk of Epilepsy After Aneurysmal Subarachnoid Hemorrhage: The RISE Score. Neurology 2024; 102:e209221. [PMID: 38527232 DOI: 10.1212/wnl.0000000000209221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/02/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The occurrence of seizures after aneurysmal subarachnoid hemorrhage (aSAH) is associated with a poorer functional and cognitive prognosis and less favorable quality of life. It would be of value to promptly identify patients at risk of epilepsy to optimize follow-up protocols and design preventive strategies. Our aim was to develop a predictive score to help stratify epilepsy risk in patients with aSAH. METHODS This is a retrospective, longitudinal study of all adults with aSAH admitted to our center (2012-2021). We collected demographic data, clinical and radiologic variables, data on early-onset seizures (EOSs), and data on development of epilepsy. Exclusion criteria were previous structural brain lesion, epilepsy, and ≤7 days' follow-up. Multiple Cox regression was used to evaluate factors independently associated with unprovoked remote seizures (i.e., epilepsy). The best fitting regression model was used to develop a predictive score. Performance was evaluated in an external validation cohort of 308 patients using receiver-operating characteristic curve analysis. RESULTS From an initial database of 743 patients, 419 met the inclusion criteria and were included in the analysis. The mean age was 60 ± 14 years, 269 patients (64%) were women, and 50 (11.9%) developed epilepsy within a median follow-up of 4.2 years. Premorbid modified Rankin Score (mRS) (hazard ratio [HR] 4.74 [1.8-12.4], p = 0.001), VASOGRADE score (HR 2.45 [1.4-4.2], p = 0.001), surgical treatment (HR 2.77 [1.6-4.9], p = 0.001), and presence of EOSs (HR 1.84 [1.0-3.4], p = 0.05) were independently associated with epilepsy. The proposed scale, designated RISE, scores 1 point for premorbid mRS ≥ 2 (R), VASOGRADE-Yellow (I, Ischemia), surgical intervention (S), and history of EOSs (E) and 2 points for VASOGRADE-Red. RISE stratifies patients into 3 groups: low (0-1), moderate (2-3), and high (4-5) risk (2.9%, 20.8%, and 75.7% developed epilepsy, respectively). On validation in a cohort from a different tertiary care center (N = 308), the new scale yielded a similar risk distribution and good predictive power for epilepsy within 5 years after aSAH (area under the curve [AUC] 0.82; 95% CI 0.74-0.90). DISCUSSION The RISE scale is a robust predictor of post-SAH epilepsy with immediate clinical applicability. In addition to facilitating personalized diagnosis and treatment, RISE may be of value for exploring future antiepileptogenesis strategies.
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Affiliation(s)
- Daniel Campos-Fernandez
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Laura Abraira
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Manuel Quintana Luque
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Manel Santafé
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Sofia Lallana
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Elena Fonseca
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Manuel Toledo
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Darío F Gándara
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Fuat Arikan
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Jacint X Sala Padró
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Merce Falip
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Pablo López-Ojeda
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Andreu Gabarrós
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Anna Sánchez
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
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Gaastra B, Zhang J, Tapper W, Bulters D, Galea I. Sphingosine-1-phosphate Signalling in Aneurysmal Subarachnoid Haemorrhage: Basic Science to Clinical Translation. Transl Stroke Res 2024; 15:352-363. [PMID: 36749550 PMCID: PMC10891271 DOI: 10.1007/s12975-023-01133-9] [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: 01/01/2023] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
Sphingosine-1-phosphate (S1P) is generated intracellularly and, when transported to the extracellular compartment, predominantly signals through S1P receptors. The S1P signalling pathway has been implicated in the pathophysiology of neurological injury following aneurysmal subarachnoid haemorrhage (aSAH). In this review, we bring together all the available data regarding the role of S1P in neurological injury following aSAH. There is agreement in the literature that S1P increases in the cerebrospinal fluid following aSAH and leads to cerebral artery vasospasm. On the other hand, the role of S1P in the parenchyma is less clear cut, with different studies arguing for beneficial and deleterious effects. A parsimonious interpretation of this apparently conflicting data is presented. We discuss the potential of S1P receptor modulators, in clinical use for multiple sclerosis, to be repurposed for aSAH. Finally, we highlight the gaps in our knowledge of S1P signalling in humans, the clinical challenges of targeting the S1P pathway after aSAH and other research priorities.
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Affiliation(s)
- Ben Gaastra
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, SO16 6YD, UK.
| | - John Zhang
- Center of Neuroscience Research, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Will Tapper
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Ian Galea
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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4
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Lim MJR, Tan J, Neo AYY, Ng BCJ, Asano M. Acceptance of disability in stroke: a systematic review. Ann Phys Rehabil Med 2024; 67:101790. [PMID: 38118296 DOI: 10.1016/j.rehab.2023.101790] [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: 09/14/2022] [Revised: 06/27/2023] [Accepted: 08/15/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Evidence for the association between acceptance of disability (AOD) and positive rehabilitation outcomes, as well as for the use of AOD measurements in stroke rehabilitation practice, has increased in the international literature in the last decade. However, measurement tools for AOD are heterogenous and there has not been a systematic review summarizing the current evidence on the use of AOD measures and factors associated with AOD. OBJECTIVE This study aimed to summarize current evidence on measurement tools used, present existing AOD scores in people with stroke and identify risk factors for and protective factors against poor AOD in people with stroke. METHODS The original design and protocol of this systematic review were registered with PROSPERO. The included studies were published from 2008 to 2020 and identified from 5 databases-PubMed, EMBASE, CINAHL Plus, PsycInfo, and the Cochrane Library-using the following inclusion criteria: participants diagnosed with stroke and aged ≥16 years, measurement of AOD, and published in English in a peer-reviewed scientific journal. Review articles were excluded. RESULTS Five measurement tools for AOD were reported. The Revised Acceptance of Disability Scale (ADS-R) and the acceptance subscale of the Illness Cognition Questionnaire (ICQ) had the highest internal consistency. Scores ranged from 71.7 to 74.2 on the ADS-R, 16.9-18.3 on the ICQ, 16.5-26.9 on the Acceptance of Illness Scale, and 87.8-93.2 on the Attitudes towards Disabled Persons Form A. Poorer function and depressive symptoms were associated with poor AOD, whereas religious beliefs, support from others, and an understanding of stroke were associated with better AOD. CONCLUSIONS The ADS-R and the acceptance subscale of the ICQ are currently the most reliable measurement tools for measuring AOD in people with stroke. Further research to validate the measurement tools is required. This may help to identify people who require additional support. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42017077063; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77063.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Health System, 1E Kent Ridge Rd, Singapore 119228 Singapore; Ministry of Health Holdings, Singapore, 1 Maritime Square 099253, Singapore.
| | - Jaclyn Tan
- Division of Neurosurgery, University Surgical Centre, National University Health System, 1E Kent Ridge Rd, Singapore 119228 Singapore
| | | | | | - Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore
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5
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Bandyopadhyay S, Schwendinger N, Jahromi BR, Lad SP, Blackburn S, Wolf S, Bulters D, Galea I, Hugelshofer M. Red Blood Cells in the Cerebrospinal Fluid Compartment After Subarachnoid Haemorrhage: Significance and Emerging Therapeutic Strategies. Transl Stroke Res 2024:10.1007/s12975-024-01238-9. [PMID: 38418755 DOI: 10.1007/s12975-024-01238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Subarachnoid haemorrhage (SAH) is a subtype of stroke that predominantly impacts younger individuals. It is associated with high mortality rates and can cause long-term disabilities. This review examines the contribution of the initial blood load and the dynamics of clot clearance to the pathophysiology of SAH and the risk of adverse outcomes. These outcomes include hydrocephalus and delayed cerebral ischaemia (DCI), with a particular focus on the impact of blood located in the cisternal spaces, as opposed to ventricular blood, in the development of DCI. The literature described underscores the prognostic value of haematoma characteristics, such as volume, density, and anatomical location. The limitations of traditional radiographic grading systems are discussed, compared with the more accurate volumetric quantification techniques for predicting patient prognosis. Further, the significance of red blood cells (RBCs) and their breakdown products in secondary brain injury after SAH is explored. The review presents novel interventions designed to accelerate clot clearance or mitigate the effects of toxic byproducts released from erythrolysis in the cerebrospinal fluid following SAH. In conclusion, this review offers deeper insights into the complex dynamics of SAH and discusses the potential pathways available for advancing its management.
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Affiliation(s)
- Soham Bandyopadhyay
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nina Schwendinger
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital and University of Zurich, Zurich, Switzerland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Spiros Blackburn
- Department of Neurosurgery, University of Texas Houston Health Science Center, Houston, TX, USA
| | - Stefan Wolf
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Diederik Bulters
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Hugelshofer
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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6
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Fanning JP, Campbell BCV, Bulbulia R, Gottesman RF, Ko SB, Floyd TF, Messé SR. Perioperative stroke. Nat Rev Dis Primers 2024; 10:3. [PMID: 38238382 DOI: 10.1038/s41572-023-00487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
Ischaemic or haemorrhagic perioperative stroke (that is, stroke occurring during or within 30 days following surgery) can be a devastating complication following surgery. Incidence is reported in the 0.1-0.7% range in adults undergoing non-cardiac and non-neurological surgery, in the 1-5% range in patients undergoing cardiac surgery and in the 1-10% range following neurological surgery. However, higher rates have been reported when patients are actively assessed and in high-risk populations. Prognosis is significantly worse than stroke occurring in the community, with double the 30-day mortality, greater disability and diminished quality of life among survivors. Considering the annual volume of surgeries performed worldwide, perioperative stroke represents a substantial burden. Despite notable differences in aetiology, patient populations and clinical settings, existing clinical recommendations for perioperative stroke are extrapolated mainly from stroke in the community. Perioperative in-hospital stroke is unique with respect to the stroke occurring in other settings, and it is essential to apply evidence from other settings with caution and to identify existing knowledge gaps in order to effectively guide patient care and future research.
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Affiliation(s)
- Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
- Anaesthesia & Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
- The George Institute for Global Health, Sydney, New South Wales, Australia.
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bruce C V Campbell
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Richard Bulbulia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Sang-Bae Ko
- Department of Neurology and Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Thomas F Floyd
- Department of Anaesthesiology & Pain Management, Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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7
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Ahmed A. Quality Metrics in Acute Stroke: Time to Own. Indian J Crit Care Med 2023; 27:786-787. [PMID: 37936796 PMCID: PMC10626240 DOI: 10.5005/jp-journals-10071-24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Ahmed A. Quality Metrics in Acute Stroke: Time to Own. Indian J Crit Care Med 2023;27(11):786-787.
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Affiliation(s)
- Asif Ahmed
- Department of Critical Care Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
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Ramamoorthy V, Chan K, Roy M, Saxena A, Ahmed MA, Zhang Z, Appunni S, Thomas R, McGranaghan P, McDermott M, La Rosa FDLR, Rubens M. Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107333. [PMID: 37659191 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107333] [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: 02/28/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND In the US, between 2018 and 2019, approximately $57 billion were expended on stroke and related conditions. The aim of this study was to understand trends in direct healthcare expenditures among stroke patients using novel cost estimation methods and a nationally representative database. METHODS This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during 2009-2016. Manning and Mullahy's two-part model were used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. RESULTS The mean (Standard Deviation) direct annual healthcare expenditure among stroke patients was $16,979.0 ($16,222.0- $17,736.0) and was nearly 3 times greater than non-stroke participants which were $5,039.7 ($4,951.0-$5,128.5) and were mainly spent on inpatient services, prescription medications, and office-based visits. Stroke patients had an additional healthcare expenditure of $4096.0 (3543.9, 4648.1) per person per year, compared to participants without stroke after adjusting for covariates (P<0.001). The total mean annual direct healthcare expenditure for stroke survivors increased from $16,142.0 (15,017.0-17,267.0) in 2007-2008 to $16,979.0 (16,222.0-17,736.0) in 2015-2016. CONCLUSION Our study showed that stroke survivors had significantly greater healthcare expenses, compared to non-stroke individuals, mainly due to higher expenditures on inpatient services, prescription drugs, and office visits. These findings are concerning because the prevalence of stroke is projected to increase due to aging population and increased survival rates.
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Affiliation(s)
| | - Kelvin Chan
- Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Michael McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Felipe De Los Rios La Rosa
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
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9
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Deitelzweig S, Terasawa E, Atreja N, Kang A, Hines DM, Dhamane AD, Hagan M, Noman A, Luo X. Payer formulary tier increases of apixaban: how patients respond and potential implications. Curr Med Res Opin 2023; 39:1093-1101. [PMID: 37519272 DOI: 10.1080/03007995.2023.2232636] [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: 03/24/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To assess potential impacts of formulary tier increases of apixaban-an efficacious oral anticoagulant (OAC) for preventing stroke in patients with atrial fibrillation (AF)-on patients' prescription drug plan (PDP) switching and OAC treatment patterns. METHODS Nationwide claims data for Medicare beneficiaries with Parts A, B, and D (100% sample) were used to assess apixaban-treated AF patients who faced a formulary tier increase for apixaban in 2017 by their Part D PDP. Patients' out-of-pocket (OOP) costs for apixaban were described, along with PDP switching and OAC treatment patterns. RESULTS Among 1845 included patients, 97.7% had apixaban on tier 3 of their plan's formulary in 2016 and faced its increase to tier 4 for 2017. Approximately 4% (N = 81) of patients pre-emptively switched to a different PDP for 2017 with almost all switching to plans with apixaban on a lower formulary tier and 85.2% continuing apixaban treatment. Among the 96% (N = 1764) of patients who remained on the same PDP for 2017, over half (57.5%) continued apixaban treatment, despite increased OOP costs ($54 vs. $135 for a 30-day supply in 2016 vs. 2017). Only 12.4% of those who remained on the same plan for 2017 switched to another OAC, while as much as 30.1% discontinued OACs. These discontinuers exhibited higher comorbidity burdens than patients continuing on any OAC. CONCLUSION The majority of patients continued on apixaban despite higher OOP cost, suggesting patients' reluctance to change treatment for non-medical reasons; however, 30% of patients discontinued OAC treatment after higher apixaban tier placement.
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Affiliation(s)
- Steven Deitelzweig
- Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | | | - Nipun Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | - Amiee Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | | | | | - Melissa Hagan
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
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10
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Galea I, Bandyopadhyay S, Bulters D, Humar R, Hugelshofer M, Schaer DJ. Haptoglobin Treatment for Aneurysmal Subarachnoid Hemorrhage: Review and Expert Consensus on Clinical Translation. Stroke 2023; 54:1930-1942. [PMID: 37232189 PMCID: PMC10289236 DOI: 10.1161/strokeaha.123.040205] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke frequently affecting young to middle-aged adults, with an unmet need to improve outcome. This special report focusses on the development of intrathecal haptoglobin supplementation as a treatment by reviewing current knowledge and progress, arriving at a Delphi-based global consensus regarding the pathophysiological role of extracellular hemoglobin and research priorities for clinical translation of hemoglobin-scavenging therapeutics. After aneurysmal subarachnoid hemorrhage, erythrocyte lysis generates cell-free hemoglobin in the cerebrospinal fluid, which is a strong determinant of secondary brain injury and long-term clinical outcome. Haptoglobin is the body's first-line defense against cell-free hemoglobin by binding it irreversibly, preventing translocation of hemoglobin into the brain parenchyma and nitric oxide-sensitive functional compartments of cerebral arteries. In mouse and sheep models, intraventricular administration of haptoglobin reversed hemoglobin-induced clinical, histological, and biochemical features of human aneurysmal subarachnoid hemorrhage. Clinical translation of this strategy imposes unique challenges set by the novel mode of action and the anticipated need for intrathecal drug administration, necessitating early input from stakeholders. Practising clinicians (n=72) and scientific experts (n=28) from 5 continents participated in the Delphi study. Inflammation, microvascular spasm, initial intracranial pressure increase, and disruption of nitric oxide signaling were deemed the most important pathophysiological pathways determining outcome. Cell-free hemoglobin was thought to play an important role mostly in pathways related to iron toxicity, oxidative stress, nitric oxide, and inflammation. While useful, there was consensus that further preclinical work was not a priority, with most believing the field was ready for an early phase trial. The highest research priorities were related to confirming haptoglobin's anticipated safety, individualized versus standard dosing, timing of treatment, pharmacokinetics, pharmacodynamics, and outcome measure selection. These results highlight the need for early phase trials of intracranial haptoglobin for aneurysmal subarachnoid hemorrhage, and the value of early input from clinical disciplines on a global scale during the early stages of clinical translation.
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Affiliation(s)
- Ian Galea
- Department of Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Hampshire, United Kingdom (I.G., S.B., D.B.)
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (I.G., S.B., D.B.)
| | - Soham Bandyopadhyay
- Department of Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Hampshire, United Kingdom (I.G., S.B., D.B.)
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (I.G., S.B., D.B.)
| | - Diederik Bulters
- Department of Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Hampshire, United Kingdom (I.G., S.B., D.B.)
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (I.G., S.B., D.B.)
| | - Rok Humar
- Division of Internal Medicine (R.H., D.J.S.), Universitätsspital and University of Zurich, Switzerland
| | - Michael Hugelshofer
- Department of Neurosurgery, Clinical Neuroscience Center (M.H.), Universitätsspital and University of Zurich, Switzerland
| | - Dominik J. Schaer
- Division of Internal Medicine (R.H., D.J.S.), Universitätsspital and University of Zurich, Switzerland
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11
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Wolfrum M, Handerer IJ, Moccetti F, Schmeisser A, Braun-Dullaeus RC, Toggweiler S. Cerebral embolic protection during transcatheter aortic valve replacement: a systematic review and meta-analysis of propensity score matched and randomized controlled trials using the Sentinel cerebral embolic protection device. BMC Cardiovasc Disord 2023; 23:306. [PMID: 37330463 PMCID: PMC10276451 DOI: 10.1186/s12872-023-03338-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND The Sentinel cerebral embolic protection device (CEP) aims to reduce the risk of stroke during transcatheter aortic valve replacement (TAVR). We performed a systematic review and meta-analysis of propensity score matched (PSM) and randomized controlled trials (RCT) investigating the effect of the Sentinel CEP to prevent strokes during TAVR. METHODS Eligible trials were searched through PubMed, ISI Web of science databases, Cochrane database, and proceedings of major congresses. Primary outcome was stroke. Secondary outcomes included all-cause mortality, major or life-threatening bleeding, major vascular complications and acute kidney injury at discharge. Fixed and random effect models were used to calculate the pooled risk ratio (RR) with 95% confidence intervals (CI) and absolute risk difference (ARD). RESULTS A total of 4066 patients from 4 RCTs (3'506 patients) and 1 PSM study (560 patients) were included. Use of Sentinel CEP was successful in 92% of patients and was associated with a significantly lower risk of stroke (RR: 0.67, 95% CI: 0.48-0.95, p = 0.02. ARD: -1.3%, 95% CI: -2.3 - -0.2, p = 0.02, number needed to treat (NNT) = 77), and a reduced risk of disabling stroke (RR: 0.33, 95% CI: 0.17-0.65. ARD: -0.9%, 95% CI: -1.5 - -0.3, p = 0.004, NNT = 111). Use of Sentinel CEP was associated with a lower risk of major or life-threatening bleeding (RR: 0.37, 95% CI: 0.16-0.87, p = 0.02). Risk for nondisabling stroke (RR: 0.93, 95% CI: 0.62-1.40, p = 0.73), all-cause mortality (RR: 0.70, 95% CI: 0.35-1.40, p = 0.31), major vascular complications (RR: 0.74, 95% CI: 0.33-1.67, p = 0.47) and acute kidney injury (RR: 0.74, 95% CI: 0.37-1.50, p = 0.40) were similar. CONCLUSIONS The use of CEP during TAVR was associated with lower risks of any stroke and disabling stroke with an NNT of 77 and 111, respectively.
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Affiliation(s)
- Mathias Wolfrum
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany.
| | - Immanuel Justus Handerer
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | | | - Alexander Schmeisser
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Ruediger C Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
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12
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Lauzier DC, Jayaraman K, Yuan JY, Diwan D, Vellimana AK, Osbun J, Chatterjee AR, Athiraman U, Dhar R, Zipfel GJ. Early Brain Injury After Subarachnoid Hemorrhage: Incidence and Mechanisms. Stroke 2023; 54:1426-1440. [PMID: 36866673 PMCID: PMC10243167 DOI: 10.1161/strokeaha.122.040072] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Aneurysmal subarachnoid hemorrhage is a devastating condition causing significant morbidity and mortality. While outcomes from subarachnoid hemorrhage have improved in recent years, there continues to be significant interest in identifying therapeutic targets for this disease. In particular, there has been a shift in emphasis toward secondary brain injury that develops in the first 72 hours after subarachnoid hemorrhage. This time period of interest is referred to as the early brain injury period and comprises processes including microcirculatory dysfunction, blood-brain-barrier breakdown, neuroinflammation, cerebral edema, oxidative cascades, and neuronal death. Advances in our understanding of the mechanisms defining the early brain injury period have been accompanied by improved imaging and nonimaging biomarkers for identifying early brain injury, leading to the recognition of an elevated clinical incidence of early brain injury compared with prior estimates. With the frequency, impact, and mechanisms of early brain injury better defined, there is a need to review the literature in this area to guide preclinical and clinical study.
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Affiliation(s)
- David C. Lauzier
- Department of Neurological Surgery, Washington University School of Medicine
| | - Keshav Jayaraman
- Department of Neurological Surgery, Washington University School of Medicine
| | - Jane Y. Yuan
- Department of Neurological Surgery, Washington University School of Medicine
| | - Deepti Diwan
- Department of Neurological Surgery, Washington University School of Medicine
| | - Ananth K. Vellimana
- Department of Neurological Surgery, Washington University School of Medicine
- Department of Neurology, Washington University School of Medicine
- Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | - Joshua Osbun
- Department of Neurological Surgery, Washington University School of Medicine
- Department of Neurology, Washington University School of Medicine
- Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | - Arindam R. Chatterjee
- Department of Neurological Surgery, Washington University School of Medicine
- Department of Neurology, Washington University School of Medicine
- Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | | | - Rajat Dhar
- Department of Neurology, Washington University School of Medicine
| | - Gregory J. Zipfel
- Department of Neurological Surgery, Washington University School of Medicine
- Department of Neurology, Washington University School of Medicine
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13
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Hossain I, Younsi A, Castaño Leon AM, Lippa L, Tóth P, Terpolilli N, Tobieson L, Latini F, Raabe A, Depreitere B, Rostami E. Huge variability in restrictions of mobilization for patients with aneurysmal subarachnoid hemorrhage - A European survey of practice. BRAIN & SPINE 2023; 3:101731. [PMID: 37383447 PMCID: PMC10293289 DOI: 10.1016/j.bas.2023.101731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/30/2023]
Abstract
Introduction One of the major goals of neurointensive care is to prevent secondary injuries following aSAH. Bed rest and patient immobilization are practiced in order to decrease the risk of DCI. Research question To explore the current practices in place concerning the management of patients with aSAH, specifically, protocols and habits regarding restrictions of mobilization and HOB positioning. Material and methods A survey was designed, modified, and approved by the panel of the Trauma & Critical Care section of the EANS to cover the practice of restrictions of patient mobilization and HOB positioning in patients with aSAH. Results Twenty-nine physicians from 17 countries completed the questionnaire. The majority (79.3%) stated that non-secured aneurysm and the presence of an EVD were the factors related to the establishment of restriction of mobilization. The average duration of the restriction varied widely ranging between 1 and 21 days. The presence of an EVD (13.8%) was found to be the main reason to recommend restriction of HOB elevation. The average duration of restriction of HOB positioning ranged between 3 and 14 days. Rebleeding or complications related to CSF over-drainage were found to be related to these restrictions. Discussion and conclusion Restriction of patient mobilization regimens vary widely in Europe. Current limited evidence does not support an increased risk of DCI rather the early mobilization might be beneficial. Large prospective studies and/or the initiative of a RCT are needed to understand the significance of early mobilization on the outcome of patients with aSAH.
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Affiliation(s)
- Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Alexander Younsi
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ana Maria Castaño Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milano, Italy
| | - Péter Tóth
- Department of Neurosurgery, University of Pecs, Hungary
| | - Nicole Terpolilli
- Department of Neurosurgery, Munich University Hospital, Munich, Germany
| | - Lovisa Tobieson
- Department of Neurosurgery of Linköping, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Francesco Latini
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Elham Rostami
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
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Abstract
Despite contemporary rehabilitation strategies, stroke remains a leading cause of loss of function, limited mobility, psycho-social complications, and decreased quality of life. Stroke rehabilitation is a process that aims to prevent deterioration of function, increase function, and assist the patient in achieving the highest possible level of independence physically, socially, spiritually, psychologically, vocationally, and economically. The process begins with relearning activities of daily living such as grooming, bathing, toileting, eating, and dressing. As the patient progresses, stroke rehabilitation works on instrumental activities of daily living such as housekeeping, cooking, driving, and managing financial responsibilities.
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Affiliation(s)
- Helen P Neil
- Louisiana State University Health New Orleans, School of Nursing, 1900 Gravier Street Room 328, New Orleans, LA 70112, USA.
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15
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Levy EI, Monteiro A, Waqas M, Siddiqui AH. Access to Mechanical Thrombectomy for Stroke: Center Qualifications, Prehospital Management, and Geographic Disparities. Neurosurgery 2023; 92:3-9. [PMID: 36519855 DOI: 10.1227/neu.0000000000002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/25/2022] [Indexed: 12/23/2022] Open
Abstract
Mechanical thrombectomy (MT) became the "gold-standard" treatment for most patients with acute ischemic stroke due to anterior circulation large vessel occlusion. With such a remarkable paradigm shift, it is important that this modality of treatment becomes widely and homogeneously available throughout the United States and other countries. Although the time window for MT is large (24 hours in selected patients), time is still a major determinant of outcome. Several variables are involved in achieving timely access of MT for the majority of the population: prehospital management systems, transportation models, in-hospital workflow organization, accreditation and infrastructure of centers, training of neurointervention professionals, and geographic distribution of centers. The current situation in the United States regarding MT access is marked by geographic and socioeconomic disparities. We provide an overview of current challenges and solutions in achieving more universal access to MT for the population.
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Affiliation(s)
- Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.,Jacobs Institute, Buffalo, New York, USA
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16
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Gaastra B, Duncan P, Bakker MK, Hostettler IC, Alg VS, Houlden H, Ruigrok YM, Galea I, Tapper W, Werring D, Bulters D. Genetic variation in NFE2L2 is associated with outcome following aneurysmal subarachnoid haemorrhage. Eur J Neurol 2023; 30:116-124. [PMID: 36148820 PMCID: PMC10092511 DOI: 10.1111/ene.15571] [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: 07/13/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Nuclear factor erythroid 2-related factor 2 (NRF2; encoded by the NFE2L2 gene) has been implicated in outcome following aneurysmal subarachnoid haemorrhage (aSAH) through its activity as a regulator of inflammation, oxidative injury and blood breakdown product clearance. The aim of this study was to identify whether genetic variation in NFE2L2 is associated with clinical outcome following aSAH. METHODS Ten tagging single nucleotide polymorphisms (SNPs) in NFE2L2 were genotyped and tested for association with dichotomized clinical outcome, assessed by the modified Rankin scale, in both a discovery and a validation cohort. In silico functional analysis was performed using a range of bioinformatic tools. RESULTS One SNP, rs10183914, was significantly associated with outcome following aSAH in both the discovery (n = 1007) and validation cohorts (n = 466). The risk of poor outcome was estimated to be 1.33-fold (95% confidence interval 1.12-1.58) higher in individuals with the T allele of rs10183914 (pmeta-analysis = 0.001). In silico functional analysis identified rs10183914 as a potentially regulatory variant with effects on transcription factor binding in addition to alternative splicing with the T allele, associated with a significant reduction in the NFE2L2 intron excision ratio (psQTL = 1.3 × 10-7 ). CONCLUSIONS The NFE2L2 SNP, rs10183914, is significantly associated with outcome following aSAH. This is consistent with a clinically relevant pathophysiological role for oxidative and inflammatory brain injury due to blood and its breakdown products in aSAH. Furthermore, our findings support NRF2 as a potential therapeutic target following aSAH and other forms of intracranial haemorrhage.
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Affiliation(s)
- Ben Gaastra
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - Poppy Duncan
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark K Bakker
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Isabel C Hostettler
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Varinder S Alg
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Henry Houlden
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Will Tapper
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Werring
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
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17
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Gaastra B, Carmichael H, Galea I, Bulters D. Long-term fatigue following aneurysmal subarachnoid haemorrhage and the impact on employment. Eur J Neurol 2022; 29:3564-3570. [PMID: 36039524 PMCID: PMC9825863 DOI: 10.1111/ene.15533] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Fatigue is common following aneurysmal subarachnoid haemorrhage (aSAH) but little is known about its frequency, prognosis and impact on employment. The aim of this study was to assess the frequency of fatigue, whether it changes over time and the relationship to employment in the long term. METHODS This was a retrospective observational study of aSAH cases and matched controls from the UK Biobank. The presence of fatigue was compared between cases and controls using the chi-squared test. The change in frequency over time was assessed using Spearman's rank correlation coefficient. The effect of fatigue on employment was assessed using mediation analysis. RESULTS Fatigue is more common following aSAH compared to matched controls (aSAH 18.7%; controls 13.7%; χ2 = 13.0, p < 0.001) at a mean follow-up of 123 months. Fatigue gradually improves over time with significant fatigue decreasing by 50% from ~20% in the first year to ~10% after a decade (p = 0.04). Fatigue significantly mediated 24.0% of the effect of aSAH status on employment. CONCLUSIONS Fatigue is common following aSAH and persists in the long term. It gradually improves over time but has a major impact on aSAH survivors, significantly contributing to unemployment following haemorrhage. Further work is required to develop treatments and management strategies for fatigue with a view to improving this symptom and consequently employment following aSAH.
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Affiliation(s)
- Ben Gaastra
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK,Department of Neurosurgery, Wessex Neurological CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Harry Carmichael
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
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18
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Temporal averaging angiographic reconstructions from whole-brain CT perfusion for the detection of vasospasm. J Neuroradiol 2022; 50:333-340. [PMID: 36216294 DOI: 10.1016/j.neurad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study is to evaluate the image quality and diagnostic performance of angiographic images reconstructed from whole-brain CT perfusion (CTP) using temporal averaging compared to CT angiography (CTA) for the detection of vasospasm. MATERIALS AND METHODS 39 CT studies in 28 consecutive patients who underwent brain CTA with CTP for suspected vasospasm between September 2020 and May 2021 were retrospectively evaluated. The image quality of these two vascular imaging techniques was assessed either quantitatively (image noise, vascular enhancement, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios,) and qualitatively (4 criteria assessed on a 5-point scale). Intra and interobserver agreements and a diagnostic confidence score on the diagnosis of vasospasm were measured. Radiation dose parameters (volume CT dose index (CTDIvol) and dose-length product (DLP)) were recorded. RESULTS Both SNR and CNR were significantly higher with temporal averaging compared to CTA, increasing by 104% and 113%, respectively (p<0.001). The qualitative assessment found no significant difference in overall image quality between temporal averaging (4.33 ± 0.48) and brain CTA (4.19 ± 0.52) (p = 0.12).There was a significant improvement in intravascular noise and arterial contrast enhancement with temporal averaging. The evaluation of intra and interobserver agreements showed a robust concordance in the diagnosis of vasospasm between the two techniques. CONCLUSIONS Temporal averaging appeared as a feasible and reliable imaging technique for the detection of vasospasm. The use of temporal averaging, replacing brain CTA, could represent a new strategy of radiation and contrast material doses reduction in these patients.
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19
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Watson N, Bonsack F, Sukumari-Ramesh S. Intracerebral Hemorrhage: The Effects of Aging on Brain Injury. Front Aging Neurosci 2022; 14:859067. [PMID: 35547620 PMCID: PMC9082316 DOI: 10.3389/fnagi.2022.859067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/01/2022] [Indexed: 12/25/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a devastating subtype of stroke with high rates of mortality and morbidity. ICH patients often suffer devastating and debilitating neurological impairments, from which the majority of victims are unable to fully recover to functional independence. Unfortunately, there is no established medical therapy for ICH, which is partly attributed to the lack of understanding of the complex pathology of the disorder. Despite advanced age being a major risk factor of ICH, most preclinical studies on ICH employed young animal subjects. Due to this discrepancy, the molecular level changes in the aging brain after ICH are largely unknown, limiting the translation of preclinical studies into potential human treatments. The purpose of this review is to highlight the effects of advanced age on ICH- induced brain injury and recovery and to draw attention to current knowledge gaps, which warrant further investigation.
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20
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Motolese F, Capone F, Di Lazzaro V. New tools for shaping plasticity to enhance recovery after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:299-315. [PMID: 35034743 DOI: 10.1016/b978-0-12-819410-2.00016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stroke is the second most common cause of death worldwide and its prevalence is projected to increase in the coming years in parallel with the increase of life expectancy. Despite the great improvements in the management of the acute phase of stroke, some residual disability persists in most patients thus requiring rehabilitation. One third of patients do not reach the maximal recovery potential and different approaches have been explored with the aim to boost up recovery. In this regard, noninvasive brain stimulation techniques have been widely used to induce neuroplasticity phenomena. Different protocols of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (tES) can induce short- and long-term changes of synaptic excitability and are promising tools for enhancing recovery in stroke patients. New options for neuromodulation are currently under investigation. They include: vagal nerve stimulation (VNS) that can be delivered invasively, with implanted stimulators and noninvasively with transcutaneous VNS (tVNS); and extremely low-frequency (1-300Hz) magnetic fields. This chapter will provide an overview on the new techniques that are used for neuroprotection and for enhancing recovery after stroke.
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Affiliation(s)
- Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
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21
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Szelényi A, Fernández-Conejero I, Kodama K. Surgery and intraoperative neurophysiologic monitoring for aneurysm clipping. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:375-393. [PMID: 35772896 DOI: 10.1016/b978-0-12-819826-1.00008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter describes the feasibility, utilization, and value of intraoperative neurophysiologic monitoring (IONM) in cerebrovascular cases. Practical advice on the integration of these adjunct methods into the modern neurosurgical operating room is based on our own neurophysiologic and neurosurgical experience. Most IONM is done for anterior circulation aneurysms. Somatosensory and motor evoked potentials are the modalities of choice covering vascular territories of the internal, anterior, and middle cerebral arteries. While monitoring both hemispheres with the unoperated side as control, monitoring focus is laid upon those territories at risk and bearing the aneurysm. The specificity of IONM is close to 1, and sensitivity ranges from 0.2 to 1, depending on the categorization of transient changes. The overall likelihood of worsened neurologic outcome after any intraoperative signal deterioration (transient or permanent) is 0.4.
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Affiliation(s)
- Andrea Szelényi
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Isabel Fernández-Conejero
- Unit of Intraoperative Neurophysiology, Department of Neurology, University Hospital of Bellvitge, Barcelona, Spain
| | - Kunihiko Kodama
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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22
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Lobo EH, Abdelrazek M, Grundy J, Kensing F, Livingston PM, Rasmussen LJ, Islam SMS, Frølich A. Caregiver Engagement in Stroke Care: Opportunities and Challenges in Australia and Denmark. Front Public Health 2021; 9:758808. [PMID: 34900907 PMCID: PMC8661098 DOI: 10.3389/fpubh.2021.758808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/04/2021] [Indexed: 01/01/2023] Open
Abstract
Globally, there is a rise in incident cases of stroke, particularly in low- and middle-income countries, due to obesity-related and lifestyle risk factors, including health issues such as high cholesterol, diabetes and hypertension. Since the early 20th century, stroke mortality has declined due to proper management of the risk factors and improved treatment practices. However, despite the decline in mortality, there is an increase in the levels of disability that requires long-term support. In countries such as Australia and Denmark, where most care is provided within the community; family members, generally spouses, assume the role of caregiver, with little to no preparation that affects the quality of care provided to the person living with stroke. While past research has highlighted aspects to improve caregiver preparedness of stroke and its impact on care; health planning, recovery, and public health policies rarely consider these factors, reducing engagement and increasing uncertainty. Hence, there is a need to focus on improving strategies during recovery to promote caregiver engagement. In this study, we, therefore, try to understand the needs of the caregiver in stroke that limit engagement, and processes employed in countries such as Australia and Denmark to provide care for the person with stroke. Based on our understanding of these factors, we highlight the potential opportunities and challenges to promote caregiving engagement in these countries.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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23
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Gilmore N, Katz DI, Kiran S. Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation. ACTA ACUST UNITED AC 2021; 6:714-727. [PMID: 34746412 DOI: 10.1044/2021_persp-21-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults. Method This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The paper concludes by providing: 1) suggestions for key components of cognitive rehabilitation for young adults with ABI; 2) an example from our own research providing intensive academically-focused cognitive rehabilitation for young adults with ABI pursuing college; and 3) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity- naturally embedded within many cognitive rehabilitation approaches-could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.
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Affiliation(s)
- Natalie Gilmore
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
| | - Douglas I Katz
- Neurology, Boston University School of Medicine, Boston, USA
| | - Swathi Kiran
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
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24
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Park C, Charalambous LT, Yang Z, Adil SM, Hodges SE, Lee HJ, Verbick LZ, McCabe AR, Lad SP. Inpatient mortality and healthcare resource utilization of nontraumatic intracerebral hemorrhage complications in the US. J Neurosurg 2021; 135:1081-1090. [PMID: 33482635 DOI: 10.3171/2020.8.jns201839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nontraumatic, primary intracerebral hemorrhage (ICH) accounts for 2 million strokes worldwide annually and has a 1-year survival rate of 50%. Recent studies examining functional outcomes from ICH evacuation have been performed, but limited work has been done quantifying the incidence of subsequent complications and their healthcare economic impact. The purpose of this study was to quantify the incidence and healthcare resource utilization (HCRU) for major complications that can arise from ICH. METHODS The IBM MarketScan Research databases were used to retrospectively identify patients with ICH from 2010 to 2015. Complications examined included cerebral edema, hydrocephalus, venous thromboembolic events (VTEs), pneumonia, urinary tract infections (UTIs), and seizures. For each complication, inpatient mortality and HCRU were assessed. RESULTS Of 25,322 adult patients included, 10,619 (42%) developed complications during the initial admission of ICH: 22% had cerebral edema, 11% hydrocephalus, 10% pneumonia, 6% UTIs, 5% seizures, and 5% VTEs. The inpatient mortality rates at 7 and 30 days for each complication of ICH ranked from highest to lowest were hydrocephalus (24% and 32%), cerebral edema (15% and 20%), pneumonia (8% and 18%), seizure (7% and 13%), VTE (4% and 11%), and UTI (4% and 8%). Hydrocephalus had the highest total cost (median $92,776, IQR $39,308-$180,716) at 7 days post-ICH diagnosis and the highest cumulative total cost (median $170,839, IQR $91,462-$330,673) at 1 year post-ICH diagnosis. CONCLUSIONS This study characterizes one of the largest cohorts of patients with nontraumatic ICH in the US. More than 42% of the patients with ICH developed complications during initial admission, which resulted in high inpatient mortality and considerable HCRU.
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Affiliation(s)
| | | | - Zidanyue Yang
- 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and
| | | | | | - Hui-Jie Lee
- 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and
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25
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Megaly M, Sorajja P, Cavalcante JL, Pershad A, Gössl M, Abraham B, Omer M, Elbadawi A, Garcia S. Ischemic Stroke With Cerebral Protection System During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 13:2149-2155. [PMID: 32972578 DOI: 10.1016/j.jcin.2020.05.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate in-hospital outcomes with use of the Sentinel cerebral protection system (CPS) in transcatheter aortic valve replacement (TAVR). BACKGROUND The role of the Sentinel CPS in preventing clinical ischemic stroke has been controversial. METHODS The Nationwide Inpatient Sample database from the last three quarters of 2017, after the approval of the Sentinel CPS device, was queried to identify hospitalizations for TAVR. A 1:2 propensity score-matched analysis to compare in-hospital outcomes with versus without use of the CPS. The primary outcome was the occurrence of ischemic strokes. RESULTS A total of 36,220 weighted discharges of patients who underwent TAVR (525 with the CPS and 35,695 without) were identified. The overall percentages of ischemic and hemorrhagic strokes were 2.4% and 0.2%, respectively. After propensity score matching (525 CPS, 1,050 no CPS), the risk for ischemic stroke was lower with use of the CPS (1 % vs. 3.8%, odd ratio [OR]: 0.243 (95% confidence interval: 0.095 to 0.619); p = 0.003). The cost of the index hospitalization was higher with use of the CPS ($47,783 vs. $44,578; p = 0.002). In multivariate regression analysis, use of the CPS was independently associated with a lower risk for ischemic stroke (OR: 0.380; 95% confidence interval: 0.157 to 0.992; p = 0.032). CONCLUSIONS Use of the Sentinel CPS in patients undergoing TAVR is associated with a lower incidence of ischemic stroke and in-hospital mortality, without an increased risk for procedural complications but with an increased cost of the index hospitalization.
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Affiliation(s)
- Michael Megaly
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, Arizona
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bishoy Abraham
- Division of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan
| | - Mohamed Omer
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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26
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Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc 2021; 96:1970-2000. [PMID: 33992453 DOI: 10.1016/j.mayocp.2021.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.
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Affiliation(s)
- Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
| | - Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport
| | | | | | - William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Critical Care, Mayo Clinic, Jacksonville, FL
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27
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Zhu Z, Bower M, Stern-Nezer S, Atallah S, Stradling D, Groysman L, Dastur CK, Akbari Y, Yu W. Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost for Patients with Hypertensive Intracerebral Hemorrhage. Neurocrit Care 2021; 32:707-714. [PMID: 32253732 DOI: 10.1007/s12028-020-00951-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Intravenous nicardipine infusion is effective for rapid blood pressure control. However, its use requires hemodynamic monitoring in the intensive care unit (ICU) and is associated with high hospital cost. This study aimed to examine the effect of early versus late initiation of oral antihypertensives on ICU length of stay (LOS) and cost of hospitalization in patients with hypertensive intracerebral hemorrhage (ICH). METHODS This is a single-center retrospective study of patients with hypertensive ICH treated with nicardipine infusion from January 1, 2013, to December 31, 2017. Patients were dichotomized into study and control groups, based on receiving oral antihypertensives within 24 h versus after 24 h of emergency department arrival. Baseline characteristics, duration of nicardipine infusion, LOS in the ICU and hospital, functional outcome at discharge, and hospital cost were compared between the two groups using univariate and multivariate analysis. RESULTS A total of 90 patients in the study group and 76 in the control group were identified. There was no significant difference in demographics, past medical history, and initial SBP between the two groups. After adjusting for confounding factors with multivariate regression models, early initiation of oral antihypertensives was associated with significant reductions in duration of nicardipine infusion (55.5 ± 60.1 vs 121.6 ± 141.3 h, p <0.005), nicardipine cost ($14,207 vs $29,299, p < 0.01), ICU LOS (2 vs 5 days, p < 0.005), and cost of hospitalization ($24,564 vs $47,366, p < 0.01). There was no significant difference in adversary renal events, favorable outcomes, and mortality between the two groups. CONCLUSIONS Early initiation of oral antihypertensives is safe and may have a significant financial impact on patients with hypertensive ICH.
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Affiliation(s)
- Zhu Zhu
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Matthew Bower
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Sara Stern-Nezer
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Steven Atallah
- Departments of Pharmacy, University of California, Irvine, Orange, CA, USA
| | - Dana Stradling
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Leonid Groysman
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Cyrus K Dastur
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Yama Akbari
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, 200 S. Manchester Ave., Suite 206E, Orange, CA, 92868, USA.
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28
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Zheng J, Zhou R, Meng B, Li F, Liu H, Wu X. Knowledge framework and emerging trends in intracranial aneurysm magnetic resonance angiography: a scientometric analysis from 2004 to 2020. Quant Imaging Med Surg 2021; 11:1854-1869. [PMID: 33936970 DOI: 10.21037/qims-20-729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background As magnetic resonance angiography (MRA) has been increasingly used in the follow-up of intracranial aneurysms (IAs) as a non-invasive technique, the knowledge framework and areas of research interest in intracranial aneurysms magnetic resonance angiography (IAMRA) change approximately every 10 years. However, few studies have quantitatively analyzed the published literature in this field. In the present study, we used scientometrics to survey the knowledge field, development trends, and research focus of IAMRA with the aim of providing a reference for further study. Methods We collected articles on IAMRA published from 2004 (Jan 1, 2004) to 2020 (May 24, 2020). Web of Science Core Collection databases (WoSCCd) including the Science Citation Index Expanded were searched. An experienced staff member from the Department of Radiology at Southern Medical University, assisted in screening articles for relevant articles. We used ArcGIS (a mapping and location analytics platform) to perform geographic visualization. Excel 2016 was used to analyze the literature data, including number of publications, impact factor (IF), and publication year. CiteSpace V was used to conduct a series of literature feature clustering, including author co-citation analysis, reference co-citation analysis (RCA), and burst keywords analysis. Results A total of 1,272 articles on IAMRA published between 2004 and 2020 were included. Of 257 journals, American Journal of Neuroradiology (IF 2018: 3.256) published the most IAMRA articles (109 publications, 8.57%), followed by Journal of Neurosurgery (IF 2018: 4.131, 51 publications, 4.16%), and Neuroradiology (IF 2018: 2.504, 51 publications, 4.01%). Of 56 countries, the USA published the most, with 347 articles [27.28%, IF: 3.14 (average IF of all journals in the country)], followed by Japan (242 articles, 19.03%, IF: 2.38), Germany (135 articles, 10.61%, IF: 3.21), and China (101 articles, 7.94%, IF: 2.86). A total of 1387 institutions published articles, with the Mayo Clinic publishing the most (33 articles, 2.59%), followed by Shanghai Jiao Tong University (25 article, 1.97%), Seoul National University (23 articles, 1.81%), and University Medical Center Utrecht (19 articles, 1.49%). Of 399 authors, Rinkel ranked first with 19 articles, followed by Li MH (18 articles), Uchino A (15 articles), and Saito N (13 articles). Cluster RCA showed that the first cluster was "#0 growth", followed by "#1 Guglielmi detachable coils". Timeline views showed that the time span of "#0 growth" was the closest to today. The modularity value was 0.6971, and the mean silhouette value was 0.5477. According to the burst keyword analysis, "risk factors associated to rupture" was the topic with the strongest burst since 2017. Studies conducted in several countries suggested that age is inversely related to the risk of rupture, which implies the importance of MRA follow-up for patients of different age. Conclusions From 2004 to 2020, the number of published IAMRA-related articles gradually increased. The USA and Western Europe lead in the field, with a concentration of cutting-edge talents and high-level scientific research institutions. A synthesis of the clustering results of RCA and burst keyword analysis indicated that unruptured IA growth, stent-assisted coil embolization, and risk factors associated to rupture were the current hotspots in IAMRA research.
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Affiliation(s)
- Jiazhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Bingyao Meng
- Department of Radiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Furong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Huamin Liu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
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Chung DY, Oka F, Jin G, Harriott A, Kura S, Aykan SA, Qin T, Edmiston WJ, Lee H, Yaseen MA, Sakadžić S, Boas DA, Whalen MJ, Ayata C. Subarachnoid hemorrhage leads to early and persistent functional connectivity and behavioral changes in mice. J Cereb Blood Flow Metab 2021; 41:975-985. [PMID: 32936728 PMCID: PMC8054726 DOI: 10.1177/0271678x20940152] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) leads to significant long-term cognitive deficits, which can be associated with alterations in resting state functional connectivity (RSFC). However, modalities such as fMRI-which is commonly used to assess RSFC in humans-have practical limitations in small animals. Therefore, we used non-invasive optical intrinsic signal imaging to determine the effect of SAH on RSFC in mice up to three months after prechiasmatic blood injection. We assessed Morris water maze (MWM), open field test (OFT), Y-maze, and rotarod performance from approximately two weeks to three months after SAH. Compared to sham, we found that SAH reduced motor, retrosplenial, and visual seed-based connectivity indices. These deficits persisted in retrosplenial and visual cortex seeds at three months. Seed-to-seed analysis confirmed early attenuation of correlation coefficients in SAH mice, which persisted in predominantly posterior network connections at later time points. Seed-independent global and interhemispheric indices of connectivity revealed decreased correlations following SAH for at least one month. SAH led to MWM hidden platform and OFT deficits at two weeks, and Y-maze deficits for at least three months, without altering rotarod performance. In conclusion, experimental SAH leads to early and persistent alterations both in hemodynamically derived measures of RSFC and in cognitive performance.
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Affiliation(s)
- David Y Chung
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Fumiaki Oka
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan
| | - Gina Jin
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Harriott
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sreekanth Kura
- Neurophotonics Center, Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Sanem A Aykan
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Tao Qin
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - William J Edmiston
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Hang Lee
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad A Yaseen
- Department of Bioengineering, Northeastern University, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Sava Sakadžić
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - David A Boas
- Neurophotonics Center, Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Michael J Whalen
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Cenk Ayata
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Shimizu K, Imai H, Kawashima A, Okada A, Ono I, Miyamoto S, Kataoka H, Aoki T. Induction of CCN1 in Growing Saccular Aneurysms: A Potential Marker Predicting Unstable Lesions. J Neuropathol Exp Neurol 2021; 80:695-704. [PMID: 33885814 DOI: 10.1093/jnen/nlab037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/17/2018] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
Growing evidence has suggested that inflammatory responses promote the progression of saccular intracranial aneurysms (IAs). However, a biomarker predicting the progression has yet to be established. This study aimed to identify novel molecules upregulated during the progression using a previously established rat aneurysm model. In this model, aneurysms are induced at the surgically created common carotid artery (CCA) bifurcation. Based on sequential morphological data, the observation periods after the surgical manipulations were defined as the growing phase (on the 10th day) or the stable phase (on the 30th day). Total cell lysates from the CCA with or without an aneurysm lesion were prepared to perform protein array analysis. The protein array analysis revealed that the matricellular protein cellular communication network factor 1 (CCN1) is induced in lesions during the growing phase. Immunohistochemistry corroborated the significant upregulation of CCN1 in the growing phase compared with the stable phase. Simultaneously with the induction of CCN1, significant increases in the number of CD68-positive macrophages, myeloperoxidase-positive cells, and proliferating smooth muscle cells in lesions were observed. Immunohistochemistry of human IA specimens reproduced the induction of CCN1 in some lesions. These findings imply a potential role of CCN1 as a marker predicting the progression of saccular aneurysms.
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Affiliation(s)
- Kampei Shimizu
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Hirohiko Imai
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Akitsugu Kawashima
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Akihiro Okada
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Isao Ono
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Susumu Miyamoto
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Hiroharu Kataoka
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
| | - Tomohiro Aoki
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (KS, AO, IO, SM); Core Research for Evolutional Science and Technology (CREST) From Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Osaka (KS, AO, IO, TA); Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto (HI); Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba (AK); and Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka (HK), Japan
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Camara-Lemarroy CR, Escobedo-Zúñiga N, Guzmán-de la Garza FJ, Castro-Garza J, Vargas-Villarreal J, Góngora-Rivera F. D-Lactate and intestinal fatty acid-binding protein are elevated in serum in patients with acute ischemic stroke. Acta Neurol Belg 2021; 121:87-93. [PMID: 29785495 DOI: 10.1007/s13760-018-0940-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022]
Abstract
Experimental studies suggest that the intestinal barrier is affected in ischemic stroke. D-Lactate and intestinal fatty acid-binding protein (IFABP) are markers of intestinal mucosa integrity and barrier function. Our purpose was to evaluate the serum concentrations of these markers in patients with acute ischemic stroke (AIS). We included patients with AIS and used healthy subjects as controls. Clinical, demographic and outcome measures were recorded. Blood was drawn within 24 h of symptom onset. Serum concentrations of D-Lactate and IFABP were determined using commercially available colorimetric and ELISA kits, respectively. We included a total of 61 patients (median age of 64 years). The majority of patients were male (57.4%). The most common cause of stroke was atherosclerosis (34.4%), followed by small-vessel disease and cardioembolic (32.7% each). Mean admission NIHSS score was 8. Median IFABP and D-Lactate concentrations were significantly higher in patients than in controls. Concentrations were not associated with stroke severity or 3-month outcome. Patients with large-artery atherosclerosis and cardioembolic etiology had higher D-Lactate values than patients with small-vessel disease. D-Lactate and IFABP were significantly elevated in patients with AIS. This suggests that there is disruption of the intestinal barrier in patients with AIS.
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Affiliation(s)
- Carlos R Camara-Lemarroy
- Servicio de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico.
| | - Nicolás Escobedo-Zúñiga
- Servicio de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico
| | - Francisco J Guzmán-de la Garza
- Centro de Investigaciones Biomédicas del Noreste, IMSS, Monterrey, Mexico
- Departamento de Fisiologia, Facultad de Medicina, UANL, Monterrey, Mexico
| | - Jorge Castro-Garza
- Centro de Investigaciones Biomédicas del Noreste, IMSS, Monterrey, Mexico
| | | | - Fernando Góngora-Rivera
- Servicio de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico.
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32
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Yousufuddin M, Moriarty JP, Lackore KA, Zhu Y, Peters JL, Doyle T, Jensen KL, Ahmmad EM, Al Ward RY, Al-Zu'bi HM, Sharma UM, Seshadri A, Arumaithurai K, Keenan LR, Bhagra S, Murad MH, Borah BJ. Initial and subsequent 3-year cost after hospitalization for first acute ischemic stroke and intracerebral hemorrhage. J Neurol Sci 2020; 419:117181. [PMID: 33099173 DOI: 10.1016/j.jns.2020.117181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/26/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022]
Abstract
AIMS To examine 1) the major drivers of index hospitalization and 3-year post-acute follow-up care, 2) cost for rehabilitation and homecare, and 3) indirect cost from lost productivity after acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). METHODS Retrospective study of adults hospitalized with AIS (n = 811) and ICH (N = 145) between 2003 and 2014. Direct costs standardized to Medicare reimbursement rates were captured for hospitalization and 3-year follow-up or death. Adjusted cost estimates were assessed using generalized linear modeling with gamma distribution. Costs for rehabilitation, home healthcare, and lost productivity were assessed using sets of cost captured through literature review. RESULTS Calculated as mean cost per person: hospitalization $18,154 for AIS and $24,077 for ICH; monthly 3-year aggregate $5138 for AIS and $8172 for ICH; 3-year inpatient rehabilitation $4185 for AIS and $4196 for ICH; homecare $19,728 for AIS and $14,487 for ICH; indirect cost from lost productivity $77,078 for AIS and $56,601 for ICH. Age < 55 years, being non-white, and stroke severity were strongly associated with greater hospitalization cost for AIS and ICH. Hyperlipidemia incurred lower while cancer, coronary artery disease, asthma/chronic obstructive pulmonary disease, heart failure, and anemia incurred higher 3-year aggregate cost for AIS. Cancer and diabetes mellitus incurred higher 3-year aggregate cost for ICH. CONCLUSIONS We provide estimates of direct and indirect costs incurred for acute and continuing post-acute care through a 3-year follow-up period after first-ever AIS and ICH with important comparisons for predictors between index hospitalization and 3-year post-stroke costs.
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Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
| | - James P Moriarty
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace A Lackore
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Ye Zhu
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Jessica L Peters
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Taylor Doyle
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Kelsey L Jensen
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Eimad M Ahmmad
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Ruaa Y Al Ward
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Hossam M Al-Zu'bi
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Umesh M Sharma
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Ashok Seshadri
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, MN, USA
| | | | - Lawrence R Keenan
- Department of Cardiology, Mayo Clinic Health System, Austin, MN, USA
| | - Sumit Bhagra
- Department of Endocrinology, Mayo Clinic Health System, Austin, MN, USA
| | - Mohammad Hassan Murad
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA; Department of Preventive Medicine, Mayo Clinic, Rochester, United States of America
| | - Bijan J Borah
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
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Corry JJ, Asaithambi G, Shaik AM, Lassig JP, Marino EH, Ho BM, Castle AL, Banerji N, Tipps ME. Conivaptan for the Reduction of Cerebral Edema in Intracerebral Hemorrhage: A Safety and Tolerability Study. Clin Drug Investig 2020; 40:503-509. [PMID: 32253717 DOI: 10.1007/s40261-020-00911-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) growth in intracranial hemorrhage (ICH) is a biomarker for worse outcomes. Although the management of PHE is potentially beneficial for ICH patients, there is currently no proven clinical therapy that both reduces PHE and improves outcomes in this population. OBJECTIVE To examine the safety and tolerability of conivaptan, a non-peptide vasopressin (AVP) receptor antagonist, for the management of PHE in ICH patients. METHODS We performed a single-center, open-label, phase I study in seven patients with ICH at risk for developing PHE. Conivaptan (20 mg) was administered every 12 h for 2 days, along with the standard ICH management. Electrolyte levels, renal and cardiac function, and vital signs were monitored throughout treatment. Neurological status, ICH, and PHE volumes were assessed at study baseline, 24 h, 72 h, and 7 days from the first conivaptan administration, as well as at the 3-month follow-up. RESULTS Conivaptan was well tolerated in our patients. We observed the expected increase in sodium levels following conivaptan administration (p = 0.01), with no change in cardiac or renal function. All patients survived to follow-up, and adverse event rates were comparable with those of the neurocritical care unit overall. CONCLUSIONS These data indicate that conivaptan can be safely administered to ICH patients and support further clinical investigation into the efficacy of this drug for ICH treatment. CLINICAL TRIAL REGISTRATION clinicaltrials.gov; NCT03000283, 22 December 2016.
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Affiliation(s)
- Jesse J Corry
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA.
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA.
| | - Ganesh Asaithambi
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Arif M Shaik
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Jeffrey P Lassig
- Midwest Radiology, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Emily H Marino
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bridget M Ho
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Amy L Castle
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Nilanjana Banerji
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Megan E Tipps
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Wang M, Xie Y, Zhao S, Wang Y, Cui J, Chang S. Association of alcohol consumption with prognosis of ischemic stroke by subtype in different follow-up periods: a hospital-based study in China. Postgrad Med 2020; 133:154-159. [PMID: 33522353 DOI: 10.1080/00325481.2020.1805945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Alcohol consumption is a risk factor for stroke. However, there are no available data on the effect of alcohol consumption on the long-term outcome of ischemic stroke in China. Therefore, this study aimed to explore the association of alcohol consumption with the prognosis of ischemic stroke by subtype in different follow-up periods after stroke. METHODS This 12-month follow-up study recruited 3830 acute ischemic stroke patients from Tianjin, China, between 2016 and 2018. Patients were categorized into two groups according to their consumption of alcohol. Differences in mortality, recurrence, and dependency rates at 3 and 12 months after stroke were compared between both groups. RESULTS The mortality, recurrence, and dependency rates at 12 months after stroke were significantly higher in patients who previously consumed alcohol than in those without previous alcohol consumption (all P < 0.005). A similar trend was observed for mortality rate at 3 months after stroke (P < 0.001). The risk of death at 3 months after an atherothrombotic stroke decreased by 63.4% (relative risk [RR], 0.366; 95% confidence interval [CI], 0.144-0.935) among patients who previously consumed alcohol compared with those who never consumed alcohol. Moreover, for patients with small artery disease classified according to the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST), the recurrence and dependency rates at 12 months after stroke decreased by 49.2% (RR, 0.508; 95% CI, 0.259-0.996) and 49.5% (RR, 0.505; 95% CI, 0.258-0.990), respectively, among patients who consumed alcohol. CONCLUSIONS Previous alcohol consumption decreased the risk of death at 3 months after stroke among patients with atherothrombotic stroke according to the TOAST classification. Furthermore, for patients with small artery disease (according to TOAST classification), alcohol consumption significantly decreased the risk of recurrence and dependency at 12 months after stroke. This study highlights an urgent need to quantify the association of alcohol consumption with outcomes after stroke in China to improve stroke prognosis.
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Affiliation(s)
- Min Wang
- Department of Neurology, Dongying People's Hospital, Dongying, Shandong Province, China
| | - Yuanli Xie
- Department of Neurology, Dongying People's Hospital, Dongying, Shandong Province, China
| | - Suzhen Zhao
- Department of Oncology, Dongying People's Hospital, Dongying, Shandong Province, China
| | - Yucui Wang
- Department of Neurology, Dongying People's Hospital, Dongying, Shandong Province, China
| | - Jingjing Cui
- Department of Neurology, Dongying People's Hospital, Dongying, Shandong Province, China
| | - Shihui Chang
- Department of Neurology, Dongying People's Hospital, Dongying, Shandong Province, China
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Bayona H, Ropero B, Salazar AJ, Pérez JC, Granja MF, Martínez CF, Useche JN. Comprehensive Telestroke Network to Optimize Health Care Delivery for Cerebrovascular Diseases: Algorithm Development. J Med Internet Res 2020; 22:e18058. [PMID: 32716302 PMCID: PMC7418009 DOI: 10.2196/18058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Health care delivery for cerebrovascular diseases is a complex process, which may be improved using telestroke networks. Objective The purpose of this work was to establish and implement a protocol for the management of patients with acute stroke symptoms according to the available treatment alternatives at the initial point of care and the transfer possibilities. Methods The review board of our institutions approved this work. The protocol was based on the latest guidelines of the American Heart Association and American Stroke Association. Stroke care requires human and technological resources, which may differ according to the patient’s point of entry into the health care system. Three health care settings were identified to define the appropriate protocols: primary health care setting, intermediate health care setting, and advanced health care setting. Results A user-friendly web-based telestroke solution was developed. The predictors, scales, and scores implemented in this system allowed the assessment of the vascular insult severity and neurological status of the patient. The total number of possible pathways implemented was as follows: 10 in the primary health care setting, 39 in the intermediate health care setting, and 1162 in the advanced health care setting. Conclusions The developed comprehensive telestroke platform is the first stage in optimizing health care delivery for patients with stroke symptoms, regardless of the entry point into the emergency network, in both urban and rural regions. This system supports health care personnel by providing adequate inpatient stroke care and facilitating the prompt transfer of patients to a more appropriate health care setting if necessary, especially for patients with acute ischemic stroke within the therapeutic window who are candidates for reperfusion therapies, ultimately contributing to mitigating the mortality and morbidity associated with stroke.
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Affiliation(s)
- Hernán Bayona
- Primary Stroke Center, Neurology Department, University Hospital Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,College of Medicine, University of Los Andes, Bogotá DC, Colombia
| | - Brenda Ropero
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
| | - Antonio José Salazar
- Electrophysiology and Telemedicine Laboratory, University of Los Andes, Bogotá DC, Colombia
| | - Juan Camilo Pérez
- Electrophysiology and Telemedicine Laboratory, University of Los Andes, Bogotá DC, Colombia
| | - Manuel Felipe Granja
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,Lyerly Neurosurgery, Baptist Health, Jacksonville, FL, United States
| | - Carlos Fernando Martínez
- Primary Stroke Center, Neurology Department, University Hospital Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
| | - Juan Nicolás Useche
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
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Neuroprotective role of glutathione peroxidase 4 in experimental subarachnoid hemorrhage models. Life Sci 2020; 257:118050. [PMID: 32634425 DOI: 10.1016/j.lfs.2020.118050] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Early brain injury is an essential pathological process after subarachnoid hemorrhage (SAH), with many cell death modalities. Ferroptosis is a newly discovered regulated cell death caused by the iron-dependent accumulation of lipid peroxidation, which can be prevented by glutathione peroxidase 4 (GPX4). Our study aimed to investigate the role of GPX4 in neuronal cell death after experimental SAH. METHODS In vivo experimental SAH was induced by injecting autologous arterial blood into the prechiasmatic cistern in male Sprague-Dawley rats. Meanwhile, the in vitro SAH model was performed with primary rat cortical neurons cultured in medium containing hemoglobin (Hb). Adenovirus was used to overexpress GPX4 before experimental SAH. GPX4 expression was detected by western blot and immunofluorescence experiments. Malondialdehyde (MDA) was measured to evaluate the level of lipid peroxidation. Nissl staining was employed to assess cell death in vivo, whereas lactate dehydrogenase (LDH) release was used to evaluate cell damage in vitro. The brain water content and neurological deficits were evaluated to determine brain injury. RESULTS Endogenous GPX4 was mainly expressed in neurons, and its expression decreased at 24 h after experimental SAH. Overexpression of GPX4 significantly reduced lipid peroxidation and cell death in the experimental SAH models both in vivo and in vitro. Moreover, overexpression of GPX4 ameliorated brain edema and neurological deficits at 24 h after SAH. CONCLUSIONS The decrease of GPX4 expression potentially plays an important role in ferroptosis during early brain injury after SAH. Overexpression of GPX4 has a neuroprotective effect after SAH.
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Collins CI, Hasan TF, Mooney LH, Talbot JL, Fouraker AL, Nelson KF, Ohanian M, Bonnett SL, Tawk RG, Nordan LM, Hodge DO, Kaplan RS, Thiemann BL, Karney M, Freeman WD. Subarachnoid Hemorrhage "Fast Track": A Health Economics and Health Care Redesign Approach for Early Selected Hospital Discharge. Mayo Clin Proc Innov Qual Outcomes 2020; 4:238-248. [PMID: 32542215 PMCID: PMC7283927 DOI: 10.1016/j.mayocpiqo.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To determine whether earlier hospital discharge is feasible and safe in selected patients with subarachnoid hemorrhage (SAH) using an outpatient “fast-track” protocol. Patients and Methods We conducted a prospective quality improvement cohort study with the primary feasibility end point of patients with SAH deemed safe for discharge by treating team consensus. All patients received detailed education and outpatient transcranial Doppler monitoring; caregivers could contact the on-call team 24-7. Primary safety end points were adverse events after discharge and hospital readmission. Results From January 1, 2010, to January 1, 2015, our center had 377 SAH diagnoses, of which 200 were included in the final cohort, 36 qualifying for fast-track early discharge. The 30-day readmission rate for fast-track patients was 11.0% (4 of 36) compared with 11.4% (18 of 164) for non–fast-track patients. The rate of delayed cerebral ischemia and stroke was 3% (1 of 36) in the fast-track group vs 25.0% (41 of 164) for the non–fast-track group. Adverse events occurred in 11.0% (4 of 36) of the fast-track group compared with 26.0% (43 of 164) in the non–fast-track group. The mean length of stay was reduced 60% from 15 days to 6.6 days in the fast-track group. Conclusion Although our fast-track group was relatively small, data suggested early feasibility and safety in a carefully selected group of patients with SAH. Direct and indirect financial benefits of early discharge over a 5-year period were an estimated savings at least $864,000 in overall costs. A comparative effectiveness study is planned to replicate and validate these results using a larger multicenter design.
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Key Words
- DCI, delayed cerebral ischemia
- ICU, intensive care unit
- LOS, length of stay
- MCA, middle cerebral artery
- QI, quality improvement
- SAH, subarachnoid hemorrhage
- TCD, transcranial Doppler ultrasonography
- TDABC, time-driven activity-based cost
- WFNS, World Federation of Neurological Surgeons
- mFS, modified Fisher scale
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Affiliation(s)
| | - Tasneem F Hasan
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | | | | | | | - Katherine F Nelson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL
| | | | | | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | - Lisa M Nordan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - Robert S Kaplan
- Accounting and Management, Harvard Business School, Boston, MA
| | - Benjamin L Thiemann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | | | - William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.,Department of Neurology, Mayo Clinic, Jacksonville, FL.,Department of Critical Care and Multidisciplinary Program, Mayo Clinic, Jacksonville, FL
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Girotra T, Lekoubou A, Bishu KG, Ovbiagele B. A contemporary and comprehensive analysis of the costs of stroke in the United States. J Neurol Sci 2020; 410:116643. [DOI: 10.1016/j.jns.2019.116643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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Bertogliat MJ, Morris-Blanco KC, Vemuganti R. Epigenetic mechanisms of neurodegenerative diseases and acute brain injury. Neurochem Int 2020; 133:104642. [PMID: 31838024 PMCID: PMC8074401 DOI: 10.1016/j.neuint.2019.104642] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/25/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
Epigenetic modifications are emerging as major players in the pathogenesis of neurodegenerative disorders and susceptibility to acute brain injury. DNA and histone modifications act together with non-coding RNAs to form a complex gene expression machinery that adapts the brain to environmental stressors and injury response. These modifications influence cell-level operations like neurogenesis and DNA repair to large, intricate processes such as brain patterning, memory formation, motor function and cognition. Thus, epigenetic imbalance has been shown to influence the progression of many neurological disorders independent of aberrations in the genetic code. This review aims to highlight ways in which epigenetics applies to several commonly researched neurodegenerative diseases and forms of acute brain injury as well as shed light on the benefits of epigenetics-based treatments.
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Affiliation(s)
- Mario J Bertogliat
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Kahlilia C Morris-Blanco
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; William S. Middleton VA Hospital, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; William S. Middleton VA Hospital, Madison, WI, USA.
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Uivarosan D, Bungau S, Tit DM, Moisa C, Fratila O, Rus M, Bratu OG, Diaconu CC, Pantis C. Financial Burden of Stroke Reflected in a Pilot Center for the Implementation of Thrombolysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E54. [PMID: 32013001 PMCID: PMC7074434 DOI: 10.3390/medicina56020054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 01/01/2023]
Abstract
Stroke represents a serious illness and is extremely relevant from the public health point of view, implying important social and economic burdens. Introducing new procedures or therapies that reduce the costs both in the acute phase of the disease and in the long term becomes a priority for health systems worldwide. The present study quantifies and compares the direct costs for ischemic stroke in patients with thrombolysis treatment versus conservative treatment over a 24-month period from the initial diagnosis, in one of the 7 national pilot centres for the implementation of thrombolytic treatment. The significant reduction (p < 0.001) of the hospitalization period, especially of the days in the intensive care unit (ICU) for stroke, resulted in a significant reduction (p < 0.001) of the total average costs in the patients with thrombolysis, both at the first hospitalization and for the subsequent hospitalizations, during the period followed in the study. It was also found that the percentage of patients who were re-hospitalized within the first 24-months after stroke was significantly lower (p < 0.001) among thrombolyzed patients. The present study demonstrates that the quick intervention in cases of stroke is an efficient policy regarding costs, of Romanian Public Health System, Romania being the country with the highest rates of new strokes and deaths due to stroke in Europe.
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Affiliation(s)
- Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Corina Moisa
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Ovidiu Fratila
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (O.F.); (M.R.)
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (O.F.); (M.R.)
| | - Ovidiu Gabriel Bratu
- Clinical Department 3, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Camelia C. Diaconu
- Department 5, University of Medicine and Pharmacy ”Carol Davila”, 050474 Bucharest, Romania;
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Carmen Pantis
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Emergency Clinical County Hospital, 410169 Oradea, Romania
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Wang J, Liu Y, Shen H, Li H, Wang Z, Chen G. Nox2 and Nox4 Participate in ROS-Induced Neuronal Apoptosis and Brain Injury During Ischemia-Reperfusion in Rats. ACTA NEUROCHIRURGICA. SUPPLEMENT 2020; 127:47-54. [PMID: 31407062 DOI: 10.1007/978-3-030-04615-6_8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previously studies have shown that Nox2 and Nox4, as members of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase, Nox), participate in brain damage caused by ischemia-reperfusion (I/R). The aim of this study is to investigate the effects of specific chemical inhibitors of Nox2 and Nox4 on cerebral I/R-induced brain injury in rats. METHODS At 0.5 h before MCAO surgery, the rats were pretreated with vehicle, Nox2 inhibitor (gp91ds-tat), and Nox4 inhibitor (GKT137831), respectively. After reperfusion for 24 h, the infarct sizes of brain tissues in rats in various groups are determined. The penumbra (ischemic) tissues are collected to measure ROS levels, neuronal apoptosis, and degeneration, as well as the integrity of the blood-brain barrier (BBB) in brain tissues of rats. RESULTS gp91ds-tat and GKT137831 pretreatment significantly reduced the infarct sizes in brain tissues of rats, effectively suppressed I/R-induced increase in ROS levels, neuronal apoptosis and degeneration, and obviously alleviated BBB damage. CONCLUSION Under cerebral I/R conditions, Nox2 inhibitor (gp91ds-tat) and Nox4 inhibitor (GKT137831) can effectively play a protective role in the brain tissues of rats.
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Affiliation(s)
- Jinjin Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurosurgery, Jiangsu Shengze Hospital, Suzhou, China
| | - Yin Liu
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurosurgery, Suzhou Municipal Hospital, Suzhou, China
| | - Haitao Shen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Li
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Intracerebral Hemorrhage: Blood Components and Neurotoxicity. Brain Sci 2019; 9:brainsci9110316. [PMID: 31717522 PMCID: PMC6896063 DOI: 10.3390/brainsci9110316] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a subtype of stroke which is associated with the highest mortality and morbidity rates of all strokes. Although it is a major public health problem, there is no effective treatment for ICH. As a consequence of ICH, various blood components accumulate in the brain parenchyma and are responsible for much of the secondary brain damage and ICH-induced neurological deficits. Therefore, the strategies that could attenuate the blood component-induced neurotoxicity and improve hematoma resolution are highly needed. The present article provides an overview of blood-induced brain injury after ICH and emphasizes the need to conduct further studies elucidating the mechanisms of hematoma resolution after ICH.
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Alisar DC, Ozen S, Sozay S. Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study. J Stroke Cerebrovasc Dis 2019; 29:104454. [PMID: 31699572 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104454] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function. METHODS Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group RESULTS: The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham. CONCLUSIONS Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.
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Affiliation(s)
- Dilek Cetinkaya Alisar
- Baskent University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bahçelievler Ankara, Turkey.
| | - Selin Ozen
- Baskent University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bahçelievler Ankara, Turkey
| | - Seyhan Sozay
- Baskent University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bahçelievler Ankara, Turkey
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44
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Salazar AJ, Useche N, Bermúdez S, Morillo A, Torres O, Granja M, Rueda N, Ropero B. Evaluation of the Accuracy Equivalence of Head CT Interpretations in Acute Stroke Patients Using a Smartphone, a Laptop, or a Medical Workstation. J Am Coll Radiol 2019; 16:1561-1571. [DOI: 10.1016/j.jacr.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
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45
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Shavelle RM, Brooks JC, Strauss DJ, Turner-Stokes L. Life Expectancy after Stroke Based On Age, Sex, and Rankin Grade of Disability: A Synthesis. J Stroke Cerebrovasc Dis 2019; 28:104450. [PMID: 31676160 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of death and disability in the developed world. The major factor affecting long term survival (other than age) is known to be the severity of disability. Yet to our knowledge there are no studies reporting life expectancies stratified by both age and severity. Remaining life expectancy is a key measure of health. METHODS We identified 11 long-term follow-up studies of stroke patients that reported the multivariate effects of age, sex, the modified Rankin Scale (mRS) grade of disability, and other factors. From these we computed the composite effects of these factors on survival, then used these to calculate age-, sex-, and mRS-specific mortality rates. Finally we used the rates to construct life tables, and hence obtain life expectancies. RESULTS Life expectancy varies by age, sex, and mRS. The life expectancies of males age 70, for example, were 13, 13, 11, 8, 6, and 5 years for Rankin Grades 0-5, respectively, representing reductions of 1, 1, 3, 6, 8, and 9 years from the corresponding general population figure. CONCLUSIONS These figures demonstrate the importance of rehabilitation following stroke, and can be used in discussion of public policy and benchmarking of future results.
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Affiliation(s)
| | | | | | - Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Northwick Park Hospital, Harrow, Middlesex, UK
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Peultier AC, Redekop WK, Allen M, Peters J, Eker OF, Severens JL. Exploring the Cost-Effectiveness of Mechanical Thrombectomy Beyond 6 Hours Following Advanced Imaging in the United Kingdom. Stroke 2019; 50:3220-3227. [PMID: 31637975 PMCID: PMC6824506 DOI: 10.1161/strokeaha.119.026816] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. In the United Kingdom, mechanical thrombectomy (MT) for acute ischemic stroke patients assessed beyond 6 hours from symptom onset will be commissioned up to 12 hours provided that advanced imaging (AdvImg) demonstrates salvageable brain tissue. While the accuracy of AdvImg differs across technologies, evidence is limited regarding the proportion of patients who would benefit from late MT. We compared the cost-effectiveness of 2 care pathways: (1) MT within and beyond 6 hours based on AdvImg selection versus (2) MT only within 6 hours based on conventional imaging selection. The impact of varying AdvImg accuracy and prior probability for acute ischemic stroke patients to benefit from late MT was assessed.
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Affiliation(s)
- Anne-Claire Peultier
- From Erasmus School of Health Policy and Management (A.-C.P., W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands
| | - William K Redekop
- From Erasmus School of Health Policy and Management (A.-C.P., W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands.,Institute for Medical Technology Assessment (W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands
| | - Michael Allen
- University of Exeter Medical School, United Kingdom (M.A.).,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, United Kingdom (M.A.)
| | - Jaime Peters
- Exeter Test Group, University of Exeter Medical School, United Kingdom (J.P.)
| | - Omer Faruk Eker
- Department of Neuroradiology, Lyon University Hospital, France (O.F.E.)
| | - Johan L Severens
- From Erasmus School of Health Policy and Management (A.-C.P., W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands.,Institute for Medical Technology Assessment (W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands
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Cisse FA, Damien C, Haba M, Touré ML, Barry M, Djibo ABA, Bah AK, Soumah FM, Naeije G. Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry. Int J Stroke 2019; 15:666-667. [DOI: 10.1177/1747493019884521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.
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Affiliation(s)
- F Abass Cisse
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - C Damien
- Department of Neurology, Université Libre de Bruxelles, Bruxelles Belgium
| | - M Haba
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - ML Touré
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - M Barry
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - ABA Djibo
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - AK Bah
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - FM Soumah
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - G Naeije
- Department of Neurology, Université Libre de Bruxelles, Bruxelles Belgium
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Akamatsu Y, Pagan VA, Hanafy KA. The role of TLR4 and HO-1 in neuroinflammation after subarachnoid hemorrhage. J Neurosci Res 2019; 98:549-556. [PMID: 31468571 PMCID: PMC6980436 DOI: 10.1002/jnr.24515] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
This review on the mechanisms of neuroinflammation following subarachnoid hemorrhage will focus mainly on toll-like receptor 4 (TLR4), Heme Oxygenase-1 (HO-1), and the role of microglia and macrophages in this process. Vasospasm has long been the focus of research in SAH; however, clinical trials have shown that amelioration of vasospasm does not lead to an improved clinical outcome. This necessitates the need for novel avenues of research. Our work has demonstrated that microglial TLR4 and microglial HO-1, not only affects cognitive dysfunction, but also circadian dysrhythmia in a mouse model of SAH. To attempt to translate these findings, we have also begun investigating macrophages in the cerebrospinal fluid of SAH patients. The goal of this review is to provide an update on the role of TLR4, HO-1, and other signal transduction pathways in SAH-induced neuroinflammation.
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Affiliation(s)
- Yosuke Akamatsu
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Vicente A Pagan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Khalid A Hanafy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Division of Neurointensive Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Ray B, Ross SR, Danala G, Aghaei F, Nouh CD, Ford L, Hollabaugh KM, Karfonta BN, Santucci JA, Cornwell BO, Bohnstedt BN, Zheng B, Dale GL, Prodan CI. Systemic response of coated-platelet and peripheral blood inflammatory cell indices after aneurysmal subarachnoid hemorrhage and long-term clinical outcome. J Crit Care 2019; 52:1-9. [PMID: 30904732 PMCID: PMC8663918 DOI: 10.1016/j.jcrc.2019.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Post-hemorrhage period after aneurysmal subarachnoid hemorrhage (aSAH) has several systemic manifestations including prothrombotic and pro-inflammatory states. Inter-relationship between these states using established/routine laboratory biomarkers and its long-term effect on clinical outcome is not well-defined. MATERIALS AND METHODS Retrospective analysis of prospective cohort of 44 aSAH patients. Trend of procoagulant biomarkers [coated-platelets, mean platelet volume to platelet count (MPV:PLT)] and peripheral inflammatory biomarkers [platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NLR)] were analyzed using regression analysis. Occurrence of delayed cerebral ischemia (DCI), modified Rankin score (mRS) of 3-6 and Montreal cognitive assessment (MoCA) of <26 at 1-year defined adverse clinical outcome. RESULTS Patients with worse mRS and MoCA score had higher rise in coated-platelet compared to those with better scores [20.4 (IQR: 15.6, 32.9) vs. 10.95 (IQR: 6.1, 18.9), p = 0.003] and [16.9 (IQR: 13.4, 28.1) vs. 10.95 (IQR: 6.35, 18.65), p = 0.02] respectively. NLR and PLR trends showed significant initial decline followed by a gradual rise in NLR among those without DCI as compared to persistent low levels in those developing DCI (0.13 units/day vs. -0.07 units/day, p = 0.06). CONCLUSIONS Coated-platelet rise after aSAH is associated with adverse long-term clinical outcome. NLR and PLR trends show an early immune-depressed state after aSAH.
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Affiliation(s)
- Bappaditya Ray
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Stephen R Ross
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Faranak Aghaei
- Electrical Engineering, University of Oklahoma, Norman, OK, USA
| | - Claire Delpirou Nouh
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lance Ford
- Biostatistics & Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly M Hollabaugh
- Biostatistics & Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Brittany N Karfonta
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joshua A Santucci
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin O Cornwell
- Radiology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bradley N Bohnstedt
- Neurosurgery, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bin Zheng
- Electrical Engineering, University of Oklahoma, Norman, OK, USA
| | - George L Dale
- Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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50
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Yee MK, Gibson CM, Nafee T, Kerneis M, Daaboul Y, Korjian S, Chi G, AlKhalfan F, Hernandez AF, Hull RD, Cohen AT, Goldhaber SZ. Characterization of Major and Clinically Relevant Non-Major Bleeds in the APEX Trial. TH OPEN 2019; 3:e103-e108. [PMID: 31249989 PMCID: PMC6524922 DOI: 10.1055/s-0039-1685496] [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: 12/20/2018] [Accepted: 02/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background
Among medically ill patients treated with thromboprophylaxis, betrixaban was not associated with an increase in major bleeding compared with enoxaparin, but an increase in clinically relevant non-major (CRNM) bleeding was observed. The aim of this analysis is to describe the severity and clinical consequences of major and CRNM bleeding in the APEX trial.
Methods
The APEX trial randomized 7,513 hospitalized acutely ill medical patients to receive either enoxaparin for 6 to 14 days or betrixaban for 35 to 42 days. Subjects receiving a concomitant strong p-glycoprotein inhibitor or with creatinine clearance <30 mL/min were administered a reduced dose of study drug.
Results
A total of 25 (0.7%) and 21 (0.6%) major bleeds occurred in the betrixaban and enoxaparin arms, respectively (
p
= NS) and a total of 91 (2.5%) and 38 (1.0%) CRNM bleeds occurred in the betrixaban and enoxaparin arm (
p
< 0.001), respectively. Most major bleeds were considered moderate or severe and most CRNM bleeds were considered mild and moderate (
p
= NS). One fatal major bleed occurred in each treatment arm. Rates of major or CRNM bleeds resulting in new or prolonged hospitalization (major: 44.0 vs. 28.6%; CRNM: 12.1 vs. 21.1%) or study treatment interruption or cessation (major: 72.0 vs. 71.4%; CRNM: 71.3 vs. 68.4%) were similar between treatment arms (
p
= NS).
Conclusions
In the APEX trial, CRNM bleeds were mild or moderate in nature and had less of a clinical impact than major bleeds. The severity and clinical sequela of bleeds in the betrixaban arm were comparable to those in the enoxaparin arm.
Clinical Trial Registration
URL:
http://www.clinicaltrials.gov
.; Unique identifier: NCT01583218.
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Affiliation(s)
- Megan K Yee
- Boston Clinical Research Institute, Newton, Massachusetts, United States
| | - C Michael Gibson
- Boston Clinical Research Institute, Newton, Massachusetts, United States
| | - Tarek Nafee
- Boston Clinical Research Institute, Newton, Massachusetts, United States
| | - Mathieu Kerneis
- PERFUSE Study Group, Division of Cardiovascular, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Yazan Daaboul
- PERFUSE Study Group, Division of Cardiovascular, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Serge Korjian
- PERFUSE Study Group, Division of Cardiovascular, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Gerald Chi
- PERFUSE Study Group, Division of Cardiovascular, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Fahad AlKhalfan
- PERFUSE Study Group, Division of Cardiovascular, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Adrian F Hernandez
- Duke University and Duke Clinical Research Institute, Durham, North Carolina, United States
| | - Russell D Hull
- Division of Cardiology, R.A.H. Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander T Cohen
- Department of Haematological Medicine, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Samuel Z Goldhaber
- Division of Cardiovascular, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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