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Caproni S, Ottavi P, Borghetti V, Taddei G, Conti C, Riva A, Di Schino C, Costantini F, Colosimo C. Transient ischemic attack and minor stroke as "surgeons affairs": a narrative review. Neurol Sci 2023; 44:4233-4245. [PMID: 37542547 DOI: 10.1007/s10072-023-06985-5] [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: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The scope of this paper is to review the subtypes of transient ischemic attack (TIA) and minor stroke (mS) in which a surgical treatment is needed, discussing the importance and the timing of a multidisciplinary approach, in order to achieve an optimized management and prevent major strokes or other critical complications. MATERIALS AND METHODS The keywords "transient ischemic attack," "minor stroke," "surgical treatment," "vascular surgery," "heart surgery," "neurosurgery," and "multidisciplinary" were searched using MEDLINE, EMBASE, and Scopus. Relevant search results were discussed by the authors for references inclusion. RESULTS Notwithstanding that best medical therapy is usually the first choice for the most part of cases, there are specific but recurrent etiologies that must be properly recognized because of a potential surgical approach, even in urgency. In fact, symptomatic carotid stenosis, or particular cases of hemodynamic cerebrovascular events, should be promptly referred to vascular surgeon, since increasing evidences highlighted a benefit from an early artery revascularization. In addition, beyond arrhythmic causes, cardioembolic events due to bacterial endocarditis and atrial myxoma should be quickly diagnosed, possibly in emergency department, because they are a presumptive urgency for heart surgery. In addition to the above-mentioned conditions, in patients suffering from vertebrobasilar TIA or mS, clinicians should keep in mind the Bow Hunter disease, because surgical artery decompression can represent the only suitable treatment in selected cases. CONCLUSIONS TIA and mS require a multidisciplinary in order to discuss therapeutic options, comparing risks and benefits and determining the best timing for an optimized management.
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Affiliation(s)
- S Caproni
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - P Ottavi
- Vascular Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - V Borghetti
- Heart Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - G Taddei
- Neurosurgery, Surgery Department, "S. Maria Goretti" Hospital, Via Lucia Scaravelli, 04100, Latina, Italy
| | - C Conti
- Neurosurgery, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - A Riva
- Neurology, Medicine Department, "Università Politecnica delle Marche", Via Conca 71, 60126, Ancona, Italy
| | - Chiara Di Schino
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - F Costantini
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - C Colosimo
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
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The White Matter Functional Abnormalities in Patients with Transient Ischemic Attack: A Reinforcement Learning Approach. Neural Plast 2022; 2022:1478048. [PMID: 36300173 PMCID: PMC9592236 DOI: 10.1155/2022/1478048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Transient ischemic attack (TIA) is a known risk factor for stroke. Abnormal alterations in the low-frequency range of the gray matter (GM) of the brain have been studied in patients with TIA. However, whether there are abnormal neural activities in the low-frequency range of the white matter (WM) in patients with TIA remains unknown. The current study applied two resting-state metrics to explore functional abnormalities in the low-frequency range of WM in patients with TIA. Furthermore, a reinforcement learning method was used to investigate whether altered WM function could be a diagnostic indicator of TIA. Methods We enrolled 48 patients with TIA and 41 age- and sex-matched healthy controls (HCs). Resting-state functional magnetic resonance imaging (rs-fMRI) and clinical/physiological/biochemical data were collected from each participant. We compared the group differences between patients with TIA and HCs in the low-frequency range of WM using two resting-state metrics: amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF). The altered ALFF and fALFF values were defined as features of the reinforcement learning method involving a Q-learning algorithm. Results Compared with HCs, patients with TIA showed decreased ALFF in the right cingulate gyrus/right superior longitudinal fasciculus/left superior corona radiata and decreased fALFF in the right cerebral peduncle/right cingulate gyrus/middle cerebellar peduncle. Based on these two rs-fMRI metrics, an optimal Q-learning model was obtained with an accuracy of 82.02%, sensitivity of 85.42%, specificity of 78.05%, precision of 82.00%, and area under the curve (AUC) of 0.87. Conclusion The present study revealed abnormal WM functional alterations in the low-frequency range in patients with TIA. These results support the role of WM functional neural activity as a potential neuromarker in classifying patients with TIA and offer novel insights into the underlying mechanisms in patients with TIA from the perspective of WM function.
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Zhao XY, Li JF, Li TZ, Pan CX, Xue FS, Wang GY. Morphine pretreatment protects against cerebral ischemic injury via a cPKCγ-mediated anti-apoptosis pathway. Exp Ther Med 2021; 22:1016. [PMID: 34373702 DOI: 10.3892/etm.2021.10448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
It has been reported that morphine pretreatment (MP) can exert neuroprotective effects, and that protein kinase C (PKC) participates in the initiation and development of ischemic/hypoxic preconditioning in the brain. However, it remains unknown whether PKC is involved in MP-induced neuroprotection. The aim of the present study, which included in vivo and in vitro experiments, was to determine whether the conventional γ isoform of PKC (cPKCγ) was involved in the protective effects of MP against cerebral ischemic injury. The present study included an in vivo experiment using a mouse model of middle cerebral artery occlusion and an in vitro experiment using neuroblastoma N2a cells with oxygen-glucose deprivation (OGD). Furthermore, a cPKCγ antagonist, Go6983, was used to determine the involvement of cPKCγ in the protective effects of MP against cerebral ischemic injury. In the in vivo experiment, neurological deficits, ischemic infarct volume, neural cell damage, apoptosis and caspase-3 activation were evaluated. In the in vitro experiment, flow cytometry was used to determine the activation of caspase-3 in N2a cells with OGD. It was found that MP protected against cerebral ischemic injury. However, intracerebroventricular injection of the cPKCγ antagonist before MP attenuated the neuroprotective effect of MP and increased the activation of cleaved caspase-3. These findings suggested that MP may provide protection against cerebral ischemic injury via a cPKCγ-mediated anti-apoptosis pathway.
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Affiliation(s)
- Xiao-Yan Zhao
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Jun-Fa Li
- Department of Neurobiology, Capital Medical University; Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, P.R. China
| | - Tian-Zuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Chu-Xiong Pan
- Department of Anesthesiology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Gu-Yan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
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Portegies MLP, Kavousi M, Leening MJG, Bos MJ, van den Meiracker AH, Hofman A, Franco OH, Koudstaal PJ, Ikram MA. N-terminal pro-B-type natriuretic peptide and the risk of stroke and transient ischaemic attack: the Rotterdam Study. Eur J Neurol 2015; 22:695-701. [DOI: 10.1111/ene.12633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/27/2014] [Indexed: 01/15/2023]
Affiliation(s)
- M. L. P. Portegies
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Neurology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - M. Kavousi
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - M. J. G. Leening
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Cardiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - M. J. Bos
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - A. H. van den Meiracker
- Department of Internal Medicine; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - A. Hofman
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - O. H. Franco
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - P. J. Koudstaal
- Department of Neurology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - M. A. Ikram
- Department of Epidemiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Neurology; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Radiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
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Fens M, van Heugten CM, Beusmans GHMI, Limburg M, Haeren R, Kaemingk A, Metsemakers JFM. Not as transient: patients with transient ischaemic attack or minor stroke experience cognitive and communication problems; an exploratory study. Eur J Gen Pract 2012; 19:11-6. [DOI: 10.3109/13814788.2012.715147] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Delgado P, Chacón P, Penalba A, Pelegri D, García-Berrocoso T, Giralt D, Santamarina E, Ribó M, Maisterra O, Alvarez-Sabín J, Rosell A, Montaner J. Lipoprotein-Associated Phospholipase A 2 Activity Is Associated with Large-Artery Atherosclerotic Etiology and Recurrent Stroke in TIA Patients. Cerebrovasc Dis 2012; 33:150-8. [DOI: 10.1159/000334193] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/30/2011] [Indexed: 11/19/2022] Open
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Perasso L, Spallarossa P, Gandolfo C, Ruggeri P, Balestrino M. Therapeutic Use of Creatine in Brain or Heart Ischemia: Available Data and Future Perspectives. Med Res Rev 2011; 33:336-63. [DOI: 10.1002/med.20255] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Luisa Perasso
- Department of Neuroscience, Opthalmology and Genetics; University of Genova; Genova Italy
- Department of Experimental Medicine, Section of Human Physiology; University of Genova; Genova Italy
| | - Paolo Spallarossa
- Department of Internal Medicine and Cardionephrology; University of Genova; Genova Italy
| | - Carlo Gandolfo
- Department of Neuroscience, Opthalmology and Genetics; University of Genova; Genova Italy
| | - Piero Ruggeri
- Department of Experimental Medicine, Section of Human Physiology; University of Genova; Genova Italy
| | - Maurizio Balestrino
- Department of Neuroscience, Opthalmology and Genetics; University of Genova; Genova Italy
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