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Fruhwirth V, Enzinger C, Fandler-Höfler S, Kneihsl M, Eppinger S, Ropele S, Schmidt R, Gattringer T, Pinter D. Baseline white matter hyperintensities affect the course of cognitive function after small vessel disease-related stroke: a prospective observational study. Eur J Neurol 2020; 28:401-410. [PMID: 33065757 PMCID: PMC7839458 DOI: 10.1111/ene.14593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Background and purpose Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD. Methods Patients with magnetic resonance imaging (MRI)‐proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set‐shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1‐weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate‐to‐severe WMH. Results The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one‐third of the sample after 15 months. After age correction, there were no significant differences in set‐shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set‐shifting after 15 months, there was no improvement in patients with moderate‐to‐severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke. Conclusions This longitudinal study demonstrates that preexisting moderate‐to‐severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD.
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Affiliation(s)
- V Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - S Fandler-Höfler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - M Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - R Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - D Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria.,Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
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Badar Z, Tonzi E, Choudhry A, Pinter D, Goel A, Amankwah K. 04:12 PM Abstract No. 61 Medical malpractice related to inferior vena cava filter placement: how commonly are interventional radiologists named in cases? J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pinter D, Enzinger C, Gattringer T, Eppinger S, Niederkorn K, Horner S, Fandler S, Kneihsl M, Krenn K, Bachmaier G, Fazekas F. Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients. Eur J Neurol 2019; 26:727-732. [PMID: 30489673 PMCID: PMC6491967 DOI: 10.1111/ene.13879] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Information on the prevalence and course of post-stroke cognitive impairment in young stroke patients is limited. The aim was to assess a consecutive sample of acute young ischaemic stroke patients (18-55 years) for the presence and development of neuropsychological deficits. METHODS Patients prospectively underwent a comprehensive clinical and cognitive assessment, examining general cognitive function, processing speed, attention, flexibility/executive function and word fluency within the first 3 weeks after hospital admission (median assessment at day 6) and at a 3 months' follow-up (FU). Cognitive dysfunction was defined in comparison to age-standardized published norms. RESULTS At baseline (N = 114), deficits were highly prevalent in processing speed (56.0%), flexibility/executive function (49.5%), attention (46.4%) and general cognitive function (42.1%). These frequencies were comparable for those with FU assessment (N = 87). In most domains, cognitive performance improved within 3 months, except for word fluency. However, in about one-third of patients, cognitive deficits (as defined by 1.5 standard deviations below the standardized mean) were still present 3 months after stroke. At FU, 44.0% were impaired in the domain flexibility/executive function, 35.0% in processing speed and 30.0% in attention. CONCLUSIONS The high prevalence of cognitive deficits in acute young patients with ischaemic stroke highlights the importance of early post-stroke cognitive assessment to capture a patient's dysfunction in a comprehensive manner and to offer adequate rehabilitation. The role of factors which promote neuropsychological deficits needs further exploration.
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Affiliation(s)
- D Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Neuroradiology, Medical University of Graz, Graz, Austria
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - K Niederkorn
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Horner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Fandler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - M Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - K Krenn
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - G Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
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Nemeth K, Gorog A, Mezey E, Pinter D, Kuroli E, Harsing J, Kovacs L, Fischer M, Rady P, Sillo P, Tyring S, Karpati S. Cover Image: Detection of hair follicle-associated Merkel cell polyomavirus in an immunocompromised host with follicular spicules and alopecia. Br J Dermatol 2017; 175:1409. [PMID: 27996135 DOI: 10.1111/bjd.15039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Nemeth
- Department of Dermatology, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - A Gorog
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - E Mezey
- Adult Stem Cell Section, NIDCR, CSDB, National Institutes of Health, Bethesda, MD, U.S.A
| | - D Pinter
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - E Kuroli
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - J Harsing
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - L Kovacs
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - M Fischer
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, U.S.A
| | - P Rady
- Department of Dermatology, University of Texas Medical School of Houston, TX, U.S.A
| | - P Sillo
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - S Tyring
- Department of Dermatology, University of Texas Medical School of Houston, TX, U.S.A
| | - S Karpati
- Department of Dermatology, Semmelweis University, Budapest, Hungary
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Seiler S, Pirpamer L, Gesierich B, Hofer E, Duering M, Pinter D, Jouvent E, Fazekas F, Mangin JF, Chabriat H, Ropele S, Schmidt R. Lower Magnetization Transfer Ratio in the Forceps Minor Is Associated with Poorer Gait Velocity in Older Adults. AJNR Am J Neuroradiol 2017; 38:500-506. [PMID: 27979793 DOI: 10.3174/ajnr.a5036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gait disturbances in the elderly are disabling and a major public health issue but are poorly understood. In this multimodal MR imaging study, we used 2 voxel-based analysis methods to assess the voxelwise relationship of magnetization transfer ratio and white matter hyperintensity location with gait velocity in older adults. MATERIALS AND METHODS We assessed 230 community-dwelling participants of the Austrian Stroke Prevention Family Study. Every participant underwent 3T MR imaging, including magnetization transfer imaging. Voxel-based magnetization transfer ratio-symptom mapping correlated the white matter magnetization transfer ratio of each voxel with gait velocity. To assess a possible relationship between white matter hyperintensity location and gait velocity, we applied voxel-based lesion-symptom mapping. RESULTS We found a significant association between the magnetization transfer ratio within the forceps minor and gait velocity (β = 0.134; 95% CI, 0.011-0.258; P = .033), independent of demographics, general physical performance, vascular risk factors, and brain volume. White matter hyperintensities did not significantly change this association. CONCLUSIONS Our study provides new evidence for the importance of magnetization transfer ratio changes in gait disturbances at an older age, particularly in the forceps minor. The histopathologic basis of these findings is yet to be determined.
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Affiliation(s)
- S Seiler
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - L Pirpamer
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - B Gesierich
- Institute for Stroke and Dementia Research (B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - E Hofer
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
- Institute of Medical Informatics, Statistics and Documentation (E.H.), Medical University of Graz, Graz, Austria
| | - M Duering
- Institute for Stroke and Dementia Research (B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - D Pinter
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - E Jouvent
- Department of Neurology (E.J., H.C.), Institut National de la Santé et de la Recherche Médicale, UMR-740, Centre Hospitalo-Universitaire Lariboisière, Paris, France
| | - F Fazekas
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - J-F Mangin
- Neurospin (J.-F.M.), Commissariat à l'Energie Atomique et aux Energies Alternatives Saclay, Gif/Yvette, France
| | - H Chabriat
- Department of Neurology (E.J., H.C.), Institut National de la Santé et de la Recherche Médicale, UMR-740, Centre Hospitalo-Universitaire Lariboisière, Paris, France
| | - S Ropele
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - R Schmidt
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
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de Campo A, Landsmann B, Pinter D, Pichler G, Pirker E, Schippinger W, Gattringer T, Fazekas F, Enzinger C. P-277: An exploratory study on the effects of mobility training in chronic stroke patients using repeated fMRI. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pichler A, Khalil M, Langkammer C, Pinter D, Bachmaier G, Ropele S, Fuchs S, Enzinger C, Fazekas F. Combined analysis of global and compartmental brain volume changes in early multiple sclerosis in clinical practice. Mult Scler 2015; 22:340-6. [DOI: 10.1177/1352458515593405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/31/2015] [Indexed: 11/16/2022]
Abstract
Background: The extent and clinical significance of brain volume changes in different phases of multiple sclerosis (MS) is still under discussion. Objective: To determine the rate of global and compartmental brain volume changes in patients with a clinically-isolated syndrome (CIS) compared to patients with definite MS, by long-term follow-up and as a predictor of conversion to MS in a routine clinical setting. Methods: We investigated 120 patients (63 CIS and 57 MS) at baseline and after a mean follow-up period of 43 months, including detailed clinical examination and 3-Tesla magnetic resonance imaging (MRI). Our imaging analyses comprised the normalized brain volume (NBV), cortical grey matter (cGMV) and white matter (WMV) volumes using SIENA/X, the percentage of brain volume change (PBVC) using SIENA and the change in the volume of the thalami (TV) and basal ganglia (BGV). We also determined the amount and change of T2-lesion load (T2-LL). Results: At baseline, all the brain volume metrics, except cGMV, were significantly lower; and the T2-LL was significantly higher, in patients with MS rather than CIS. During the follow-up, only the PBVC was higher in MS ( p = 0.008) and this difference was driven by converters from CIS to MS. Quartiles of PBVC did not allow us to predict conversion to MS, but were associated with the degree of disability. Conclusions: PBVC is the most sensitive marker of progressing atrophy and a higher PBVC was generally associated with more active disease; however, it did not serve to predict the course of MS on an individual basis, in this study.
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Affiliation(s)
| | - M Khalil
- Medical University of Graz, Austria
| | | | - D Pinter
- Medical University of Graz, Austria
| | | | - S Ropele
- Medical University of Graz, Austria
| | - S Fuchs
- Medical University of Graz, Austria
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Pinter D, Sumowski J, Pichler A, Khalil M, Langkammer C, Fuchs S, Deluca J, Fazekas F, Enzinger C. Educational attainment moderates the effect of T2 lesion load and atrophy on cognition in multiple sclerosis. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Loitfelder M, Pinter D, Langkammer C, Jehna M, Ropele S, Fazekas F, Schmidt R, Enzinger C. Connectivity patterns obtained by emulated vs. conventional resting state fMRI in clinical cohorts —/INS; Can parts tell the whole story? J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abdrahmanov EO, Basina AN, Chasnikov IY, Gaitinov AS, Streltsov IS, Vinitsky AK, Abdinov OB, Mehtiev RR, Backović S, Drndarević S, Krpić D, Sakota V, Balea E, Balea O, Boldea V, Hakman S, Ponta T, Gemesy T, Krasznovszky S, Pinter D, Kowalski M, Angelov N, Anoshin AI, Ahababian N, Baatar T, Baldin AM, Bartke J, Cheplakov AP, Didenko LA, Dzhmukhadze SV, Gasparian AP, Grecova LD, Grigalashvili NS, Grishin VG, Ivanovskaja IA, Jenik L, Kanarek T, Kladnitskaya EN, Kopylova DK, Lyubimov VB, Lyutov SI, Melnikova NN, Nikitina VF, Popova VM, Shcheglova LM, Shklovskaya AI, Solomin AN, Soloviev MI, Sulejmanov MK, Toneeva GP, Tuvdendorzh D, Erofeeva IN, Murzin VS, Smirnova LN, Korbel Z, Trka Z, Trkova Y, Kerachev P, markov P, Semerdzhiev H, Azimov SA, Inogamov SV, Turdaliev KT, Yuldashev AA, Yuldashev BS, Amaglobeli NS, Dasaeva MA, Makharadze TG, Tevzadze YV, Topuridze MV, Tsivtsivadze ET, Chadraa B, Dalkhazhav N, Togoo R, Armutlijsky D, Prokopeva S, Białkowska H, Kiełczewska D, Lang K, Ahababian NM, Gulkanian GR, Kirakosian ZA, Korchagin SA, Vartanian VA. Interaction cross sections and negative pion multiplicities in nucleus-nucleus collisions at 4.2 GeV/c per nucleon. ACTA ACUST UNITED AC 1980. [DOI: 10.1007/bf01546951] [Citation(s) in RCA: 41] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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