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Melis F, Guido M, Amellone C, Suppo M, Bonanno M, Bovio C, Pessia A, Savio K, Lucciola MT, Ebrille E, Guastamacchia G, Cassano D, Filippi P, Milano E, Giammaria M, Imperiale D. Prevalence and predictors of atrial fibrillation in patients with embolic stroke of undetermined source: a real-life single-center retrospective study. Neurol Sci 2021; 42:3707-3714. [PMID: 33443664 DOI: 10.1007/s10072-020-04963-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Up to one-third of ischemic strokes remained cryptogenic despite extensive investigations. Atrial fibrillation may be detected in a significant proportion of patients with embolic stroke of undetermined source, particularly after the introduction of implantable loop recorder in clinical practice. METHODS We retrospectively included all the consecutive patients with embolic stroke of undetermined source referred to our units in the period November 2013 to December 2018 and in which an implantable loop recorder was positioned within 6 months from stroke event. Prevalence and predictors of atrial fibrillation were investigated. RESULTS One hundred thirty-eight patients with embolic stroke of undetermined source fulfilling inclusion criteria were identified. The crude prevalence of atrial fibrillation at the end of observation period was of 45.7%. Incidence rates at 6, 12, 18, 24, and 36 months resulted, respectively, 31.8% (95% CI, 30.4-46.7), 38.0% (95% CI, 30.4-46.9), 42.6% (95% CI, 34.5-51.6), 46.6% (95% CI, 38.2-55.8), and 50.4% (95% CI, 41.6-59.9). On multivariate analysis, only excessive supraventricular electric activity and left atrial enlargement resulted to be significant predictors of atrial fibrillation (p = 0.037 and p < 0.0001, respectively). CONCLUSIONS Atrial fibrillation may be detected in a relevant proportion (up to 50%) of patients with embolic stroke of undetermined source if a careful and extensive diagnostic work-up is employed. Excessive supraventricular electric activity and left atrial enlargement are significant predictors of the occurrence of atrial fibrillation in these patients.
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Affiliation(s)
- Fabio Melis
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Marilena Guido
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | | | - Marco Suppo
- SC Cardiologia 1 - Ospedale Maria Vittoria, Torino, Italy
| | - Maria Bonanno
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Consuelo Bovio
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Andrea Pessia
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Katia Savio
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | | | - Elisa Ebrille
- SC Cardiologia 1 - Ospedale Maria Vittoria, Torino, Italy
| | - Giulia Guastamacchia
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Daniela Cassano
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Paola Filippi
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Eva Milano
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | | | - Daniele Imperiale
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy.
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Savio K, Pietra GLD, Oddone E, Reggiani M, Leone MA. Reliability of the modified Rankin Scale applied by telephone. Neurol Int 2013; 5:e2. [PMID: 23717781 PMCID: PMC3661983 DOI: 10.4081/ni.2013.e2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/27/2012] [Accepted: 10/02/2012] [Indexed: 11/22/2022] Open
Abstract
We aimed to evaluate the reliability of the modified Rankin Scale applied telephonically compared with face-to-face assessment in clinically stable hospitalized patients with acute stroke. One hundred and thirty-one patients were interviewed twice by 2 certified nurses (unstructured interview). Half of the patients were randomized to be interviewed by telephone followed by the face-to-face assessment, and half in the reverse order. The median value of the modified Rankin Scale score was 4 (first to third interquartile range 3–5) by telephone as well as by face-to-face assessment (P=0.8). The weighted kappa between the two methods was 0.82 (95% confidence interval: 0.77–0.88). Sensitivity of the telephone assessment was lower for scores 2 and 3 (17% and 46%, respectively) than for the other scores (range 67–90%). Telephone assessment of stroke disability with the modified Rankin Scale is reliable in comparison to direct face-to-face assessment.
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Affiliation(s)
- Katia Savio
- SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale A. Avogadro, Novara, Italy
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Abstract
Background and Purpose—
We aimed to evaluate validity and reliability of the Barthel Index administered telephonically compared with face-to-face assessment in clinically stable patients with stroke.
Methods—
One hundred thirty-one patients were interviewed twice by 2 registered nurses with identical training. Half of the patients were randomized to receive the telephone interview followed by the face-to-face interview and half the contrary. The sequence of interviewers was randomized.
Results—
The median value of the Barthel Index score was 30 (first to third interquartile range, 15 to 80) by telephone and 35 (15 to 75) by face-to-face (
P
=0.29). The weighted κ was 0.90 (95% CI, 0.85 to 0.94); κ values ranged from 0.70 (0.58 to 0.82) for bowel control to 0.91 (0.83 to 0.99) for bathing.
Conclusions—
Telephone assessment of stroke disability with the Barthel Index is reliable in comparison to direct face-to-face assessment.
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Affiliation(s)
- Gian Luca Della Pietra
- From the SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Katia Savio
- From the SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Elodie Oddone
- From the SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Monica Reggiani
- From the SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Francesco Monaco
- From the SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale “A. Avogadro,” Novara, Italy
| | - Maurizio A. Leone
- From the SCDU Neurologia, AOU Maggiore della Carità and Università del Piemonte Orientale “A. Avogadro,” Novara, Italy
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Ripellino P, Comi C, Mula M, Varrasi C, Conconi A, Stecco A, Brustia D, Nasuelli N, Savio K, De Paoli L, Cantello R, Gaidano G, Monaco F. Progressive multifocal leucoencephalopathy after autologous bone marrow transplantation: a treatment option. BMJ Case Rep 2011; 2011:2011/apr15_1/bcr1120103549. [PMID: 22701032 DOI: 10.1136/bcr.11.2010.3549] [Citation(s) in RCA: 13] [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] [Indexed: 11/04/2022] Open
Abstract
A patient with multiple myeloma was treated with high-dose chemotherapy followed by two autologous bone marrow transplantations (ABMTs). Nine months after the second ABMT the patient complained of severe left hemiparesis, paraesthesias, left homonymous visual field defects and gait ataxia. She was diagnosed with progressive multifocal leucoencephalopathy (PML) confirmed by detection of JC virus (JCV) DNA and prescribed cidofovir every other week and mirtazapine daily. Her symptoms and signs remained stable and after 6 months the JCV DNA was undetectable in the cerebrospinal fluid. Repeated MRI scans demonstrated the stabilisation of demyelinating lesion volume; after more than 2 years of follow-up the patient's neurological examination does not show significant variations. Combination of cidofovir and mirtazapine may be helpful in the treatment of PML in HIV-negative patients.
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Affiliation(s)
- P Ripellino
- Department of Neurology, University of Turin, Turin, Italy.
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