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Pezzini A, Iacoviello L, Di Castelnuovo A, Costanzo S, Tarantino B, de Gaetano G, Zedde M, Marcheselli S, Silvestrelli G, Ciccone A, DeLodovici ML, Princiotta Cariddi L, Paciaroni M, Azzini C, Padroni M, Gamba M, Magoni M, Del Sette M, Tassi R, De Franco IG, Cavallini A, Calabrò RS, Cappellari M, Giorli E, Giacalone G, Lodigiani C, Zenorini M, Valletta F, Pascarella R, Grisendi I, Assenza F, Napoli M, Moratti C, Acampa M, Grassi M. Long-Term Risk of Arterial Thrombosis After Intracerebral Hemorrhage: MUCH-Italy. Stroke 2024; 55:634-642. [PMID: 38299371 PMCID: PMC10896192 DOI: 10.1161/strokeaha.123.044626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/25/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND The identification of patients surviving an acute intracerebral hemorrhage who are at a long-term risk of arterial thrombosis is a poorly defined, crucial issue for clinicians. METHODS In the setting of the MUCH-Italy (Multicenter Study on Cerebral Haemorrhage in Italy) prospective observational cohort, we enrolled and followed up consecutive 30-day intracerebral hemorrhage survivors to assess the long-term incidence of arterial thrombotic events, to assess the impact of clinical and radiological variables on the risk of these events, and to develop a tool for estimating such a risk at the individual level. Primary end point was a composite of ischemic stroke, myocardial infarction, or other arterial thrombotic events. A point-scoring system was generated by the β-coefficients of the variables independently associated with the long-term risk of arterial thrombosis, and the predictive MUCH score was calculated as the sum of the weighted scores. RESULTS Overall, 1729 patients (median follow-up time, 43 months [25th to 75th percentile, 69.0]) qualified for inclusion. Arterial thrombotic events occurred in 169 (9.7%) patients. Male sex, diabetes, hypercholesterolemia, atrial fibrillation, and personal history of coronary artery disease were associated with increased long-term risk of arterial thrombosis, whereas the use of statins and antithrombotic medications after the acute intracerebral hemorrhage was associated with a reduced risk. The area under the receiver operating characteristic curve of the MUCH score predictive validity was 0.716 (95% CI, 0.56-0.81) for the 0- to 1-year score, 0.672 (95% CI, 0.58-0.73) for the 0- to 5-year score, and 0.744 (95% CI, 0.65-0.81) for the 0- to 10-year score. C statistic for the prediction of events that occur from 0 to 10 years was 0.69 (95% CI, 0.64-0.74). CONCLUSIONS Intracerebral hemorrhage survivors are at high long-term risk of arterial thrombosis. The MUCH score may serve as a simple tool for risk estimation.
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Affiliation(s)
- Alessandro Pezzini
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy (A.P.)
- Programma Stroke Care, Dipartimento di Emergenza-Urgenza, Azienda Ospedaliera Universitaria, Parma, Italy (A.P.)
| | - Licia Iacoviello
- Dipartimento di Epidemiologia e Prevenzione, IRCCS Neuromed, Pozzilli, Italy (L.I., S.C., G.G.)
- Dipartimento di Medicina e Chirurgia (L.I.), Università dell’Insubria, Varese, Italy
| | | | - Simona Costanzo
- Dipartimento di Epidemiologia e Prevenzione, IRCCS Neuromed, Pozzilli, Italy (L.I., S.C., G.G.)
| | - Barbara Tarantino
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Italy (B.T., M. Grassi)
| | - Giovanni de Gaetano
- Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italy (G.G.)
| | - Marialuisa Zedde
- S.C. Neurologia, Stroke Unit (M. Zedde, I.G., F.A.), AUSL-IRCCS di Reggio Emilia, Italy
| | - Simona Marcheselli
- Neurologia d’Urgenza and Stroke Unit (S.M.), IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - Giorgio Silvestrelli
- Stroke Unit, Dipartimento di Neuroscienze, ASST Mantova, Italy (G.S., A. Ciccone)
| | - Alfonso Ciccone
- Stroke Unit, Dipartimento di Neuroscienze, ASST Mantova, Italy (G.S., A. Ciccone)
| | - Maria Luisa DeLodovici
- Unità di Neurologia, Ospedale di Circolo (M.L.D.L., L.P.C.), Università dell’Insubria, Varese, Italy
| | - Lucia Princiotta Cariddi
- Unità di Neurologia, Ospedale di Circolo (M.L.D.L., L.P.C.), Università dell’Insubria, Varese, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Italy (M. Paciaroni)
| | - Cristiano Azzini
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italy (C.A., M. Padroni)
| | - Marina Padroni
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italy (C.A., M. Padroni)
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italy (M. Gamba, M.M.)
| | - Mauro Magoni
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italy (M. Gamba, M.M.)
| | - Massimo Del Sette
- U.O. Neurologia, IRCCS Policlinico San Martino, Genova, Italy (M.D.S.)
| | - Rossana Tassi
- Stroke Unit, AOU Senese, Siena, Italy (R.T., I.G.D.F., M.A.)
| | | | - Anna Cavallini
- UOC Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino,” Pavia, Italy (A. Cavallini)
| | - Rocco Salvatore Calabrò
- Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italy (R.S.C.)
| | - Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italy (M.C., M. Zenorini, F.V.)
| | - Elisa Giorli
- U.O. Neurologia, Ospedale S. Andrea, La Spezia, Italy (E.G.)
| | - Giacomo Giacalone
- Dipartimento di Epidemiologia e Prevenzione, IRCCS Neuromed, Pozzilli, Italy (L.I., S.C., G.G.)
| | - Corrado Lodigiani
- UOC Centro Trombosi e Malattie Emorragiche (C.L.), IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - Mara Zenorini
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italy (M.C., M. Zenorini, F.V.)
| | - Francesco Valletta
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italy (M.C., M. Zenorini, F.V.)
| | - Rosario Pascarella
- SSD Neuroradiologia (R.P., M.N., C.M.), AUSL-IRCCS di Reggio Emilia, Italy
| | - Ilaria Grisendi
- S.C. Neurologia, Stroke Unit (M. Zedde, I.G., F.A.), AUSL-IRCCS di Reggio Emilia, Italy
| | - Federica Assenza
- S.C. Neurologia, Stroke Unit (M. Zedde, I.G., F.A.), AUSL-IRCCS di Reggio Emilia, Italy
| | - Manuela Napoli
- SSD Neuroradiologia (R.P., M.N., C.M.), AUSL-IRCCS di Reggio Emilia, Italy
| | - Claudio Moratti
- SSD Neuroradiologia (R.P., M.N., C.M.), AUSL-IRCCS di Reggio Emilia, Italy
| | - Maurizio Acampa
- Stroke Unit, AOU Senese, Siena, Italy (R.T., I.G.D.F., M.A.)
| | - Mario Grassi
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Italy (B.T., M. Grassi)
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Romani I, Sarti C, Nencini P, Pracucci G, Zedde M, Cianci V, Nucera A, Moller J, Orsucci D, Toni D, Palumbo P, Casella C, Pinto V, Barbarini L, Bella R, Scoditti U, Ragno M, Mezzapesa DM, Tassi R, Volpi G, Diomedi M, Bigliardi G, Cavallini AM, Chiti A, Ricci S, Cecconi E, Linoli G, Sacco S, Rasura M, Giordano A, Bonetti B, Melis M, Cariddi LP, Dossi RC, Grisendi I, Aguglia U, Di Ruzza MR, Melis M, Sbardella E, Vista M, Valenti R, Musolino RF, Passarella B, Direnzo V, Pennisi G, Genovese A, Di Marzio F, Sgobio R, Acampa M, Nannucci S, Dagostino F, Dell'Acqua ML, Cuzzoni MG, Picchioni A, Calchetti B, Notturno F, Di Lisi F, Forlivesi S, Delodovici ML, Buechner SC, Biagini S, Accavone D, Manna R, Morrone A, Inzitari D. Prevalence of Fabry disease and GLA variants in young patients with acute stroke: The challenge to widen the screening. The Fabry-Stroke Italian Registry. J Neurol Sci 2024; 457:122905. [PMID: 38295534 DOI: 10.1016/j.jns.2024.122905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/12/2023] [Revised: 12/10/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Fabry disease (FD) is a treatable X-linked lysosomal storage disorder caused by GLA gene variants leading to alpha-galactosidase A deficiency. FD is a rare cause of stroke, and it is still controversial whether in stroke patients FD should be searched from the beginning or at the end of the diagnostic workup (in cryptogenic strokes). METHODS Fabry-Stroke Italian Registry is a prospective, multicentric screening involving 33 stroke units. FD was sought by measuring α-galactosidase A activity (males) and by genetic tests (males with reduced enzyme activity and females) in patients aged 18-60 years hospitalized for TIA, ischemic stroke, or intracerebral hemorrhage. We diagnosed FD in patients with 1) already known pathogenic GLA variants; 2) novel GLA variants if additional clinical, laboratory, or family-derived criteria were present. RESULTS Out of 1906 patients, we found a GLA variant in 15 (0.79%; 95%CI 0.44-1.29) with a certain FD diagnosis in 3 (0.16%; 95%CI 0.03-0.46) patients, none of whom had hemorrhage. We identified 1 novel pathogenic GLA variant. Ischemic stroke etiologies in carriers of GLA variants were: cardioaortic embolism (33%), small artery occlusion (27%), other causes (20%), and undetermined (20%). Mild severity, recurrence, previous TIA, acroparesthesias, hearing loss, and small artery occlusion were predictors of GLA variant. CONCLUSION In this large multicenter cohort the frequency of FD and GLA variants was consistent with previous reports. Limiting the screening for GLA variants to patients with cryptogenic stroke may miss up to 80% of diagnoses. Some easily recognizable clinical features could help select patients for FD screening.
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Affiliation(s)
- Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Cristina Sarti
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy.
| | - Patrizia Nencini
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Vittoria Cianci
- Neurology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Antonia Nucera
- Stroke Unit - Neurology, Spaziani Hospital, Frosinone, Italy
| | | | | | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Emergency Department Stroke Unit, Umberto I Polyclinic Hospital, Rome, Italy
| | - Pasquale Palumbo
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | | | - Rita Bella
- Acute Cerebrovascular Diseases Unit, G. Rodoloco-San Marco Polyclinic University Hospital, Catania, Italy; Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Italy
| | - Umberto Scoditti
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | - Michele Ragno
- Division of Neurology, ASUR Marche AV5, Ascoli Piceno-San Benedetto del Tronto, Italy
| | | | - Rossana Tassi
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | - Gino Volpi
- Neurology, San Iacopo Hospital, Pistoia, Italy
| | - Marina Diomedi
- Comprehensive Stroke Center, Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Anna Maria Cavallini
- Department of Cerebrovascular Disease and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Stefano Ricci
- Stroke Center - Neurology, Città Di Castello Hospital, Perugia, Italy; Stroke Center - Neurology, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | | | | | - Simona Sacco
- Neurology and Stroke Unit, SS. Filippo e Nicola Hospital, Avezzano, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maurizia Rasura
- Stroke Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Bruno Bonetti
- Stroke Unit, Verona University Hospital, Verona, Italy
| | - Marta Melis
- Neurology, Monserrato University Hospital, Cagliari, Italy
| | | | | | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Emilia Sbardella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Raffaella Valenti
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | | | - Bruno Passarella
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | | | - Giovanni Pennisi
- Acute Cerebrovascular Diseases Unit, G. Rodoloco-San Marco Polyclinic University Hospital, Catania, Italy; Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Antonio Genovese
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | - Fabio Di Marzio
- Division of Neurology, ASUR Marche AV5, Ascoli Piceno-San Benedetto del Tronto, Italy
| | - Rossana Sgobio
- University Neurology, Bari Polyclinic Hospital, Bari, Italy
| | - Maurizio Acampa
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | | | - Federica Dagostino
- Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Maria Luisa Dell'Acqua
- Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Maria Giovanna Cuzzoni
- Department of Cerebrovascular Disease and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonella Picchioni
- Stroke Center - Neurology, Città Di Castello Hospital, Perugia, Italy; Stroke Center - Neurology, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | | | - Francesca Notturno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Filomena Di Lisi
- Stroke Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Silvia Biagini
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Donatella Accavone
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Raffaele Manna
- Department of Internal Medicine, Gemelli University Hospital, Rome, Italy; Rare Diseases and Periodic Fevers Research Centre, Catholic University of the Sacred Heart, Rome, Italy
| | - Amelia Morrone
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Laboratory of Molecular Biology of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Domenico Inzitari
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy
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3
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Cappellari M, Pracucci G, Saia V, Fainardi E, Casetta I, Sallustio F, Ruggiero M, Longoni M, Simonetti L, Zini A, Lazzarotti GA, Giannini N, Da Ros V, Diomedi M, Vallone S, Bigliardi G, Limbucci N, Nencini P, Ajello D, Marcheselli S, Burdi N, Boero G, Bracco S, Tassi R, Boghi A, Naldi A, Biraschi F, Nicolini E, Castellan L, Del Sette M, Allegretti L, Sugo A, Buonomo O, Dell'Aera C, Saletti A, De Vito A, Lafe E, Mazzacane F, Bergui M, Cerrato P, Feraco P, Piffer S, Augelli R, Vit F, Gasparotti R, Magoni M, Comelli S, Melis M, Menozzi R, Scoditti U, Cavasin N, Critelli A, Causin F, Baracchini C, Guzzardi G, Tarletti R, Filauri P, Orlandi B, Giorgianni A, Cariddi LP, Piano M, Motto C, Gallesio I, Sepe FN, Romano G, Grasso MF, Pauciulo A, Rizzo A, Comai A, Franchini E, Sicurella L, Galvano G, Mannino M, Mangiafico S, Toni D, On Behalf Of The Iretas Group. IV thrombolysis plus thrombectomy versus IV thrombolysis alone for minor stroke with anterior circulation large vessel occlusion from the IRETAS and Italian SITS-ISTR cohorts. Neurol Sci 2023; 44:4401-4410. [PMID: 37458843 DOI: 10.1007/s10072-023-06948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/10/2023] [Accepted: 07/04/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The aim of this study was to compare the outcomes of patients treated with intravenous thrombolysis (IVT) <4.5 h after symptom onset plus mechanical thrombectomy (MT) <6 h with those treated with IVT alone <4.5 h for minor stroke (NIHSS ≤5) with large vessel occlusion (LVO) in the anterior circulation. PATIENTS AND METHODS Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analyzed. RESULTS Among the patients with complete data on 24-h ICH type, 236 received IVT plus MT and 382 received IVT alone. IVT plus MT was significantly associated with unfavorable shift on 24-h ICH types (from no ICH to PH-2) (OR, 2.130; 95% CI, 1.173-3.868; p=0.013) and higher rate of PH (OR, 4.363; 95% CI, 1.579-12.055; p=0.005), sICH per ECASS II definition (OR, 5.527; 95% CI, 1.378-22.167; p=0.016), and sICH per NINDS definition (OR, 3.805; 95% CI, 1.310-11.046; p=0.014). Among the patients with complete data on 3-month mRS score, 226 received IVT plus MT and 262 received IVT alone. No significant difference was reported between IVT plus MT and IVT alone on mRS score 0-1 (72.1% versus 69.1%), mRS score 0-2 (79.6% versus 79%), and death (6.2% versus 6.1%). CONCLUSIONS Compared with IVT alone, IVT plus MT was associated with unfavorable shift on 24-h ICH types and higher rate of 24-h PH and sICH in patients with minor stroke and LVO in the anterior circulation. However, no difference was reported between the groups on 3-month functional outcome measures.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Valentina Saia
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Enrico Fainardi
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Fabrizio Sallustio
- Unitá di Trattamento Neurovascolare, Ospedale dei Castelli-ASL6, Rome, Italy
| | - Maria Ruggiero
- Neuroradiologia, AUSL Romagna Ospedale Bufalini, Cesena, Italy
| | - Marco Longoni
- Neurologia e Stroke Unit Ospedale Bufalini Cesena, AUSL Romagna, Ravenna, Italy
| | - Luigi Simonetti
- UO Neuroradiologia Ospedale Maggiore-IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | - Nicola Giannini
- Neurological Institute, University Hospital of Pisa, Pisa, Italy
| | - Valerio Da Ros
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Nicola Limbucci
- Neurovascular Interventional Unit-Careggi University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit, Azienda Ospedaliero Univarsitaria Careggi, Firenze, Italy
| | - Daniele Ajello
- Neuroradiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Nicola Burdi
- Neuroradiology, SS. Annunziata Hospital, Taranto, Italy
| | | | - Sandra Bracco
- Neuroradiologia interventistica, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Andrea Boghi
- SC Radiologia e Neuroradiologia, Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- S.C. Neurologia 2 Ospedale San Giovanni Bosco, Torino, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Universita degli Studi di Roma Sapienza, Rome, Lazio, Italy
| | - Ettore Nicolini
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lucio Castellan
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Massimo Del Sette
- Neurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Allegretti
- Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy
| | - Annalisa Sugo
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Orazio Buonomo
- Neuroradiology Unit, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences-University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine-University of Messina, Messina, Italy
| | - Andrea Saletti
- Servizio di Neuroradiologia, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Neurology Division-Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Elvis Lafe
- UOC Radiologia Diagnostica per Immagini 2-Neuroradiologia, Policlinico IRCCS San Matteo, Pavia, Italy
| | - Federico Mazzacane
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Mauro Bergui
- Università Torino Dipartimento Neuroscienze, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paola Feraco
- U.O.C. Neuroradiologia diagnostica e Radiologia Interventistica, Ospedale Santa Chiara, Trento, Italy
| | - Silvio Piffer
- U.O.C Neurologia, Ospedale Santa Chiara, APSS di Trento, Trento, Italy
| | - Raffaele Augelli
- Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Federica Vit
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neuroscience Department, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Nicola Cavasin
- Neuroradiology Unit, Ospedale dell'Angelo, USSL 3 Serenissima, Mestre, Venice, Italy
| | - Adriana Critelli
- Neurology Unit, Ospedale dell'Angelo, USSL 3 Serenissima, Mestre, Venice, Italy
| | - Francesco Causin
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | | | | | - Pietro Filauri
- UOSD Radiologia interventistica, p.o., Avezzano, AQ, Italy
| | | | - Andrea Giorgianni
- UOC Neuroradiologia, ASST Sette Laghi Varese-Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Mariangela Piano
- Interventional Neuroradiology Unit, Ospedale Niguarda, Milan, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit AO "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | | | | | | | | | - Annalisa Rizzo
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Alessio Comai
- Neuroradiologia, Ospedale Provinciale di Bolzano, Bolzano, Italy
| | | | | | | | | | - Salvatore Mangiafico
- IRCCS Neuromed, Pozzilli, IS, Italy
- Tor Vergata University, Rome, Italy
- Sapienza University, Rome, Italy
- S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Cappellari M, Pracucci G, Saia V, Sallustio F, Casetta I, Fainardi E, Capasso F, Nencini P, Vallone S, Bigliardi G, Saletti A, De Vito A, Ruggiero M, Longoni M, Semeraro V, Boero G, Silvagni U, Stancati F, Lafe E, Mazzacane F, Bracco S, Tassi R, Comelli S, Melis M, Romano D, Napoletano R, Menozzi R, Scoditti U, Chiumarulo L, Petruzzellis M, Vinci SL, Ferraù L, Taglialatela F, Zini A, Sanna A, Tassinari T, Iacobucci M, Nicolini E, Bergui M, Cerrato P, Giorgianni A, Princiotta Cariddi L, Amistà P, Russo M, Gallesio I, Sepe F, Comai A, Franchini E, Filauri P, Orlandi B, Besana M, Giossi A, Lazzarotti GA, Orlandi G, Castellano D, Naldi A, Plebani M, Zivelonghi C, Invernizzi P, Mangiafico S, Toni D. Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization. Int J Stroke 2023; 18:1238-1246. [PMID: 37337362 DOI: 10.1177/17474930231185690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 06/21/2023]
Abstract
BACKGROUND Predictors of radiological complications attributable to reperfusion injury remain unknown when baseline setting is optimal for endovascular treatment and procedural setting is the best in stroke patients with large vessel occlusion (LVO). AIMS To identify clinical and radiological/procedural predictors for hemorrhagic transformation (HT) and cerebral edema (CED) at 24 hr in patients obtaining complete recanalization in one pass of thrombectomy for ischemic stroke ⩽ 6 h from symptom onset with intra-cranial anterior circulation LVO and ASPECTS ⩾ 6. METHODS We conducted a cohort study on prospectively collected data from 1400 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. RESULTS HT was reported in 248 (18%) patients and early CED was reported in 260 (19.2%) patients. In the logistic regression model including predictors from a first model with clinical variables and from a second model with radiological/procedural variables, diabetes mellitus (odds ratio (OR) = 1.832, 95% confidence interval (CI) = 1.201-2.795), higher National Institutes of Health Stroke Scale (NIHSS) (OR = 1.076, 95% CI = 1.044-1.110), lower Alberta Stroke Program Early CT (ASPECTS) (OR = 0.815, 95% CI = 0.694-0.957), and longer onset-to-groin time (OR = 1.005, 95% CI = 1.002-1.007) were predictors of HT, whereas general anesthesia was inversely associated with HT (OR = 0.540, 95% CI = 0.355-0.820). Higher NIHSS (OR = 1.049, 95% CI = 1.021-1.077), lower ASPECTS (OR = 0.700, 95% CI = 0.613-0.801), intravenous thrombolysis (OR = 1.464, 95% CI = 1.061-2.020), longer onset-to-groin time (OR = 1.002, 95% CI = 1.001-1.005), and longer procedure time (OR = 1.009, 95% CI = 1.004-1.015) were predictors of early CED. After repeating a fourth logistic regression model including also good collaterals, the same variables remained predictors for HT and/or early CED, except diabetes mellitus and thrombolysis, while good collaterals were inversely associated with early CED (OR = 0.385, 95% CI = 0.248-0.599). CONCLUSIONS Higher NIHSS, lower ASPECTS, and longer onset-to-groin time were predictors for both HT and early CED. General anesthesia and good collaterals were inversely associated with HT and early CED, respectively. Longer procedure time was predictor of early CED.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elvis Lafe
- Policlinico IRCCS San Matteo, Pavia, Italy
| | | | - Sandra Bracco
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | | | | | - Daniele Romano
- AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | | | | | | | | | | | | | | | | | - Andrea Zini
- IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy
| | | | | | | | | | - Mauro Bergui
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Andrea Giorgianni
- ASST Sette Laghi Varese-Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Monia Russo
- Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Ivan Gallesio
- AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Federica Sepe
- AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | | | | | | | | | | | | | | | | | | | | | - Mauro Plebani
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | - Salvatore Mangiafico
- Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Tor Vergata University, Rome, Italy
- S. Andrea Hospital, Rome, Italy
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Cappellari M, Saia V, Pracucci G, Casetta I, Fainardi E, Sallustio F, Ruggiero M, Romoli M, Simonetti L, Zini A, Lazzarotti GA, Orlandi G, Vallone S, Bigliardi G, Renieri L, Nencini P, Semeraro V, Boero G, Bracco S, Tassi R, Castellano D, Naldi A, Biraschi F, Nicolini E, Del Sette B, Malfatto L, Allegretti L, Tassinari T, Tessitore A, Ferraù L, Saletti A, De Vito A, Lafe E, Cavallini A, Bergui M, Bosco G, Feraco P, Bignamini V, Mandruzzato N, Vit F, Mardighian D, Magoni M, Comelli S, Melis M, Menozzi R, Scoditti U, Cester G, Viario F, Stecco A, Fleetwood T, Filauri P, Sacco S, Giorgianni A, Cariddi LP, Piano M, Motto C, Gallesio I, Sepe F, Romano G, Grasso MF, Lozupone E, Fasano A, Comai A, Franchini E, Bruni S, Silvestrini M, Chiumarulo L, Petruzzelli M, Pavia M, Invernizzi P, Puglielli E, Casalena A, Pedicelli A, Frisullo G, Amistà P, Russo M, Allegritti M, Caproni S, Mangiafico S, Toni D. Stroke with large vessel occlusion in the posterior circulation: IV thrombolysis plus thrombectomy versus IV thrombolysis alone. J Thromb Thrombolysis 2023; 56:454-462. [PMID: 37378700 DOI: 10.1007/s11239-023-02844-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
Efficacy and safety of mechanical thrombectomy (MT) for stroke with posterior circulation large vessel occlusion (LVO) is still under debate. We aimed to compare the outcomes of stroke patients with posterior circulation LVO treated with intravenous thrombolysis (IVT) (< 4.5 h after symptom onset) plus MT < 6 h after symptom onset with those treated with IVT alone (< 4.5 h after symptom onset). Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analysed. We identified 409 IRETAS patients treated with IVT plus MT and 384 SITS-ISTR patients treated with IVT alone. IVT plus MT was significantly associated with higher rate of sICH (ECASS II) compared with IVT alone (3.1 vs 1.9%; OR 3.984, 95% CI 1.014-15.815), while the two treatments did not differ significantly in 3-month mRS score ≤ 3 (64.3 vs 74.1%; OR 0.829, 95% CI 0.524-1.311). In 389 patients with isolated basilar artery (BA) occlusion, IVT plus MT was significantly associated with higher rate of any ICH compared with IVT alone (9.4 vs 7.4%; OR 4.131, 95% CI 1.215-14.040), while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with higher rate mRS score ≤ 2 (69.1 vs 52.1%; OR 2.692, 95% CI 1.064-6.811) and lower rate of death (13.8 vs 27.1%; OR 0.299, 95% CI 0.095-0.942) in patients with distal-segment BA occlusion, while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with lower rate of mRS score ≤ 3 (37.1 vs 53.3%; OR 0.137, 0.009-0.987), mRS score ≤ 1 (22.9 vs 53.3%; OR 0.066, 95% CI 0.006-0.764), mRS score ≤ 2 (34.3 vs 53.3%; OR 0.102, 95% CI 0.011-0.935), and higher rate of death (51.4 vs 40%; OR 16.244, 1.395-89.209) in patients with proximal-segment BA occlusion. Compared with IVT alone, IVT plus MT was significantly associated with higher rate of sICH per ECASS II definition in patients with stroke and posterior circulation LVO, while two treatment groups did not differ significantly in 3-month mRS score ≤ 3. IVT plus MT was associated with lower rate of mRS score ≤ 3 compared with IVT alone in patients with proximal-segment BA occlusion, whereas no significant difference was found between the two treatments in primary endpoints in patients isolated BA occlusion and in the other subgroups based on site occlusion.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Valentina Saia
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy
| | - Fabrizio Sallustio
- Unitá di Trattamento Neurovascolare, ospedale dei Castelli-ASL6, Roma, Italy
| | - Maria Ruggiero
- Neuroradiologia, AUSL Romagna Ospedale Bufalini, Cesena, Italy
| | - Michele Romoli
- Neurologia e Stroke Unit H Bufalini Cesena, AUSL Romagna, Cesena, Italy
| | - Luigi Simonetti
- UO Neuroradiologia Ospedale Maggiore, IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | - Giovanni Orlandi
- Neurological Institute, University Hospital of Pisa, Italy, Italy
| | | | | | - Leonardo Renieri
- Neurovascular Interventional Unit, Careggi University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit, Azienda Ospedaliero Univarsitaria Careggi, Firenze, Italy
| | | | | | - Sandra Bracco
- Neuroradiologia Interventistica, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
| | - Davide Castellano
- S.C. Radiologia e Neuroradiologia, Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- , 2 Ospedale San Giovanni Bosco, S.C. Neurologia, Torino, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Universita degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Ettore Nicolini
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Bruno Del Sette
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Malfatto
- Neurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Allegretti
- Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy
| | | | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Saletti
- Servizio di Neuroradiologia, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Neurology Division-Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Elvis Lafe
- UOC Radiologia Diagnostica Per Immagini 2, Neuroradiologia, Policlinico IRCCS San Matteo, Pavia, Italy
| | - Anna Cavallini
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Mauro Bergui
- Università Torino Dipartimento Neuroscienze, Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Giovanni Bosco
- Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paola Feraco
- U.O.C. Neuroradiologia Diagnostica e Radiologia Interventistica, Ospedale Santa Chiara, Trento, Italy
| | - Valeria Bignamini
- U.O.C Neurologia, Ospedale Santa Chiara, APSS di Trento, Trento, Italy
| | - Nicolò Mandruzzato
- Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Federica Vit
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neuroscience Department, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Giacomo Cester
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Federica Viario
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | | | | | - Pietro Filauri
- UOSD Radiologia Interventistica, p.o. Avezzano, AQ, Italy
| | - Simona Sacco
- UOC Neurologia e Stroke Unit, p.o. Avezzano, AQ, Italy
| | - Andrea Giorgianni
- UOC Neuroradiologia, ASST Sette Laghi Varese, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Mariangela Piano
- Interventional Neuroradiology Unit, Ospedale Niguarda, Milano, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit AO "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Federica Sepe
- Neurology Unit AO "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | | | | | - Emilio Lozupone
- Department of Neuroradiology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Fasano
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Alessio Comai
- Neuroradiologia, Ospedale Provinciale di Bolzano, Bolzano, Italy
| | | | - Stefano Bruni
- Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Mauro Silvestrini
- Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Luigi Chiumarulo
- UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Policlinico Bari, Italy
| | | | - Marco Pavia
- Neuroradiologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Invernizzi
- Stroke Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy
| | | | - Alessandro Pedicelli
- Dipartimento di Diagnostica per Immagini, UOSA Neuroradiologia Interventistica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Giovanni Frisullo
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, UOC Neurologia, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pietro Amistà
- Neuroradiologia, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Massimiliano Allegritti
- Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera S. Maria Terni Angiografia Diagostica e Terapeutica, Azienda Ospedaliera "S. Maria", Terni, Italy
| | - Stefano Caproni
- Neurologia e Stroke Unit, Dipartimento di Neuroscienze, Azienda Ospedaliera "S. Maria", Terni, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS Neuromed, Pozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
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Princiotta Cariddi L, Mauri M, Cosentino M, Versino M, Marino F. Alzheimer’s Disease: From Immune Homeostasis to Neuroinflammatory Condition. Int J Mol Sci 2022; 23:13008. [PMID: 36361799 PMCID: PMC9658357 DOI: 10.3390/ijms232113008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/14/2022] [Indexed: 08/13/2023] Open
Abstract
Alzheimer’s Disease is the most common cause in the world of progressive cognitive decline. Although many modifiable and non-modifiable risk factors have been proposed, in recent years, neuroinflammation has been hypothesized to be an important contributing factor of Alzheimer’s Disease pathogenesis. Neuroinflammation can occur through the combined action of the Central Nervous System resident immune cells and adaptive peripheral immune system. In the past years, immunotherapies for neurodegenerative diseases have focused wrongly on targeting protein aggregates Aβ plaques and NFT treatment. The role of both innate and adaptive immune cells has not been fully clarified, but several data suggest that immune system dysregulation plays a key role in neuroinflammation. Recent studies have focused especially on the role of the adaptive immune system and have shown that inflammatory markers are characterized by increased CD4+ Teff cells’ activities and reduced circulating CD4+ Treg cells. In this review, we discuss the key role of both innate and adaptive immune systems in the degeneration and regeneration mechanisms in the pathogenesis of Alzheimer’s Disease, with a focus on how the crosstalk between these two systems is able to sustain brain homeostasis or shift it to a neurodegenerative condition.
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Affiliation(s)
- Lucia Princiotta Cariddi
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, 21100 Varese, Italy
- Neurology and Stroke Unit, ASST Sette Laghi Hospital, 21100 Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, ASST Sette Laghi Hospital, 21100 Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Marco Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi Hospital, 21100 Varese, Italy
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
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Fanella G, Baiata C, Candeloro E, Toscano G, Colnaghi S, Mauri M, Cariddi LP, Rebecchi V, Solazzo F, Banfi P, Piatti M, Ferrarese C, Versino M. New-onset myasthenia gravis after mRNA SARS-CoV-2 vaccination: a case series. Neurol Sci 2022; 43:5799-5802. [PMID: 35870026 PMCID: PMC9308404 DOI: 10.1007/s10072-022-06284-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Background Myasthenia gravis (MG) is an autoimmune disease that targets acetylcholine receptor (AChR) of the neuromuscular junction. New-onset MG after SARS-CoV-2 vaccination has rarely been reported. Case presentation We report about three patients who presented new-onset myasthenia gravis after receiving mRNA SARS-CoV-2 vaccination. The patients were all males and older than 55 years. All the patients presented with ocular and bulbar symptoms. The interval between vaccine administration and MG onset ranged from 3 days after the first dose to 10 days after the second dose. All the patients had elevated serum AChR antibodies and responded to pyridostigmine. Two out of three patients were successfully treated with IVIG or plasma exchange and with long-term immunosuppression. Conclusions MG is a rare disease; clinicians should be aware of possible new-onset MG after SARS-CoV-2 vaccination, especially with the current recommendation of booster doses. The hyperstimulation of the innate immune system or the exacerbation of a subclinical pre-existing MG could be possible explanations.
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Affiliation(s)
- Gaia Fanella
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Claudio Baiata
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Elisa Candeloro
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Gianpaolo Toscano
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Silvia Colnaghi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Valentina Rebecchi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Francesca Solazzo
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Marialuisa Piatti
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- DMC, University of Insubria, Varese, Italy
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Mauri M, Gobbo CL, Princiotta Cariddi L, Schiorlin I, Versino M. Depressive symptoms in amnesic mild cognitive impairment: an FDG-PET/CT study. Arch Med Sci 2022; 18:1108-1111. [PMID: 35832723 PMCID: PMC9266860 DOI: 10.5114/aoms/149717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The detection in mild cognitive impairment (MCI) of metabolic alterations suggestive of depression and/or of evolution to dementia. METHODS Sixty-nine MCI patients underwent clinical and imaging evaluation including position emission tomography/computed tomography with fluorodeoxy-glucose (FDG-PET/CT). RESULTS The metabolism mean values in parietal, temporal and pre-cuneus areas were lower in subjects who evolved to dementia, and in frontal and in anterior cingulate areas in depressed subjects. Abnormal metabolism values were higher in the frontal and parietal lobes, and in the precuneus in subjects who evolved to dementia independently from depression. CONCLUSIONS In MCI FDG-PET/CT abnormality patterns suggest the presence of depression or the evolution to dementia.
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Affiliation(s)
- Marco Mauri
- U.O.C. Neurologia e Stroke Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Clara Luigia Gobbo
- Nuclear Medicine Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
| | - Lucia Princiotta Cariddi
- U.O.C. Neurologia e Stroke Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
- PhD program in Clinical and Experimental Medicine and Clinical Humanities, University of Insubria, Varese, Italy
| | - Ilaria Schiorlin
- Nuclear Medicine Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
| | - Maurizio Versino
- U.O.C. Neurologia e Stroke Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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9
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Romani I, Nencini P, Sarti C, Pracucci G, Zedde M, Nucera A, Cianci V, Moller J, Toni D, Orsucci D, Casella C, Pinto V, Palumbo P, Barbarini L, Bella R, Ragno M, Scoditti U, Mezzapesa DM, Tassi R, Diomedi M, Cavallini A, Volpi G, Chiti A, Bigliardi G, Sacco S, Linoli G, Ricci S, Giordano A, Bonetti B, Rasura M, Cecconi E, Princiotta Cariddi L, Currò Dossi R, Melis M, Consoli D, Guidetti D, Biagini S, Accavone D, Inzitari D. Fabry-Stroke Italian Registry (FSIR): a nationwide, prospective, observational study about incidence and characteristics of Fabry-related stroke in young-adults. Presentation of the study protocol. Neurol Sci 2021; 43:2433-2439. [PMID: 34609660 PMCID: PMC8918192 DOI: 10.1007/s10072-021-05615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/06/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Background TIA and stroke, both ischemic and hemorrhagic, may complicate Fabry disease at young-adult age and be the first manifestation that comes to the clinician’s attention. No definite indications have yet been elaborated to guide neurologists in Fabry disease diagnostics. In current practice, it is usually sought in case of cryptogenic strokes (while Fabry-related strokes can also occur by classical pathogenic mechanisms) or through screening programs in young cerebrovascular populations. Data on recurrence and secondary prevention of Fabry’s stroke are scanty. Methods The study had a prospective observational design involving 33 Italian neurological Stroke Units. Considering the incidence of TIA/stroke in the European population aged < 60 years and the frequency of Fabry disease in this category (as foreseen by a pilot study held at the Careggi University-Hospital, Florence), we planned to screen for Fabry disease a total of 1740 < 60-year-old individuals hospitalized for TIA, ischemic, or hemorrhagic stroke. We investigated TIA and stroke pathogenesis through internationally validated scales and we gathered information on possible early signs of Fabry disease among all cerebrovascular patients. Every patient was tested for Fabry disease through dried blood spot analysis. Patients who received Fabry disease diagnosis underwent a 12-month follow-up to monitor stroke recurrence and multi-system progression after the cerebrovascular event. Discussion The potential implications of this study are as follows: (i) to add information about the yield of systematic screening for Fabry disease in a prospective large cohort of acute cerebrovascular patients; (ii) to deepen knowledge of clinical, pathophysiological, and prognostic characteristics of Fabry-related stroke.
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Affiliation(s)
- Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
| | | | - Cristina Sarti
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | - Antonia Nucera
- Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy
| | - Vittoria Cianci
- Neurology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Danilo Toni
- Emergency Department Stroke Unit, Umberto I Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | - Pasquale Palumbo
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | | | - Rita Bella
- Acute Cerebrovascular Diseases Unit, Vittorio Emanuele University Hospital, Catania, Italy
| | - Michele Ragno
- Division of Neurology, C. e G. Mazzoni Hospital and Madonna del Soccorso Hospital, Ascoli Piceno, Italy
| | - Umberto Scoditti
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | | | - Rossana Tassi
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | - Marina Diomedi
- Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | | | - Gino Volpi
- Neurology, San Iacopo Hospital, Pistoia, Italy
| | | | - Guido Bigliardi
- Stroke Unit, Sant'Agostino Estense New Hospital, Modena, Italy
| | - Simona Sacco
- Neurology and Stroke Unit, SS Filippo e Nicola Hospital , Avezzano, Italy
| | | | - Stefano Ricci
- Stroke Center - Neurology, Città Di Castello Hospital and Gubbio-Gualdo Tadino Hospital, Città di Castello, Italy
| | | | - Bruno Bonetti
- Stroke Unit, Verona University Hospital, Verona, Italy
| | | | | | | | | | - Marta Melis
- Neurology, Monserrato University Hospital, Cagliari, Italy
| | | | | | - Silvia Biagini
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Donatella Accavone
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Domenico Inzitari
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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10
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Locatelli M, Grassi M, Saba V, Iacovello L, di Castelnuovo A, de Gaetano G, Zedde M, Marcheselli S, Silvestrelli G, Ciccone A, Delodovici ML, Princiotta Cariddi L, Giossi A, Zini A, Paciaroni M, Acciarresi M, Azzini C, De Vito A, Gamba M, Magoni M, Del Sette M, Toriello A, Gandolfo C, Finocchi C, Bonifati DM, Tassi R, Martini G, Cavallini A, Morotti A, Bonacina S, Mazzoleni V, Pezzini D, Chiti A, Calabrò RS, Musolino R, La Spina P, Grillo F, Tomelleri G, Lodigiani C, Ritelli M, Colombi M, Padovani A, Pezzini A. Age-dependent effect of susceptibility factors on the risk of intracerebral haemorrhage: Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy). J Neurol Neurosurg Psychiatry 2021; 92:1068-1071. [PMID: 34253639 DOI: 10.1136/jnnp-2020-325648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/09/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the age-dependent impact of traditional stroke risk factors on the occurrence of intracerebral haemorrhage (ICH). METHODS We performed a case-control analysis, comparing consecutive patients with ICH with age-matched and sex-matched stroke-free controls, enrolled in the setting of the Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy) between 2002 and 2014 by multivariable logistic regression model within subgroups stratified by age quartiles (Q1-Q4). RESULTS We analysed 3492 patients and 3492 controls. The impact of untreated hypertension on the risk of ICH was higher in the lower than in the upper age quartile (OR 11.64, 95% CI 7.68 to 17.63 in Q1 vs OR 6.05, 95% CI 3.09 to 11.85 in Q4 with intermediate ORs in Q2 and Q3), while the opposite trend was observed for untreated hypercholesterolaemia (OR 0.63, 95% CI 0.45 to 0.97 in Q1 vs OR 0.36, 95% CI 0.26 to 0.56 in Q4 with intermediate ORs in Q2 and Q3). The effect of untreated diabetes and excessive alcohol intake was detected only in the older age group (OR 3.63, 95% CI 1.22 to 10.73, and OR 1.69, 95% CI 1.13 to 2.51, respectively). CONCLUSIONS Our findings provide evidence of age-dependent differences in the effects of susceptibility factors on the risk of ICH.
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Affiliation(s)
- Martina Locatelli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Mario Grassi
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, University of Pavia, Pavia, Italy
| | - Valentina Saba
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, University of Pavia, Pavia, Italy
| | - Licia Iacovello
- Università dell'Insubria, Varese, Italia.,Dipartimento di Epidemiologia e Prevenzione, NEUROMED, Pozzilli, Italia
| | | | | | - Marialuisa Zedde
- S.C. Neurologia, Stroke Unit, Università di Modena e Reggio Emilia, Reggio Emilia, Italia
| | - Simona Marcheselli
- Neurologia d'Urgenza and Stroke Unit, IRCCS Humanitas Group, Rozzano, Italia
| | - Giorgio Silvestrelli
- Stroke Unit, Dipartimento di Neuroscienze, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italia
| | - Alfonso Ciccone
- Stroke Unit, Dipartimento di Neuroscienze, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italia
| | | | | | - Alessia Giossi
- UO Neurologia, Azienda Ospedaliera Istituti Ospedalieri di Cremona, Cremona, Italia
| | - Andrea Zini
- Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, IRCCS Policlinico Sant'Orsola-Malpighi Università di Bologna, Bologna, Italia
| | - Maurizio Paciaroni
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università degli Studi di Perugia, Perugia, Italia
| | - Monica Acciarresi
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università degli Studi di Perugia, Perugia, Italia
| | - Cristiano Azzini
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Università di Ferrara, Ferrara, Italia
| | - Alessandro De Vito
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Università di Ferrara, Ferrara, Italia
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, ASST Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italia
| | - Mauro Magoni
- Stroke Unit, Neurologia Vascolare, ASST Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italia
| | | | - Antonella Toriello
- UOC Neurologia, Università degli Studi di Salerno Facoltà di Medicina e Chirurgia, Salerno, Italia
| | - Carlo Gandolfo
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italia
| | - Cinzia Finocchi
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italia
| | | | | | | | | | - Andrea Morotti
- UOC Neurologia, ASST Azienda Ospedaliera Spedali Civili, Brescia, Italia
| | - Sonia Bonacina
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Valentina Mazzoleni
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Debora Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Alberto Chiti
- Neurologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italia
| | - Rocco Salvatore Calabrò
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino Pulejo, Messina, Italia
| | - Rosa Musolino
- Dipartimento di Medicina Clinica e Sperimentale, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina Facoltà di Medicina e Chirurgia, Messina, Italia
| | - Paolo La Spina
- Dipartimento di Medicina Clinica e Sperimentale, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina Facoltà di Medicina e Chirurgia, Messina, Italia
| | - Francesco Grillo
- Dipartimento di Medicina Clinica e Sperimentale, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina Facoltà di Medicina e Chirurgia, Messina, Italia
| | - Giampaolo Tomelleri
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italia
| | - Corrado Lodigiani
- UOC Centro Trombosi e Malattie Emorragiche, IRCCS Humanitas Group, Rozzano, Italia
| | - Marco Ritelli
- Sezione di Biologia e Genetica, Dipartimento di Medicina Molecolare e Traslazionale, Università degli Studi di Brescia, Brescia, Italia
| | - Marina Colombi
- Sezione di Biologia e Genetica, Dipartimento di Medicina Molecolare e Traslazionale, Università degli Studi di Brescia, Brescia, Italia
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
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11
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Rebecchi V, Gallo D, Princiotta Cariddi L, Piantanida E, Tabaee Damavandi P, Carimati F, Gallazzi M, Clemenzi A, Banfi P, Candeloro E, Tanda ML, Mauri M, Versino M. Vitamin D, Chronic Migraine, and Extracranial Pain: Is There a Link? Data From an Observational Study. Front Neurol 2021; 12:651750. [PMID: 34054696 PMCID: PMC8155378 DOI: 10.3389/fneur.2021.651750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023] Open
Abstract
Several studies focused on the role of vitamin D (vitD) in pain chronification. This study focused on vitD level and pain chronification and extension in headache disorders. Eighty patients with primary headache underwent neurological examination, laboratory exams, including serum calcifediol 25(OH)D, and headache features assessment along with three questionnaires investigating depression, anxiety, and allodynia. The 86.8% of the population had migraine (48% episodic and 52% chronic). The 44.1% of patients had extracranial pain, and 47.6% suffered from allodynia. A vitD deficit, namely a serum 25(OH)D level <20 ng/ml, was detectable in 46.1% of the patients, and it occurred more frequently (p = 0.009) in patients suffering from chronic migraine (CM)–medication overuse migraine (MOH) (62.9%) than in episodic migraine (EM, 25.7%) or tension-type headache (TTH, 11.4%). The occurrence of extracranial pain and allodynia was higher in the CM-MOH than in the EM and in the TTH groups but was not related to the co-occurrence of vitD deficiency (Fisher's exact test p = 0.11 and p = 0.32, respectively). Our findings show that 25(OH)D deficit is also related to chronic headache, probably because of vitD anti-inflammatory and tolerogenic properties, reinforcing the idea of a neuroinflammatory mechanism underpinning migraine chronification.
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Affiliation(s)
| | - Daniela Gallo
- Endocrine Unit, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Eliana Piantanida
- Endocrine Unit, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Federico Carimati
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | - Marco Gallazzi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | | | - Paola Banfi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | - Elisa Candeloro
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | - Maria Laura Tanda
- Endocrine Unit, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
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12
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Gallazzi M, Mauri M, Bianchi ML, Riboldazzi G, Princiotta Cariddi L, Carimati F, Rebecchi V, Versino M. Selegiline reduces daytime sleepiness in patients with Parkinson's disease. Brain Behav 2021; 11:e01880. [PMID: 33759401 PMCID: PMC8119812 DOI: 10.1002/brb3.1880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Excessive daytime sleepiness (EDS) affects a large percentage of Parkinson's disease (PD) patients, and it is enhanced by dopamine agonist drugs. Currently, there is no treatment of choice for EDS in PD. Our aim was to check the clinical impression that some patients who were given selegiline, a selective inhibitor of monoamine oxidase B, experienced an improvement in their daytime somnolence. METHODS In the present study, we retrospectively identified 45 Parkinson's disease patients (21 females and 24 males) among those referred to the PD Center in Varese that (a) showed excessive daytime sleepiness, usually developed after the introduction of a dopamine agonist, (b) were given selegiline 10 mg to improve their treatment schedule independently of excessive sleepiness, and (c) in whom the Epworth Sleepiness Scale (ESS) and the Parkinson's Disease Sleep Scale (PDSS) scores were available both before and 3 months after the introduction of selegiline. RESULTS We compared the corresponding scores (ESS, PDSS, and UPDRS III) evaluated before and 3 months after the introduction of selegiline by the nonparametric Mann-Whitney U test: The differences showed a statistically significant improvement of somnolence but no change in the UPDRS III scores. CONCLUSION Despite some limitations, our data suggest that selegiline may be a valuable add-on therapy in PD patients to reduce their daytime somnolence.
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Affiliation(s)
- Marco Gallazzi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Marco Mauri
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| | | | - Giulio Riboldazzi
- Neurologia e Stroke Unit, ASST Valle Olona, Ospedale S. Antonio Abate, Gallarate, Italy
| | - Lucia Princiotta Cariddi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| | - Federico Carimati
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Valentina Rebecchi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Maurizio Versino
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
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13
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Piubelli L, Pollegioni L, Rabattoni V, Mauri M, Princiotta Cariddi L, Versino M, Sacchi S. Serum D-serine levels are altered in early phases of Alzheimer's disease: towards a precocious biomarker. Transl Psychiatry 2021; 11:77. [PMID: 33500383 PMCID: PMC7838302 DOI: 10.1038/s41398-021-01202-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
D-Serine acts as a co-agonist of N-methyl-D-aspartate receptors (NMDAR) which appear overactivated in AD, while D-aspartate is a modulatory molecule acting on NMDAR as a second agonist. The aim of this work is to clarify whether the levels of these D-amino acids in serum are deregulated in AD, with the final goal to identify novel and precocious biomarkers in AD. Serum levels of L- and D-enantiomers of serine and aspartate were determined by HPLC using a pre-column derivatization procedure and a selective enzymatic degradation. Experimental data obtained from age-matched healthy subjects (HS) and AD patients were statistically evaluated by considering age, gender, and disease progression, and compared. Minor changes were apparent in the serum L- and D-aspartate levels in AD patients compared to HS. A positive correlation for the D-serine level and age was apparent in the AD cohort. Notably, the serum D-serine level and the D-/total serine ratio significantly increased with the progression of the disease. Gender seems to have a minor effect on the levels of all analytes tested. This work proposes that the serum D-serine level and D-/total serine ratio values as novel and valuable biomarkers for the progression of AD: the latter parameter allows to discriminate CDR 2 and CDR 1 patients from healthy (CDR 0) individuals.
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Affiliation(s)
- Luciano Piubelli
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Loredano Pollegioni
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Valentina Rabattoni
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Mauri
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Neurology Unit, Ospedale di Circolo and Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Lucia Princiotta Cariddi
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maurizio Versino
- Neurology Unit, Ospedale di Circolo and Fondazione Macchi, ASST Settelaghi, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Silvia Sacchi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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14
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Sturchio A, Gastaldi M, Cariddi LP, Biacchi D, Espay AJ, Franciotta D, Versino M, Mauri M. Levodopa-responsive progressive encephalomyelitis with rigidity and myoclonus associated with glycine receptor antibodies. Parkinsonism Relat Disord 2021; 82:7-9. [DOI: 10.1016/j.parkreldis.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
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15
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Colombo A, Martinelli Boneschi F, Beretta S, Bresolin N, Versino M, Lorusso L, Spagnoli D, Nastasi G, Vallauri D, Rota S, Repaci M, Ferrarini M, Pozzato M, Princiotta Cariddi L, Tabaee Damavandi P, Carimati F, Banfi P, Clemenzi A, Marelli M, Giorgianni A, Vinacci G, Mauri M, Melzi P, Di Stefano M, Tetto A, Canesi M, Salmaggi A. Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy. eNeurologicalSci 2020; 22:100306. [PMID: 33490654 PMCID: PMC7806512 DOI: 10.1016/j.ensci.2020.100306] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/28/2020] [Revised: 12/03/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment.
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Affiliation(s)
- Antonio Colombo
- SNO (Society of Hospital Neurosciences, Italy) and Polo Neurologico Brianteo, Seregno, MB, Italy
| | - Filippo Martinelli Boneschi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy
| | - Sandro Beretta
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Nereo Bresolin
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy
| | - Maurizio Versino
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Lorenzo Lorusso
- Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy
| | - Diego Spagnoli
- Neurosurgery and Neurorehabilitation Gravedona Hospital, Como, Italy
| | - Giulia Nastasi
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Davide Vallauri
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Stefania Rota
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Maria Repaci
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Massimo Ferrarini
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Mattia Pozzato
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy
| | - Lucia Princiotta Cariddi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Payam Tabaee Damavandi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Federico Carimati
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Paola Banfi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Alessandro Clemenzi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Margherita Marelli
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Andrea Giorgianni
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Gabriele Vinacci
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Paola Melzi
- Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy
| | | | - Antonio Tetto
- Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy
| | - Margherita Canesi
- Neurosurgery and Neurorehabilitation Gravedona Hospital, Como, Italy
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16
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Sallustio F, Saia V, Marrama F, Pracucci G, Gandini R, Koch G, Mascolo AP, D'Agostino F, Rocco A, Argiro' R, Nezzo M, Morosetti D, Wlderk A, Da Ros V, Diomedi M, Renieri L, Nencini P, Vallone S, Zini A, Bigliardi G, Caragliano A, Francalanza I, Bracco S, Tassi R, Bergui M, Naldi A, Saletti A, De Vito A, Gasparotti R, Magoni M, Cirillo L, Commodaro C, Biguzzi S, Castellan L, Malfatto L, Menozzi R, Grisendi I, Cosottini M, Orlandi G, Comai A, Franchini E, D'Argento F, Frisullo G, Puglielli E, Casalena A, Causin F, Baracchini C, Boghi A, Chianale G, Augelli R, Cappellari M, Chiumarulo L, Petruzzellis M, Sgreccia A, Tosi P, Cavasin N, Critelli A, Semeraro V, Boero G, Vizzari F, Cariddi LP, Di Benedetto O, Pugliese P, Iacobucci M, De Michele M, Fusaro F, Moller J, Allegretti L, Tassinari T, Nuzzi NP, Marcheselli S, Sacco S, Pavia M, Invernizzi P, Gallesio I, Ruiz L, Zedda S, Rossi R, Amistà P, Russo M, Pintus F, Sanna A, Craparo G, Mannino M, Inzitari D, Mangiafico S, Toni D. Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries : The Italian Registry of Endovascular Treatment in Acute Stroke. Clin Neuroradiol 2020; 31:21-29. [PMID: 33301052 DOI: 10.1007/s00062-020-00980-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. METHODS A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. RESULTS Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. CONCLUSION Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
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Affiliation(s)
- Fabrizio Sallustio
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. .,Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Federico Marrama
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Roberto Gandini
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Giacomo Koch
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Alfredo Paolo Mascolo
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Federica D'Agostino
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Alessandro Rocco
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Renato Argiro'
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marco Nezzo
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Daniele Morosetti
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Andrea Wlderk
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto di Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy
| | - Antonio Caragliano
- Interventional Neuroradiology Unit, Policlinico G. Martino, Messina, Italy
| | | | - Sandra Bracco
- Interventional Neuroradiology Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Andrea Naldi
- Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Andrea Saletti
- Interventional Neuroradiology Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Neurology Division and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | | | - Luigi Cirillo
- IRCCS Istituto di Scienze Neurologiche di Bologna, Neuroradiology Unit, Ospedale Bellaria, Bologna University-DIMES, Bologna, Italy
| | | | - Sara Biguzzi
- Neurology and Stroke Unit, AUSL Romagna Cesena, Cesena, Italy
| | - Lucio Castellan
- Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova, Italy
| | | | - Roberto Menozzi
- Interventional Neuroradiology Unit, Ospedale Universitario, Parma, Italy
| | | | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | | | | | | | | | - Edoardo Puglielli
- Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy
| | | | - Francesco Causin
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Padova, Italy
| | | | - Andrea Boghi
- Interventional Neuroradiology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | | | - Raffaele Augelli
- Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit, AOU Consorziale Policlinico, Bari, Italy
| | | | - Alessandro Sgreccia
- Diagnostic Radiology and Interventional Neuroradiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piera Tosi
- Cerebrovascular Disease and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Nicola Cavasin
- Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Adriana Critelli
- Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | | | - Giovanni Boero
- Neurology Unit, Osp. "SS. Annunziata"-ASL TA, Taranto, Italy
| | - Francesco Vizzari
- Neuroradiology Department, Ospedale di Circolo di Varese, ASST-Sette Laghi, Varese, Italy
| | | | | | | | - Marta Iacobucci
- Interventional Neuroradiology Unit, University of Rome La Sapienza, Roma, Italy
| | | | - Federico Fusaro
- Interventional Neuroradiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Jessica Moller
- Stroke Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Luca Allegretti
- Neuroradiology Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | | | | | - Simona Sacco
- Department of Clinical Sciences and Biotechnology, University of L'Aquila, Avezzano, L'Aquila, Italy
| | - Marco Pavia
- Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Luigi Ruiz
- Neurology Department, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Sandro Zedda
- Interventional Radiology, Ospedale San Francesco, Nuoro, Italy
| | - Rosario Rossi
- Neurology and Stroke Unit, Ospedale San Francesco, Nuoro, Italy
| | - Pietro Amistà
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | | | | | - Giuseppe Craparo
- Interventional Radiology, Ospedale Civico e Benfratelli, Palermo, Italy
| | - Marina Mannino
- Neurology Unit, Ospedale Civico e Benfratelli, Palermo, Italy
| | | | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Danilo Toni
- Stroke Unit, University of Rome La Sapienza, Roma, Italy
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17
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Candeloro E, Carimati F, Tabaee Damavandi P, Princiotta Cariddi L, Banfi P, Clemenzi A, Gallazzi M, Mauri M, Rebecchi V, Baruzzi F, Giorgianni A, Tozzi M, Bianchi M, Ageno W, Versino M. An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era. Front Neurol 2020; 11:1029. [PMID: 33178094 PMCID: PMC7593656 DOI: 10.3389/fneur.2020.01029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022] Open
Abstract
During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.
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Affiliation(s)
- Elisa Candeloro
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Federico Carimati
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Bicocca University, Milan, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Alessandro Clemenzi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Marco Gallazzi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Valentina Rebecchi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Fabio Baruzzi
- Neuroradiology Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Andrea Giorgianni
- Neuroradiology Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, Varese, Italy.,Vascular Surgery Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Massimo Bianchi
- Emergency Department, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, Insubria University, Varese, Italy.,Emergency Department, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
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18
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D'Amore F, Vinacci G, Agosti E, Cariddi LP, Terrana AV, Vizzari FA, Mauri M, Giorgianni A. Pressing Issues in COVID-19: Probable Cause to Seize SARS-CoV-2 for Its Preferential Involvement of Posterior Circulation Manifesting as Severe Posterior Reversible Encephalopathy Syndrome and Posterior Strokes. AJNR Am J Neuroradiol 2020; 41:1800-1803. [PMID: 32732268 DOI: 10.3174/ajnr.a6679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Since December 2019, a novel Severe Acute Respiratory Syndrome coronavirus 2 from China has rapidly spread worldwide. Although respiratory involvement is the mainstay of coronavirus disease 2019 (COVID-19), systemic involvement has recently drawn more attention. In particular, a number of recent articles have shed light on the nervous system as one of the possible targets. At our institution, we observed 15 patients with acute brain vascular manifestations; most interesting, we had a higher prevalence of the posterior circulation acute impairment. In our series, 7 patients had acute posterior cerebral injury: 1, hemorrhagic posterior reversible encephalopathy syndrome; 5, posterior circulation ischemic stroke; and 1, parieto-occipital hemorrhagic stroke. On the basis of our evidence and previous basic science reports, we believe a common etiopathogenetic thread may connect ischemic/hemorrhagic events of the posterior circulation and posterior reversible encephalopathy syndrome in the setting of COVID-19.
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Affiliation(s)
- F D'Amore
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
| | | | - E Agosti
- Neurosurgery (E.A.), University of Insubria, Hospital of Circolo and Macchi Foundation, Varese, Lombardia, Italy
| | - L P Cariddi
- Neurology and Stroke Unit (L.P.C., M.M.), Hospital of Circolo and Macchi Foundation, Varese, Lombardia, Italy.,Clinical and Experimental Medical Humanities (L.P.C.), Center of Research in Medical Pharmacology, Univeristy of Insubria, Varese, Italy
| | - A V Terrana
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
| | - F A Vizzari
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
| | - M Mauri
- Neurology and Stroke Unit (L.P.C., M.M.), Hospital of Circolo and Macchi Foundation, Varese, Lombardia, Italy
| | - A Giorgianni
- From the Departments of Neuroradiology (F.D., A.V.T., F.A.V., A.G.)
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19
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Casetta I, Fainardi E, Saia V, Pracucci G, Padroni M, Renieri L, Nencini P, Inzitari D, Morosetti D, Sallustio F, Vallone S, Bigliardi G, Zini A, Longo M, Francalanza I, Bracco S, Vallone IM, Tassi R, Bergui M, Naldi A, Saletti A, De Vito A, Gasparotti R, Magoni M, Castellan L, Serrati C, Menozzi R, Scoditti U, Causin F, Pieroni A, Puglielli E, Casalena A, Sanna A, Ruggiero M, Cordici F, Di Maggio L, Duc E, Cosottini M, Giannini N, Sanfilippo G, Zappoli F, Cavallini A, Cavasin N, Critelli A, Ciceri E, Plebani M, Cappellari M, Chiumarulo L, Petruzzellis M, Terrana A, Cariddi LP, Burdi N, Tinelli A, Auteri W, Silvagni U, Biraschi F, Nicolini E, Padolecchia R, Tassinari T, Filauri P, Sacco S, Pavia M, Invernizzi P, Nuzzi NP, Marcheselli S, Amistà P, Russo M, Gallesio I, Craparo G, Mannino M, Mangiafico S, Toni D. Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset. Stroke 2020; 51:2051-2057. [DOI: 10.1161/strokeaha.119.027974] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and Purpose:
To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice.
Methods:
From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours.
Results:
Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients).
Conclusions:
This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
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Affiliation(s)
- Ilaria Casetta
- Clinica Neurologica, University of Ferrara, (I.C., M.P.)
| | | | - Valentina Saia
- Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S.)
| | - Giovanni Pracucci
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Marina Padroni
- Clinica Neurologica, University of Ferrara, (I.C., M.P.)
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.)
| | - Patrizia Nencini
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Domenico Inzitari
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Daniele Morosetti
- Diagnostic Imaging and Interventional Radiology Unit (D.M.), University of Rome Tor Vergata
| | | | - Stefano Vallone
- Interventional Neuroradiology Unit (S.V.), Ospedale Civile “S.Agostino-Estense”, AOU Modena
| | - Guido Bigliardi
- Stroke Unit (G.B.), Ospedale Civile “S.Agostino-Estense”, AOU Modena
| | - Andrea Zini
- Neurology and Stroke Unit, Maggiore Hospital, Bologna (A.Z.)
| | - Marcello Longo
- Interventional Neuroradiology Unit, Policlinico G Martino, Messina (M.L.)
| | | | - Sandra Bracco
- Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.)
| | - Ignazio M. Vallone
- Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.)
| | - Rossana Tassi
- Stroke Unit, University Hospital “S. Maria delle Scotte”, Siena (R.T.)
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza—Molinette, Turin (M.B.)
| | - Andrea Naldi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin (A.N.)
| | - Andrea Saletti
- Interventional Neuroradiology Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.S.)
| | - Alessandro De Vito
- Stroke Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.D.V.)
| | | | | | - Lucio Castellan
- Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova (L.C.)
| | - Carlo Serrati
- Neurology and Stroke Unit, IRCCS San Martino-IST, Genova (C.S.)
| | - Roberto Menozzi
- Interventional Neuroradiology Unit (R.M.), University Hospital, Parma
| | | | | | - Alessio Pieroni
- Stroke Unit and Neurosonology Lab (A.P.), Padua University Hospital
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile “Mazzini”, Teramo
| | | | - Antioco Sanna
- Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena
| | - Maria Ruggiero
- Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena
| | | | - Luca Di Maggio
- Interventional Radiology and Neuroradiology Unit (L.D.M), San Giovanni Bosco Hospital, Torino
| | - Enrica Duc
- Neurology Unit (E.D.), San Giovanni Bosco Hospital, Torino
| | | | | | - Giuseppina Sanfilippo
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.)
| | - Federico Zappoli
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.)
| | | | - Nicola Cavasin
- Neuroradiology Unit (N.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre
| | - Adriana Critelli
- Neurology Unit (A.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre
| | | | | | | | | | | | - Alberto Terrana
- Neuroradiology Unit (A.T.), AOU Circolo, ASST-Settelaghi, Varese
| | | | - Nicola Burdi
- Interventional Radiology (N.B.), Ospedale SS. Annunziata, Taranto
| | | | - William Auteri
- Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.)
| | - Umberto Silvagni
- Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.)
| | | | - Ettore Nicolini
- Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.)
| | | | - Tiziana Tassinari
- Neurology and Stroke Unit (T.T.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure
| | - Pietro Filauri
- Interventional Neuroradiology Unit, PO SS. Filippo e Nicola, Avezzano (P.F.)
| | - Simona Sacco
- Department of Applied Clinical Sciences e Biotechnology, University of L’Aquila, L’Aquila (S.S.)
| | - Marco Pavia
- Neuroradiology Unit (M.P.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Paolo Invernizzi
- Neurology Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Nunzio P. Nuzzi
- Interventional Neuroradiology Unit (N.P.N.), Humanitas Research Hospital, Rozzano
| | - Simona Marcheselli
- Urgent Neurology and Stroke Unit (S.M.), Humanitas Research Hospital, Rozzano
| | - Pietro Amistà
- Interventional Neuroradiology Unit (P.A.), S. Maria della Misericordia Hospital, Rovigo
| | - Monia Russo
- Stroke Unit (M.R.), S. Maria della Misericordia Hospital, Rovigo
| | - Ivan Gallesio
- Neuroradiology Unit, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria (I.G.)
| | - Giuseppe Craparo
- Interventional Neuroradiology Unit (G.C.), Ospedale Civico-A.R.N.A.S., Palermo
| | | | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.)
| | - Danilo Toni
- Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.)
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20
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Princiotta Cariddi L, Tabaee Damavandi P, Carimati F, Banfi P, Clemenzi A, Marelli M, Giorgianni A, Vinacci G, Mauri M, Versino M. Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient. J Neurol 2020; 267:3157-3160. [PMID: 32583053 PMCID: PMC7312113 DOI: 10.1007/s00415-020-10001-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2.
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Affiliation(s)
- Lucia Princiotta Cariddi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy.,Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy.,University of Milano Bicocca, Monza, Italy
| | - Federico Carimati
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy
| | - Alessandro Clemenzi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy
| | | | - Andrea Giorgianni
- Neuroradiology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Gabriele Vinacci
- Radiology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy.,Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy.,University of Insubria, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy. .,University of Insubria, Varese, Italy.
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