Baseline white matter hyperintensities affect the course of cognitive function after small vessel disease-related stroke: a prospective observational study

Background and purpose

Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD.

Methods

Patients with magnetic resonance imaging (MRI)‐proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set‐shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1‐weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate‐to‐severe WMH.

Results

The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one‐third of the sample after 15 months. After age correction, there were no significant differences in set‐shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set‐shifting after 15 months, there was no improvement in patients with moderate‐to‐severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke.

Conclusions

This longitudinal study demonstrates that preexisting moderate‐to‐severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD.

Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients

BACKGROUND AND PURPOSE

Information on the prevalence and course of post-stroke cognitive impairment in young stroke patients is limited. The aim was to assess a consecutive sample of acute young ischaemic stroke patients (18-55 years) for the presence and development of neuropsychological deficits.

METHODS

Patients prospectively underwent a comprehensive clinical and cognitive assessment, examining general cognitive function, processing speed, attention, flexibility/executive function and word fluency within the first 3 weeks after hospital admission (median assessment at day 6) and at a 3 months' follow-up (FU). Cognitive dysfunction was defined in comparison to age-standardized published norms.

RESULTS

At baseline (N = 114), deficits were highly prevalent in processing speed (56.0%), flexibility/executive function (49.5%), attention (46.4%) and general cognitive function (42.1%). These frequencies were comparable for those with FU assessment (N = 87). In most domains, cognitive performance improved within 3 months, except for word fluency. However, in about one-third of patients, cognitive deficits (as defined by 1.5 standard deviations below the standardized mean) were still present 3 months after stroke. At FU, 44.0% were impaired in the domain flexibility/executive function, 35.0% in processing speed and 30.0% in attention.

CONCLUSIONS

The high prevalence of cognitive deficits in acute young patients with ischaemic stroke highlights the importance of early post-stroke cognitive assessment to capture a patient's dysfunction in a comprehensive manner and to offer adequate rehabilitation. The role of factors which promote neuropsychological deficits needs further exploration.

[In memory of our Jewish colleagues who were murdered or committed suicide during the National Socialist Era]

With this article, we commemorate our Jewish colleagues who were murdered or committed suicide during the National Socialist Era in 1933-1945. Additionally, this article should provide an impulse to create a worthy memorial place. We thereby propose to put up commemorative plaques, e.g. in front of the administrative office of the German Dermatologic Society. Fifty-six Jewish dermatologists were killed in concentration camps in the National Socialist Era; 23 died in Theresienstadt, 19 in Auschwitz, and 14 in other concentration or extermination camps. Thirteen Jewish dermatologists committed suicide.

Therapie von Hautmetastasen beim malignen Melanom

Malignant melanoma represents a particular challenge for dermatologists and oncologists because of its high and increasing incidence and the poor prognosis of patients with thick primary tumors (T3, T4). In advanced stages of melanoma, cutaneous and subcutaneous metastases have a special significance, as they markedly affect the patient and may lead to a limitation in quality of life. While topical therapy is possible, there are only limited clinical studies. The location, number, size and distribution of skin metastases, involvement of internal organs, age and general condition should be considered in assessing therapeutic options. Especially with solitary, easily accessible metastases, surgical excision represents the therapy of choice. Ablation using CO(2) laser is an alternative. With extensive metastases in just one extremity, isolated limb perfusion (ILP) with melphalan is an option, while multiple, smaller metastases can be irradiated. Further, several chemotherapeutic agents and immune modulators can be used topically, peri- and intralesionally.

Morbus Reiter oder reaktive Arthritis?

There is an ongoing international discussion on whether the condition reactive arthritis should be named after a former Nazi functionary. The German dermatological community should participate in this debate. In 1916, Hans Reiter described a disease with the symptoms urethritis, conjunctivitis, and arthritis, which was later named after him. After becoming titular professor in May 1918, Reiter was appointed director of the regional public health department Mecklenburg-Schwerin in 1926. At the same time he taught social hygiene at the University of Rostock, where he was appointed full professor in 1928. In 1931, Hans Reiter became a member of the National Socialist German Workers Party (NSDAP). In July 1932 he was elected representative of the NSDAP to the seventh assembly of Mecklenburg-Schwerin. After becoming its acting director in July 1933, Reiter was appointed president of the Reich public health department in Berlin on October 1, 1933. Both his excellent professional qualifications, as well as his National Socialist attitudes, were considered key criteria for taking over this important position. As the president of the Reich public health department, Reiter was said to have known about the conduct of experiments with typhus-fever at the concentration camp Buchenwald in which 250 humans died. From the end of the Second World War until 1947, Reiter was imprisoned in the Nuremberg Prison for War Criminals, but never convicted of a crime.

The emigration of Germany's Jewish dermatologists in the period of National Socialism

In the context of our investigation, we found information on 432 (76%) of the 569 Jewish dermatologists in Germany. There is evidence that 57 (10%) of the Jewish dermatologists were murdered in concentration camps, 61 (10.7%) died a natural death, 13 (2%) committed suicide, and 25 (4%) survived the Third Reich in Germany. After 1933, 276 (49%) Jewish dermatologists were able to leave Germany; the United States of America was the main destination and 107 (or 41%) emigrated there. A total of 34 (13%) Jewish dermatologists emigrated from Germany to Palestine and 16 to Latin America. Regarding emigration to other European countries, 20 of the Jewish dermatologists from Germany went to Great Britain (including Walter Freudenthal, 1893-1952, and Ernst Sklarz, 1894-1975), and 24 emigrated to other European countries, such as France (Rudolf Mayer, 1895-1962), Sweden (Carl Lennhoff, 1883-1963), and the Netherlands (Otto Schlein, 1895-1944).

[Multiple miliary osteomas of the face]

Osteoma cutis is a single or multiple ectope calcification with development of bony structures in the skin. We distinguish between primary and secondary ossification. Multiple miliary osteoma in the face has mostly been described secondary to preexisting acne vulgaris. We present a 62-year-old woman who developed multiple miliary osteoma in the face together with repeated doses of estrogen and discuss pathogenesis and therapeutic possibilities.