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Merella P, Casu G, Chessa P, Atzori E, Bandino S, Deiana G. When Atrial Fibrillation Meets Cerebral Amyloid Angiopathy: Current Evidence and Strategies. J Clin Med 2023; 12:7704. [PMID: 38137773 PMCID: PMC10743760 DOI: 10.3390/jcm12247704] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Non-valvular atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) are two common diseases in elderly populations. Despite the effectiveness of oral anticoagulant therapy in cardioembolic stroke prevention, intracranial hemorrhage represents the most serious complication of these therapies. Cerebral amyloid angiopathy is one of the main risk factors for spontaneous intracranial bleeding, and this risk is highly increased by age and concomitant antithrombotic therapies. Cerebral amyloid angiopathy can be silent for years and then manifest with clinical features simulating TIA (TIA-mimics) or stroke in AF patients, pushing clinicians to rapidly start VKAs or DOACs, thus increasing the risk of intracranial bleeding if the diagnosis of CAA was unknown. Because the cerebral amyloid angiopathy is easily diagnosed with non-contrast MRI, suspecting the disease can avoid catastrophic complications. In this review, we will provide physicians managing anticoagulant therapies with key tips to familiarize themselves with cerebral amyloid angiopathy, with a focus on the possible clinical presentations and on the diagnostic criteria.
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Affiliation(s)
- Pierluigi Merella
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
| | - Gavino Casu
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
- Faculty of Medicine, University of Sassari, 07100 Sassari, Italy
| | - Paola Chessa
- Department of Pharmacy, San Francesco Hospital, 08100 Nuoro, Italy;
| | - Enrico Atzori
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
| | - Stefano Bandino
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
| | - Gianluca Deiana
- Department of Neurology and Stroke Unit, San Francesco Hospital, 08100 Nuoro, Italy;
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Mostert CQB, Singh RD, Gerritsen M, Kompanje EJO, Ribbers GM, Peul WC, van Dijck JTJM. Long-term outcome after severe traumatic brain injury: a systematic literature review. Acta Neurochir (Wien) 2022; 164:599-613. [PMID: 35098352 DOI: 10.1007/s00701-021-05086-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. METHODS A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2 years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. RESULTS Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. CONCLUSION Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. HIGHLIGHTS 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.
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Affiliation(s)
- Cassidy Q B Mostert
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands.
| | - Ranjit D Singh
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Maxime Gerritsen
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Jeroen T J M van Dijck
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
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Demir Y, Köroğlu Ö, Tekin E, Adıgüzel E, Kesikburun S, Güzelküçük Ü, Yılmaz B, Alaca R, Yaşar E. Factors affecting functional outcome in patients with traumatic brain injury sequelae: Our single-center experiences on brain injury rehabilitation. Turk J Phys Med Rehabil 2019; 65:67-73. [PMID: 31453545 DOI: 10.5606/tftrd.2019.2281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/01/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effect of rehabilitation on functional level of traumatic brain injury (TBI) patients and to examine the associated factors on functional gain in this patient population. Patients and methods Between October 2010 and November 2015, a total of 71 patients (63 males, 8 females; mean age 26.6±8.1 years; range, 18 to 56 years) who were admitted to our rehabilitation clinic with moderate-to-severe TBI were retrospectively analyzed. Functional recovery was assessed using the Functional Independence Measure (FIM) and Functional Ambulation Classification (FAC) scales. The patients were divided into two groups according to time from TBI to the initiation of rehabilitation: early (<6 months) and late (≥6 months). Possible predictive factors associated with FIM gain were evaluated. Results There was a significant improvement in the FIM scores from admission to discharge (p<0.001). There was a statistically significant difference in the FIM gain and FIM efficiency between the patient groups according to the initiation of rehabilitation (p<0.001). The FAC scores increased from admission to discharge, showing statistical significance (p<0.001). Duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis were found to be significant factors associated with FIM gain (p<0.001). Conclusion Our study results suggest that rehabilitation is effective for functional gain, particularly in the early period in patients with moderate- to-severe TBI and duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis are also predictors of functional improvement.
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Ruet A, Bayen E, Jourdan C, Ghout I, Meaude L, Lalanne A, Pradat-Diehl P, Nelson G, Charanton J, Aegerter P, Vallat-Azouvi C, Azouvi P. A Detailed Overview of Long-Term Outcomes in Severe Traumatic Brain Injury Eight Years Post-injury. Front Neurol 2019; 10:120. [PMID: 30846966 PMCID: PMC6393327 DOI: 10.3389/fneur.2019.00120] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background and aims: Severe traumatic brain injury is a leading cause of acquired persistent disabilities, and represents an important health and economic burden. However, the determinants of long-term outcome have rarely been systematically studied in a prospective longitudinal study of a homogeneous group of patients suffering exclusively from severe TBI Methods: Prospective observational study of an inception cohort of adult patients with severe traumatic brain injury in the Parisian area (PariS-TBI). Outcome was assessed with face-to-face interview 8 years after Traumatic Brain Injury, focusing on impairments, activity limitations, and participation restriction. Results: Five hundred and four patients were included between 2005 and 2007. At 8-year follow-up, 261 patients were deceased, 128 were lost to follow-up, 22 refused to participate, and 86 were finally evaluated. Age, gender, initial injury severity did not significantly differ between evaluated patients and lost to follow-up, but the latter were more frequently students or unemployed. Mean age was 41.9 (SD 13.6), 79% were male, median initial Glasgow Coma Scale Score was 6. The most frequent somatic complaints concerned balance (47.5%), motricity (31%), and headaches (36%), but these were less frequent than cognitive complaints (Memory 71%, Slowness 68%, Concentration 67%). According to the Hospital Anxiety and Depression Scale (HADS), 25 % had a score >8 for anxiety and 23.7% for depression. According to the Extended Glasgow Outcome Scale, 19.8% remained severely disabled, 46.5% moderately disabled, 33.7% had a good recovery. Older age, longer education duration, lower functional status upon intensive care discharge, and more severe 8-year dysexecutive problems were significantly associated with a lower Extended Glasgow Outcome Scale score in multivariable analysis. At 8 years, 48.7% of patients were employed in a productive job. Of those, 38% declared a salary loss since traumatic brain injury. Unemployment was significantly associated with lower 1-year GOSE score and more severe 8-year dysexecutive problems. Conclusions: These results from an inception cohort study highlight the fact that long-term outcome after severe TBI is determined by a complex combination of injury-related, demographic and neuropsychological factors. Long after the injury, persisting impairments still interfere with social integration, and participation.
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Affiliation(s)
- Alexis Ruet
- Physical Medicine and Rehabilitation Department, CHRU, Caen, France.,Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,EPHE, INSERM, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France.,Sorbonne Université GRC18, Paris, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Idir Ghout
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Layidé Meaude
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Astrid Lalanne
- Physical Medicine and Rehabilitation Department, APHP, Raymond-Poincaré Hospital, Garches, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France.,Laboratoire d'Imagerie Biomedicale Inserm U1146, Sorbonne Université GRC18, Paris, France
| | - Gaëlle Nelson
- Regional Reference Center for Bain Injury in the Parisan Area, CRFTC, Paris, France
| | - James Charanton
- Regional Reference Center for Bain Injury in the Parisan Area, CRFTC, Paris, France
| | - Philippe Aegerter
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Claire Vallat-Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France.,Laboratoire de Psychopathologie et Neuropsychologie, EA 2027, Université Paris 8, Saint-Denis, France
| | - Philippe Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, APHP, Raymond-Poincaré Hospital, Garches, France
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Almangour W, Schnitzler A, Salga M, Debaud C, Denormandie P, Genêt F. Recurrence of heterotopic ossification after removal in patients with traumatic brain injury: A systematic review. Ann Phys Rehabil Med 2016; 59:263-9. [PMID: 27173174 DOI: 10.1016/j.rehab.2016.03.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A systematic review of the literature to determine whether in patients with neurological heterotopic ossification (NHO) after traumatic brain injury, the extent of the neurological sequelae, the timing of surgery and the extent of the initial NHO affect the risk of NHO recurrence. DATA SOURCES We searched MEDLINE via PubMed and Cochrane library for articles published up to June 2015. Results were compared with epidemiological studies using data from the BANKHO database of 357 patients with central nervous system (CNS) lesions who underwent 539 interventions for troublesome HO. RESULTS A large number of studies were published in the 1980s and 1990s, most showing poor quality despite being performed by experienced surgical teams. Accordingly, results were contradictory and practices heterogeneous. Results with the BANKHO data showed troublesome NHO recurrence not associated with aetiology, sex, age at time of CNS lesion, multisite HO, or "early" surgery (before 6months). Equally, recurrence was not associated with neurological sequelae or disease extent around the joint. CONCLUSIONS The recurrence of NHO is not affected by delayed surgery, neurological sequelae or disease extent around the joint. Surgical excision of NHO should be performed as soon as comorbid factors are under control and the NHO is sufficiently constituted for excision.
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