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Fandler-Höfler S, Storti B. Acquired cerebral amyloid angiopathy: more questions than answers. Eur J Neurol 2024; 31:e16299. [PMID: 38597136 DOI: 10.1111/ene.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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2
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Pikija S, Pretnar-Oblak J, Frol S, Malojcic B, Gattringer T, Rak-Frattner K, Staykov D, Salmaggi A, Milani R, Magdic J, Iglseder S, Trinka E, Kraus T, Toma A, DiFrancesco JC, Tabaee Damavandi P, Fabin N, Bersano A, de la Riva Juez P, Albajar Gomez I, Storti B, Fandler-Höfler S. Iatrogenic cerebral amyloid angiopathy: A multinational case series and individual patient data analysis of the literature. Int J Stroke 2024; 19:314-321. [PMID: 37700397 DOI: 10.1177/17474930231203133] [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: 09/14/2023]
Abstract
BACKGROUND The transmission of amyloid β (Aβ) in humans leading to iatrogenic cerebral amyloid angiopathy (iCAA) is a novel concept with analogies to prion diseases. However, the number of published cases is low, and larger international studies are missing. AIMS We aimed to build a large multinational collaboration on iCAA to better understand the clinical spectrum of affected patients. METHODS We collected clinical data on patients with iCAA from Austria, Croatia, Italy, Slovenia, and Spain. Patients were included if they met the proposed Queen Square diagnostic criteria (QSC) for iCAA. In addition, we pooled data on disease onset, latency, and cerebrospinal fluid (CSF) biomarkers from previously published iCAA cases based on a systematic literature review. RESULTS Twenty-seven patients (22% women) were included in this study. Of these, 19 (70%) met the criteria for probable and 8 (30%) for possible iCAA. Prior neurosurgical procedures were performed in all patients (93% brain surgery, 7% spinal surgery) at median age of 8 (interquartile range (IQR) = 4-18, range = 0-26 years) years. The median symptom latency was 39 years (IQR = 34-41, range = 28-49). The median age at symptom onset was 49 years (IQR = 43-55, range = 32-70). Twenty-one patients (78%) presented with intracranial hemorrhage and 3 (11%) with seizures. CONCLUSIONS Our large international case series of patients with iCAA confirms a wide age boundary for the diagnosis of iCAA. Dissemination of awareness of this rare condition will help to identify more affected patients.
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Affiliation(s)
- Slaven Pikija
- Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Janja Pretnar-Oblak
- Department of Vascular Neurology, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Senta Frol
- Department of Vascular Neurology, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Branko Malojcic
- Department of Neurology, Zagreb School of Medicine, University Hospital Center, Zagreb, Croatia
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Kinga Rak-Frattner
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Austria
| | - Dimitre Staykov
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Austria
| | - Andrea Salmaggi
- Department of Neurology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Riccardo Milani
- Department of Neurology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Jozef Magdic
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Sarah Iglseder
- Department of Vascular Neurology, University Medical Centre Innsbruck, Innsbruck, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
- Department of Public Health, Health Services Research, and Health Technology Assessment, Hall in Tirol, Austria
| | - Theo Kraus
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Andreea Toma
- Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Natalia Fabin
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Patricia de la Riva Juez
- Stroke Unit, Donostia University Hospital, Neurovascular Diseases, Biodonostia Institute, San Sebastián, Spain
| | - Ines Albajar Gomez
- Stroke Unit, Donostia University Hospital, Neurovascular Diseases, Biodonostia Institute, San Sebastián, Spain
| | - Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Schiavolin S, Camarda G, Mazzucchelli A, Mariniello A, Marinoni G, Storti B, Canavero I, Bersano A, Leonardi M. Cognitive and psychological characteristics in patients with Cerebral Amyloid Angiopathy: a literature review. Neurol Sci 2024:10.1007/s10072-024-07399-7. [PMID: 38388894 DOI: 10.1007/s10072-024-07399-7] [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: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
AIM To review the current data on cognitive and psychological characteristics of patients with CAA and on the instruments used for their evaluation. METHODS A systematic search was performed in Embase, Scopus and PubMed with terms related to "cerebral amyloid angiopathy", "neuropsychological measures" and "patient-reported outcome measures" from January 2001 to December 2021. RESULTS Out of 2851 records, 18 articles were selected. The cognitive evaluation was present in all of which, while the psychological one only in five articles. The MMSE (Mini Mental State Examination), TMT (Trail Making Test), fluency test, verbal learning test, digit span, digit symbol and Rey figure tests were the most used cognitive tests, while executive function, memory, processing speed, visuospatial function, attention and language were the most frequent impaired cognitive functions. Depression was the most considered psychological factor usually measured with BDI (Beck Depression Inventory) and GDS (Geriatric Depression Scale). CONCLUSIONS The results of this study might be used in clinical practice as a guide to choose cognitive and psychological instruments and integrate them in the clinical evaluation. The results might also be used in the research field for studies investigating the impact of cognitive and psychological variables on the disease course and for consensus studies aimed at define a standardized evaluation of these aspects.
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Affiliation(s)
- Silvia Schiavolin
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giorgia Camarda
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - Alessia Mazzucchelli
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Arianna Mariniello
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giulia Marinoni
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Benedetta Storti
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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Storti B, Canavero I, Gabriel MM, Capozza A, Rifino N, Stanziano M, Tagliabue L, Bersano A. Iatrogenic cerebral amyloid angiopathy: An illustrative case of a newly introduced disease. Eur J Neurol 2023; 30:3397-3399. [PMID: 37494007 DOI: 10.1111/ene.15997] [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: 06/22/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND AND PURPOSE Iatrogenic cerebral amyloid angiopathy (iCAA) is a specific type of cerebral amyloid angiopathy which is becoming increasingly diagnosed. It has been hypothesized that iCAA might arise as a late consequence of past neurosurgical interventions involving dural patch grafts. Positron emission tomography (PET) scans with amyloid tracers and the assay of beta-amyloid levels in cerebrospinal fluid (CSF) are auxiliary criteria, however, definite diagnosis remains histopathologically determined. METHODS Case report. RESULTS We present a 48-year-old patient who suffered multiple lobar cerebral haemorrhages from the age of 47. The patient had undergone surgery for remolval of hemangioblastoma with lyophilized dural graft at the age of 11, in 1987. Brain MRI, amiloid PET and CSF analysis led to a diagnosis of probable iCAA. CONCLUSION It is necessary to increase the awareness of iCAA, in order to avoid overlooking the potential causal involvement of surgical procedures which took place far back in time. Moreover, the diagnostic relevance of amyloid PET and beta-amyloid levels in CSF must be emphasised.
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Affiliation(s)
- Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Magdalena Gabriel
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Antonella Capozza
- Nuclear Medicine Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Nicola Rifino
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Luca Tagliabue
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Storti B, Gabriel MM, Sennfält S, Canavero I, Rifino N, Gatti L, Bersano A. Rare forms of cerebral amyloid angiopathy: pathogenesis, biological and clinical features of CAA-ri and iCAA. Front Neurosci 2023; 17:1219025. [PMID: 37492402 PMCID: PMC10363735 DOI: 10.3389/fnins.2023.1219025] [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: 05/08/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
Thanks to a more widespread knowledge of the disease, and improved diagnostic techniques, the clinical spectrum of cerebral amyloid angiopathy (CAA) is now broad. Sporadic CAA, hereditary CAA, CAA-related inflammation (CAA-ri) and iatrogenic CAA (iCAA) create a clinical and radiological continuum which is intriguing and only partially discovered. Despite being relatively rare, CAA-ri, an aggressive subtype of CAA with vascular inflammation, has gained growing attention also because of the therapeutic efficacy of anti-inflammatory and immunomodulating drugs. More recently, diagnostic criteria have been proposed for an unusual variant of CAA, probably related to an iatrogenic origin (iCAA), toward which there is mounting scientific interest. These atypical forms of CAA are still poorly known, and their recognition can be challenging and deserve to be pursued in specialized referral centres. The aim of this brief review is to focus current developments in the field of rare forms of CAA, its pathogenesis as well as clinical and biological features in order to increase awareness of these rare forms.
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Affiliation(s)
- Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Magdalena Gabriel
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nicola Rifino
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Gatti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Romoli M, Giammello F, Mosconi MG, De Mase A, De Marco G, Digiovanni A, Ciacciarelli A, Ornello R, Storti B. Immunological Profile of Vasospasm after Subarachnoid Hemorrhage. Int J Mol Sci 2023; 24:ijms24108856. [PMID: 37240207 DOI: 10.3390/ijms24108856] [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: 03/25/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) carries high mortality and disability rates, which are substantially driven by complications. Early brain injury and vasospasm can happen after SAH and are crucial events to prevent and treat to improve prognosis. In recent decades, immunological mechanisms have been implicated in SAH complications, with both innate and adaptive immunity involved in mechanisms of damage after SAH. The purpose of this review is to summarize the immunological profile of vasospasm, highlighting the potential implementation of biomarkers for its prediction and management. Overall, the kinetics of central nervous system (CNS) immune invasion and soluble factors' production critically differs between patients developing vasospasm compared to those not experiencing this complication. In particular, in people developing vasospasm, a neutrophil increase develops in the first minutes to days and pairs with a mild depletion of CD45+ lymphocytes. Cytokine production is boosted early on after SAH, and a steep increase in interleukin-6, metalloproteinase-9 and vascular endothelial growth factor (VEGF) anticipates the development of vasospasm after SAH. We also highlight the role of microglia and the potential influence of genetic polymorphism in the development of vasospasm and SAH-related complications.
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Affiliation(s)
- Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, 47521 Cesena, Italy
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98122 Messina, Italy
| | - Maria Giulia Mosconi
- Emergency and Vascular Medicine, University of Perugia-Santa Maria Della Misericordia Hospital, 06129 Perugia, Italy
| | - Antonio De Mase
- Neurology and Stroke Unit, AORN Cardarelli, 80131 Napoli, Italy
| | - Giovanna De Marco
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, 40126 Bologna, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66013 Chieti, Italy
| | - Antonio Ciacciarelli
- Stroke Unit, Department of Emergency Medicine, University of Roma La Sapienza-Umberto I Hospital, 00161 Rome, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Benedetta Storti
- Cerebrovascular Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
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Pasini F, Karantzoulis A, Fanella G, Brovelli F, Iacobucci D, Aprea V, Storti B, Santangelo F, Canonico F, Remida P, Ferrarese C, Brighina L. Hypoglycemic Encephalopathy Manifesting with Cortical Hemichorea-Hemiballismus Syndrome: A Case Report. Case Rep Neurol 2023; 15:24-30. [PMID: 36762000 PMCID: PMC9906039 DOI: 10.1159/000528880] [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: 07/21/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
Hyper-/hypoglycemic states are rare but well-established causes of hyperkinetic movements, including chorea and ballismus, usually associated with brain lesions in the basal ganglia. We report a case of hemichorea-hemiballismus (HCHB) syndrome that developed after a severe hypoglycemic episode in a 71-year-old man with poorly controlled type 2 diabetes mellitus. Uncommonly, brain MRI showed contralateral cortical-subcortical T2 and T2-FLAIR-hyperintense frontoparietal lesions, with cingulate gyrus involved, while the basal ganglia were unaffected. In patients with hypoglycemic encephalopathy associated with cortical lesions, the long-term prognosis is usually poor. Nevertheless, in our patient, the dyskinesias and the cerebral lesions progressively regressed by achieving good glycemic control. After four and 12 months, the patient's neurological examination was normal. To our knowledge, this is the first evidence of hypoglycemic etiology of cortical HCHB syndrome, supporting recent theories that cortical circuitries may independently contribute to the pathogenesis of chorea and ballismus. This is also the first report of cingulate gyrus involvement in hypoglycemic encephalopathy. Finally, this case may indicate that a subset of patients with cortical lesions due to hypoglycemia could present a good clinical outcome, likely depending on the size of the lesions and the duration and severity of the hypoglycemic episode.
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Affiliation(s)
- Francesco Pasini
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Aristotelis Karantzoulis
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Gaia Fanella
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Francesco Brovelli
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Davide Iacobucci
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Vittoria Aprea
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Benedetta Storti
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Francesco Santangelo
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Francesco Canonico
- Department of Neuroradiology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Paolo Remida
- Department of Neuroradiology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Ferrarese
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Laura Brighina
- Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
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Tabaee Damavandi P, Storti B, Fabin N, Bianchi E, Ferrarese C, DiFrancesco JC. Epilepsy in cerebral amyloid angiopathy: an observational retrospective study of a large population. Epilepsia 2023; 64:500-510. [PMID: 36515439 DOI: 10.1111/epi.17489] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/17/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cerebral amyloid angiopathy (CAA) is a major cause of spontaneous intracranial hemorrhage in older adults. Epilepsy represents a possible sequela of the disease. To date, studies on epilepsy in CAA are lacking, and the few data available mainly focus on CAA-related inflammation (CAA-ri), the inflammatory form of the disease. METHODS In this retrospective observational study, we consecutively recruited CAA patients observed over a time span of 10 years, collecting demographic, clinical, and instrumental data. Significant baseline characteristics were evaluated as potential risk factors for the development of epilepsy in the CAA population, and in the subgroups of CAA-ri and CAA without inflammatory reaction (CAA-nri). The effect of potential risk factors for epilepsy was measured as odds ratio with 95% confidence interval. RESULTS Within 96 recruited CAA cases, 33 (34.4%) developed epilepsy during follow-up (median = 13.5 months). The prevalent type of seizure was focal (81.3%); 12.1% of the epileptic patients presented status epilepticus, and 6.1% developed drug-resistant epilepsy. Electroencephalographic traces revealed slow and epileptic discharge activity in the majority of epileptic patients, but also in those without epilepsy. The presence of focal or disseminated cortical superficial siderosis (cSS) was associated with an increased risk of epilepsy in the CAA-nri group, and the association with CAA-ri and epilepsy was present in the overall population. SIGNIFICANCE Epilepsy is a common manifestation during the course of CAA, where CAA-ri and cSS represent predisposing factors for the development of seizures. These data suggest the importance of a deep characterization of CAA patients, to better select those more prone to develop epilepsy.
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Affiliation(s)
- Payam Tabaee Damavandi
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Benedetta Storti
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Natalia Fabin
- Laboratory of Epidemiological and Clinical Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elisa Bianchi
- Neurological Disorders, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
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Storti B, Nastasi G, Acampora R, Ferri F, Isella V, Ferrarese C, Appollonio I, Tremolizzo L. A Case of Reversible Dementia Due to a Strictly Fruitarian Diet: If an Apple a Day Keeps the Doctor Away, a Fruitarian Diet Throws Your Mind Away. Neurol Clin Pract 2021; 11:e784-e786. [PMID: 34840910 DOI: 10.1212/cpj.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/09/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Benedetta Storti
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Giulia Nastasi
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Roberto Acampora
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Francesca Ferri
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Valeria Isella
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Carlo Ferrarese
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Ildebrando Appollonio
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
| | - Lucio Tremolizzo
- Neurology Unit (BS, GN, RA, FF, VI, CF, IA, LT), San Gerardo Hospital and Department of Medicine and Surgery, University of Milano Bicocca, Monza; and Neuromi (Milan Center for Neuroscience) (CF, IA, LT), Italy
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Storti B, Brovelli F, Pozzi FE, Zuffi A, Piatti M, Appollonio I, Tremolizzo L, Ferrarese C. Progression in cognitively impaired patients with atrial fibrillation: An observational study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aprea V, Conti E, Sala G, Zoia C, Storti B, Da Re F, Appollonio I, Tremolizzo L, Ferrarese C. Neuroinflammation and behavioral dysfunction: Exploring the role of Diazepam binding inhibitor. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Storti B, Gallone A, Paris L, Foresti C. A Rare Case of Atypical Palatal‐Lingual Tremor Associated with Waldenström's Macroglobulinemia. Mov Disord Clin Pract 2021. [DOI: 10.1002/mdc3.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Benedetta Storti
- UOS Neurofisiopatologia e UOC Neurologia, ASST Papa Giovanni XXIII Bergamo Italy
- Università Milano Bicocca, San Gerardo Hospital Monza Italy
| | - Annamaria Gallone
- UOS Neurofisiopatologia e UOC Neurologia, ASST Papa Giovanni XXIII Bergamo Italy
| | - Laura Paris
- USC Ematologia, ASST Papa Giovanni XXIII Bergamo Italy
| | - Camillo Foresti
- UOS Neurofisiopatologia e UOC Neurologia, ASST Papa Giovanni XXIII Bergamo Italy
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13
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Storti B, Diamanti S, Tremolizzo L, Riva N, Lunetta C, Filippi M, Ferrarese C, Appollonio I. ALS Mimics due to Affection of the Cervical Spine: From Common Compressive Myelopathy to Rare CSF Epidural Collection. Case Rep Neurol 2021; 13:145-156. [PMID: 33790773 PMCID: PMC7989791 DOI: 10.1159/000512810] [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: 09/18/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a clinically heterogeneous disease, with chameleon presentations and several mimics. Considering the poor prognosis of ALS, their precise and timely identification is pivotal. Affection of the cervical spine represents one potential source of ALS mimics that should never be missed, since it is potentially treatable. We hereby present 5 cases initially diagnosed as ALS but eventually found to have different kinds of cervical spine affection, from a common compressive myelopathy to a rare space-occupying cystic fluid collection.
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Affiliation(s)
- Benedetta Storti
- Neurology Unit, San Gerardo Hospital, and School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Susanna Diamanti
- Neurology Unit, San Gerardo Hospital, and School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- Neurology Unit, San Gerardo Hospital, and School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Nilo Riva
- Neuropathology Unit, "San Raffaele" Scientific Institute, Milan, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Massimo Filippi
- Neuropathology Unit, "San Raffaele" Scientific Institute, Milan, Italy
| | - Carlo Ferrarese
- Neurology Unit, San Gerardo Hospital, and School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Ildebrando Appollonio
- Neurology Unit, San Gerardo Hospital, and School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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14
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Uncini A, Foresti C, Frigeni B, Storti B, Servalli MC, Gazzina S, Cosentino G, Bianchi F, Del Carro U, Alfonsi E, Piccinelli SC, De Maria G, Padovani A, Filosto M, Ippoliti L. Electrophysiological features of acute inflammatory demyelinating polyneuropathy associated with SARS-CoV-2 infection. Neurophysiol Clin 2021; 51:183-191. [PMID: 33685769 PMCID: PMC7891083 DOI: 10.1016/j.neucli.2021.02.001] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. Methods Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared. Results S-AIDP patients more frequently developed respiratory failure (83.3% vs. 25%, P = 0.000) and required intensive care unit (ICU) hospitalization (58.3% vs. 31.3%, P = 0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs. 26.2%, P = 0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs. 32.4%, P = 0.002) and F waves were more often absent (45.6% vs. 31.8%, P = 0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs. 2.8%, P = 0.000);11 S-AIDP patients showed this pattern in 2 nerves. Conclusion Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.
| | - Camillo Foresti
- Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Barbara Frigeni
- Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Benedetta Storti
- Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | | | | | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia and IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Bianchi
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano, Italy
| | - Ubaldo Del Carro
- Neurology and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano, Italy
| | | | - Stefano Cotti Piccinelli
- Center for Neuromuscular Diseases, Unit of Neurology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Alessandro Padovani
- Center for Neuromuscular Diseases, Unit of Neurology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Massimiliano Filosto
- Center for Neuromuscular Diseases, Unit of Neurology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Luigi Ippoliti
- Statistics Unit, Department of Economics, University "G. d'Annunzio", Pescara, Italy
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15
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Beretta S, Da Re F, Francioni V, Remida P, Storti B, Fumagalli L, Piatti ML, Santoro P, Cereda D, Cutellè C, Pirro F, Montisano DA, Beretta F, Pasini F, Cavallero A, Appollonio I, Ferrarese C. Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection. Front Neurol 2021; 12:622130. [PMID: 33643200 PMCID: PMC7902908 DOI: 10.3389/fneur.2021.622130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/22/2021] [Indexed: 01/28/2023] Open
Abstract
Thrombotic complications are common in COVID-19 patients, but cerebral venous system involvement, timing after infection, optimal treatment, and long-term outcome are uncertain. We report a case of massive cerebral venous thrombosis and concomitant internal iliac vein thrombosis occurring in the late phase of paucisymptomatic COVID-19 infection. Mild respiratory symptoms, without fever, started 3 weeks before headache and acute neurological deficits. The patient had silent hypoxemia and typical COVID-19 associated interstitial pneumonia. Brain CT scan showed a left parietal hypodense lesion with associated sulcal subarachnoid hemorrhage. CT cerebral venography showed a massive cerebral venous thrombosis involving the right transverse sinus, the right jugular bulb, the superior sagittal sinus, the straight sinus, the vein of Galen, and both internal cerebral veins. Abdominal CT scan showed no malignancy but revealed an asymptomatic right internal iliac vein thrombosis. Both cerebral venous thrombosis and pelvic vein thrombosis were effectively treated with unfractionated heparin started on the day of admission, then shifted to low molecular weight heparin, with a favorable clinical course. Nasopharyngel swab, repeated twice, tested negative for SARS-CoV-2. Serological tests confirmed SARS-CoV-2 infection. Our case supports active surveillance and prevention of thrombotic complications associated with COVID-19, which may affect both peripheral and cerebral venous system. Early initiation of unfractionated heparin may lead to good neurologic outcome.
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Affiliation(s)
- Simone Beretta
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMi (Milan Center for Neuroscience), Milan, Italy
| | - Fulvio Da Re
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMi (Milan Center for Neuroscience), Milan, Italy
| | | | - Paolo Remida
- Department of Neuroradiology, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Benedetta Storti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lorenzo Fumagalli
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy
| | | | - Patrizia Santoro
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Diletta Cereda
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Claudia Cutellè
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fiammetta Pirro
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Francesca Beretta
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Pasini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Annalisa Cavallero
- Department of Microbiology and Virology, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Ildebrando Appollonio
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMi (Milan Center for Neuroscience), Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, San Gerardo Hospital ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMi (Milan Center for Neuroscience), Milan, Italy
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16
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Storti B, Cereda D, Balducci C, Santangelo F, Ferrarese C, Appollonio I. Who is really blind in the time of coronavirus: the patient or the doctor? A rare case of Balint's syndrome. Neurol Sci 2021; 42:2079-2080. [PMID: 33400067 PMCID: PMC7782050 DOI: 10.1007/s10072-020-04934-0] [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: 08/12/2020] [Accepted: 11/20/2020] [Indexed: 12/03/2022]
Abstract
Background Selective bilateral lesions of the parietal–occipital lobes can lead to an uncommon and incompletely understood clinical entity, Balint’ syndrome, which consists of simultanagnosia, oculomotor apraxia, optic ataxia and difficulty in perceiving distances between objects. Case presentation We herein report a rare presentation of Balint’s syndrome in a 65-year-old woman suffering from stroke and SARS-CoV2 infection. Conclusion During SARS-CoV2 pandemic, Italian physicians were forced to work with less instrumental diagnostic resources, relying on their clinical knowledge mostly. The aim of this case report is to highlight the importance of performing a precise neurological evaluation, particularly during these challenging times: it might avoid incorrect diagnosis and favour the discovery of rare clinical diseases.
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Affiliation(s)
- Benedetta Storti
- Department of Neurology, San Gerardo Hospital ASST, Monza, Italy. .,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Diletta Cereda
- Department of Neurology, San Gerardo Hospital ASST, Monza, Italy
| | - Claudia Balducci
- Department of Neurology, San Gerardo Hospital ASST, Monza, Italy
| | - Francesco Santangelo
- Department of Neurology, San Gerardo Hospital ASST, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carlo Ferrarese
- Department of Neurology, San Gerardo Hospital ASST, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ildebrando Appollonio
- Department of Neurology, San Gerardo Hospital ASST, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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17
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Rifino N, Censori B, Agazzi E, Alimonti D, Bonito V, Camera G, Conti MZ, Foresti C, Frigeni B, Gerevini S, Grimoldi M, La Gioia S, Partziguian T, Quadri S, Riva R, Servalli MC, Sgarzi M, Storti B, Vedovello M, Venturelli E, Viganò M, Callegaro A, Arosio M, Sessa M. Neurologic manifestations in 1760 COVID-19 patients admitted to Papa Giovanni XXIII Hospital, Bergamo, Italy. J Neurol 2020; 268:2331-2338. [PMID: 33026520 PMCID: PMC7539268 DOI: 10.1007/s00415-020-10251-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 07/21/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Evidences from either small series or spontaneous reporting are accumulating that SARS-CoV-2 involves the Nervous Systems. The aim of this study is to provide an extensive overview on the major neurological complications in a large cohort of COVID-19 patients. METHODS Retrospective, observational analysis on all COVID-19 patients admitted from February 23rd to April 30th, 2020 to ASST Papa Giovanni XXIII, Bergamo, Italy for whom a neurological consultation/neurophysiological assessment/neuroradiologic investigation was requested. Each identified neurologic complication was then classified into main neurologic categories. RESULTS Of 1760 COVID-19 patients, 137 presented neurologic manifestations that manifested after COVID-19 symptoms in 98 pts and was the presenting symptom in 39. Neurological manifestations were classified as: (a) cerebrovascular disease [53 pts (38.7%)] including 37 ischemic and 11 haemorrhagic strokes, 4 transient ischemic attacks, 1 cerebral venous thrombosis; (b) peripheral nervous system diseases [31 (22.6%)] including 17 Guillain-Barrè syndromes; (c) altered mental status [49 (35.8%)] including one necrotizing encephalitis and 2 cases with RT-PCR detection of SARS-Cov-2 RNA in CSF; (d) miscellaneous disorders, among whom 2 patients with myelopathy associated with Ab anti-SARS-CoV-2 in CSF. Patients with peripheral nervous system involvement had more frequently severe ARDS compared to patients with cerebrovascular disease (87.1% vs 42%; difference = 45.1% 95% CI 42.0-48.2; χ2= 14.306; p < 0.0002) and with altered mental status (87.1% vs 55.6%; difference = 31.5% 95% CI 27.5-37.5%; χ2= 7.055; p < 0.01). CONCLUSION This study confirms that involvement of nervous system is common in SARS-CoV-2 infection and offers clinicians useful information for prevention and prompt identification in order to set the adequate therapeutic strategies.
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Affiliation(s)
| | - Bruno Censori
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Neurology, Cremona Hospital, Cremona, Italy
| | - Emanuela Agazzi
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Dario Alimonti
- University of Milano-Bicocca, Milan, Italy.,Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Virginio Bonito
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giorgia Camera
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Marta Zaffira Conti
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Camillo Foresti
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Barbara Frigeni
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Simonetta Gerevini
- Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Grimoldi
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Sara La Gioia
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Tania Partziguian
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefano Quadri
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Riccardo Riva
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | | | - Manlio Sgarzi
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | | | - Marcella Vedovello
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Elisabetta Venturelli
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | | | - Annapaola Callegaro
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Arosio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Sessa
- Department of Neurology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
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18
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Foresti C, Servalli MC, Frigeni B, Rifino N, Storti B, Gritti P, Fabretti F, Grazioli L, Sessa M. COVID-19 provoking Guillain-Barré syndrome: The Bergamo case series. Eur J Neurol 2020; 28:e84-e85. [PMID: 32961593 PMCID: PMC7537113 DOI: 10.1111/ene.14549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Camillo Foresti
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Barbara Frigeni
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Nicola Rifino
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Benedetta Storti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Gritti
- Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Fabretti
- Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Grazioli
- Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Sessa
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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19
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Tremolizzo L, Storti B, Ferrarese C, Appollonio I. Unilateral axillary nerve palsy following birthing bar use. Int J Gynaecol Obstet 2020; 151:475-476. [DOI: 10.1002/ijgo.13308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/28/2020] [Accepted: 07/13/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Lucio Tremolizzo
- Department of Neurology San Gerardo Hospital Monza and School of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Benedetta Storti
- Department of Neurology San Gerardo Hospital Monza and School of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Carlo Ferrarese
- Department of Neurology San Gerardo Hospital Monza and School of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Ildebrando Appollonio
- Department of Neurology San Gerardo Hospital Monza and School of Medicine and Surgery University of Milano‐Bicocca Milan Italy
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20
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Conti E, Andreoni S, Tomaselli D, Storti B, Brovelli F, Acampora R, Da Re F, Appollonio I, Ferrarese C, Tremolizzo L. Serum DBI and biomarkers of neuroinflammation in Alzheimer's disease and delirium. Neurol Sci 2020; 42:1003-1007. [PMID: 32705487 PMCID: PMC7870594 DOI: 10.1007/s10072-020-04608-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
Background Alzheimer’s disease (AD) patients often express significant behavioral symptoms: for this reason, accessible related biomarkers could be very useful. Neuroinflammation is a key pathogenic process in both AD and delirium (DEL), a clinical condition with behavioral symptoms resembling those of AD. Methods A total of n = 30 AD patients were recruited together with n = 30 DEL patients and n = 15 healthy controls (CTRL). Serum diazepam binding inhibitor (DBI), IL-17, IL-6, and TNF-α were assessed by ELISA. Results DBI serum levels were increased in AD patients with respect to CTRL (+ 81%), while DEL values were 70% higher than AD. IL-17 was increased in DEL with respect to CTRL (+ 146%), while AD showed dispersed values and failed to reach significant differences. On the other hand, IL-6 showed a more robust increase in DEL with respect to the other two groups (+ 185% and + 205% vs. CTRL and AD, respectively), and TNF-α failed to show any change. Conclusions DBI may be a very promising candidate for AD, perhaps marking psychomotor DEL-like symptoms, in view of developing future helping tool for practicing physicians. Furthermore, DBI rise in DEL offers novel cues for a better comprehension of the pathogenesis of this potentially fatal condition.
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Affiliation(s)
- Elisa Conti
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy
| | - Simona Andreoni
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy
| | - Davide Tomaselli
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy
| | - Benedetta Storti
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy.,Neurology Unit, "San Gerardo" Hospital, Monza, Italy
| | - Francesco Brovelli
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy.,Neurology Unit, "San Gerardo" Hospital, Monza, Italy
| | - Roberto Acampora
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy.,Neurology Unit, "San Gerardo" Hospital, Monza, Italy
| | - Fulvio Da Re
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy.,Neurology Unit, "San Gerardo" Hospital, Monza, Italy
| | - Ildebrando Appollonio
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy.,Neurology Unit, "San Gerardo" Hospital, Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy.,Neurology Unit, "San Gerardo" Hospital, Monza, Italy
| | - Lucio Tremolizzo
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Room 2043, Building U8, via Cadore 48, 20900, Monza, MB, Italy. .,Neurology Unit, "San Gerardo" Hospital, Monza, Italy.
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21
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Moretti R, Caruso P, Storti B, Saro R, Kassabian B, Sala A, Giannini A, Gazzin S. Behavior in subcortical vascular dementia with sight pathologies: visual hallucinations as a consequence of precocious gait imbalance and institutionalization. Neurol Sci 2020; 41:3283-3292. [PMID: 32405881 DOI: 10.1007/s10072-020-04445-y] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 04/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subcortical vascular dementia (sVAD) is considered the most frequent dementia in old population, and it is due to a small vessel disease. It has a very specific nosography, where the dominant factors are dysexecutive functions, depression, and apathy. Very few studies described visual hallucinations in sVAD, apart from in the final stages of it. METHODS This study recruited 577 patients with a diagnosis of sVAD associated with major ocular pathologies and 1118 patients with sVAD without any significant ocular pathology: Patients were followed up for 24 months. We studied the influence of ocular pathologies in precocious visual hallucinations, on behavior disorder (aggressiveness), and gait disorders (instability, fells). We registered the necessity of neuropsychiatric therapies, incidence of hospitalization, and institutionalization. RESULTS What emerges from our study is that the ocular comorbidities might change the behavior profile of dementia, provoking behavioral alterations, and the need for therapies with adverse effects. As far as old age is a complicated status of life, many factors can modify its development. The possible contribution of multiple biological events cannot be neglected, particularly the underlying influence of chronic diseases as well as the geriatric conditions, per se, might compromise the cognitive functions and the pathological conditions. Ocular pathology as a superimposing event in sVAD might worse the outcome. A correct and rapid identification of critical patients might be relevant for the dynamic life events in these patients and their caregivers.
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Affiliation(s)
- Rita Moretti
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy
| | - Paola Caruso
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Benedetta Storti
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy
| | - Riccardo Saro
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy
| | - Benedetta Kassabian
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy
| | - Alessia Sala
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy
| | - Anna Giannini
- Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447, Trieste, Italy
| | - Silvia Gazzin
- Italian Liver Foundation, Science Park, Trieste, Italy
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Checcucci G, Storti B, Ghetti F, Signore G, Bizzarri R. Fluorescence lifetime microscopy reveals the biologically-related photophysical heterogeneity of oxyblepharismin in light-adapted (blue) Blepharisma japonicum cells. Photochem Photobiol Sci 2017. [PMID: 28636018 DOI: 10.1039/c7pp00072c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The step-up photophobic response of the heterotrich ciliate Blepharisma japonicum is mediated by a hypericinic pigment, blepharismin, which is not present in any of the known six families of photoreceptors, namely rhodopsins, phytochromes, xanthopsins, cryptochromes, phototropins, and BLUF proteins. Upon irradiation, native cells become light-adapted (blue) by converting blepharismin into the photochemically stable oxyblepharismin (OxyBP). So far, OxyBP has been investigated mainly from a photophysical point of view in vitro, either alone or complexed with proteins. In this work, we exploit the vivid fluorescence of OxyBP to characterize its lifetime emission in blue B. Japonicum cells, on account of the recognized role of the fluorescence lifetime to provide physicochemical insights into the fluorophore environment at the nanoscale. In a biological context, OxyBP modifies its emission lifetime as compared to isotropic media. The phasor approach to fluorescence lifetime microscopy in confocal mode highlights that fluorescence originates from two excited states, whose relative balance changes throughout the cell body. Additionally, Cilia and kinetids, i.e., the organelles involved in photomovement, display lifetime asymmetry between the anterior and posterior part of the cell. From these data, some hypotheses on the phototransduction mechanism are proposed.
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Affiliation(s)
- G Checcucci
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Piazza San Silvestro 12, I-56127 Pisa, Italy.
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