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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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Milella G, Introna A, Mezzapesa DM, D'Errico E, Fraddosio A, Ucci M, Zoccolella S, Simone IL. Clinical Profiles and Patterns of Neurodegeneration in Amyotrophic Lateral Sclerosis: A Cluster-Based Approach Based on MR Imaging Metrics. AJNR Am J Neuroradiol 2023; 44:403-409. [PMID: 36958798 PMCID: PMC10084907 DOI: 10.3174/ajnr.a7823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND PURPOSE The previous studies described phenotype-associated imaging findings in amyotrophic lateral sclerosis (ALS) with a prior categorization of patients based on clinical characteristics. We investigated the natural segregation of patients through a radiologic cluster-based approach without a priori patient categorization using 3 well-known prognostic MR imaging biomarkers in ALS, namely bilateral precentral and paracentral gyrus cortical thickness and medulla oblongata volume. We aimed to identify clinical/prognostic features that are cluster-associated. MATERIALS AND METHODS Bilateral precentral and paracentral gyri and medulla oblongata volume were calculated using FreeSurfer in 90 patients with amyotrophic lateral sclerosis and 25 healthy controls. A 2-step cluster analysis was performed using precentral and paracentral gyri (averaged pair-wise) and medulla oblongata volume. RESULTS We identified 3 radiologic clusters: 28 (31%) patients belonged to "cluster-1"; 51 (57%), to "cluster 2"; and 11 (12%), to "cluster 3." Patients in cluster 1 showed statistically significant cortical thinning of the analyzed cortical areas and lower medulla oblongata volume compared with subjects in cluster 2 and cluster 3, respectively. Patients in cluster 3 exhibited significant cortical thinning of both paracentral and precentral gyri versus those in cluster 2, and this latter cluster showed lower medulla oblongata volume than cluster 3. Patients in cluster 1 were characterized by older age, higher female prevalence, greater disease severity, higher progression rate, and lower survival compared with patients in clusters 2 and 3. CONCLUSIONS Patients with amyotrophic lateral sclerosis spontaneously segregate according to age and sex-specific patterns of neurodegeneration. Some patients with amyotrophic lateral sclerosis showed an early higher impairment of cortical motor neurons with relative sparing of bulbar motor neurons (cluster 3), while others expressed an opposite pattern (cluster 2). Moreover, 31% of patients showed an early simultaneous impairment of cortical and bulbar motor neurons (cluster 1), and they were characterized by higher disease severity and lower survival.
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Affiliation(s)
- G Milella
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - A Introna
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - D M Mezzapesa
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - E D'Errico
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - A Fraddosio
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - M Ucci
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - S Zoccolella
- Azienda Sanitaria Locale Bari (S.Z.), San Paolo Hospital, Bari, Italy
| | - I L Simone
- From the Neurology Unit (G.M., A.I., D.M.M., E.D., A.F., M.U., I.L.S.), Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
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De Matteis E, De Santis F, Ornello R, Censori B, Puglisi V, Vinciguerra L, Giossi A, Di Viesti P, Inchingolo V, Fratta GM, Diomedi M, Bagnato MR, Cenciarelli S, Bedetti C, Padiglioni C, Tassinari T, Saia V, Russo A, Petruzzellis M, Mezzapesa DM, Caccamo M, Rinaldi G, Bavaro A, Paciaroni M, Mosconi MG, Foschi M, Querzani P, Muscia F, Gallo Cassarino S, Candelaresi P, De Mase A, Guarino M, Cupini LM, Sanzaro E, Zini A, La Spada S, Palmieri C, Sepe FN, Beretta S, Paci C, Caggia EA, De Angelis MV, Bonanni L, Volpi G, Tassi R, Pistoia F, Scoditti U, Tonon A, Viticchi G, Ruzza G, Nencini P, Cavallini A, Toni D, Ricci S, Sacco S. Divergence Between Clinical Trial Evidence and Actual Practice in Use of Dual Antiplatelet Therapy After Transient Ischemic Attack and Minor Stroke. Stroke 2023; 54:1172-1181. [PMID: 36951052 DOI: 10.1161/strokeaha.122.041660] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs. METHODS READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers. The study comprises a 90-day follow-up from symptom onset. In the present work, we reported descriptive statistics of baseline data of patients recruited up to July 31, 2022, and proportions of patients who would have been excluded from RCTs. We compared categorical data through the χ² test. RESULTS We evaluated 1070 patients, who had 72 (interquartile range, 62-79) years median age, were mostly Caucasian (1045; 97.7%), and were men (711; 66.4%). Among the 726 (67.9%) patients with ischemic stroke, 226 (31.1%) did not meet the RCT inclusion criteria because of National Institutes of Health Stroke Scale score >3 and 50 (6.9%) because of National Institutes of Health Stroke Scale score >5. Among the 344 (32.1%) patients with TIA, 69 (19.7%) did not meet the RCT criteria because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <4 and 252 (74.7%) because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <6 and no symptomatic arterial stenosis. Additionally, 144 (13.5%) patients would have been excluded because of revascularization procedures. Three hundred forty-five patients (32.2%) did not follow the RCT procedures because of late (>24 hours) DAPT initiation; 776 (72.5%) and 676 (63.2%) patients did not take loading doses of aspirin and clopidogrel, respectively. Overall, 84 (7.8%) patients met the RCT inclusion/exclusion criteria. CONCLUSIONS The real-world use of DAPT is broader than RCTs. Most patients did not meet the RCT criteria because of the severity of ischemic stroke, lower risk of TIA, late DAPT start, or lack of antiplatelet loading dose. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT05476081.
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Affiliation(s)
- Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
| | - Federico De Santis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
| | - Bruno Censori
- Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V., A.G.)
| | - Valentina Puglisi
- Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V., A.G.)
| | - Luisa Vinciguerra
- Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V., A.G.)
| | - Alessia Giossi
- Department of Neurology, ASST Cremona Hospital, Italy (B.C., V.P., L.V., A.G.)
| | - Pietro Di Viesti
- Department of Neurology, Casa sollievo della sofferenza, San Giovanni Rotondo, Italy (P.D.V., V.I., G.M.F.)
| | - Vincenzo Inchingolo
- Department of Neurology, Casa sollievo della sofferenza, San Giovanni Rotondo, Italy (P.D.V., V.I., G.M.F.)
| | - Giovanni Matteo Fratta
- Department of Neurology, Casa sollievo della sofferenza, San Giovanni Rotondo, Italy (P.D.V., V.I., G.M.F.)
| | - Marina Diomedi
- Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy (M.D., M.R.B.)
| | - Maria Rosaria Bagnato
- Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy (M.D., M.R.B.)
| | - Silvia Cenciarelli
- Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)
| | - Chiara Bedetti
- Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)
| | - Chiara Padiglioni
- Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)
| | - Tiziana Tassinari
- Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy (T.T., V.S., A.R.)
| | - Valentina Saia
- Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy (T.T., V.S., A.R.)
| | - Alessandro Russo
- Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy (T.T., V.S., A.R.)
| | - Marco Petruzzellis
- Department of Neurology and Stroke Unit "F. Puca," AOU Consorziale Policlinico, Bari, Italy (M. Petruzzellis, D.M.M., M.C.)
| | - Domenico Maria Mezzapesa
- Department of Neurology and Stroke Unit "F. Puca," AOU Consorziale Policlinico, Bari, Italy (M. Petruzzellis, D.M.M., M.C.)
| | - Martina Caccamo
- Department of Neurology and Stroke Unit "F. Puca," AOU Consorziale Policlinico, Bari, Italy (M. Petruzzellis, D.M.M., M.C.)
| | - Giuseppe Rinaldi
- Department of Neurology, Di Venere Hospital, Bari, Italy (G. Rinaldi, A.B.)
| | - Alessandra Bavaro
- Department of Neurology, Di Venere Hospital, Bari, Italy (G. Rinaldi, A.B.)
| | - Maurizio Paciaroni
- Stroke Unit, University Hospital Santa Maria della Misericordia, Perugia, Italy (M. Paciaroni, M.G.M.)
| | - Maria Giulia Mosconi
- Stroke Unit, University Hospital Santa Maria della Misericordia, Perugia, Italy (M. Paciaroni, M.G.M.)
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
- Department of Neuroscience, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy (M.F., P.Q.)
| | - Pietro Querzani
- Department of Neuroscience, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy (M.F., P.Q.)
| | - Francesco Muscia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
- Department of Neurology, ASST Ovest Milanese, Legnano, Italy (F.M., S.G.C.)
| | | | - Paolo Candelaresi
- Department of Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy (P.C., A.D.M.)
| | - Antonio De Mase
- Department of Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy (P.C., A.D.M.)
| | - Maria Guarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology, Policlinico S. Orsola-Malpighi, Bologna, Italy (M.G.)
| | - Letizia Maria Cupini
- Department of Neurology and Stroke Unit, S. Eugenio Hospital, Rome, Italy (L.M.C.)
| | - Enzo Sanzaro
- Department of Neurology and Stroke Unit, Umberto I Hospital, Siracusa, Italy (E.S.)
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z.)
| | - Salvatore La Spada
- Department of Neurology, Antonio Perrino Hospital, Brindisi, Italy (S.L.S.)
| | - Carmela Palmieri
- Department of Neurology, Hospital "E. Agnelli," Pinerolo, Italy (C. Palmieri)
| | - Federica Nicoletta Sepe
- Department of Neurology and Stroke Unit, S.S. Biagio e Arrigo Hospital, Alessandria, Italy (F.N.S.)
| | - Simone Beretta
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy (S.B.)
| | - Cristina Paci
- Neurology Unit, Ospedale Provinciale "Madonna del Soccorso," San Benedetto del Tronto, Italy (C. Paci)
| | | | | | - Laura Bonanni
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio di Chieti-Pescara e Clinica Neurologica e Stroke Unit Ospedale Clinicizzato S.S. Annunziata di Chieti, Italy (L.B.)
| | - Gino Volpi
- Department of Neurology, San Jacopo Hospital, Pistoia, Italy (G. Volpi)
| | - Rossana Tassi
- Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy (R.T.)
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
| | - Umberto Scoditti
- Department of Emergency-Neurology-Stroke Care, University Hospital of Parma, Italy (U.S.)
| | - Agnese Tonon
- Department of Neurology, Ospedale Civile S.S. Giovanni e Paolo, Venezia, Italy (A.T.)
| | - Giovanna Viticchi
- Clinical and Experimental Medicine Department, Marche Polytechnic University, Ancona, Italy (G. Viticchi)
| | | | - Patrizia Nencini
- Stroke Unit, Careggi University Hospital, Florence, Italy (P.N.)
| | - Anna Cavallini
- Department of Emergency Neurology and Stroke Unit, IRCCS C. Mondino Foundation, Pavia, Italy (A.C.)
| | - Danilo Toni
- Department of Human Neurosciences, University of Rome La Sapienza, Italy (D.T.)
| | - Stefano Ricci
- Department of Neurology, Città di Castello Hospital, Italy (S.C., C.B., C. Padiglioni, S.R.)
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (E.D.M., F.D.S., R.O., M.F., F.P., S.S.)
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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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Introna A, Caputo F, Santoro C, Guerra T, Ucci M, Mezzapesa DM, Trojano M. Guillain-Barré syndrome after AstraZeneca COVID-19-vaccination: A causal or casual association? Clin Neurol Neurosurg 2021; 208:106887. [PMID: 34418708 PMCID: PMC8360997 DOI: 10.1016/j.clineuro.2021.106887] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 06/07/2021] [Revised: 07/22/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022]
Abstract
We report a case of Guillain-Barré syndrome (GBS) following the first dose of Oxford/AstraZeneca COVID-19 vaccine with papilledema as atypical onset. As the COVID-19 vaccination campaign progresses worldwide, GBSs vaccine-related have been increasingly reported. After reviewing the available literature, considering the annual incidence of GBS, in this historical moment, the public health systems cannot afford an unjustified distrust in vaccines, caused by misinterpretation of epidemiological data. Nonetheless, it is important for clinicians to promptly recognize neurological complications potentially associated with COVID-19 vaccinations and report them to pharmacovigilance agencies.
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Affiliation(s)
- Alessandro Introna
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy.
| | - Francesca Caputo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Carlo Santoro
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Tommaso Guerra
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Maria Ucci
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Domenico Maria Mezzapesa
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
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6
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Distaso E, Milella G, Mezzapesa DM, Introna A, D'Errico E, Fraddosio A, Zoccolella S, Dicuonzo F, Simone IL. Magnetic resonance metrics to evaluate the effect of therapy in amyotrophic lateral sclerosis: the experience with edaravone. J Neurol 2021; 268:3307-3315. [PMID: 33655342 PMCID: PMC8357666 DOI: 10.1007/s00415-021-10495-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Edaravone was approved as a new treatment for amyotrophic lateral sclerosis (ALS), although there are different opinions on its effectiveness. Magnetic resonance (MRI) measures appear promising as diagnostic and prognostic indicators of disease. However, published studies on MRI using to monitor treatment efficacy in ALS are lacking. PURPOSE The objective of this study was to investigate changes in brain MRI measures in patients treated with edaravone. METHODS Thirteen ALS patients assuming edaravone (ALS-EDA) underwent MRI at baseline (T0) and after 6 months (T6) to measure cortical thickness (CT) and fractional anisotropy (FA) of white matter (WM) tracts. MRI data of ALS-EDA were compared at T0 with those of 12 control subjects (CS), and at T6 with those of 11 ALS patients assuming only riluzole (ALS-RIL), extracted from our ALS cohort using a propensity-score-matching. A longitudinal MRI analysis was performed in ALS-EDA between T6 and T0. RESULTS At T0, ALS-EDA showed a cortical widespread thinning in both hemispheres, particularly in the bilateral precentral gyrus, and a reduction of FA in bilateral corticospinal tracts, in comparison to CS. Thinning in bilateral precentral cortex and significant widespread reduction of FA in several WM tracts were observed in ALS-EDA at T6 compared to T0. At T6, no significant differences in MRI measures of ALS-EDA versus ALS-RIL were found. CONCLUSIONS Patients treated with edaravone showed progression of damage in the motor cortex and several WM tracts, at a six-month follow-up. Moreover, this study showed no evidence of a difference between edaravone and riluzole.
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Affiliation(s)
- Eugenio Distaso
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giammarco Milella
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Domenico Maria Mezzapesa
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Eustachio D'Errico
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Angela Fraddosio
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | | | - Franca Dicuonzo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Manni A, Iaffaldano A, Lucisano G, D'Onghia M, Mezzapesa DM, Felica V, Iaffaldano P, Trojano M, Paolicelli D. Lymphocyte Count and Body Mass Index as Biomarkers of Early Treatment Response in a Multiple Sclerosis Dimethyl Fumarate-Treated Cohort. Front Immunol 2019; 10:1343. [PMID: 31258529 PMCID: PMC6587065 DOI: 10.3389/fimmu.2019.01343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/08/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: In relapsing Multiple Sclerosis (RMS) patients treated with disease modifying drugs (DMDs), few data are available regarding the biomarkers of treatment response. We aimed to assess the predictive value of lymphocyte count (LC) and Body Mass Index (BMI) for treatment response in a real life setting of dimethyl fumarate (DMF) treated patients. Materials and Methods: We included in our observational analysis 338 patients who were prescribed DMF in an Italian MS Center. We collected clinical and demographic data at the beginning of DMF (T0), and assessed White Blood Cells (WBC) and LC at T0 and at 3 (T3), 6 (T6), 9 (T9), and 12 (T12) months. Gadolinium enhancing (Gd+), new T2 lesions and relapses within the first year of treatment (T12) were recorded in order to evaluate clinical activity at 12 months. Analysis of correlation was performed to correlate WBC, LC and BMI with clinical and radiological responses. We evaluated whether BMI or LC can predict treatment response by using multivariate logistic regression models at each follow-up. Results: Our cohort was followed up for a mean period of 19.8 ± 6.8 months. The mean BMI at baseline was 24.19 ± 4.48. The multivariate models gave as predictive factors for Gd+ lesions at T12, LC at T3 (OR = 1.003, 95% CI = 1.00-1.07; p = 0.046) and baseline BMI (OR = 0.71, 95% CI = 0.52-0.98; p = 0.037). Predictive factors for new T2 lesions at T12 were LC at T3 (OR = 1.01 95%CI = 1.00-1.95; p = 0.005) and baseline BMI (OR = 0.99, 95% CI = 0.98-1.00; p = 0.026). Conclusions: In our real life-experience, BMI and LC may be early biomarkers to predict treatment response during DMF.
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Affiliation(s)
- Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Domenico Maria Mezzapesa
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Felica
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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8
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Introna A, Mezzapesa DM, Petruzzellis M, Savarese M, Chiumarulo L, Zimatore DS, Dicuonzo F, Simone IL. Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter? Neurol Sci 2019; 40:1419-1424. [PMID: 30937557 DOI: 10.1007/s10072-019-03868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/24/2018] [Accepted: 03/23/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear. METHODS Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA). RESULTS All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH. None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition, DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection. CONCLUSIONS We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic hypothesis of coexisting c-SAH and AIS.
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Affiliation(s)
- Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Domenico Maria Mezzapesa
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Marco Petruzzellis
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Mariantonietta Savarese
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Luigi Chiumarulo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Domenico Sergio Zimatore
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Franca Dicuonzo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
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9
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Mezzapesa DM, D’Errico E, Tortelli R, Distaso E, Cortese R, Tursi M, Federico F, Zoccolella S, Logroscino G, Dicuonzo F, Simone IL. Cortical thinning and clinical heterogeneity in amyotrophic lateral sclerosis. PLoS One 2013; 8:e80748. [PMID: 24278317 PMCID: PMC3835750 DOI: 10.1371/journal.pone.0080748] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/07/2013] [Indexed: 12/14/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) has heterogeneous clinical features that could be translated into specific patterns of brain atrophy. In the current study we have evaluated the relationship between different clinical expressions of classical ALS and measurements of brain cortical thickness. Cortical thickness analysis was conducted from 3D-MRI using FreeSurfer software in 29 ALS patients and 20 healthy controls. We explored three clinical traits of the disease, subdividing the patients into two groups for each of them: the bulbar or spinal onset, the higher or lower upper motor neuron burden, the faster or slower disease progression. We used both a whole brain vertex-wise analysis and a ROI analysis on primary motor areas. ALS patients showed cortical thinning in bilateral precentral gyrus, bilateral middle frontal gyrus, right superior temporal gyrus and right occipital cortex. ALS patients with higher upper motor neuron burden showed a significant cortical thinning in the right precentral gyrus and in other frontal extra-motor areas, compared to healthy controls. ALS patients with spinal onset showed a significant cortical thinning in the right precentral gyrus and paracentral lobule, compared to healthy controls. ALS patients with faster progressive disease showed a significant cortical thinning in widespread bilateral frontal and temporal areas, including the bilateral precentral gyrus, compared to healthy controls. Focusing on the primary motor areas, the ROI analysis revealed that the mean cortical thickness values were significantly reduced in ALS patients with higher upper motor neuron burden, spinal onset and faster disease progression related to healthy controls. In conclusion, the thickness of primary motor cortex could be a useful surrogate marker of upper motor neuron involvement in ALS; also our results suggest that cortical thinning in motor and non motor areas seem to reflect the clinical heterogeneity of the disease.
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Affiliation(s)
- Domenico Maria Mezzapesa
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Eustachio D’Errico
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Rosanna Tortelli
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Eugenio Distaso
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Rosa Cortese
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Marianna Tursi
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Francesco Federico
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Stefano Zoccolella
- Neurophysiopathology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Giancarlo Logroscino
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Franca Dicuonzo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
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Abstract
The primary role of magnetic resonance imaging (MRI) in the evaluation of patients with parkinsonian syndromes is traditionally thought to be the differentiation between neurodegenerative and symptomatic parkinsonisms. Non conventional MRI techniques, however, could improve the clinical diagnosis by detecting ultrastructural damage even in brain regions not suspected to be involved. Moreover, functional MRI provides useful information upon the pathophysiology of Parkinson's disease.
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Affiliation(s)
- Francesco Federico
- Clinica Neurologica, Dipartimento di Scienze Neurologiche e Psichiatriche, Piazza G. Cesare, 11, 70124 Bari, Italy.
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11
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Lucivero V, Prontera M, Mezzapesa DM, Petruzzellis M, Sancilio M, Tinelli A, Di Noia D, Ruggieri M, Federico F. Different roles of matrix metalloproteinases-2 and -9 after human ischaemic stroke. Neurol Sci 2007; 28:165-70. [PMID: 17690845 DOI: 10.1007/s10072-007-0814-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 06/21/2007] [Indexed: 12/27/2022]
Abstract
Accumulating data suggest that matrix metalloproteinases (MMPs), in particular MMP-2 and MMP-9, are deleterious after acute ischaemic stroke. A beneficial effect of MMPs in the repairing phases of cerebral ischaemia has also been proposed. This study investigated the relationship between MMP-2 and MMP-9 and stroke subtypes, clinical recovery and haemorrhagic transformation (HT). We measured MMP-9 and MMP-2 plasma levels in 29 patients with ischaemic stroke at days one and seven. MMP-2 levels increased only in lacunar strokes, whilst MMP-9 increased only in patients with more severe stroke. Basal MMP-2 levels were higher in patients with stable or recovering symptoms whilst MMP-9 values at day seven were correlated with worse clinical outcome. No differences related to the presence of HT were found. This study sustains a different behaviour of MMPs after ischaemic stroke. MMP-2 seems to be expressed early and related to better outcome, whilst MMP-9 seems to be late and related to more severe stroke.
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Affiliation(s)
- V Lucivero
- Department of Neurological and Psychiatric Sciences, University of Bari, Piazza G. Cesare 12, 1-70124, Bari, Italy
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12
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Petruzzellis M, De Blasi R, Lucivero V, Sancilio M, Prontera M, Tinelli A, Mezzapesa DM, Federico F. Cerebral aneurysms in a patient with osteogenesis imperfecta and exon 28 polymorphism of COL1A2. AJNR Am J Neuroradiol 2007; 28:397-8. [PMID: 17353301 PMCID: PMC7977849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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13
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Mezzapesa DM, Ceccarelli A, Dicuonzo F, Carella A, De Caro MF, Lopez M, Samarelli V, Livrea P, Simone IL. Whole-brain and regional brain atrophy in amyotrophic lateral sclerosis. AJNR Am J Neuroradiol 2007; 28:255-9. [PMID: 17296989 PMCID: PMC7977419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Accepted: 03/24/2006] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Recent evidence from neuropsychologic and neuroimaging studies suggests that central nervous system involvement in amyotrophic lateral sclerosis (ALS) extends beyond motor neurons. Our purpose was to obtain measures of global and regional atrophy in nondemented patients with ALS to assess subtle structural brain changes. METHODS MR images, acquired from 16 patients and 9 healthy subjects (HS), were processed by using the Structural Imaging Evaluation of Normalized Atrophy (SIENA) software to estimate whole-brain atrophy measures and the voxel-based morphometry (VBM) method to highlight the selective volumetric decrease of single cerebral areas. In addition, each subject underwent a neuropsychologic examination. RESULTS In patients with ALS, brain parenchymal fraction was slightly lower compared with HS (P = .012), and seemed to be related to the presence of cognitive impairment. Patients showed a gray matter volume decrease in several frontal and temporal areas bilaterally (P < .001 uncorrected) compared with HS, with a slight prevalence in the right hemisphere. No volume reduction in primary motor cortices of patients was detected. Performances on Symbol Digit Modalities Test were significantly worse in patients compared with HS (P = .025). CONCLUSIONS The presence of mild whole-brain volume loss and regional frontotemporal atrophy in patients with ALS could explain the presence of cognitive impairment and confirms the idea of ALS as a degenerative brain disease not confined to motor system.
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Affiliation(s)
- D M Mezzapesa
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
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14
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Tortorella P, Rocca MA, Mezzapesa DM, Ghezzi A, Lamantia L, Comi G, Filippi M. MRI quantification of gray and white matter damage in patients with early–onset multiple sclerosis. J Neurol 2006; 253:903-7. [PMID: 16511645 DOI: 10.1007/s00415-006-0129-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 12/19/2005] [Accepted: 12/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Contrary to what happens in adult-onset multiple sclerosis (MS), in a previous preliminary magnetic resonance imaging (MRI) study we showed only subtle normal-appearing brain tissue changes in patients with earlyonset MS. Our objective was to evaluate the presence and extent of tissue damage in the brain normalappearing white matter (NAWM) and gray matter (GM) from a larger population of patients with earlyonset MS. METHODS Using diffusion tensor (DT) and magnetization transfer (MT) MRI, we obtained DT and MT ratio (MTR) maps of the NAWM and GM from 23 patients with early-onset MS and 16 sex- and age-matched healthy volunteers. RESULTS Compared with healthy volunteers, patients with early-onset MS had significantly increased average MD (p = 0.02) and FA peak height (p = 0.007) and decreased average FA (p <0.0001) of the NAWM. Brain dual-echo lesion load was significantly correlated with average FA (r = -0.48, p = 0.02) and with FA peak height (r = 0.45, p = 0.03) of the NAWM. No MTR and diffusion changes were detected in the GM. CONCLUSIONS This study confirms the paucity of the 'occult' brain tissue damage in patients with earlyonset MS. It also suggests that in these patients GM is spared by the disease process and that NAWM changes are likely to be secondary to Wallerian degeneration of fibers passing through macroscopic lesions.
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Affiliation(s)
- P Tortorella
- Neuroimaging Research Unit Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
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Mezzapesa DM, Petruzzellis M, Lucivero V, Prontera M, Tinelli A, Sancilio M, Carella A, Federico F. Multimodal MR examination in acute ischemic stroke. Neuroradiology 2006; 48:238-46. [PMID: 16508783 DOI: 10.1007/s00234-005-0045-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 10/06/2005] [Indexed: 12/11/2022]
Abstract
In recent years, combined diffusion-weighted imaging (DWI) with perfusion imaging (PI) has become an important investigational tool in the acute phase of ischemic stroke, as it may differentiate reversible from irreversible brain tissue damage. We consecutively examined 20 subjects within 12 h of stroke onset using a multiparametric magnetic resonance (MR) examination consisting of DWI, mean transit time (MTT) as PI parameter, and MR angiography (MRA). T2-weighted and fluid-attenuated inversion recovery (FLAIR) on day 7 were also acquired in order to obtain final infarct volume. The following MR parameters were considered: volumetric measures of lesion growth and MTT abnormalities, quantification of regional apparent diffusion coefficient (ADC) and visual inspection of MRA findings. Our results showed: (1) an acute DWI lesion was not predictive of lesion growth and the DWI abnormality did not represent the irreversibly infarcted tissue; (2) ADC values in the ischemic penumbra could not predict tissue at risk; (3) the DWI-PI mismatch did not predict lesion growth, and the PI abnormality overestimated the amount of tissue at risk; and (4) patients with proximal middle cerebral artery occlusion had greater initial and final infarct volumes. This study did not demonstrate the prognostic value of a multimodal MR approach in early ischemic stroke; MRA alone provided predictive information about the volumetric evolution of the lesion.
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Affiliation(s)
- D M Mezzapesa
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy
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16
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Lucivero V, Mezzapesa DM, Petruzzellis M, Carella A, Lamberti P, Federico F. Ischaemic stroke in progressive systemic sclerosis. Neurol Sci 2004; 25:230-3. [PMID: 15549510 DOI: 10.1007/s10072-004-0327-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Accepted: 07/24/2004] [Indexed: 11/28/2022]
Abstract
Progressive systemic sclerosis (PSS) or scleroderma is a multisystem disease affecting the skin, lungs, myocardium, kidneys and gastrointestinal tract. Primary involvement of cerebral arteries in PSS has been reported but is very rare. A 61-year-old woman suffering from scleroderma for six years was hospitalised for two subsequent episodes of transient acute dysarthria and left hemiparesis. After five hours from the first onset of symptoms, she was submitted to brain magnetic resonance (MR) protocol that showed a right subinsular ischaemic lesion and whole right middle cerebral artery (MCA) territory hypoperfusion. Intracranial and epiaortic MR angiography reported a focal stenosis in the M2 portion of MCA. She was immediately treated with i.v. high dose steroids and oral acetylsalicylic acid. At one-month follow up, MR findings were confirmed. We have documented a cerebral infarct in a PSS patient. In our opinion, the ischaemic stroke was caused by a localised autoimmune angiopathy.
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Affiliation(s)
- V Lucivero
- Department of Neurological and Psychiatric Sciences, University of Bari, Piazza G. Cesare 12, I-70124 Bari, Italy
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17
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Rocca MA, Agosta F, Mezzapesa DM, Falini A, Martinelli V, Salvi F, Bergamaschi R, Scotti G, Comi G, Filippi M. A functional MRI study of movement-associated cortical changes in patients with Devic's neuromyelitis optica. Neuroimage 2004; 21:1061-8. [PMID: 15006674 DOI: 10.1016/j.neuroimage.2003.10.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Revised: 10/07/2003] [Accepted: 10/07/2003] [Indexed: 11/18/2022] Open
Abstract
Movement-associated cortical changes have been shown in several neurological conditions and were found to be associated to the extent of brain and cord damage. Devic's neuromyelitis optica (DNO) is characterized by a severe involvement of the cord and optic nerve, with sparing of the brain. To assess the actual role of cord pathology on the pattern of movement-associated cortical recruitment, we obtained functional magnetic resonance imaging (fMRI) from patients with DNO and investigated whether the extent of brain activation is correlated with the extent of cervical cord damage. We studied 10 right-handed DNO patients and 15 sex- and age-matched healthy controls. The MRI assessment consisted of the following: (a) fMRI during repetitive flexion extension of the last four fingers of the right and left hand, (b) brain and cervical cord conventional MRI, and (c) cervical cord magnetization transfer (MT) MRI. Compared to controls and for both tasks, DNO patients had an increased recruitment of several regions of the sensorimotor network (primary sensorimotor cortex, postcentral gyrus, middle frontal gyrus, rolandic operculum, secondary sensorimotor cortex, precuneus, and cerebellum) and of several other regions mainly in the temporal and occipital lobes, such as MT/V5, the fusiform gyrus, the cuneus, and the parahippocampal gyrus. For both tasks, strong correlations (r values ranging from -0.76 to -0.85) were found between relative activations of cortical sensorimotor areas and the severity of cervical cord damage. This study shows an abnormal pattern of movement-associated cortical activations in patients with DNO, which extends beyond the 'classical' sensorimotor network and also involves visual areas devoted to motion processing. The correlation found between fMRI changes and the extent of cord damage suggests that such functional cortical changes might have an adaptive role in limiting the clinical outcome of DNO structural pathology.
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Affiliation(s)
- M A Rocca
- Department of Neuroradiology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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18
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Rocca MA, Agosta F, Mezzapesa DM, Martinelli V, Salvi F, Ghezzi A, Bergamaschi R, Comi G, Filippi M. Magnetization transfer and diffusion tensor MRI show gray matter damage in neuromyelitis optica. Neurology 2004; 62:476-8. [PMID: 14872036 DOI: 10.1212/01.wnl.0000106946.08741.41] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Using magnetization transfer (MT) and diffusion tensor (DT) MRI, the authors assessed the extent of tissue damage of the brain normal-appearing white and gray matter (NAGM) in patients with neuromyelitis optica (NMO). Compared to healthy controls, patients with NMO showed reduced MT ratio and increased mean diffusivity of the NAGM. This challenges the classic notion of a sparing of the brain tissue in the course of NMO.
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Affiliation(s)
- M A Rocca
- Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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19
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Rocca MA, Mezzapesa DM, Ghezzi A, Falini A, Agosta F, Martinelli V, Scotti G, Comi G, Filippi M. Cord damage elicits brain functional reorganization after a single episode of myelitis. Neurology 2003; 61:1078-85. [PMID: 14581668 DOI: 10.1212/01.wnl.0000086821.49353.40] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess, using fMRI, the brain pattern of movement-associated cortical activations in patients with a previous remitting episode of acute cervical myelitis of possible demyelinating origin and to investigate whether the extent of cortical reorganization is associated with the extent of cervical cord pathology measured using magnetization transfer (MT) MRI. METHODS From 14 right-handed patients in a chronic and stable phase after an isolated myelitis (male/female = 7/7, mean age = 35.3 years, median disease duration = 21.2 months) involving the cervical cord and 15 sex- and age-matched healthy control subjects, we obtained 1) fMRI during repetitive flexion-extension of the last four fingers of the right hand, 2) brain diffusion tensor MRI, and 3) brain and cervical cord conventional and MT MRI. FMRI data were analyzed using Statistical Parametric Mapping software. Brain mean diffusivity, fractional anisotropy, and MT ratio (MTR) histograms of the normal-appearing white and gray matter and cervical cord MTR histograms were produced. RESULTS Patients with myelitis had lower average cord MTR (p < 0.0001) and cord MTR histogram peak position (p = 0.002) than control subjects. Compared with healthy volunteers, patients with myelitis showed increased recruitment of the ipsilateral hemisphere in the primary sensorimotor cortex (p < 0.0001), supplementary motor area (p = 0.002), and middle frontal gyrus (MFG) (p < 0.0001). Average cervical cord MTR was inversely correlated with relative activations of the ipsilateral MFG (r = -0.80) and of the ipsilateral postcentral gyrus (r = -0.80). The relative activation of the ipsilateral MFG was also correlated with cervical cord MTR peak position (r = -0.92). CONCLUSIONS An abnormal pattern of movement-associated cortical activations was found in patients with a previous episode of cervical myelitis. These functional cortical changes might have an adaptive role in limiting the clinical outcome of structural cord damage.
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Affiliation(s)
- M A Rocca
- Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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20
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Mezzapesa DM, Rocca MA, Pagani E, Comi G, Filippi M. Evidence of subtle gray-matter pathologic changes in healthy elderly individuals with nonspecific white-matter hyperintensities. Arch Neurol 2003; 60:1109-12. [PMID: 12925367 DOI: 10.1001/archneur.60.8.1109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate whether additional "occult" tissue changes can be detected in the normal-appearing white matter and gray matter of otherwise normal elderly individuals with nonspecific white-matter hyperintensities on conventional magnetic resonance images of the brain. METHODS Conventional and magnetization transfer magnetic resonance images were obtained from 12 otherwise normal elderly subjects with white-matter hyperintensities and 11 age- and sex-matched normal individuals. After automatic tissue segmentation, image coregistration, and masking of T2-visible lesions, we obtained magnetization transfer ratio histograms of the normal-appearing white matter and gray matter. For each histogram, the average magnetization transfer ratio, the peak height, and the peak position were measured. We also calculated the percentages of gray-matter and white-matter volumes normalized over the total volume of the intracranial content and the total normalized brain volumes. RESULTS Average magnetization transfer ratio (P =.03) and mean peak position (P =.01) of the gray-matter histograms from elderly individuals with white-matter hyperintensities were significantly lower than the corresponding quantities from those without white-matter hyperintensities. The normalized percentages of gray and white matter and normalized brain volume did not differ between the 2 groups. The average gray-matter magnetization transfer ratio was correlated with the average lesion magnetization transfer ratio (r = 0.68; P<.01). CONCLUSIONS This study shows that brain abnormalities in otherwise normal elderly subjects with nonspecific white-matter hyperintensities extend beyond the macroscopic white-matter lesions visualized on conventional magnetic resonance images.
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Affiliation(s)
- Domenico Maria Mezzapesa
- Neuroimaging Research Unit, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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21
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Federico F, Lucivero V, Simone IL, Defazio G, De Salvia R, Mezzapesa DM, Petruzzellis M, Tortorella C, Livrea P. Proton MR spectroscopy in idiopathic spasmodic torticollis. Neuroradiology 2001; 43:532-6. [PMID: 11512580 DOI: 10.1007/s002340000532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Single-voxel proton magnetic resonance spectroscopy (1H-MRS), localised to the basal ganglia, was used to determine changes in metabolite levels in idiopathic spasmodic torticollis (IST). We examined nine patients and 13 healthy subjects. The mean values (+/- SD) of peak area ratios were: IST: N-acetyl-aspartate (NAA)/choline-containing compounds (Cho) 1.79 +/- 0.39, NAA/creatine and phosphocreatine compounds (Cr) 1.61 +/- 0.38, Cho/Cr 0.91 +/- 0.19; controls: NAA/Cho 2.07 +/- 0.35, NAA/ Cr 1.82 +/- 0.31, Cho/Cr 0.89 +/- 0.12. Statistical analysis showed that NAA/Cho and NAA/Cr were significantly lower in patients than in controls (P = 0.0304 and 0.0431, respectively). These results indicate a reduction in NAA, and suggest striatal involvement in the pathogenesis IST.
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Affiliation(s)
- F Federico
- Department of Neurology and Psychiatry, Bari, Italy.
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22
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Federico F, Simone IL, Lucivero V, Mezzapesa DM, de Mari M, Lamberti P, Petruzzellis M, Ferrari E. Usefulness of proton magnetic resonance spectroscopy in differentiating parkinsonian syndromes. Ital J Neurol Sci 1999; 20:223-9. [PMID: 10551908 DOI: 10.1007/s100720050035] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H-MRS) was performed in patients with a clinical diagnosis of idiopathic Parkinson's disease (IPD), multiple system atrophy (MSA) or progressive supranuclear palsy (PSP) in order to assess metabolic differences between the three groups of patients. Single-volume (1)H-MRS, localized to the lentiform nucleus, was carried out in 19 IPD patients, 14 MSA patients, 11 PSP patients and 12 age-matched healthy subjects. The signals of N-acetylaspartate (NAA), choline-containing compounds (Cho) and creatine-phosphocreatine (Cr) were evaluated as peak area ratios. The NAA/Cho peak ratio was significantly reduced in MSA and in PSP patients compared to IPD patients and to controls. The NAA/Cr peak ratio was significantly reduced in MSA, in PSP and in IPD patients compared to controls, but only in MSA compared to IPD patients. The NAA reduction in the basal ganglia of MSA and PSP patients may reflect a neuronal loss or damage. Single-volume (1)H-MRS may be a useful tool in differentiating MSA and PSP from IPD patients.
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Affiliation(s)
- F Federico
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy
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Federico F, Simone IL, Lucivero V, Defazio G, De Salvia R, Mezzapesa DM, Petruzzellis M, Tortorella C, Livrea P. Proton magnetic resonance spectroscopy in primary blepharospasm. Neurology 1998; 51:892-5. [PMID: 9748053 DOI: 10.1212/wnl.51.3.892] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Single-volume proton magnetic resonance spectroscopy, localized to basal ganglia, was carried out in 10 patients with primary blepharospasm (PB) to assess the levels of N-acetyl aspartate (NAA), creatine-phosphocreatine, and choline-containing compounds. NAA was reduced significantly in patients compared with control subjects. This result suggests a striatal neuronal loss in PB.
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Affiliation(s)
- F Federico
- Department of Neurology and Psychiatry, University of Bari, Italy
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Federico F, Laddomada G, Lucivero V, Mezzapesa DM. Rhabdomyolysis following acute ischemic stroke. Eur Neurol 1998; 40:52-3. [PMID: 9729112] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- F Federico
- Institute of Neurology, University of Bari, Italy
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Federico F, Simone IL, Lucivero V, Giannini P, Laddomada G, Mezzapesa DM, Tortorella C. Prognostic value of proton magnetic resonance spectroscopy in ischemic stroke. Arch Neurol 1998; 55:489-94. [PMID: 9561976 DOI: 10.1001/archneur.55.4.489] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the correlation between metabolite concentrations and clinical outcome during the acute or subacute phase of ischemic stroke by using single-voxel localized proton magnetic resonance spectroscopy (1H-MRS). SETTING A university hospital neurologic department. PATIENTS AND METHODS Combined single-voxel 1H-MRS and magnetic resonance imaging were performed on 26 patients with a recent ischemic stroke (on 8 patients during the first 24 hours after the stroke and on 18 during the first week). For all patients, the signals from N-acetylaspartate, choline-containing compounds, and creatine-phosphocreatine were compared with those on the contralateral side as peak area ratios. The data for 1H-MRS were related to scores on the Scandinavian Stroke Scale and the Barthel Index at a 6-month clinical follow-up. RESULTS The signals from N-acetylaspartate, choline-containing compounds, and creatine-phosphocreatine were significantly reduced in all infarcted areas (P<.001, P<.001, and P=.003, respectively, Wilcoxon signed rank test). A lactate signal was present in 19 patients. The statistical analysis showed a significant positive correlation between N-acetylaspartate signals and Scandinavian Stroke Scale scores and between reduction of N-acetylaspartate signals and Barthel Index scores (Spearman rank correlation test). Patients in whom lactate was present had Scandinavian Stroke Scale scores significantly lower than patients in the group without lactate (Mann-Whitney U test). CONCLUSION Single-voxel 1H-MRS performed during the acute or subacute phase of ischemic stroke may provide prognostic information.
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Affiliation(s)
- F Federico
- I Clinica Neurologica, University of Bari, Italy
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Federico F, Simone IL, Lucivero V, Iliceto G, De Mari M, Giannini P, Mezzapesa DM, Tarantino A, Lamberti P. Proton magnetic resonance spectroscopy in Parkinson's disease and atypical parkinsonian disorders. Mov Disord 1997; 12:903-9. [PMID: 9399213 DOI: 10.1002/mds.870120611] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS), localized to the lentiform nucleus, was carried out in 12 patients with idiopathic Parkinson's disease (IPD), seven patients with multiple-system atrophy (MSA), seven patients with progressive supranuclear palsy (PSP), and 10 healthy age-matched controls. The study assessed the level of N-acetylaspartate (NAA), creatine-phosphocreatine (Cr), and choline (Cho) in the putamen and globus pallidus of these patients. NAA/Cho and NAA/Cr ratios were significantly reduced in MSA and PSP patients. No significant difference was found between IPD patients and controls. These results suggest an NAA deficit, due to neuronal loss, in the lentiform nucleus of MSA and PSP patients. 1H-MRS is a noninvasive technique that can provide useful information regarding striatal neuronal loss in basal ganglia of patients with atypical parkinsonian disorders and represents a potential tool for diagnosing these disorders.
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Affiliation(s)
- F Federico
- Institute of Clinical Neurology and Neuroradiology, University of Bari, Italy
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Federico F, Simone IL, Lucivero V, De Mari M, Giannini P, Iliceto G, Mezzapesa DM, Lamberti P. Proton magnetic resonance spectroscopy in Parkinson's disease and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 1997; 62:239-42. [PMID: 9069478 PMCID: PMC1064152 DOI: 10.1136/jnnp.62.3.239] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Proton magnetic resonance spectroscopy (1H-MRS) localised to the lentiform nucleus, was carried out in eight patients with idiopathic Parkinson's disease and five patients with progressive supranuclear palsy. The aim of the study was to assess the concentration of N-acetyl-aspartate (NAA), creatine and phosphocreatine (Cr), and choline containing compounds (Cho) in the putamen and globus pallidus of these patients. METHODS Peak ratios obtained from patients were compared with those from nine healthy age matched controls. RESULTS NAA/Cho and NAA/Cr ratios were reduced significantly in patients with progressive supranuclear palsy. CONCLUSION These results suggest an NAA deficit, due to neuronal loss, in the lentiform nucleus of these patients. 1H-MRS is a non-invasive technique that can provide useful information concerning striatal neuronal loss in the basal ganglia of patients with parkinsonian syndromes.
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Affiliation(s)
- F Federico
- Institute of Neurology, University of Bari, Italy
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