1
|
Magriço M, Serôdio M, Ramos JN, Ventura R, Sobral-Pinho A, Marto JP, Viana-Baptista M. Are we missing an opportunity? Prehospital delay in patients with acute ischemic stroke and known atrial fibrillation. Rev Port Cardiol 2024:S0870-2551(24)00065-9. [PMID: 38395298 DOI: 10.1016/j.repc.2023.11.005] [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: 10/21/2022] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The follow-up of patients with atrial fibrillation (AF) presents an opportunity to alert patients and their families on how to recognize and act in the event of stroke. Our aim was to compare stroke recognition-to-door time and prehospital stroke code activation in patients with known AF (KAF) and AF detected after stroke (AFDAS). METHODS We performed a retrospective cohort study of consecutive patients receiving acute recanalization treatment for acute ischemic stroke between January 2016 and August 2022, with AF as a potential stroke cause. Patients were divided into KAF and AFDAS, and stroke recognition-to-door time and prehospital stroke code activation were compared. In the KAF subgroup, we assessed whether the use of preadmission anticoagulation was associated with the studied prehospital parameters. RESULTS We included 438 patients, 290 female (66.2%), mean age 79.3±9.4 years. In total, 238 patients had KAF (54.3%) and 200 (45.7%) had AFDAS. Of those with KAF, 114 (48.1%) were pretreated with anticoagulation. Patients with KAF and AFDAS had no differences in stroke recognition-to-door time (74.0 [55.0-101.0] vs. 78.0 [60.0-112.0] min; p=0.097) or prehospital stroke code activation [148 (64.6%) vs. 128 (65.3%); p=0.965]. In the KAF subgroup, preadmission anticoagulation did not influence stroke recognition-to-door time or mode of hospital admission. CONCLUSION Stroke recognition-to-door time and prehospital stroke code activation were similar between patients with known or newly diagnosed AF. Preadmission anticoagulation treatment also did not affect the studied parameters. Our findings highlight a missed opportunity to promote stroke knowledge in patients followed due to AF.
Collapse
Affiliation(s)
- Marta Magriço
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Serôdio
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rita Ventura
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - André Sobral-Pinho
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas|NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas|NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
2
|
Machado-Pereira M, Grayston A, Garcia-Gabilondo M, Francisco V, Cristóvão A, Marto J, Vieira H, Viana-Baptista M, Ferreira L, Bernardino L, Rosell A, Ferreira R. Retinoic Acid-Loaded Nanoparticles Promote Neurovascular Protection in Stroke. Stroke 2023; 54:e149-e151. [PMID: 36912140 DOI: 10.1161/strokeaha.122.041839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Marta Machado-Pereira
- Health Sciences Research Centre (M.M.-P., A.C., L.B., R.F.), University of Beira Interior, Portugal
| | - Alba Grayston
- Health Sciences Research Centre (M.M.-P., A.C., L.B., R.F.), University of Beira Interior, Portugal
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca, Universitat Autónoma de Barcelona, Spain (A.G., M.G.-G., A.R.)
| | - Miguel Garcia-Gabilondo
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca, Universitat Autónoma de Barcelona, Spain (A.G., M.G.-G., A.R.)
| | - Vitor Francisco
- Center for Neuroscience and Cell Biology (V.F., L.F.), University of Coimbra, Portugal
- Faculty of Medicine (V.F., L.F.), University of Coimbra, Portugal
| | - Ana Cristóvão
- NeuroSoV, UBImedical (A.C.), University of Beira Interior, Portugal
| | - João Marto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal (J.M., M.V.-B.)
- NMS Research, Nova Medical School Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal (J.M., H.V., M.V.-B., R.F.)
| | - Helena Vieira
- NMS Research, Nova Medical School Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal (J.M., H.V., M.V.-B., R.F.)
- Applied Molecular Biosciences Unit (H.V.), NOVA School of Science and Technology, Universidade NOVA de Lisboa, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Department of Chemistry (H.V.), NOVA School of Science and Technology, Universidade NOVA de Lisboa, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal (J.M., M.V.-B.)
- NMS Research, Nova Medical School Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal (J.M., H.V., M.V.-B., R.F.)
| | - Lino Ferreira
- Center for Neuroscience and Cell Biology (V.F., L.F.), University of Coimbra, Portugal
- Faculty of Medicine (V.F., L.F.), University of Coimbra, Portugal
| | - Liliana Bernardino
- Health Sciences Research Centre (M.M.-P., A.C., L.B., R.F.), University of Beira Interior, Portugal
| | - Anna Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca, Universitat Autónoma de Barcelona, Spain (A.G., M.G.-G., A.R.)
| | - Raquel Ferreira
- Health Sciences Research Centre (M.M.-P., A.C., L.B., R.F.), University of Beira Interior, Portugal
- NMS Research, Nova Medical School Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal (J.M., H.V., M.V.-B., R.F.)
- Now with Technophage, Lisbon, Portugal (R.F.)
| |
Collapse
|
3
|
Fouto AR, Nunes RG, Pinto J, Alves L, Calado S, Gonçalves C, Rebolo M, Viana-Baptista M, Vilela P, Figueiredo P. Impact of white-matter mask selection on DTI histogram-based metrics as potential biomarkers in cerebral small vessel disease. MAGMA 2022; 35:779-790. [PMID: 34997895 DOI: 10.1007/s10334-021-00991-4] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Histogram-based metrics extracted from diffusion-tensor imaging (DTI) have been suggested as potential biomarkers for cerebral small vessel disease (SVD), but methods and results have varied across studies. This work aims to assess the impact of mask selection for extracting histogram-based metrics of fractional anisotropy (FA) and mean diffusivity (MD) on their sensitivity as SVD biomarkers. METHODS DTI data were collected from 17 SVD patients and 12 healthy controls. FA and MD maps were estimated; from these, histograms were computed on two whole-brain white-matter masks: normal-appearing white-matter (NAWM) and mean FA tract skeleton (TBSS). Histogram-based metrics (median, peak height, peak width, peak value) were extracted from the FA and MD maps. These were compared between groups and correlated with the patients' cognitive scores (executive function and processing speed). RESULTS White-matter mask selection significantly impacted FA and MD histogram metrics. In particular, significant interactions were found between Mask and Group for FA peak height (p = 0.027), MD Median (p = 0.035) and MD peak width (p = 0.047); indicating that the mask used affected their ability to discriminate between groups. In fact, MD peak width showed a significant 8.8% increase in patients when using TBSS (p = 0.037), but not when using NAWM (p = 0.69). Moreover, the mask may have an effect on the correlations with cognitive measures. Nevertheless, MD peak width (TBSS: r = - 0.75, NAWM: r = - 0.71) and MD peak height (TBSS: r = 0.65, NAWM: r = 0.62) remained significantly correlated with executive function, regardless of the mask. CONCLUSION The impact of the processing methodology, in particular the choice of white-matter mask, highlights the need for standardized MRI data-processing pipelines.
Collapse
Affiliation(s)
- Ana R Fouto
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001, Lisbon, Portugal.
| | - Rita G Nunes
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001, Lisbon, Portugal
| | - Joana Pinto
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001, Lisbon, Portugal
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Luísa Alves
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC - NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Sofia Calado
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC - NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Carina Gonçalves
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC - NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | | | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC - NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Pedro Vilela
- Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Patrícia Figueiredo
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001, Lisbon, Portugal
| |
Collapse
|
4
|
Jacob MA, Ekker MS, Allach Y, Cai M, Aarnio K, Arauz A, Arnold M, Bae HJ, Bandeo L, Barboza MA, Bolognese M, Bonardo P, Brouns R, Chuluun B, Chuluunbatar E, Cordonnier C, Dagvajantsan B, Debette S, Don A, Enzinger C, Ekizoglu E, Fandler-Höfler S, Fazekas F, Fromm A, Gattringer T, Hora TF, Jern C, Jood K, Kim YS, Kittner S, Kleinig T, Klijn CJ, Kõrv J, Kumar V, Lee KJ, Lee TH, Maaijwee NA, Martinez-Majander N, Marto JP, Mehndiratta MM, Mifsud V, Montanaro V, Pacio G, Patel VB, Phillips MC, Piechowski-Jozwiak B, Pikula A, Ruiz-Sandoval J, von Sarnowski B, Swartz RH, Tan KS, Tanne D, Tatlisumak T, Thijs V, Viana-Baptista M, Vibo R, Wu TY, Yesilot N, Waje-Andreassen U, Pezzini A, Putaala J, Tuladhar AM, de Leeuw FE. Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative. Neurology 2022; 98:e573-e588. [PMID: 34906974 PMCID: PMC8829964 DOI: 10.1212/wnl.0000000000013195] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide. METHODS We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression. RESULTS We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36). DISCUSSION Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keon-Joo Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | - Tsong-Hai Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frank-Erik de Leeuw
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| |
Collapse
|
5
|
Matthiesen R, Lauber C, Sampaio JL, Domingues N, Alves L, Gerl MJ, Almeida MS, Rodrigues G, Araújo Gonçalves P, Ferreira J, Borbinha C, Pedro Marto J, Neves M, Batista F, Viana-Baptista M, Alves J, Simons K, Vaz WLC, Vieira OV. Shotgun mass spectrometry-based lipid profiling identifies and distinguishes between chronic inflammatory diseases. EBioMedicine 2021; 70:103504. [PMID: 34311325 PMCID: PMC8330692 DOI: 10.1016/j.ebiom.2021.103504] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/15/2021] [Revised: 06/12/2021] [Accepted: 07/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Localized stress and cell death in chronic inflammatory diseases may release tissue-specific lipids into the circulation causing the blood plasma lipidome to reflect the type of inflammation. However, deep lipid profiles of major chronic inflammatory diseases have not been compared. Methods Plasma lipidomes of patients suffering from two etiologically distinct chronic inflammatory diseases, atherosclerosis-related vascular disease, including cardiovascular (CVD) and ischemic stroke (IS), and systemic lupus erythematosus (SLE), were screened by a top-down shotgun mass spectrometry-based analysis without liquid chromatographic separation and compared to each other and to age-matched controls. Lipid profiling of 596 lipids was performed on a cohort of 427 individuals. Machine learning classifiers based on the plasma lipidomes were used to distinguish the two chronic inflammatory diseases from each other and from the controls. Findings Analysis of the lipidomes enabled separation of the studied chronic inflammatory diseases from controls based on independent validation test set classification performance (CVD vs control - Sensitivity: 0.94, Specificity: 0.88; IS vs control - Sensitivity: 1.0, Specificity: 1.0; SLE vs control – Sensitivity: 1, Specificity: 0.93) and from each other (SLE vs CVD ‒ Sensitivity: 0.91, Specificity: 1; IS vs SLE - Sensitivity: 1, Specificity: 0.82). Preliminary linear discriminant analysis plots using all data clearly separated the clinical groups from each other and from the controls, and partially separated CVD severities, as classified into five clinical groups. Dysregulated lipids are partially but not fully counterbalanced by statin treatment. Interpretation Dysregulation of the plasma lipidome is characteristic of chronic inflammatory diseases. Lipid profiling accurately identifies the diseases and in the case of CVD also identifies sub-classes. Funding Full list of funding sources at the end of the manuscript.
Collapse
Affiliation(s)
- Rune Matthiesen
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal.
| | - Chris Lauber
- Lipotype GmbH, Tatzberg 47, 01307 Dresden, Germany
| | | | - Neuza Domingues
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - Liliana Alves
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | | | - Manuel S Almeida
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal; Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Gustavo Rodrigues
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Pedro Araújo Gonçalves
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal; Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Jorge Ferreira
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Cláudia Borbinha
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126 1349-019 Lisboa, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126 1349-019 Lisboa, Portugal
| | - Marisa Neves
- Hospital Dr. Fernando da Fonseca, IC 19, 2720-276 Amadora, Portugal
| | | | - Miguel Viana-Baptista
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126 1349-019 Lisboa, Portugal
| | - Jose Alves
- Hospital Dr. Fernando da Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Kai Simons
- Lipotype GmbH, Tatzberg 47, 01307 Dresden, Germany
| | - Winchil L C Vaz
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - Otilia V Vieira
- iNOVA4Health, CEDOC, NOVA Medical School, NMS, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal.
| |
Collapse
|
6
|
Bose G, Graveline J, Yogendrakumar V, Shorr R, Fergusson DA, Le Gal G, Coutinho J, Mendonça M, Viana-Baptista M, Nagel S, Dowlatshahi D. Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review. BMJ Open 2021; 11:e040212. [PMID: 33593766 PMCID: PMC7888326 DOI: 10.1136/bmjopen-2020-040212] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Current guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT. DATA SOURCES MEDLINE, Embase and COCHRANE databases up to 18 November 2020. ELIGIBILITY CRITERIA All published articles of patients with CVT treated with DOAC were included. Studies without follow-up information were excluded. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened articles and extracted data. A risk of bias analysis was performed. PRIMARY AND SECONDARY OUTCOME MEASURES Safety data included mortality, intracranial haemorrhage (ICH) or other adverse events. Efficacy data included recurrent CVT, recanalisation rates and disability by modified Rankin Scales (mRS). RESULTS 33 studies met inclusion criteria. One randomised controlled trial, 5 observational cohorts and 27 case series or studies reported 279 patients treated with DOAC for CVT: 41% dabigatran, 47% rivaroxaban, 10% apixaban and 2% edoxaban, in addition to 315 patients treated with standard therapy. The observational cohorts showed a similar risk of death in DOAC and standard therapy arms (RR 2.12, 95% CI 0.29 to 15.59). New ICH was reported in 2 (0.7%) DOAC-treated patients and recurrent CVT occurred in 4 (1.5%). A favourable mRS between 0 and 2 was reported in 94% of DOAC-treated patients, more likely than standard therapy in observational cohorts (RR 1.13, 95% CI 1.02 to 1.25). CONCLUSION The evidence for DOAC use in CVT is limited although suggests sufficient safety and efficacy despite variability in timing and dose of treatment. This systematic review highlights that further rigorous trials are needed to validate these findings and to determine optimal treatment regimens.
Collapse
Affiliation(s)
- Gauruv Bose
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Justin Graveline
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vignan Yogendrakumar
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregoire Le Gal
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jonathan Coutinho
- Department of Neurology, University Medical Center, Amsterdam, The Netherlands
| | - Marcelo Mendonça
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, NOVA Medical School, NMS, Universidade Nova de Lisboa, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, NOVA Medical School, NMS, Universidade Nova de Lisboa, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Simon Nagel
- Department of Neurology, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Salavisa M, Paixão P, Ladeira AF, Mendes A, Correia AS, Viana JF, Viana-Baptista M. Prognostic value of kappa free light chains determination in first-ever multiple sclerosis relapse. J Neuroimmunol 2020; 347:577355. [PMID: 32795735 DOI: 10.1016/j.jneuroim.2020.577355] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/29/2020] [Revised: 07/16/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
Abstract
Given its highly variable clinical course, an unmet need for objective prognostic assessment in Multiple Sclerosis (MS) persists. In this work, we suggest that CSF kappa free light chains (KFLC) determination at first relapse may provide insight into future disease activity and disability worsening. We quantified KFLC by nephelometry in paired CSF/serum samples of 28 patients, collected within one month of first-ever MS relapse, and explored correlations with clinical data on disease activity, retrospectively registered across a median follow-up time of 79 months. We documented KFLC ratio (CSF-FKLC/Serum-KFLC) as an independent predictor of second relapse occurrence and disability worsening at follow-up, in this cohort.
Collapse
Affiliation(s)
- Manuel Salavisa
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.
| | - Pedro Paixão
- Clinical Pathology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Ana Filipa Ladeira
- Neurology Department, Hospital dos Capuchos, Centro Hospitalar Lisboa Central, Portugal
| | - Alexandra Mendes
- Clinical Pathology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Ana Sofia Correia
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - João Faro Viana
- Clinical Pathology Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Portugal
| |
Collapse
|
8
|
Ramos JN, Marto JP, Viana-Baptista M. Letter by Ramos et al Regarding Article, "Neuroimaging in Ischemic Stroke Is Different Between Men and Women in the DEFUSE 3 Cohort". Stroke 2020; 51:e83. [PMID: 32212899 DOI: 10.1161/strokeaha.120.029009] [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: 11/16/2022]
Affiliation(s)
- João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| |
Collapse
|
9
|
Gil I, Serrazina F, Pinto M, Viana-Baptista M. Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine. BMJ Case Rep 2020; 13:13/2/e229319. [PMID: 32066575 DOI: 10.1136/bcr-2019-229319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by a combination of headache, encephalopathy, seizures and visual disturbances, associated with high-intensity abnormalities on T2-weighted images affecting subcortical white and grey matter of the occipital and parietal lobes. Among other causes, PRES has been associated with the use of several medications including chemotherapeutic agents. Here we report a case of a 65-year-old patient with squamous cell carcinoma of the lung treated with cisplatin/vinorelbine. Following the second administration of vinorelbine, she was admitted to the hospital for a generalised seizure. Blood pressure was just slightly elevated and, except for drowsiness, she had a near-normal neurological examination. MRI corroborated the diagnosis. Vinorelbine-induced PRES has been reported only once in the literature, also in association with cisplatin. Our case underlines the role of vinorelbine and suggests that its association with cisplatin in this setting may enhance the risk of PRES.
Collapse
Affiliation(s)
- Ines Gil
- Neurorradiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Filipa Serrazina
- Neurology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Miguel Pinto
- Neurology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | | |
Collapse
|
10
|
Fonseca AC, Marto JP, Pimenta D, Guimarães T, Alves PN, Inácio N, Viana-Baptista M, Pinho E Melo T, Pinto FJ, Ferro JM, Almeida AG. Undetermined stroke genesis and hidden cardiomyopathies determined by cardiac magnetic resonance. Neurology 2019; 94:e107-e113. [PMID: 31792090 DOI: 10.1212/wnl.0000000000008698] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To determine whether cardiac magnetic resonance imaging (CMR) could be useful in identifying previously undiagnosed cardiomyopathies in a cohort of patients with ischemic stroke who underwent standard etiologic investigation and to describe the type and frequency of these cardiomyopathies. METHODS We performed a subanalysis of a previously collected prospective cohort of patients with ischemic stroke. Patients with structural changes on echocardiography that are considered causal for stroke in the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3T CMR was performed. We compared the frequency of the cardiomyopathies that we found with reference values for the general population. RESULTS One hundred thirty-two patients with a mean age of 68.4 years were included. In 7 patients (5.3%, 95% confidence interval 2.59%-10.54%) CMR identified cardiomyopathy. Four patients had hypertrophic cardiomyopathy, 2 had restrictive cardiomyopathy, and 1 had noncompaction cardiomyopathy. Six of these patients had been classified after standard evaluation as having undetermined stroke and 1 patient as having cardioembolic stroke (atrial fibrillation). We found a higher frequency of hypertrophic cardiomyopathy in the entire cohort and in the undetermined cause group compared to the general population (3.03% and 5.81% vs 0.2%, respectively, p = 0.001 and p < 0.001). The frequency of noncompaction cardiomyopathy was also higher in our cohort (0.76% vs 0.05%, respectively, p < 0.001). CONCLUSIONS Although rare, cardiomyopathies should be considered as a possible cause of ischemic stroke classified as of undetermined etiology after standard evaluation.
Collapse
Affiliation(s)
- Ana Catarina Fonseca
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal.
| | - João Pedro Marto
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Daniela Pimenta
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Tatiana Guimarães
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Pedro N Alves
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Nuno Inácio
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Miguel Viana-Baptista
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Teresa Pinho E Melo
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Fausto J Pinto
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - José M Ferro
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Ana G Almeida
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| |
Collapse
|
11
|
Viana-Baptista M, Cruz-E-Silva V, Caetano A, Marto JP, Azevedo E, Ferreira C, Pinho-E-Melo T, Silva F, Ros Forteza FJ, Inácio N, Veiga A, Rodrigues M, Martins J, Nogueira Pinto AA, Carmona C, Soares P. Vascular White Matter Lesions in Young Adults: A Neurology Outpatient Clinic Registry. Eur Neurol 2019; 82:23-31. [PMID: 31752011 DOI: 10.1159/000504409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/06/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although frequently assumed to be age-related changes, vascular white matter lesions (WML) are sometimes found in young adults. Etiology is usually attributed to sporadic small vessel disease; nevertheless, genetic disorders may also be implicated. We aimed to characterize the population of young adults with vascular WML in Neurology outpatient clinics. METHODS Neurologists from 12 Portuguese hospitals were invited to include patients aged 18-55 years evaluated in consultation, with vascular WML on MRI, scoring II or III in the Fazekas scale. Central imaging validation was performed by 2 independent, blinded, Neuroradiologists. Demographic and clinical data were collected as well as results of investigations performed. RESULTS During 2 years, 77 patients were included (mean age 47.7 years). Vascular risk factors were present in 88.3% patients (hypertension in 53.2%) and previous history of stroke in 36.4%. Patients without history of stroke were younger (46.6 ± 7.2 vs. 49.6 ± 3.9 years, p = 0.045) and had fewer vascular risk factors (p < 0.001). They were more frequently females (87.8 vs. 46.4%, p < 0.001), and headache (30.6 vs. 3.6%, p = 0.007), contrary to focal symptoms (16.3 vs. 53.6%, p = 0.001), was the most frequent reason of referral. Etiological investigations performed differed between Neurologists. A genetic disorder was identified in 6 out of 58 patients (CADASIL n = 5; COL4A1 n = 1). CONCLUSION Young adults with vascular WML evaluated in Neurology outpatient clinics concentrate in the oldest age groups. Vascular risk factors should be screened carefully in this population. Among patients without history of stroke, females largely outweigh males. Diagnostic investigations performed do not follow a standardized protocol.
Collapse
Affiliation(s)
- Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,
| | - Vera Cruz-E-Silva
- Department of Neuroradiology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - André Caetano
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Carla Ferreira
- Department of Neurology, Hospital de Braga, Braga, Portugal
| | | | - Fernando Silva
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Nuno Inácio
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Andreia Veiga
- Department of Neurology, Hospital de São Pedro, Vila Real, Portugal
| | - Miguel Rodrigues
- Department of Neurology, Hospital Garcia de Orta, Almada, Portugal
| | - João Martins
- Department of Neurology, Hospital Pedro Hispano, Matosinhos, Portugal
| | | | - Cátia Carmona
- Department of Neurology, Hospital de Cascais, Cascais, Portugal
| | - Pedro Soares
- Department of Neuroradiology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | |
Collapse
|
12
|
Ekker MS, Jacob MA, van Dongen MME, Aarnio K, Annamalai AK, Arauz A, Arnold M, Barboza MA, Bolognese M, Brouns R, Chuluun B, Chuluunbaatar E, Dagvajantsan B, Debette S, Don A, Enzinger C, Ekizoglu E, Fandler-Höfler S, Fazekas F, Fromm A, Gattringer T, Gulli G, Hoffmann M, Hora TF, Jern C, Jood K, Kamouchi M, Kim YS, Kitazono T, Kittner SJ, Kleinig TJ, Klijn CJM, Korv J, Lee TH, Leys D, Maaijwee NAM, Martinez-Majander N, Marto JP, Mehndiratta MM, Mifsud V, Montanaro VV, Owolabi MO, Patel VB, Phillips MC, Piechowski-Jozwiak B, Pikula A, Ruiz-Sandoval JL, Sarnowski B, Schreuder FHBM, Swartz RH, Tan KS, Tanne D, Tatlisumak T, Thijs V, Tuladhar AM, Viana-Baptista M, Vibo R, Wu TY, Yesilot N, Waje-Andreassen U, Pezzini A, Putaala J, de Leeuw FE. Global Outcome Assessment Life-long after stroke in young adults initiative-the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis. BMJ Open 2019; 9:e031144. [PMID: 31727655 PMCID: PMC6887075 DOI: 10.1136/bmjopen-2019-031144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Worldwide, 2 million patients aged 18-50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients. METHODS AND ANALYSIS The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence. ETHICS AND DISSEMINATION Ethical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.
Collapse
Affiliation(s)
| | - Mina A Jacob
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Marcel Arnold
- Neurology Department, Stroke Center, the Stroke Unit and the Neurovascular Laboratory of the Inselspital Hospital, Bern, Switzerland
| | - Miguel A Barboza
- Neurology Department, Hospital Rafael Angel Calderon Guardia, San Jose, Costa Rica
| | - Manuel Bolognese
- Neurology Department, Luzerner Kantonsspital, Luzern, Switzerland
| | - Raf Brouns
- Neurology Department, ZorgSaam, Terneuzen, The Netherlands
- Neurology Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Batnairamdal Chuluun
- International School of Traditional Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Byambasuren Dagvajantsan
- Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Stephanie Debette
- Bordeaux Population Health Research Centre, University of Bordeaux College of Health Sciences, Bordeaux, France
| | - Adi Don
- School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chris Enzinger
- Department of Neurology, Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Esme Ekizoglu
- Department of Neurology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Anette Fromm
- Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Giosue Gulli
- Department of Stroke Medicine, Ashford and St Peter's Hospitals, Chertsey, UK
| | - Michael Hoffmann
- Stroke Center, Department of Neurology, University of South Florida, Tampa, Florida, USA
| | | | - Christina Jern
- Department of Medical and Clinical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department for Clinical Neuroscience and Rehabilitation, Department for Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seongdong-Gu, Korea (The Republic of)
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Fukuoka, Japan
| | - Steven J Kittner
- Neurology Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Janika Korv
- Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Tsong-Hai Lee
- Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Kweishan, Taiwan
| | - Didier Leys
- Neurology Department, University of Lille, Lille, Hauts-de-France, France
| | - Noortje A M Maaijwee
- Department of Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Luzern, LU, Switzerland
| | | | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Lisboa, Portugal
| | - Man M Mehndiratta
- Department of Neurology, Govind Ballabh Pant Hospital, New Delhi, India
| | - Victoria Mifsud
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Mayowa O Owolabi
- Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Vinod B Patel
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa
| | | | | | - Aleksandra Pikula
- Neurology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Jose Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Mexico
| | - Bettina Sarnowski
- Neurology, Ernst-Moritz-Arndt Universitat Greifswald, Greifswald, Germany
| | | | - Rick H Swartz
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - K S Tan
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Tanne
- Department of Epidemiology and Preventive Medicine, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - T Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Vincent Thijs
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anil M Tuladhar
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | | | - Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, UK
| | - Nilüfer Yesilot
- Department of Neurology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Lombardia, Italy
| | - Jukka Putaala
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | | |
Collapse
|
13
|
Fonseca AC, Marto JP, Alves PN, Inácio N, Viana-Baptista M, Pinho E Melo T, Ferro JM, Almeida AG. Women Who Have Ischemic Strokes Have a Higher Burden of Left Atrial Fibrosis Than Men. Stroke 2019; 49:2584-2589. [PMID: 30355185 DOI: 10.1161/strokeaha.118.022105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and Purpose- Women with atrial fibrillation (AF) have a higher risk of stroke than men who have AF. Atrial fibrosis is a marker of atrial disease that precedes the appearance of AF increasing the risk of ischemic stroke. We aimed to determine whether female sex is independently associated with left atrial fibrosis in stroke patients. Methods- We prospectively included a consecutive sample of ischemic stroke patients aged over 50 years of age. Late gadolinium enhancement cardiac magnetic resonance imaging was performed to quantify the severity of left atrial fibrosis and the wall pattern of its distribution. A multivariable linear regression analysis was performed to determine whether female sex was independently associated with left atrial fibrosis after adjusting for potential confounders namely AF and age. Results- One hundred twenty-four patients were deemed eligible; 117 patients were included (7 were excluded because of cardiomyopathy identified by cardiac magnetic resonance imaging). All had usable cardiac magnetic resonance imaging data. Fifty-three patients (45.3%) were women. Women were older and were less frequently treated with angiotensin-converting-enzyme inhibitors. Ninety-one patients had any degree of atrial fibrosis. Women had a higher percentage of atrial fibrosis than men-median (interquartile range)-18% (17) versus 10% (20). In a multivariable linear regression model adjusted for demographics, medications, AF, comorbidities, and cardiac parameters, female sex was found to be independently associated with left atrial fibrosis. Women were found to have more 4.70% of left atrial fibrosis than men (95% CI, 0.70-8.71%; P=0.02) after controlling for confounders. Conclusions- Female sex was found to be independently associated with left atrial fibrosis after controlling for confounders such as AF and age. Further studies are needed to understand if this contributes to the increased stroke risk related to AF in women compared with men.
Collapse
Affiliation(s)
- Ana Catarina Fonseca
- From the Department of Neurology, Institute of Molecular Medicine (A.C.F., P.N.A., T.P.M., J.M.F.), University of Lisboa, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - Pedro N Alves
- From the Department of Neurology, Institute of Molecular Medicine (A.C.F., P.N.A., T.P.M., J.M.F.), University of Lisboa, Portugal
| | - Nuno Inácio
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.)
| | | | - Teresa Pinho E Melo
- From the Department of Neurology, Institute of Molecular Medicine (A.C.F., P.N.A., T.P.M., J.M.F.), University of Lisboa, Portugal
| | - José M Ferro
- From the Department of Neurology, Institute of Molecular Medicine (A.C.F., P.N.A., T.P.M., J.M.F.), University of Lisboa, Portugal
| | - Ana G Almeida
- Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisboa, Portugal
| |
Collapse
|
14
|
Noronha Osório D, Viana-Soares R, Marto JP, Mendonça MD, Silva HP, Quaresma C, Viana-Baptista M, Gamboa H, Vieira HLA. Autonomic nervous system response to remote ischemic conditioning: heart rate variability assessment. BMC Cardiovasc Disord 2019; 19:211. [PMID: 31500561 PMCID: PMC6734354 DOI: 10.1186/s12872-019-1181-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/16/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Remote ischemic conditioning (RIC) is a procedure applied in a limb for triggering endogenous protective pathways in distant organs, namely brain or heart. The underlying mechanisms of RIC are still not fully understood, and it is hypothesized they are mediated either by humoral factors, immune cells and/or the autonomic nervous system. Herein, heart rate variability (HRV) was used to evaluate the electrophysiological processes occurring in the heart during RIC and, in turn to assess the role of autonomic nervous system. Methods Healthy subjects were submitted to RIC protocol and electrocardiography (ECG) was used to evaluate HRV, by assessing the variability of time intervals between two consecutive heart beats. This is a pilot study based on the analysis of 18 ECG from healthy subjects submitted to RIC. HRV was characterized in three domains (time, frequency and non-linear features) that can be correlated with the autonomic nervous system function. Results RIC procedure increased significantly the non-linear parameter SD2, which is associated with long term HRV. This effect was observed in all subjects and in the senior (> 60 years-old) subset analysis. SD2 increase suggests an activation of both parasympathetic and sympathetic nervous system, namely via fast vagal response (parasympathetic) and the slow sympathetic response to the baroreceptors stimulation. Conclusions RIC procedure modulates both parasympathetic and sympathetic autonomic nervous system. Furthermore, this modulation is more pronounced in the senior subset of subjects. Therefore, the autonomic nervous system regulation could be one of the mechanisms for RIC therapeutic effectiveness. Electronic supplementary material The online version of this article (10.1186/s12872-019-1181-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Daniel Noronha Osório
- LIBPhys-UNL - Laboratorio de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, 2892-516, Caparica, Portugal.,PLUX - Wireless Biosignals, S.A, Lisboa, Portugal
| | - Ricardo Viana-Soares
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal
| | - João Pedro Marto
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marcelo D Mendonça
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisboa, 7IT - Instituto de Telecomunicações, Lisboa, Portugal
| | - Hugo P Silva
- PLUX - Wireless Biosignals, S.A, Lisboa, Portugal.,EST/IPS - Escola Superior de Tecnologia do Instituto Politécnico de Setúbal, Setúbal, Portugal.,iBET - Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Cláudia Quaresma
- LIBPhys-UNL - Laboratorio de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, 2892-516, Caparica, Portugal
| | - Miguel Viana-Baptista
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Hugo Gamboa
- LIBPhys-UNL - Laboratorio de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, 2892-516, Caparica, Portugal.
| | - Helena L A Vieira
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.
| |
Collapse
|
15
|
Borbinha C, Serrazina F, Salavisa M, Viana-Baptista M. Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate. BMC Neurol 2019; 19:212. [PMID: 31464594 PMCID: PMC6714398 DOI: 10.1186/s12883-019-1437-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/13/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity. CASE PRESENTATION We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks. CONCLUSIONS Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.
Collapse
Affiliation(s)
- Cláudia Borbinha
- Neurology Department. Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Filipa Serrazina
- Neurology Department. Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Manuel Salavisa
- Neurology Department. Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department. Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal
| |
Collapse
|
16
|
Marto JP, Kauppila LA, Jorge C, Calado S, Viana-Baptista M, Pinho-E-Melo T, Fonseca AC. Intravenous Thrombolysis for Acute Ischemic Stroke After Recent Myocardial Infarction: Case Series and Systematic Review. Stroke 2019; 50:2813-2818. [PMID: 31436141 DOI: 10.1161/strokeaha.119.025630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/05/2023]
Abstract
Background and Purpose- The safety of IV r-tPA (intravenous tissue-type plasminogen activator) for acute ischemic stroke (AIS) treatment after recent myocardial infarction (MI) is still a matter of debate. We studied the safety of delivering IV r-tPA to AIS patients with a MI within the preceding 3 months. Methods- Retrospective review of consecutive AIS admitted to 2 tertiary university hospitals' and systematic literature review for AIS patients with history of MI in the previous 3 months. Patients were divided into 2 groups: treated or not treated with standard IV r-tPA dose for AIS. Cardiac complications (cardiac rupture/tamponade, intracardiac thrombus embolization, or life-threatening arrhythmias) were compared between groups and assessed by type of MI (non-ST-segment-elevation myocardial infarction [STEMI], or STEMI) and time elapsed between vascular events. Results- One hundred and two patients were included; 46 (45.1%) were derived from literature review. Median age (interquartile range) was 64 (53-75) years old, and 69 (67.6%) were men. Forty-seven (46.1%) received IV r-tPA. In the treated group, 25 (53.2%) and 23 (48.9%) patients had, respectively, concurrent AIS and MI and STEMI, in comparison with 12 (21.8%; P=0.002) and 36 (65.5%; P=0.110) patients in the nontreated. Four (8.5%) IV r-tPA-treated patients died from confirmed or presumed cardiac rupture/ tamponade, all with a STEMI in the week preceding stroke. This complication occurred in 1 (1.8%) patients in the nontreated group (P=0.178). There were no differences in thrombus embolization (1 [2.1%) versus 2 [3.6]; P=1.000) and life-threatening arrhythmias (3 [6.4%) versus 7 [12.7]; P=0.335). No non-STEMI patients receiving IV r-tPA had cardiac complications. Conclusions- In patients with AIS and recent or concurrent MI, MI type and the time elapsed between the 2 events should be taken into consideration when deciding to deliver IV r-tPA. Although recent non-STEMI or concurrent events seem safe, STEMI in the week preceding stroke should prompt caution. The low number of events and publication bias may have influenced our conclusions.
Collapse
Affiliation(s)
- João Pedro Marto
- From the Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., S.C., M.V.-B.)
- CEDOC - Nova Medical School, Universidade Nova de Lisboa, Portugal (J.P.M., S.C., M.V.-B.)
| | - Linda Azevedo Kauppila
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (L.A.K., T.P.-e.-M., C.F.)
| | - Cláudia Jorge
- Department of Cardiology, Hospital de Santa Maria, University of Lisboa, Portugal (C.J.)
| | - Sofia Calado
- From the Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., S.C., M.V.-B.)
- CEDOC - Nova Medical School, Universidade Nova de Lisboa, Portugal (J.P.M., S.C., M.V.-B.)
| | - Miguel Viana-Baptista
- From the Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., S.C., M.V.-B.)
- CEDOC - Nova Medical School, Universidade Nova de Lisboa, Portugal (J.P.M., S.C., M.V.-B.)
| | - Teresa Pinho-E-Melo
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (L.A.K., T.P.-e.-M., C.F.)
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal (T.P.-e.-M., C.F.)
| | - Ana Catarina Fonseca
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (L.A.K., T.P.-e.-M., C.F.)
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal (T.P.-e.-M., C.F.)
| |
Collapse
|
17
|
Fernandes M, Meira B, Marto JP, Correia AS, Costa J, Viana-Baptista M. The eye is the window to the diagnosis: tuberculous meningoencephalitis with choroidal tubercle. Pract Neurol 2019; 20:62-63. [DOI: 10.1136/practneurol-2019-002290] [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] [Accepted: 07/21/2019] [Indexed: 11/04/2022]
|
18
|
Caetano A, Ladeira F, Mendonça M, Barbosa R, Pinto M, Pelejão MR, Viana-Baptista M. Underuse of Prophylactic Treatment Among Portuguese Patients with Primary Headache: A Retrospective Observational Study. J Oral Facial Pain Headache 2019; 33:331–336. [PMID: 31017986 DOI: 10.11607/ofph.2122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To evaluate prescription of prophylactic treatment before and after consultation in a neurology headache clinic and to determine predictors for prophylactic treatment and clinical improvement. METHODS Clinical records of consecutive patients assessed in a neurologic headache clinic in Portugal and diagnosed with acute or chronic migraine and/or tension-type headache were assessed. Prescription of prophylaxis before and after the first visit to the clinic were compared. Logistic regression was used to evaluate predictors of the need for therapeutic intervention and clinical improvement. RESULTS Among 409 patients (86.8% women; mean age 41.6 years), 315 (77%) had indication for prophylaxis, and 70 (22%) of these patients were already on prophylactic treatment. Among the 265 patients with information for follow-up, prophylactic treatment was added in 178 (67.2%), and there was a significant change in the number of treated patients between the first and second visits. Ongoing treatment was switched or the dose increased in 21 patients. Multivariate logistic regression revealed that women (odds ratio [OR] = 2.09, 95% confidence interval [CI] 1.1 to 3.97] and patients with medication overuse headache (MOH) (OR = 6.97, 95% CI 1.60 to 30.39) were more likely to need therapeutic intervention, whereas patients referred from the emergency room were less likely to need it (OR = 0.44, 95% CI 0.22 to 0.89). Of the 265 patients, 185 (69.8%) had improved at a follow-up. Having prophylactic treatment at the time of the second visit was associated with improvement (OR = 2.39, 95% CI 1.23 to 4.63; P = .01). CONCLUSION Women and medication overuse headache patients were more likely to need therapeutic intervention. However, only a minority of patients with treatment indication were treated before their first visit to the headache clinic. Prophylaxis prescription was associated with clinical improvement at follow-up.
Collapse
|
19
|
Germain DP, Elliott PM, Falissard B, Fomin VV, Hilz MJ, Jovanovic A, Kantola I, Linhart A, Mignani R, Namdar M, Nowak A, Oliveira JP, Pieroni M, Viana-Baptista M, Wanner C, Spada M. The effect of enzyme replacement therapy on clinical outcomes in male patients with Fabry disease: A systematic literature review by a European panel of experts. Mol Genet Metab Rep 2019; 19:100454. [PMID: 30775256 PMCID: PMC6365982 DOI: 10.1016/j.ymgmr.2019.100454] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [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: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 11/17/2022] Open
Abstract
Background Enzyme replacement therapy (ERT) with recombinant human α-galactosidase has been available for the treatment of Fabry disease since 2001 in Europe and 2003 in the USA. Treatment outcomes with ERT are dependent on baseline patient characteristics, and published data are derived from heterogeneous study populations. Methods We conducted a comprehensive systematic literature review of all original articles on ERT in the treatment of Fabry disease published up until January 2017. This article presents the findings in adult male patients. Results Clinical evidence for the efficacy of ERT in adult male patients was available from 166 publications including 36 clinical trial publications. ERT significantly decreases globotriaosylceramide levels in plasma, urine, and in different kidney, heart, and skin cell types, slows the decline in estimated glomerular filtration rate, and reduces/stabilizes left ventricular mass and cardiac wall thickness. ERT also improves nervous system, gastrointestinal, pain, and quality of life outcomes. Conclusions ERT is a disease-specific treatment for patients with Fabry disease that may provide clinical benefits on several outcomes and organ systems. Better outcomes may be observed when treatment is started at an early age prior to the development of organ damage such as chronic kidney disease or cardiac fibrosis. Consolidated evidence suggests a dose effect. Data described in male patients, together with female and paediatric data, informs clinical practice and therapeutic goals for individualized treatment.
Collapse
Key Words
- ACEi, angiotensin-converting enzyme inhibitor
- ANS, autonomic nervous system
- ARB, angiotensin receptor blocker
- BPI, Brief Pain Inventory
- CES-D, Center for Epidemiologic Studies Depression Scale
- CNS, central nervous system
- CR, case report
- CT, clinical trial
- ECG, electrocardiogram/electrocardiography
- EOW, every other week
- ERT, enzyme replacement therapy
- Fabry disease
- GFR, glomerular filtration rate
- GI, gastrointestinal
- GL-3, globotriaosylceramide
- IENFD, intra-epidermal nerve fibre density
- IVST, intraventricular septum thickness
- LPWT, left posterior wall thickness
- LVEDD, left ventricular end-diastolic diameter
- LVEF, left ventricular ejection fraction
- LVH, left ventricular hypertrophy
- LVM, left ventricular mass
- LVMi, left ventricular mass index
- LVWT, left ventricular wall thickness
- MG, mixed gender
- MRI, magnetic resonance imaging
- MWT, maximal wall thickness
- NYHA, New York Heart Association
- OS, observational study
- PNS, peripheral nervous system
- QoL, quality of life
- RCT, randomized controlled trial
- SF-36, 36-item Short Form Health Survey
- TIA, transient ischaemic attack
- WMH, white matter hyperintensities.
- adult male patients
- agalsidase alfa
- agalsidase beta
- eGFR, estimated glomerular filtration rate
- enzyme replacement therapy
- lyso-GL-3, globotriaosylsphingosine
- systematic literature review
Collapse
Affiliation(s)
- Dominique P. Germain
- French Referral Center for Fabry disease, Division of Medical Genetics and INSERM U1179, University of Versailles, Paris-Saclay University, Montigny, France
- Corresponding author.
| | - Perry M. Elliott
- University College London and Barts Heart Centre, London, United Kingdom
| | - Bruno Falissard
- INSERM U1018, University of Paris-Sud, University of Paris-Descartes, Paris, France
| | - Victor V. Fomin
- Department of Internal Diseases No.1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Max J. Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Aleš Linhart
- Second Department of Medicine – Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Renzo Mignani
- Department of Nephrology, Infermi Hospital, Rimini, Italy
| | - Mehdi Namdar
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Albina Nowak
- Department of Internal Medicine, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - João-Paulo Oliveira
- Department of Genetics, São João Hospital Centre and Faculty of Medicine and “Instituto de Investigação e Inovação em Saúde (iS3)”, University of Porto, Porto, Portugal
| | | | - Miguel Viana-Baptista
- Serviço de Neurologia, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental; CEDOC Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany
| | - Marco Spada
- Department of Paediatrics, University of Torino, Torino, Italy
| |
Collapse
|
20
|
Gerl MJ, Vaz WLC, Domingues N, Klose C, Surma MA, Sampaio JL, Almeida MS, Rodrigues G, Araújo-Gonçalves P, Ferreira J, Borbinha C, Marto JP, Viana-Baptista M, Simons K, Vieira OV. Cholesterol is Inefficiently Converted to Cholesteryl Esters in the Blood of Cardiovascular Disease Patients. Sci Rep 2018; 8:14764. [PMID: 30282999 PMCID: PMC6170447 DOI: 10.1038/s41598-018-33116-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022] Open
Abstract
Shotgun lipidomic analysis of 203 lipids in 13 lipid classes performed on blood plasma of donors who had just suffered an acute coronary syndrome (ACS, n = 74), or an ischemic stroke (IS, n = 21), or who suffer from stable angina pectoris (SAP, n = 78), and an age-matched control cohort (n = 52), showed some of the highest inter-lipid class correlations between cholesteryl esters (CE) and phosphatidylcholines (PC) sharing a common fatty acid. The concentration of lysophospatidylcholine (LPC) and ratios of concentrations of CE to free cholesterol (Chol) were also lower in the CVD cohorts than in the control cohort, indicating a deficient conversion of Chol to CE in the blood plasma in the CVD subjects. A non-equilibrium reaction quotient, Q′, describing the global homeostasis of cholesterol as manifested in the blood plasma was shown to have a value in the CVD cohorts (Q′ACS = 0.217 ± 0.084; Q′IS = 0.201 ± 0.084; Q′SAP = 0.220 ± 0.071) that was about one third less than in the control cohort (Q′Control = 0.320 ± 0.095, p < 1 × 10−4), suggesting its potential use as a rapid predictive/diagnostic measure of CVD-related irregularities in cholesterol homeostasis.
Collapse
Affiliation(s)
| | - Winchil L C Vaz
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056, Lisboa, Portugal
| | - Neuza Domingues
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056, Lisboa, Portugal
| | | | | | - Júlio L Sampaio
- Lipotype GmbH, Tatzberg 47, 01307, Dresden, Germany.,Centre de Recherche, Institut Curie, 26 rue d'Ulm, 75248, Paris Cedex 05, France
| | - Manuel S Almeida
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Gustavo Rodrigues
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Pedro Araújo-Gonçalves
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Jorge Ferreira
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Claudia Borbinha
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1349-019, Lisboa, Portugal
| | - João Pedro Marto
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1349-019, Lisboa, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1349-019, Lisboa, Portugal
| | - Kai Simons
- Lipotype GmbH, Tatzberg 47, 01307, Dresden, Germany
| | - Otilia V Vieira
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056, Lisboa, Portugal.
| |
Collapse
|
21
|
Wanner C, Arad M, Baron R, Burlina A, Elliott PM, Feldt-Rasmussen U, Fomin VV, Germain DP, Hughes DA, Jovanovic A, Kantola I, Linhart A, Mignani R, Monserrat L, Namdar M, Nowak A, Oliveira JP, Ortiz A, Pieroni M, Spada M, Tylki-Szymańska A, Tøndel C, Viana-Baptista M, Weidemann F, Hilz MJ. European expert consensus statement on therapeutic goals in Fabry disease. Mol Genet Metab 2018; 124:189-203. [PMID: 30017653 DOI: 10.1016/j.ymgme.2018.06.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/31/2018] [Accepted: 06/10/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fabry disease, an inherited lysosomal storage disorder, causes multi-organ pathology resulting in substantial morbidity and a reduced life expectancy. Although Fabry disease is an X-linked disorder, both genders may be affected, but generally to a lesser extent in females. The disease spectrum ranges from classic early-onset disease to non-classic later-onset phenotypes, with complications occurring in multiple organs or being confined to a single organ system depending on the stage of the disease. The impact of therapy depends upon patient- and disease-specific factors and timing of initiation. METHODS A European panel of experts collaborated to develop a set of organ-specific therapeutic goals for Fabry disease, based on evidence identified in a recent systematic literature review and consensus opinion. RESULTS A series of organ-specific treatment goals were developed. For each organ system, optimal treatment strategies accounted for inter-patient differences in disease severity, natural history, and treatment responses as well as the negative burden of therapy and the importance of multidisciplinary care. The consensus therapeutic goals and proposed patient management algorithm take into account the need for early disease-specific therapy to delay or slow the progression of disease as well as non-specific adjunctive therapies that prevent or treat the effects of organ damage on quality of life and long-term prognosis. CONCLUSIONS These consensus recommendations help advance Fabry disease management by considering the balance between anticipated clinical benefits and potential therapy-related challenges in order to facilitate individualized treatment, optimize patient care and improve quality of life.
Collapse
Affiliation(s)
- Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Israel
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Perry M Elliott
- Barts Heart Centre, University College London, London, United Kingdom
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Section 2132, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Victor V Fomin
- I.M. Sechenov First Moscow State Medical University, Department of Internal Diseases No. 1, Moscow, Russian Federation
| | - Dominique P Germain
- French Referral Center for Fabry disease, Division of Medical Genetics and INSERM U1179, University of Versailles, Paris-Saclay University, Montigny, France
| | - Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free London NHS Foundation Trust, University College London, United Kingdom
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Aleš Linhart
- Second Department of Medicine - Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Renzo Mignani
- Department of Nephrology, Infermi Hospital, Rimini, Italy
| | | | - Mehdi Namdar
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Albina Nowak
- University Heart Center, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - João-Paulo Oliveira
- Department of Genetics, São João Hospital Centre & Faculty of Medicine and "Instituto de Investigação e Inovação em Saúde (i3S)", University of Porto, Porto, Portugal
| | - Alberto Ortiz
- Unidad de Diálisis, IIS-Fundación Jiménez Díaz/UAM, IRSIN and REDINREN, Madrid, Spain
| | | | - Marco Spada
- Department of Paediatrics, University of Torino, Torino, Italy
| | - Anna Tylki-Szymańska
- Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Camilla Tøndel
- Department of Paediatrics, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Miguel Viana-Baptista
- Serviço de Neurologia, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Frank Weidemann
- Department of Cardiology, Innere Klinik II, Katharinen-Hospital, Unna, Germany
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
22
|
Jaunmuktane Z, Quaegebeur A, Taipa R, Viana-Baptista M, Barbosa R, Koriath C, Sciot R, Mead S, Brandner S. Evidence of amyloid-β cerebral amyloid angiopathy transmission through neurosurgery. Acta Neuropathol 2018; 135:671-679. [PMID: 29450646 PMCID: PMC5904220 DOI: 10.1007/s00401-018-1822-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 01/14/2018] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/14/2022]
Abstract
Amyloid-β (Aβ) is a peptide deposited in the brain parenchyma in Alzheimer's disease and in cerebral blood vessels, causing cerebral amyloid angiopathy (CAA). Aβ pathology is transmissible experimentally in animals and through medical procedures in humans, such as contaminated growth hormone or dura mater transplantation in the context of iatrogenic prion disease. Here, we present four patients who underwent neurosurgical procedures during childhood or teenage years and presented with intracerebral haemorrhage approximately three decades later, caused by severe CAA. None of these patients carried pathogenic mutations associated with early Aβ pathology development. In addition, we identified in the literature four patients with a history of neurosurgical intervention and subsequent development of CAA. These findings raise the possibility that Aβ pathology may be transmissible, as prion disease is, through neurosurgical procedures.
Collapse
Affiliation(s)
- Zane Jaunmuktane
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Annelies Quaegebeur
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
| | - Ricardo Taipa
- Portuguese Brain Bank, Neuropathology Unit, Department of Neuroscience, Centro Hospitalar Universitario do Porto, 4099-001, Porto, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1449-005, Lisbon, Portugal
| | - Raquel Barbosa
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1449-005, Lisbon, Portugal
| | - Carolin Koriath
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Raf Sciot
- Department of Imaging and Pathology, University of Leuven, 3000, Louvain, Belgium
| | - Simon Mead
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Medical Research Council Prion Unit at UCL, UCL Institute of Prion Diseases, Queen Square, London, WC1N 3BG, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
| | - Sebastian Brandner
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| |
Collapse
|
23
|
Fonseca AC, Alves P, Inácio N, Marto JP, Viana-Baptista M, Pinho-E-Melo T, Ferro JM, Almeida AG. Patients With Undetermined Stroke Have Increased Atrial Fibrosis: A Cardiac Magnetic Resonance Imaging Study. Stroke 2018; 49:734-737. [PMID: 29371431 DOI: 10.1161/strokeaha.117.019641] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 11/04/2017] [Revised: 12/09/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Some patients with ischemic strokes that are currently classified as having an undetermined cause may have structural or functional changes of the left atrium (LA) and left atrial appendage, which increase their risk of thromboembolism. We compared the LA and left atrial appendage of patients with different ischemic stroke causes using cardiac magnetic resonance imaging. METHODS We prospectively included a consecutive sample of ischemic stroke patients. Patients with structural changes on echocardiography currently considered as causal for stroke in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3-T cardiac magnetic resonance imaging was performed. RESULTS One hundred and eleven patients were evaluated. Patients with an undetermined cause had a higher percentage of LA fibrosis (P=0.03) than patients with other stroke causes and lower, although not statistically significant, values of LA ejection fraction. Patients with atrial fibrillation and undetermined stroke cause showed a similar value of atrial fibrosis. CONCLUSIONS The LA phenotype that was found in patients with undetermined cause supports the hypothesis that an atrial disease may be associated with stroke.
Collapse
Affiliation(s)
- Ana Catarina Fonseca
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.).
| | - Pedro Alves
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - Nuno Inácio
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - João Pedro Marto
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - Miguel Viana-Baptista
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - Teresa Pinho-E-Melo
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - José M Ferro
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| | - Ana G Almeida
- From the Department of Neurology (A.C.F., P.A., T.P.-e.-M., J.M.F.) and Department of Cardiology (A.G.A.), Hospital de Santa Maria, University of Lisbon, Portugal; Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal (N.I.); and Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.)
| |
Collapse
|
24
|
Beato-Coelho J, Marto J, Alves J, Marques-Matos C, Calado S, Araújo J, Cunha L, Pinho J, Azevedo E, Viana-Baptista M, Sargento-Freitas J. Portuguese Observational Study of Ischaemic Stroke in Patients Medicated with Non-Vitamin K Antagonist Oral Anticoagulants. Eur Neurol 2018; 79:108-112. [DOI: 10.1159/000486755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/09/2018] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Clinical trials and subsequent meta-analyses showed advantages of non-vitamin K antagonists oral anticoagulants (NOACs) over vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation. The impact of preadmission anticoagulation in acute ischaemic stroke (AIS) has not been established. <b><i>Objective:</i></b> To compare functional outcome of patients with AIS with preadmission NOACs vs. VKAs. <b><i>Methods:</i></b> A retrospective analysis was conducted on consecutive AIS patients under oral anticoagulation (VKAs or NOACs) admitted in 4 Portuguese hospitals within a period of 30 months. Two primary outcomes were defined and compared between VKA and NOAC groups: symptomatic intracerebral hemorrhage transformation (sICH) and modified Rankin Scale (mRS) at 3 months. <b><i>Results:</i></b> Four hundred sixty-nine patients were included, of whom 332 (70.8%) were treated with VKA and 137 (29.2%) with NOAC. Patients’ median age was 78.0 and 234 (49.9%) were male. NOAC-treated patients had a higher median CHA<sub>2</sub>DS<sub>2</sub>-VASc score than those under VKA (5.0 vs. 4.0, <i>p</i> = 0.023). The two primary outcomes showed no statistical differences between the VKAs’ group and the NOACs’ group (sICH: 5.4 vs. 5.4% [<i>p</i> = 0.911]; mRS at 3 months: 3.0 vs. 3.0 [<i>p</i> = 0.646], respectively). <b><i>Conclusion:</i></b> Preadmission anticoagulation with NOACs in AIS has a functional impact similar to that of VKAs.
Collapse
|
25
|
Paróla A, de Palhares Falcão FDSM, Farinha H, Caetano A, Santos L, Medeiros E, Viana-Baptista M. Analysis of riluzole's profile of use in a Central Hospital in Lisbon. Patient Prefer Adherence 2018; 12:2357-2361. [PMID: 30464422 PMCID: PMC6229141 DOI: 10.2147/ppa.s167861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Riluzole is indicated to prolong life or delay the institution of mechanical ventilation in patients with amyotrophic lateral sclerosis (ALS). Clinical studies have shown that this drug prolongs survival, defined as living patients who are not intubated for mechanical ventilation and without tracheotomy. The purpose of this study is to characterize riluzole's use as well as the user population in order to contribute to a rational and safe use. PATIENTS AND METHODS Descriptive, observational, retrospective study describing and characterizing the use of riluzole in ALS patients between July 2006 and December 2016 conducted in a Lisbon's Central Hospital. RESULTS Over the course of the study period, 77 patients with different phenotypes of ALS received riluzole. The majority of patients (63%, n=49) were male. The median survival was 10.1 months, but 12 patients (16%) remained on therapy for more than 3 years; 65% of patients were lost to follow-up. The mean adherence rate was 91.2%, and the median adherence rate was 99.3%. One patient discontinued therapy due to gastrointestinal intolerance. Dyspnea and cough were the most common side effects, with roughly one third of patients experiencing each, followed by asthenia and hepatic effects. CONCLUSION Despite the extended enrollment period, only 77 patients met the criteria for study inclusion. Nonetheless, statistical data regarding our population is in accordance with reported international data. High adherence rates were observed, but 14% of patients discontinued riluzole. In such cases, assessment by a multidisciplinary team is warranted.
Collapse
Affiliation(s)
- Ana Paróla
- Pharmacy Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal,
| | | | - Helena Farinha
- Pharmacy Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal,
| | - André Caetano
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Luís Santos
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Elmira Medeiros
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Faculty of Medical Sciences, Nova University of Lisbon, Lisbon, Portugal
| |
Collapse
|
26
|
Duarte Mendonça M, Caetano A, Salavisa M, Viana-Baptista M, Miguel R, Pinto M, Barbosa R, Ladeira F, Sá F, Pelejão R. Letter to the Editor: Medication-Overuse Headache is Common in Portuguese Migraineurs. ACTA MEDICA PORT 2017; 30:664-665. [PMID: 29025537 DOI: 10.20344/amp.9076] [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: 04/13/2017] [Accepted: 06/26/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Marcelo Duarte Mendonça
- Neurology Department. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal; CEDOC - Centro de Estudos de Doenças Crónicas. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal; Champalimaud Research. Champalimaud Center for the Unknown. Lisboa. Portugal
| | - André Caetano
- Neurology Department. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Manuel Salavisa
- Neurology Department. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Miguel Viana-Baptista
- Neurology Department. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal; CEDOC - Centro de Estudos de Doenças Crónicas. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Rita Miguel
- Headache Study Group. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Miguel Pinto
- Headache Study Group. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Raquel Barbosa
- Headache Study Group. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Filipa Ladeira
- Headache Study Group. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Francisca Sá
- Headache Study Group. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Rita Pelejão
- Headache Study Group. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| |
Collapse
|
27
|
Marto JP, Saraiva M, Ladeira F, Sá F, Calado S, Viana-Baptista M. Prediabetes Is Associated with Unfavorable Outcome in Young Adult Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 27:352-356. [PMID: 28966014 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/13/2017] [Revised: 08/10/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prediabetes has been associated with unfavorable short-term outcome in patients with ischemic stroke (IS). However, its effect in the subset of young adult patients has not been fully assessed. Our aim was to study the association between prediabetes and 3-month outcome in young adult patients with IS. METHODS This is a retrospective analysis of consecutive patients aged 18-55 years with a clinical diagnosis of acute IS between January 2010 and December 2016. According to their glucose profile, patients were divided in 3 groups: normal glucose metabolism, prediabetes, and diabetes. The outcome at 3 months was assessed by the modified Rankin Scale (mRS) and dichotomized as good (mRS score ≤2) and poor (mRS score >2) outcomes. RESULTS A total of 247 patients were included, the median age was 49 years (interquartile range 42-53), and 144 (58.3%) were men. Prediabetes was diagnosed in 79 patients (32.0%) and diabetes was diagnosed in 45 patients (18.2%). Prediabetic (adjusted odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1-5.1, P = .031) and diabetic (adjusted OR 2.8, 95% CI 1.3-6.1, P = .020) patients had a worse prognosis at 3 months. A statistical significant shift in the distribution of the mRS score at 3 months was found in prediabetic (adjusted OR 2.5, 95% CI .3-1.5, P = .002) and diabetic (adjusted OR 3.74, 95% CI .5-2.2, P = .002) patients. CONCLUSION In young adults with IS, prediabetes and diabetes increase the risk of unfavorable outcome at 3 months.
Collapse
Affiliation(s)
| | - Marlene Saraiva
- Department of Neurology, Hospital Egas Moniz, Lisbon, Portugal
| | - Filipa Ladeira
- Department of Neurology, Hospital Egas Moniz, Lisbon, Portugal
| | - Francisca Sá
- Department of Neurology, Hospital Egas Moniz, Lisbon, Portugal
| | - Sofia Calado
- Department of Neurology, Hospital Egas Moniz, Lisbon, Portugal
| | | |
Collapse
|
28
|
Marto JP, Borbinha C, Lampreia T, Alves L, Viana-Baptista M. Teaching Video NeuroImages: Candy sign: The clue to the diagnosis of neurosyphilis. Neurology 2017; 88:e35. [PMID: 28115606 DOI: 10.1212/wnl.0000000000003544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- João Pedro Marto
- From the Department of Neurology (J.P.M., C.B., L.A., M.V.-B.), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa; Department of Neurology (T.L.), Hospital Beatriz Ângelo, Loures; and CEDOC (L.A., M.V.-B.), Nova Medical School, Universidade Nova de Lisboa, Portugal.
| | - Cláudia Borbinha
- From the Department of Neurology (J.P.M., C.B., L.A., M.V.-B.), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa; Department of Neurology (T.L.), Hospital Beatriz Ângelo, Loures; and CEDOC (L.A., M.V.-B.), Nova Medical School, Universidade Nova de Lisboa, Portugal
| | - Tânia Lampreia
- From the Department of Neurology (J.P.M., C.B., L.A., M.V.-B.), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa; Department of Neurology (T.L.), Hospital Beatriz Ângelo, Loures; and CEDOC (L.A., M.V.-B.), Nova Medical School, Universidade Nova de Lisboa, Portugal
| | - Luísa Alves
- From the Department of Neurology (J.P.M., C.B., L.A., M.V.-B.), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa; Department of Neurology (T.L.), Hospital Beatriz Ângelo, Loures; and CEDOC (L.A., M.V.-B.), Nova Medical School, Universidade Nova de Lisboa, Portugal
| | - Miguel Viana-Baptista
- From the Department of Neurology (J.P.M., C.B., L.A., M.V.-B.), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa; Department of Neurology (T.L.), Hospital Beatriz Ângelo, Loures; and CEDOC (L.A., M.V.-B.), Nova Medical School, Universidade Nova de Lisboa, Portugal
| |
Collapse
|
29
|
Marques-Matos C, Alves JN, Marto JP, Ribeiro JA, Monteiro A, Araújo J, Silva F, Grenho F, Viana-Baptista M, Sargento-Freitas J, Pinho J, Azevedo E. POST-NOAC: Portuguese observational study of intracranial hemorrhage on non-vitamin K antagonist oral anticoagulants. Int J Stroke 2016; 12:623-627. [PMID: 27903938 DOI: 10.1177/1747493016681021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/15/2022]
Abstract
Background There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. Aims To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. Methods We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals. Clinical and demographic data were obtained from individual medical records. Intracranial hemorrhage was classified as intracerebral, extra-axial, or multifocal using brain computed tomography. Three-month functional outcome was assessed using the modified Rankin Scale. Results Among 246 patients included, 24 (9.8%) were anticoagulated with a non-vitamin K antagonist oral anticoagulants and 222 (90.2%) with a vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants patients were older (81.5 vs. 76 years, p = 0.048) and had intracerebral hemorrhage more often (83.3% vs. 63.1%, p = 0.048). We detected a non-significant trend for larger intracerebral hemorrhage volumes in vitamin K antagonists patients ( p = 0.368). Survival analysis adjusted for age, CHA2DS2VASc, HAS-BLED, and anticoagulation reversal revealed that non-vitamin K antagonist oral anticoagulants did not influence three-month mortality (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.39-1.80, p = 0.638). Multivariable ordinal regression for three-month functional outcome did not show a significant shift of modified Rankin Scale scores in non-vitamin K antagonist oral anticoagulants patients (odds ratio (OR) 1.26, 95%CI 0.55-2.87, p = 0.585). Conclusions We detected no significant differences in the three-month outcome between non-vitamin K antagonist oral anticoagulants- and vitamin K antagonists-associated intracranial hemorrhage, despite unavailability of non-vitamin K antagonist oral anticoagulants-specific reversal agents.
Collapse
Affiliation(s)
- Cláudia Marques-Matos
- 1 Neurology Department, Centro Hospitalar São João, Porto, Portugal
- 7 Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | | | - João Pedro Marto
- 3 Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Joana Afonso Ribeiro
- 4 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Monteiro
- 1 Neurology Department, Centro Hospitalar São João, Porto, Portugal
- 7 Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - José Araújo
- 2 Neurology Department, Hospital de Braga, Portugal
| | - Fernando Silva
- 4 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Grenho
- 5 Internal Medicine Department, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Viana-Baptista
- 3 Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- 6 CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João Sargento-Freitas
- 4 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- 8 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Pinho
- 2 Neurology Department, Hospital de Braga, Portugal
| | - Elsa Azevedo
- 1 Neurology Department, Centro Hospitalar São João, Porto, Portugal
- 7 Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
30
|
Affiliation(s)
- Marcelo D Mendonça
- 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- 2 CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- 3 Champalimaud Research, Champalimaud Center for the Unknown, Lisbon, Portugal
| | - André Caetano
- 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- 2 CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
31
|
Viana-Baptista M. [Ischemic Stroke: Increasing the Number of Patients Submitted to Acute Specific Therapy and Estimating the Individual Benefits]. ACTA MEDICA PORT 2016; 29:683. [PMID: 28229832 DOI: 10.20344/amp.8367] [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: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Miguel Viana-Baptista
- Serviço de Neurologia. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal; CEDOC - iNOVA4Health. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
| |
Collapse
|
32
|
Marto JP, Gil I, Calado S, Viana-Baptista M. Cerebral Cavernous Malformation: A Portuguese Family with a Novel CCM1 Mutation. Case Rep Neurol 2016; 8:193-198. [PMID: 27790124 PMCID: PMC5073657 DOI: 10.1159/000449281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/19/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Cerebral cavernous malformation (CCM) is a vascular disorder characterized by the presence of central nervous system cavernomas. In familial forms, mutations in three genes (CCM1/KRIT1, CCM2/MGC4607 and CCM3/PDCD10) were identified. We describe a Portuguese family harboring a novel CCM1 mutation. Case Presentation The proband is a woman who at the age of 55 years started to have complex partial seizures and episodic headache. Although nothing was found during her neurological examination, brain MRI showed bilateral, supra- and infratentorial cavernomas. She had a sister who, at the age 61 years, suffered a tonic-clonic seizure. Neurological examination was normal and imaging investigation demonstrated a right frontal intracerebral hemorrhage and multiple cavernomas. In the following years, she suffered several complex partial seizures and had a new intracerebral hemorrhage located in the right temporal lobe. Genetic analysis was performed and a novel nucleotide substitution, i.e. c.1927C>T (p.Gln643*) within the exon 17 of the CCM1 gene, was detected in both sisters. The substitution encodes a stop codon, with a consequent truncated KRIT1 protein, therefore supporting its pathogenic role. Further affected family members were detected, suggesting an autosomal dominant pattern of inheritance. Conclusion We report a Portuguese family with a novel CCM1 (KRIT1) mutation – c.1927C>T (p.Gln643*). A better knowledge of the phenotype-genotype correlation is needed to improve the management of CCM patients.
Collapse
Affiliation(s)
- João Pedro Marto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Inês Gil
- Department of Neuroradiology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Sofia Calado
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center) - Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center) - Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
33
|
Marto JP, Borbinha C, Calado S, Viana-Baptista M. The Stroke Chronometer—A New Strategy to Reduce Door-to-Needle Time. J Stroke Cerebrovasc Dis 2016; 25:2305-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/08/2016] [Accepted: 05/17/2016] [Indexed: 11/29/2022] Open
|
34
|
Mendonça MD, Caetano A, Viana-Baptista M. Association of depressive symptoms with allodynia in patients with migraine: A cross-sectional study. Cephalalgia 2016; 36:1077-1081. [DOI: 10.1177/0333102415620285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Aims Migraine and depression have a strong association. We aimed to determine whether this relationship was particularly evident in migraineurs with allodynia. Methods A cross-sectional study was carried out of 98 consecutive patients with episodic migraine presenting for their first evaluation in an outpatient clinic. The participants completed a demographic questionnaire, the Allodynia Symptom Checklist and the Hospital Anxiety and Depression Scale (HADS). Results Among the migraineurs, 75 (77%) reported allodynia. Allodynia was associated with higher median HADS-Anxiety (9 vs. 6, p = 0.038) and HADS-Depression (6 vs. 4, p = 0.014) scores. In a multiple regression model, the HADS-Depression scores were independently associated with allodynia (odds ratio 1.236, 95% confidence interval 1.046–1.461). An increased severity of allodynia correlated with higher depression scores ( r = 0.224; p = 0.027). Conclusion Anxious and depressive symptoms are more common in migraineurs with allodynia than in those without allodynia. Further studies are necessary to clarify the relationship between depressive symptoms and allodynia, as well as its therapeutic implications in migraine.
Collapse
Affiliation(s)
- Marcelo D Mendonça
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - André Caetano
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | |
Collapse
|
35
|
Mendonça MD, Guedes M, Matias G, Costa J, Viana-Baptista M. Steroid-responsive painful ophthalmoplegia: Tolosa–Hunt syndrome, Eales disease, or both? Cephalalgia 2016; 37:191-194. [DOI: 10.1177/0333102416631282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Tolosa–Hunt syndrome (THS) is one of the most common ‘benign’ causes of painful ophthalmoplegia. Diagnosis is based on clinical and imaging findings and the exclusion of other causes because there is no specific biomarker for the syndrome. Eales disease, an idiopathic inflammatory venous disease that primarily affects the eye, can also affect the central (as stroke or myelitis) and peripheral nervous system. Case report We report the case of a 32-year-old woman with a subacute left ophthalmoplegia and evidence of a gadolinium-enhanced lesion suggesting an inflammatory granuloma that resolved within 48 hours after treatment with steroids. A diagnosis of THS was considered at this time. On a follow-up ophthalmological examination, a diagnosis of Eales disease with involvement of the left eye was made. The patient was treated successfully. Conclusion Eales disease could be a cause of painful ophthalmoplegia and may mimic THS. Long-term follow-up of patients diagnosed with THS may be necessary to exclude other diagnoses.
Collapse
Affiliation(s)
- Marcelo D Mendonça
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marta Guedes
- Ophthalmology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Gonçalo Matias
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Costa
- Ophthalmology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
36
|
Borbinha C, Marto JP, Calado S, Viana-Baptista M. A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection? Case Rep Neurol 2016; 8:145-50. [PMID: 27504091 PMCID: PMC4965528 DOI: 10.1159/000447296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/30/2016] [Indexed: 12/28/2022] Open
Abstract
Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.
Collapse
Affiliation(s)
- Cláudia Borbinha
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Pedro Marto
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Sofia Calado
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
37
|
Marto JP, Borbinha C, Filipe R, Calado S, Viana-Baptista M. Impact of stroke education on middle school students and their parents: A cluster randomized trial. Int J Stroke 2016; 12:401-411. [PMID: 27799456 DOI: 10.1177/1747493016677980] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families. Aim To evaluate the impact of stroke education on school students, in terms of students' and parents' acquired stroke knowledge. Methods A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later. Results We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively. Conclusions School-based interventions may improve stroke knowledge in middle school students and their parents.
Collapse
Affiliation(s)
- João Pedro Marto
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cláudia Borbinha
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rita Filipe
- 2 Public Health Unit, Agrupamento de Centros de Saúde (ACES), Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Sofia Calado
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
38
|
Ladeira F, Barbosa R, Caetano A, Mendonça MD, Calado S, Viana-Baptista M. Embolic stroke of unknown source (ESUS) in young patients. Int J Stroke 2015; 10 Suppl A100:165. [DOI: 10.1111/ijs.12596] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Filipa Ladeira
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Raquel Barbosa
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - André Caetano
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Marcelo D. Mendonça
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Calado
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
39
|
Mendonça MD, Caetano A, Pinto M, Cruz e Silva V, Viana-Baptista M. Stroke-Like Episodes Heralding a Reversible Encephalopathy: Microbleeds as the Key to the Diagnosis of Cerebral Amyloid Angiopathy–Related Inflammation—A Case Report and Literature Review. J Stroke Cerebrovasc Dis 2015; 24:e245-50. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/02/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022] Open
|
40
|
Affiliation(s)
- André Caetano
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC — Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel Pinto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC — Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC — Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
41
|
Abstract
We present the case of a 71-year-old male, admitted after a generalized tonic-clonic seizure, with a history of recurrent left arm and face paresthesias, associated with sulcal cortical subarachnoid hemorrhages. During the next 48 h, he remained agitated with a high blood pressure profile; he also suffered a cardiac arrest in relation to a severe left fronto-parietal and a smaller right parietal parenchymal hemorrhage that developed over the subarachnoid hemorrhage locations. There were no intracranial vascular abnormalities. Three months later, an MRI revealed disseminated superficial siderosis. He was discharged with a modified Rankin scale of 4. He died 1 month later of unknown cause. A diagnosis of probable cerebral amyloid angiopathy was assumed. Patients with pathologically proven cerebral amyloid angiopathy that present with transient focal neurological symptoms in relation to cortical bleeds, the so-called ‘myloid spells’ seem to be at an increased risk of future parenchymal hemorrhages. Avoiding antiplatelet agents in these cases has been proposed. Our case suggests that these patients should be monitored closely in the hyperacute phase, and tight blood pressure control should be considered as the immediate risk of bleeding may be high, even without a definitive diagnosis of cerebral amyloid angiopathy.
Collapse
Affiliation(s)
- Andre Caetano
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Pinto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Sofia Calado
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
42
|
Mendonça MD, Barbosa R, Cruz-e-Silva V, Calado S, Viana-Baptista M. Oral Direct Thrombin Inhibitor as an Alternative in the Management of Cerebral Venous Thrombosis: A Series of 15 Patients. Int J Stroke 2015; 10:1115-8. [DOI: 10.1111/ijs.12462] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/24/2014] [Indexed: 01/10/2023]
Abstract
Background Cerebral vein thrombosis is a rare cause of stroke with significant risk of death and long-term dependency. Anticoagulation has been associated with better long-term prognosis, and vitamin K antagonists are usually prescribed in this setting. Aim The aim of this study was to present a series of 15 cerebral vein thrombosis patients treated with dabigatran. Methods Retrospective study of clinical, imaging, and follow-up characterization of all patients admitted with cerebral vein thrombosis and treated with dabigatran in a tertiary neurology department between June 2011 and December 2013 was conducted. Complications and adverse effects were recorded. Modified Rankin Scale was used to assess clinical severity; excellent outcome was defined as modified Rankin Scale at six-months of 0 to 1. Recanalization was assessed with an angiographic method (computer tomography, magnetic resonance imaging, or digital subtraction angiography). Results Eighteen patients were admitted for cerebral vein thrombosis. Dabigatran was started in 11 patients, and warfarin was started in 7. Four patients on warfarin were switched to dabigatran because of adverse effects at 0·5, 1, 3·5, and 4 months. A total of 15 patients were treated with dabigatran with median follow-up time of 19 months. Excellent outcome was observed in 87% of patients and recanalization in 80%. Conclusions We report the largest series of cerebral vein thrombosis patients treated with dabigatran. Clinical outcome was excellent in most patients and not different from other studies. Dabigatran could possibly be considered an alternative to warfarin; nevertheless, further prospective assessment with randomized controlled studies is warranted.
Collapse
Affiliation(s)
- Marcelo D. Mendonça
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Raquel Barbosa
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Vera Cruz-e-Silva
- Neuroimaging Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Sofia Calado
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
43
|
Ferreira S, Ortiz A, Germain DP, Viana-Baptista M, Caldeira-Gomes A, Camprecios M, Fenollar-Cortés M, Gallegos-Villalobos Á, Garcia D, García-Robles JA, Egido J, Gutiérrez-Rivas E, Herrero JA, Mas S, Oancea R, Péres P, Salazar-Martín LM, Solera-Garcia J, Alves H, Garman SC, Oliveira JP. The alpha-galactosidase A p.Arg118Cys variant does not cause a Fabry disease phenotype: data from individual patients and family studies. Mol Genet Metab 2015; 114:248-58. [PMID: 25468652 PMCID: PMC4423738 DOI: 10.1016/j.ymgme.2014.11.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
Lysosomal α-galactosidase A (α-Gal) is the enzyme deficient in Fabry disease (FD), an X-linked glycosphingolipidosis caused by pathogenic mutations affecting the GLA gene. The early-onset, multi-systemic FD classical phenotype is associated with absent or severe enzyme deficiency, as measured by in vitro assays, but patients with higher levels of residual α-Gal activity may have later-onset, more organ-restricted clinical presentations. A change in the codon 118 of the wild-type α-Gal sequence, replacing basic arginine by a potentially sulfhydryl-binding cysteine residue - GLA p.(Arg118Cys) -, has been recurrently described in large FD screening studies of high-risk patients. Although the Cys118 allele is associated with high residual α-Gal activity in vitro, it has been classified as a pathogenic mutation, mainly on the basis of theoretical arguments about the chemistry of the cysteine residue. However its pathogenicity has never been convincingly demonstrated by pathology criteria. We reviewed the clinical, biochemical and histopathology data obtained from 22 individuals of Portuguese and Spanish ancestry carrying the Cys118 allele, including 3 homozygous females. Cases were identified either on the differential diagnosis of possible FD manifestations and on case-finding studies (n=11; 4 males), or on unbiased cascade screening of probands' close relatives (n=11; 3 males). Overall, those data strongly suggest that the GLA p.(Arg118Cys) variant does not segregate with FD clinical phenotypes in a Mendelian fashion, but might be a modulator of the multifactorial risk of cerebrovascular disease. The Cys118 allelic frequency in healthy Portuguese adults (n=696) has been estimated as 0.001, therefore not qualifying for "rare" condition.
Collapse
Affiliation(s)
- Susana Ferreira
- Departamento de Genética, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal.
| | - Alberto Ortiz
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Dominique P Germain
- University of Versailles, UFR des sciences de la santé Simone Veil, Division of Medical Genetics, 78180 Montigny, France.
| | - Miguel Viana-Baptista
- Serviço de Neurologia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Centro de Estudo de Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Marta Camprecios
- Servicio de Cardiología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Maria Fenollar-Cortés
- Laboratorio de Genética Clínica, Servicio de Análisis Clínicos, Hospital Clínico Universitario San Carlos, Madrid, Spain.
| | - Ángel Gallegos-Villalobos
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Diego Garcia
- Health In Code, Hospital Marítimo de Oza, A Coruña, Spain
| | | | - Jesús Egido
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | | | - José Antonio Herrero
- Servicio de Nefrología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Sebastián Mas
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Raluca Oancea
- Laboratorio de Genética Clínica, Servicio de Análisis Clínicos, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Paloma Péres
- Servicio de Cardiología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Jesús Solera-Garcia
- Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, Madrid, Spain
| | - Helena Alves
- Centro de Histocompatibilidade do Norte, Porto, Portugal.
| | - Scott C Garman
- Department of Biochemistry and Molecular Biology, University of Massachusetts, Amherst, MA, USA.
| | - João Paulo Oliveira
- Departamento de Genética, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; Serviço de Nefrologia, Centro Hospitalar de São João, 4200-319 Porto, Portugal; Consulta de Genética Médica, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
| |
Collapse
|
44
|
Correia AS, Matias G, Calado S, Lourenço A, Viana-Baptista M. Orolingual Angiodema Associated with Alteplase Treatment of Acute Stroke: A Reappraisal. J Stroke Cerebrovasc Dis 2015; 24:31-40. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/24/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022] Open
|
45
|
Abstract
Spinal cord infarction (SCI) is an uncommon but important cause of acute myelopathy. Nevertheless, contrary to cerebral stroke, the discussion about paradoxical embolism as a cause of cryptogenic SCI remains dubious. We describe the case of a 24-year-old woman who developed sudden-onset back pain followed by upper limb paralysis. T2-weighted MRI demonstrated hyperintense signal, extending from C5 to D1 with corresponding restricted diffusion on diffusion-weighted MRI and reduction of the apparent diffusion coefficient. Diagnostic workup, including lumbar puncture, showed no changes. Transcranial Doppler showed a right-to-left shunt with an uncountable number of microembolic signals after Valsalva maneuvers, and a patent foramen ovale (PFO) with an atrial septum aneurysm was identified. We discuss the paucity of evidence of right-to-left shunting in spinal diseases compared to cerebral events and the potential role of paradoxical embolism through PFO as a possible mechanism of SCI.
Collapse
Affiliation(s)
- Marcelo Mendonça
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Sofia Correia
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Luís
- Neurosurgery Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Soares
- Neuroimaging Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Sofia Calado
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
46
|
Cruz e Silva V, Alves L, Graça J, Jordão C, Mendonça M, Tralhão A, Serrano R, Calado S, Viana-Baptista M. Different clinical presentations with similar reversible splenial lesions. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2445] [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: 10/26/2022]
|
47
|
Bugalho P, Viana-Baptista M. REM sleep behavior disorder and motor dysfunction in Parkinson's Disease—/INS;A longitudinal study. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.453] [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: 11/29/2022]
|
48
|
Matias G, Calado S, Viana-Baptista M. Stroke Prevention: Behaviors and Attitudes of the Healthcare Professionals. Int J Stroke 2013; 8:E21. [DOI: 10.1111/ijs.12002] [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: 11/27/2022]
Affiliation(s)
- Gonçalo Matias
- Department of Neurology, Egas Moniz Hospital, Lisbon, Portugal
| | - Sofia Calado
- Department of Neurology, Egas Moniz Hospital, Lisbon, Portugal
- CEDOC, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Egas Moniz Hospital, Lisbon, Portugal
- CEDOC, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | | |
Collapse
|
49
|
Ferreira J, Ferreira D, Viana-Baptista M, Bettencourt P, Cernadas R, Crespo F. Dabigatran for stroke prevention in nonvalvular atrial fibrillation: answers to challenging "real-world" questions. Thrombosis 2012; 2012:867121. [PMID: 22645678 PMCID: PMC3356980 DOI: 10.1155/2012/867121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 12/18/2022]
Abstract
Dabigatran etexilate is a novel, oral, reversible, direct thrombin inhibitor that constitutes a major breakthrough for stroke prevention in patients with nonvalvular atrial fibrillation (AF). Dabigatran was the first new oral anticoagulant approved in Europe and became available in Portugal, for stroke prevention in nonvalvular AF, earlier than in most European countries. This paper is the joint effort of a panel of experts from different specialties and provides information on the use of dabigatran, in anticipation of the challenges that will come with increased usage.
Collapse
Affiliation(s)
- Jorge Ferreira
- Serviço de Cardiologia, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Daniel Ferreira
- Serviço de Cardiologia, Hospital da Luz, Avenida Lusíada 100, 1500-650 Lisboa, Portugal
| | - Miguel Viana-Baptista
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Rua da Junqueira 126, 1349-019 Lisboa, Portugal
- Serviço de Neurologia, Hospital Egas Moniz, 1349-019 Lisboa, Portugal
| | - Paulo Bettencourt
- Serviço de Medicina Interna, Hospital de São João, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Rui Cernadas
- Unidade de Saúde Familiar da Aguda, Avenida Padre Guilherme 21, 4405-010 Arcozelo, Portugal
| | - Francisco Crespo
- Hospital de Torres Vedras, Rua Dr. Ricardo Belo, 2560-324 Torres Vedras, Portugal
| |
Collapse
|
50
|
|