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Gharaibeh K, Aladamat N, Mierzwa AT, Rao R, Alhajala H, Al Kasab S, Anadani M, Burgess R, Zaidi S, Jumaa M. Blood Pressure after Successful Endovascular Therapy: A Systematic Review and Meta-Analysis of Randomized Control Trials. Ann Neurol 2024; 95:858-865. [PMID: 38481016 DOI: 10.1002/ana.26907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE There are limited data evaluating the optimum blood pressure (BP) goal post mechanical thrombectomy (MT) and its effect on outcomes of patients with large vessel occlusions (LVO). The objective of this study was to compare the efficacy and safety of intensive versus conventional BP control after reperfusion with MT via a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We searched PubMed and Embase to obtain articles related to BP control post MT through September 2023. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 3 months, while secondary outcomes included excellent outcome (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality. RESULTS Four RCTs with 1,566 patients (762 randomized into intensive BP control vs. 806 randomized into conventional BP control) were included. Analysis showed that there was a lower likelihood of functional independence (mRS 0-2: odds ratio [OR]: 0.68, 95% confidence interval [CI] 0.51-0.91, p = 0.009) in the more intensive treatment group compared with the conventional treatment group. There was no statistically significant difference in achieving excellent outcome (mRS0-1: OR: 0.82, 95% CI: 0.63-1.07; p = 0.15), risk of sICH or mortality. INTERPRETATION This systematic review and meta- analysis Indicates that in patients who achieved successful MT for acute ischemic stroke with LVO, intensive BP control was associated with a lower likelihood of functional independence at 3 months without significant difference in likelihood of achieving excellent outcome, sICH risk, or mortality. ANN NEUROL 2024;95:858-865.
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Affiliation(s)
- Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Rahul Rao
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Hisham Alhajala
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Mohammad Anadani
- Department of Neurosciences, Intent Medical Group, Northshore University Neurosciences Institute, Arlington Heights, IL, USA
| | - Richard Burgess
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Gharaibeh K, Aladamat N, Samara M, Mierzwa AT, Ali A, Zaidi S, Jumaa M. Hyperdense sign as a predictor for successful recanalization and clinical outcome in acute ischemic stroke: A systematic review and meta-analysis. Interv Neuroradiol 2024:15910199241235431. [PMID: 38415302 DOI: 10.1177/15910199241235431] [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] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE To assess the prognostic values of hyperdense sign on pretreatment non-contrast head CT scan for successful recanalization (mTICI ≥2b) and 90-day good functional outcome (mRs 0-2) in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT). METHODS Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 November 2023 was conducted. Twelve studies which reported hyperdense sign, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. RESULTS Pooled analysis demonstrated a statistically significant association between successful recanalization and hyperdense sign-positive patients who underwent MT (odd ratios (OR) = 1.47, 95% confidence interval (CI) = 1.03-2.10, p = 0.04). No statistically significant association was demonstrated between presence of hyperdense sign and good functional outcome (OR = 1.04, 95% CI: 0.72-1.49, p = 0.85) or symptomatic intracranial hemorrhage sICH (OR: 1.80, 95% CI 0.72-4.47, p = 0.21). CONCLUSIONS This meta-analysis demonstrated that pre-intervention hyperdense sign on CT imaging might be useful in prediction of successful recanalization after MT.
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Affiliation(s)
- Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
| | - Mohammad Samara
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
| | - Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Ahsan Ali
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine, and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Mierzwa AT, Nelson A, Kasab SA, Ortega Gutierrez S, Vivanco-Suarez J, Farooqui M, Jadhav AP, Desai S, Toth G, Alrohimi A, Nguyen TN, Klein P, Abdalkader M, Salahuddin H, Pandey A, Wilseck Z, Koduri S, Vora N, Aladamat N, Gharaibeh K, Afreen E, Al-Hajala H, Shawver J, Zaidi S, Jumaa M. Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry. Eur Stroke J 2024:23969873241234713. [PMID: 38403924 DOI: 10.1177/23969873241234713] [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] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Recent randomized controlled trials demonstrated superiority of mechanical thrombectomy compared to medical therapy in acute basilar artery occlusions, however, little data is available to guide clinicians in functional prognosis and risk stratification. PATIENTS AND METHODS Data from the retrospectively established PC-SEARCH Thrombectomy registry, which included patients with basilar artery occlusion from eight sites from January 2015 to December 2021, was interrogated. Outcomes were dichotomized into 90-day favorable (mRS ⩽ 3) and unfavorable (mRS > 3). Multivariate logistic regression analysis was performed with respect to the outcome groups and were adjusted for potential confounding baseline characteristics. RESULTS Four-hundred-forty-four patients were included in this analysis. Mean age was 66 [SD 15], with 56% male, and comprised of 76% Caucasian. Patients presented with an initial median NIHSS of 18 and 199 patients (44.8%) achieved favorable 90-day functional outcomes. Independent predictors of favorable outcomes included younger age, pc-ASPECTS > 8 (OR 2.30 p < 0.001), and TICI ⩾ 2b (OR 7.56 p < 0.001). Unfavorable outcomes were associated with increasing number of passes (OR 1.29 p = 0.004) and sICH (OR 4.19 p = 0.015). IA-tPA was an independent risk factor for sICH (OR 7.15 p = 0.002) without improving favorable functional outcomes. CONCLUSION AND DISCUSSION PC-ASPECTS > 8, successful recanalization (TICI ⩾ 2b), first-pass recanalization, and younger age are independent predictors of favorable 90-day functional outcome in thrombectomy treated patients with acute basilar artery occlusion. Conversely, sICH were independent predictors of unfavorable outcomes. IA-tPA and unsuccessful recanalization are independently associated with sICH.
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Affiliation(s)
- Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Ashley Nelson
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shashvat Desai
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gabor Toth
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Piers Klein
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, CA, USA
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Zachary Wilseck
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Niraj Vora
- Ohio Health Riverside Methodist Hospital, Columbus, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ehad Afreen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Hisham Al-Hajala
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Rao R, Aladamat N, Robbins S, Jumaa M, Zaidi S. Stroke Thrombectomy and Right Atrial Clot Aspiration in 29 Year Old Woman. Neurohospitalist 2024; 14:95-98. [PMID: 38235021 PMCID: PMC10790615 DOI: 10.1177/19418744231200052] [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] [Indexed: 01/19/2024] Open
Abstract
We present a case report of a previously healthy 29 year old woman who developed thromboembolic events in rapid fashion after a recent orthopedic surgery. This case highlights the importance of understanding risk factors for clot formation even in those who had no prior events, the efficacy of novel aspiration techniques to remove emboli, and how rapid triaging of acute symptoms can lead to the best outcomes. She presented to the emergency department with shortness of breath and was found to have a large bilateral pulmonary embolus. She was given intravenous thrombolysis. Shortly after, she developed aphasia and right-sided weakness and was taken emergently for mechanical thrombectomy of a left middle cerebral artery occlusion. She was later found to have a patent foramen ovale and a highly mobile right atrial thrombus which was aspirated. Further evaluation revealed right lower extremity peroneal and popliteal deep venous thrombi. She was placed on anticoagulation, made a full clinical recovery, and was discharged home. Prompt recognition of symptoms, efficient in-hospital work flow, and a multidisciplinary approach led to an outstanding outcome in this young patient.
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Affiliation(s)
- Rahul Rao
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Promedica Stroke Network, Toledo, OH, USA
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Mierzwa AT, Al Kasab S, Nelson A, Ortega Gutierrez S, Vivanco-Suarez J, Farooqui M, Jadhav AP, Desai S, Toth G, Alrohimi A, Nguyen TN, Klein P, Abdalkader M, Salahuddin H, Pandey A, Koduri S, Vora N, Aladamat N, Gharaibeh K, Afreen E, Zaidi S, Jumaa M. Comparing Functional Outcomes and Safety Profiles of First-Line Aspiration Thrombectomy Versus Stentriever for Acute Basilar Artery Occlusion: Propensity Analysis of the PC-SEARCH Thrombectomy Registry. Stroke 2023; 54:2512-2521. [PMID: 37747965 DOI: 10.1161/strokeaha.123.043579] [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: 04/17/2023] [Accepted: 08/03/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Aspiration catheters (ASPs) and stentriever thrombectomy devices have comparable safety and efficacy in anterior circulation ischemic strokes. However, there is lack of high-quality comparative data in acute basilar artery occlusions. Our objective is to compare the outcomes and safety of ASPs and stentriever devices in acute basilar artery occlusions. METHODS This is an analysis of the retrospectively established PC-SEARCH Thrombectomy (Posterior-Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intraprocedural Predictors for Mechanical Thrombectomy) registry. Patients were dichotomized based on their first-line thrombectomy device (ASP and stentriever) and associated with their 90-day functional outcomes, intraprocedural metrics, and safety measures. Propensity analysis based on unequal baseline characteristics was performed. Consecutive patients with acute basilar artery occlusions who received mechanical thrombectomy were included from January 2015 to December 2021. Patients received either first-line contact aspiration or stentriever mechanical thrombectomy. Primary clinical and safety outcomes were 90-day functional independence measured by a modified Rankin Scale score of 0 to 3 and symptomatic intracranial hemorrhage, respectively. Secondary outcomes included puncture-recanalization times, first-pass recanalization rates, crossovers to other thrombectomy device, and neurological/hospital complications. RESULTS Five hundred eighteen patients were included in the registry, and a total of 383 patients were included (mean [SD] age, 65.5 [15] years; 228 [59%] men) in this analysis. Of these, 219 patients were first-line ASP while 164 patients received first-line stentriever devices. Median premorbid modified Rankin Scale was zero and median presenting National Institutes of Health Stroke Scale was 17 (interquartile range, 8-26). The proportion of favorable functional outcome was similar between the 2 techniques before (47.3% versus 42.5%; odds ratio, 1.22 [95% CI, 0.78-1.89]; P=0.38) and after propensity matching (odds ratio, 1.46 [95% CI, 0.85-2.49]; P=0.17). In our propensity-matched cohorts, puncture-recanalization times (18 versus 52 minutes; P<0.01) favored first-line ASP; however, first-pass recanalization rates (43.5% versus 44.5%; P=0.90) were similar between groups. First-line ASP was associated with higher rates of crossover (22% versus 6%; P<0.01), whereas stentriever was associated with higher rates of symptomatic intracranial hemorrhage (9.8% versus 3.4%; P=0.04). CONCLUSIONS First-line ASP and stentriever methods demonstrated similar functional outcome and recanalization rates. Stentriever methods were associated with higher rates of symptomatic intracranial hemorrhage, whereas ASPs were associated with higher rates of crossover to alternative technique in patients with acute basilar occlusions.
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Affiliation(s)
- Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston (S.A.K., A.N.)
| | - Ashley Nelson
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston (S.A.K., A.N.)
| | | | | | | | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., S.D.)
| | - Shashvat Desai
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., S.D.)
| | - Gabor Toth
- Cleveland Clinic Foundation, OH (G.T., A.A.)
| | | | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K., M.A.)
| | - Piers Klein
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K., M.A.)
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K., M.A.)
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, CA (H.S.)
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor (A.P., S.K.)
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor (A.P., S.K.)
| | - Niraj Vora
- Ohio Health Riverside Methodist Hospital, Columbus (N.V.)
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
| | - Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
| | - Ehad Afreen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
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Al-Chalabi M, Hegde P, Asghar F, Aladamat N, Delcimmuto N, Gharaibeh K, Samara M, Esengul Y, Mahfooz N, Sheikh A. Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis syndrome: A comprehensive systematic review of 93 patients from 57 studies. Cephalalgia 2023; 43:3331024231157694. [PMID: 36856002 DOI: 10.1177/03331024231157694] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND Headache with neurologic deficits and cerebrospinal fluid lymphocytosis, previously also termed pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis, is a self-limiting syndrome characterized by moderate to severe headache associated with focal neurological deficits occurring in the context of lymphocytosis in the cerebrospinal fluid. As a consequence of its rarity, data regarding headache with neurologic deficits and cerebrospinal fluid lymphocytosis is sparse. Therefore, we conducted this review to analyze data related to 93 patients of headache with neurologic deficits and cerebrospinal fluid lymphocytosis, to characterize their demographics, clinical manifestations, investigations and treatment options. METHODS We performed a systematic review of cases reported through PubMed and Google scholar database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Keywords used were 'Headache with Neurologic Deficits and cerebrospinal fluid lymphocytosis', 'Headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome'. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool. RESULTS We analyzed a total of 93 cases of headache with neurologic deficits and cerebrospinal fluid lymphocytosis with a mean age of 28.8 years at onset. Seventy patients (75.2%) were adults, while 23 (24.7%) belonged to the pediatric age group. Comparing these groups, mean age at onset was 32.5 years and 14.3 years, respectively. The average duration of follow-up was 11.08 months. Thirty percent of patients experienced relapsing episodes of headache with neurologic deficits and cerebrospinal fluid lymphocytosis symptoms. The most common type of headache reported was unilateral severe throbbing episodic headache. Other associated symptoms included sensory deficit (60%) and motor deficits (54.8%). The least common symptoms were nystagmus and agraphia, which were reported in one patient each. Antiviral agents were a common treatment option in the acute phase (n = 23 patients [23.6%]), while Flunarizine was the most commonly used agent in the chronic setting (n = 3 patients [3.2%]). While most of the patients had normal brain magnetic resonance imaging, 20 patients had magnetic resonance imaging abnormalities, including (but not limited to) non-specific white matter lesions (eight patients) and meningeal enhancement (six patients). The most common electroencephalographic findings included diffuse and focal slowing. The mean cerebrospinal fluid opening-pressure was 240.5 mmH2O. Cerebrospinal fluid protein was elevated in 59 (63.4%) patients, with a mean value of 114 mg/dL. Two patients in our cohort were found to have cerebrospinal fluid oligoclonal bands. CONCLUSION Headache with neurologic deficits and cerebrospinal fluid lymphocytosis tends to affect young individuals with a slight male predominance. Unilateral severe throbbing episodic headache with associated hemi-paresthesia and hemiparesis were the most common symptoms based on our review. Elevated cerebrospinal fluid opening-pressure can be seen in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome. Early recognition of the syndrome is paramount. Antivirals were found to be among the most widely used treatments in the acute setting. Magnetic resonance imaging of the brain is mostly normal. Diffuse and focal slowing were among the most common electroencephalographic findings. Cerebral flow abnormalities on perfusion scans are not uncommon in headache with neurologic deficits and cerebrospinal fluid lymphocytosis. Prospective studies with a larger sample size are needed to validate our findings and guide the clinical care of these patients.
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Affiliation(s)
| | - Prajwal Hegde
- College of Medicine and Life Sciences, University of Toledo, OH, USA
| | - Fahham Asghar
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | | | - Mohammad Samara
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Yasar Esengul
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Naeem Mahfooz
- Department of Neurology, University of Toledo, Toledo, OH, USA.,College of Medicine and Life Sciences, University of Toledo, OH, USA
| | - Ajaz Sheikh
- College of Medicine and Life Sciences, University of Toledo, OH, USA
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Aladamat N, Gharaibeh K, Al-Chalabi M, Sheikh A. Glioblastoma masquerading radiographically as Herpes Simplex Encephalitis: A Potential Imaging Trap. Brain Disorders 2022. [DOI: 10.1016/j.dscb.2022.100063] [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: 12/29/2022] Open
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Beran A, Aladamat N, Alchalabi M, Mhanna M, Srour O, Khader Y, Kayyali A. Atypical Gradenigo Syndrome in an Elderly Man Resolved with Mastoidectomy and Petrous Apicectomy. Eur J Case Rep Intern Med 2022; 9:003344. [PMID: 36051167 PMCID: PMC9426965 DOI: 10.12890/2022_003344] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Gradenigo syndrome (GS) was described primarily in the paediatric population, especially in the pre-antibiotic era. GS is rarely reported in the elderly population, especially in the post-antibiotic era. We present the rare case of a 67-year-old man who presented with an incomplete triad of symptoms (without abducens nerve palsy) of GS that failed medical therapy and was successfully treated with surgical intervention (mastoidectomy and petrous apicectomy). Physicians should be familiar with atypical presenting symptoms of GS as it can lead to life-threatening complications, especially in the elderly. GS cases resistant to medical therapy may require prompt appropriate imaging studies and surgical intervention. LEARNING POINTS Gradenigo syndrome may present with an incomplete triad (without abducens nerve palsy), especially in the post-antibiotic era.Gradenigo syndrome can rarely affect immunocompromised elderly patients.Gradenigo syndrome cases resistant to medical therapy may require prompt appropriate imaging studies and surgical intervention (mastoidectomy and petrous apicectomy).
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Affiliation(s)
- Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Omar Srour
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Yasmin Khader
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ammar Kayyali
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
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Beran A, Aladamat N, Alchalabi M, Mhanna M, Srour O, Khader Y, Kayyali A. Atypical Gradenigo Syndrome in an Elderly Man Resolved with Mastoidectomy and Petrous Apicectomy. Eur J Case Rep Intern Med 2022. [DOI: 10.12890/2022_003433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gradenigo syndrome (GS) was described primarily in the paediatric population, especially in the pre-antibiotic era. GS is rarely reported in the elderly population, especially in the post-antibiotic era. We present the rare case of a 67-year-old man who presented with an incomplete triad of symptoms (without abducens nerve palsy) of GS that failed medical therapy and was successfully treated with surgical intervention (mastoidectomy and petrous apicectomy). Physicians should be familiar with atypical presenting symptoms of GS as it can lead to life-threatening complications, especially in the elderly. GS cases resistant to medical therapy may require prompt appropriate imaging studies and surgical intervention.
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Affiliation(s)
- Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Omar Srour
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Yasmin Khader
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ammar Kayyali
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
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10
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Beran A, Ayesh H, Mhanna M, Wahood W, Ghazaleh S, Abuhelwa Z, Sayeh W, Aladamat N, Musallam R, Matar R, Malhas SE, Assaly R. Triglyceride-Glucose Index for Early Prediction of Nonalcoholic Fatty Liver Disease: A Meta-Analysis of 121,975 Individuals. J Clin Med 2022; 11:jcm11092666. [PMID: 35566790 PMCID: PMC9102411 DOI: 10.3390/jcm11092666] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/12/2022] Open
Abstract
Insulin resistance (IR) is a major contributor to the pathogenesis of nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index has recently gained popularity for the assessment of IR and NAFLD due to its ease of acquisition and calculation. Therefore, we conducted this systematic review and meta-analysis to summarize the existing studies in the literature and provide a quantitative assessment of the significance of the TyG index in predicting the incidence of NAFLD. A comprehensive literature search in PubMed, EMBASE, and Web of Science databases from inception until 25 March 2022 was conducted. Published observational studies that evaluated the association between TyG index and NAFLD among the adult population and reported the hazard ratio (HR) or odds ratio (OR) for this association after multivariate analysis were included. The random-effects model was used as the primary statistical analysis model in the estimation of pooled ORs and HRs with the corresponding confidence intervals (CIs). A total of 17 observational studies, including 121,975 participants, were included. For studies analyzing the TyG index as a categorical variable, both pooled OR (6.00, CI 4.12–8.74) and HR (1.70, CI 1.28–2.27) were significant for the association between TyG index and incident NAFLD. For studies analyzing the TyG index as a continuous variable, pooled OR (2.25, CI 1.66–3.04) showed similar results. Consistent results were obtained in subgroup analyses according to the study design, sample size, ethnicity, and diabetic status. In conclusion, our meta-analysis demonstrates that a higher TyG index is associated with higher odds of NAFLD. TyG index may serve as an independent predictive tool to screen patients at high risk of NAFLD in clinical practice, especially in primary care settings. Patients with a high TyG index should be referred for a liver ultrasound and start intense lifestyle modifications. However, further large-scale prospective cohort studies are necessary to validate our findings.
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Affiliation(s)
- Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
- Correspondence: ; Tel.: +1-469-348-1347
| | - Hazem Ayesh
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
| | - Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33314, USA;
| | - Sami Ghazaleh
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
| | - Ziad Abuhelwa
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
| | - Wasef Sayeh
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
| | - Nameer Aladamat
- Department of Neurology, University of Toledo, Toledo, OH 43606, USA;
| | - Rami Musallam
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH 44115, USA;
| | - Reem Matar
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saif-Eddin Malhas
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (H.A.); (M.M.); (S.G.); (Z.A.); (W.S.); (S.-E.M.); (R.A.)
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11
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Beran A, Altorok N, Srour O, Malhas SE, Khokher W, Mhanna M, Ayesh H, Aladamat N, Abuhelwa Z, Srour K, Mahmood A, Altorok N, Taleb M, Assaly R. Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11071971. [PMID: 35407578 PMCID: PMC8999853 DOI: 10.3390/jcm11071971] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/08/2023] Open
Abstract
The crystalloid fluid of choice in sepsis remains debatable. We aimed to perform a comprehensive meta-analysis to compare the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults with sepsis. A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 2022, was performed for studies that compared BC vs. NS in adults with sepsis. Our outcomes included mortality and acute kidney injury (AKI), need for renal replacement therapy (RRT), and ICU length of stay (LOS). Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were obtained using a random-effect model. Fifteen studies involving 20,329 patients were included. Overall, BC showed a significant reduction in the overall mortality (RR 0.88, 95% CI 0.81-0.96), 28/30-day mortality (RR 0.87, 95% CI 0.79-0.95), and AKI (RR 0.85, 95% CI 0.77-0.93) but similar 90-day mortality (RR 0.96, 95% CI 0.90-1.03), need for RRT (RR 0.91, 95% CI 0.76-1.08), and ICU LOS (MD -0.25 days, 95% CI -3.44, 2.95), were observed between the two groups. However, subgroup analysis of randomized controlled trials (RCTs) showed no statistically significant differences in overall mortality (RR 0.92, 95% CI 0.82-1.02), AKI (RR 0.71, 95% CI 0.47-1.06), and need for RRT (RR 0.71, 95% CI 0.36-1.41). Our meta-analysis demonstrates that overall BC was associated with reduced mortality and AKI in sepsis compared to NS among patients with sepsis. However, subgroup analysis of RCTs showed no significant differences in both overall mortality and AKI between the groups. There was no significant difference in the need for RRT or ICU LOS between BC and NS. Pending further data, our study supports using BC over NS for fluid resuscitation in adults with sepsis. Further large-scale RCTs are necessary to validate our findings.
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Affiliation(s)
- Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
- Correspondence: ; Tel.: +1-469-348-1347
| | - Nehaya Altorok
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Omar Srour
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Saif-Eddin Malhas
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Waleed Khokher
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Hazem Ayesh
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Nameer Aladamat
- Department of Neurology, University of Toledo, Toledo, OH 43606, USA;
| | - Ziad Abuhelwa
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Khaled Srour
- Department of Critical Care Medicine, Henry Ford Health System, Detroit, MI 48202, USA;
| | - Asif Mahmood
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
| | - Nezam Altorok
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
- Department of Rheumatology, University of Toledo, Toledo, OH 43606, USA
| | - Mohammad Taleb
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH 43606, USA;
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA; (N.A.); (O.S.); (S.-E.M.); (W.K.); (M.M.); (H.A.); (Z.A.); (A.M.); (N.A.); (R.A.)
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH 43606, USA;
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