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Wu BP, Tsou CH, Huang P. Wall-Eyed Bilateral Internuclear Ophthalmoplegia Variant Syndrome Caused by Isolated Left Thalamic Infarction. Neurology 2024; 102:e209475. [PMID: 38669612 DOI: 10.1212/wnl.0000000000209475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Brian P Wu
- Departments of Neurology (B.P.W., P.H.) and Medical Imaging (C.-H.T.), Kaohsiung Medical University Hospital, Kaohsiung Medical University; Departments of Neurology (P.H.) and Medical Imaging (C.-H.T.), Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University; Department of Neurology (P.H.), School of Medicine, College of Medicine, Kaohsiung Medical University; Neuroscience Research Center (P.H.), Kaohsiung Medical University, Taiwan
| | - Cheng-Hsien Tsou
- Departments of Neurology (B.P.W., P.H.) and Medical Imaging (C.-H.T.), Kaohsiung Medical University Hospital, Kaohsiung Medical University; Departments of Neurology (P.H.) and Medical Imaging (C.-H.T.), Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University; Department of Neurology (P.H.), School of Medicine, College of Medicine, Kaohsiung Medical University; Neuroscience Research Center (P.H.), Kaohsiung Medical University, Taiwan
| | - Poyin Huang
- Departments of Neurology (B.P.W., P.H.) and Medical Imaging (C.-H.T.), Kaohsiung Medical University Hospital, Kaohsiung Medical University; Departments of Neurology (P.H.) and Medical Imaging (C.-H.T.), Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University; Department of Neurology (P.H.), School of Medicine, College of Medicine, Kaohsiung Medical University; Neuroscience Research Center (P.H.), Kaohsiung Medical University, Taiwan
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Wei W, Qiao Z, Qin D, Lan Y. Acute multiple brain infarctions associated with Streptococcus suis infection: a case report. BMC Infect Dis 2024; 24:447. [PMID: 38671388 DOI: 10.1186/s12879-024-09318-9] [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: 01/02/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Streptococcus suis is one of the most common zoonotic pathogens, in humans and can cause meningitis, endocarditis, arthritis and sepsis. Human cases of Streptococcus suis infection have been reported worldwide, and most of those cases occurred in Asia. Hearing loss is the most common sequela of Streptococcus suis meningitis. Streptococcus suis infection complicated with acute cerebral infarction has rarely been reported. Therefore, to provide a reference for this disease, we reported a case of acute multiple brain infarctions associated with Streptococcus suis infection. In our report, a 69yearold male patient had Streptococcus suis meningitis and sepsis, which were associated with multiple acute cerebral infarctions in the pons and bilateral frontotemporal parietal occipital lobes. After treatment, the patient exhibited cognitive impairment, dyspraxia and irritability. There are limited case reports of cerebral infarction associated with Streptococcus suis infection, and further research is needed to determine the best treatment method.
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Affiliation(s)
- Wenxin Wei
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China
| | - Zhenhu Qiao
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China
| | - Donghua Qin
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China
| | - Yu Lan
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China.
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Mistry EA, Hart KW, Davis LT, Gao Y, Prestigiacomo CJ, Mittal S, Mehta T, LaFever H, Harker P, Wilson-Perez HE, Beasley KA, Krothapalli N, Lippincott E, Stefek H, Froehler M, Chitale R, Fusco M, Grossman A, Shirani P, Smith M, Jaffa MN, Yeatts SD, Albers GW, Wanderer JP, Tolles J, Lindsell CJ, Lewis RJ, Bernard GR, Khatri P. Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke: The BEST-II Randomized Clinical Trial. JAMA 2023; 330:821-831. [PMID: 37668620 PMCID: PMC10481231 DOI: 10.1001/jama.2023.14330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 09/06/2023]
Abstract
Importance The effects of moderate systolic blood pressure (SBP) lowering after successful recanalization with endovascular therapy for acute ischemic stroke are uncertain. Objective To determine the futility of lower SBP targets after endovascular therapy (<140 mm Hg or 160 mm Hg) compared with a higher target (≤180 mm Hg). Design, Setting, and Participants Randomized, open-label, blinded end point, phase 2, futility clinical trial that enrolled 120 patients with acute ischemic stroke who had undergone successful endovascular therapy at 3 US comprehensive stroke centers from January 2020 to March 2022 (final follow-up, June 2022). Intervention After undergoing endovascular therapy, participants were randomized to 1 of 3 SBP targets: 40 to less than 140 mm Hg, 40 to less than 160 mm Hg, and 40 to 180 mm Hg or less (guideline recommended) group, initiated within 60 minutes of recanalization and maintained for 24 hours. Main Outcomes and Measures Prespecified multiple primary outcomes for the primary futility analysis were follow-up infarct volume measured at 36 (±12) hours and utility-weighted modified Rankin Scale (mRS) score (range, 0 [worst] to 1 [best]) at 90 (±14) days. Linear regression models were used to test the harm-futility boundaries of a 10-mL increase (slope of 0.5) in the follow-up infarct volume or a 0.10 decrease (slope of -0.005) in the utility-weighted mRS score with each 20-mm Hg SBP target reduction after endovascular therapy (1-sided α = .05). Additional prespecified futility criterion was a less than 25% predicted probability of success for a future 2-group, superiority trial comparing SBP targets of the low- and mid-thresholds with the high-threshold (maximum sample size, 1500 with respect to the utility-weighted mRS score outcome). Results Among 120 patients randomized (mean [SD] age, 69.6 [14.5] years; 69 females [58%]), 113 (94.2%) completed the trial. The mean follow-up infarct volume was 32.4 mL (95% CI, 18.0 to 46.7 mL) for the less than 140-mm Hg group, 50.7 mL (95% CI, 33.7 to 67.7 mL), for the less than 160-mm Hg group, and 46.4 mL (95% CI, 24.5 to 68.2 mL) for the 180-mm Hg or less group. The mean utility-weighted mRS score was 0.51 (95% CI, 0.38 to 0.63) for the less than 140-mm Hg group, 0.47 (95% CI, 0.35 to 0.60) for the less than 160-mm Hg group, and 0.58 (95% CI, 0.46 to 0.71) for the high-target group. The slope of the follow-up infarct volume for each mm Hg decrease in the SBP target, adjusted for the baseline Alberta Stroke Program Early CT score, was -0.29 (95% CI, -0.81 to ∞; futility P = .99). The slope of the utility-weighted mRS score for each mm Hg decrease in the SBP target after endovascular therapy, adjusted for baseline utility-weighted mRS score, was -0.0019 (95% CI, -∞ to 0.0017; futility P = .93). Comparing the high-target SBP group with the lower-target groups, the predicted probability of success for a future trial was 25% for the less than 140-mm Hg group and 14% for the 160-mm Hg group. Conclusions and Relevance Among patients with acute ischemic stroke, lower SBP targets less than either 140 mm Hg or 160 mm Hg after successful endovascular therapy did not meet prespecified criteria for futility compared with an SBP target of 180 mm Hg or less. However, the findings suggested a low probability of benefit from lower SBP targets after endovascular therapy if tested in a future larger trial. Trial Registration ClinicalTrials.gov Identifier: NCT04116112.
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Affiliation(s)
- Eva A. Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kimberly W. Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Larry T. Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yue Gao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Shilpi Mittal
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tapan Mehta
- Ayer Neuroscience Institute, Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Hayden LaFever
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pablo Harker
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Kalli A. Beasley
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Neeharika Krothapalli
- Ayer Neuroscience Institute, Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Emily Lippincott
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Heather Stefek
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Froehler
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rohan Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew Fusco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron Grossman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Peyman Shirani
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Matthew Smith
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Matthew N. Jaffa
- Ayer Neuroscience Institute, Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Sharon D. Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | | | - Jonathan P. Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Juliana Tolles
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Duke Clinical Research Institute, Durham, North Carolina
| | - Roger J. Lewis
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- Statistical Editor, JAMA
| | - Gordon R. Bernard
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
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Chaturvedi S, Yu J, Brown J, Wei A, Selvakumar S, Gerber GF, Moliterno AR, Streiff MB, Kraus P, Logue CM, Yui JC, Naik RP, Latif H, Lanzkron SM, Braunstein EM, Brodsky RA, Gottesman RF, Lin DD. Silent cerebral infarction during immune TTP remission: prevalence, predictors, and impact on cognition. Blood 2023; 142:325-335. [PMID: 37216688 PMCID: PMC10447499 DOI: 10.1182/blood.2023019663] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Immune thrombotic thrombocytopenic purpura (iTTP) survivors have increased risk of cardiovascular disease, including strokes, and report persistent cognitive difficulties during remission. We conducted this prospective study involving iTTP survivors during clinical remission to determine the prevalence of silent cerebral infarction (SCI), defined as magnetic resonance imaging (MRI) evidence of brain infarction without corresponding overt neurodeficits. We also tested the hypothesis that SCI is associated with cognitive impairment, assessed using the National Institutes of Health ToolBox Cognition Battery. For cognitive assessments, we used fully corrected T scores adjusted for age, sex, race, and education. Based on the diagnostic and statistical manual 5 criteria, we defined mild and major cognitive impairment as T scores with a 1 or 2 standard deviation (SD) and >2 SD below the mean on at least 1 test, respectively. Forty-two patients were enrolled, with 36 completing MRIs. SCI was present in 50% of the patients (18), of which 8 (44.4%) had prior overt stroke including during acute iTTP. Patients with SCI had higher rates of cognitive impairment (66.7% vs 27.7%; P = .026), including major cognitive impairment (50% vs 5.6%; P = .010). In separate logistic regression models, SCI was associated with any (mild or major) cognitive impairment (odds ratio [OR] 10.5 [95% confidence interval (95% CI), 1.45-76.63]; P = .020) and major cognitive impairment (OR 7.98 [95% CI, 1.11-57.27]; P = .039) after adjusting for history of stroke and Beck depression inventory scores. MRI evidence of brain infarction is common in iTTP survivors; the strong association of SCI with impaired cognition suggests that these silent infarcts are neither silent nor innocuous.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jia Yu
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jenna Brown
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aria Wei
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sruthi Selvakumar
- Nova Southeastern University College of Allopathic Medicine, Davie, FL
| | - Gloria F. Gerber
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alison R. Moliterno
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael B. Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peggy Kraus
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Claire M. Logue
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer C. Yui
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hira Latif
- Division of Hematology and Oncology, MedStar Georgetown University Hospital Center, Washington, DC
| | - Sophie M. Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Braunstein
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A. Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F. Gottesman
- Stroke, Cognition and Neuroepidemiology Section, National Institute of Neurological Disease and Stroke Intramural Research Program, Bethesda, MD
| | - Doris D. Lin
- Division of Neuroradiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
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5
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Bøgh N, Olin RB, Hansen ESS, Gordon JW, Bech SK, Bertelsen LB, Sánchez-Heredia JD, Blicher JU, Østergaard L, Ardenkjær-Larsen JH, Bok RA, Vigneron DB, Laustsen C. Metabolic MRI with hyperpolarized [1- 13C]pyruvate separates benign oligemia from infarcting penumbra in porcine stroke. J Cereb Blood Flow Metab 2021; 41:2916-2927. [PMID: 34013807 PMCID: PMC8756460 DOI: 10.1177/0271678x211018317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
Acute ischemic stroke patients benefit from reperfusion in a short time-window after debut. Later treatment may be indicated if viable brain tissue is demonstrated and this outweighs the inherent risks of late reperfusion. Magnetic resonance imaging (MRI) with hyperpolarized [1-13C]pyruvate is an emerging technology that directly images metabolism. Here, we investigated its potential to detect viable tissue in ischemic stroke. Stroke was induced in pigs by intracerebral injection of endothelin 1. During ischemia, the rate constant of pyruvate-to-lactate conversion, kPL, was 52% larger in penumbra and 85% larger in the infarct compared to the contralateral hemisphere (P = 0.0001). Within the penumbra, the kPL was 50% higher in the regions that later infarcted compared to non-progressing regions (P = 0.026). After reperfusion, measures of pyruvate-to-lactate conversion were slightly decreased in the infarct compared to contralateral. In addition to metabolic imaging, we used hyperpolarized pyruvate for perfusion-weighted imaging. This was consistent with conventional imaging for assessment of infarct size and blood flow. Lastly, we confirmed the translatability of simultaneous assessment of metabolism and perfusion with hyperpolarized MRI in healthy volunteers. In conclusion, hyperpolarized [1-13C]pyruvate may aid penumbral characterization and increase access to reperfusion therapy for late presenting patients.
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Affiliation(s)
- Nikolaj Bøgh
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rie B Olin
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Esben SS Hansen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
| | - Sabrina K Bech
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lotte B Bertelsen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Juan D Sánchez-Heredia
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jakob U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jan H Ardenkjær-Larsen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
- GE Healthcare, Brøndby, Denmark
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California San Francisco and University of California, Berkeley, CA, USA
| | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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6
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Gutierrez J, Porras TN, Yoo-Jeong M, Khasiyev F, Igwe KC, Laing KK, Brickman AM, Pavol M, Schnall R. Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV. J Acquir Immune Defic Syndr 2021; 88:79-85. [PMID: 34397745 PMCID: PMC8371714 DOI: 10.1097/qai.0000000000002729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition. SETTINGS Cross-sectional, community-based study. METHODS Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition. RESULTS We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3 and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = -0.213, P = 0.028), list learning (B = -0.275, P = 0.019), and global cognition (B = -0.129, P = 0.007). CONCLUSIONS We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Tiffany N Porras
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Moka Yoo-Jeong
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University, Saint Louis, MI
| | - Kay C Igwe
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Krystal K Laing
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Adam M Brickman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY
| | - Marykay Pavol
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Rebecca Schnall
- School of Nursing, Columbia University Irving Medical Center, New York, NY; and
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
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Benli MD, Güven B, Güven H, Conkbayır I. Silent brain infarcts and white matter lesions in patients with asymptomatic carotid stenosis. Acta Neurol Belg 2021; 121:983-991. [PMID: 33034830 DOI: 10.1007/s13760-020-01517-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/02/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
The association of carotid atherosclerosis with silent brain infarcts (SBIs) and white matter lesions (WMLs) currently remains unknown. This study aims to compare SBIs, deep white matter lesions (DWMLs), and periventricular white matter lesions (PWMLs) in ipsilateral and contralateral hemispheres to internal carotid artery (ICA) stenosis, and investigate their association with stenosis grade in patients with asymptomatic ≥ 50% unilateral extracranial ICA stenosis. Patients without previous history of stroke and/or transient ischemic attack who had ≥ 50% stenosis in unilateral ICA on carotid color Doppler ultrasound were enrolled in the study. Patient demographics, vascular risk factors and ICA stenosis grades; number, location, and size of SBIs, DWMLs, and PWMLs in ICA territory were evaluated in both hemispheres using magnetic resonance imaging of the brain. Of the 69 patients, 53 had 50-69% (76.8%) and 16 had ≥ 70% (23.2%) unilateral ICA stenosis. There was no statistically significant difference in SBIs between ipsilateral and contralateral hemispheres to ≥ 50% ICA stenosis. Comparison of ICA stenoses as 50-69% and ≥ 70% revealed a greater number of patients with SBI in ipsilateral hemisphere to ≥ 70% stenosis compared to contralateral (p = 0.025). The number of SBIs was also higher in ipsilateral hemisphere to ≥ 70% stenosis compared to contralateral (p = 0.022). While DWMLs and PWMLs did not differ between hemispheres, frequency of Fazekas grade 1 DWMLs was lower in ipsilateral hemisphere to either 50-69% or ≥ 70% ICA stenosis compared to contralateral (p = 0.035 and p = 0.025, respectively). Results of the present study indicate that stenosis grade may be relevant in the association between asymptomatic carotid stenosis and SBIs, and ≥ 70% stenosis may pose a risk of SBI development.
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Affiliation(s)
- Müjdat Deniz Benli
- Department of Neurology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Çiğdem mah. 1550/1 cad. 23/1 Çankaya, Ankara, Turkey
| | - Bülent Güven
- Department of Neurology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Çiğdem mah. 1550/1 cad. 23/1 Çankaya, Ankara, Turkey.
| | - Hayat Güven
- Department of Neurology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Çiğdem mah. 1550/1 cad. 23/1 Çankaya, Ankara, Turkey
| | - Işık Conkbayır
- Department of Radiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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8
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Königsberg A, DeMarco AT, Mayer C, Wouters A, Schlemm E, Ebinger M, Cho TH, Endres M, Fiebach JB, Fiehler J, Galinovic I, Puig J, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G, Cheng B. Influence of stroke infarct location on quality of life assessed in a multivariate lesion-symptom mapping study. Sci Rep 2021; 11:13490. [PMID: 34188114 PMCID: PMC8241844 DOI: 10.1038/s41598-021-92865-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/27/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.
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Affiliation(s)
- Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Andrew T DeMarco
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, USA
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anke Wouters
- Neurology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Neurologie der Rehaklinik Medical Park Humboldtmühle, An der Mühle 2-9, 13507, Berlin, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190, Salt, Girona, Spain
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, HeidelbergVictoria, VIC, 3084, Australia
- Department of Neurology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Oude Markt 13, Bus 5005, 3000, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Herestraat 49, Bus 602, 3000, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190, Salt, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, 8200, Aarhus, Denmark
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Lee YK, Gwak BC, Yoon BA, Kim DH, Cha JK. Atrial Cardiopathy Biomarkers and MRI-Based Infarct Patterns in Patients with Embolic Strokes of Undetermined Source. J Stroke Cerebrovasc Dis 2021; 30:105933. [PMID: 34157668 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/01/2021] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The study aimed to investigate whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration and/or left atrial volume index (LAVI), as atrial cardiopathy biomarkers, were associated with infarct patterns on diffusion-weighted imaging in patients with embolic strokes of undetermined source (ESUS). MATERIALS AND METHOD We retrospectively evaluated patient with ESUS from our stroke registry between January 2018 and November 2019. Cut-off values for atrial cardiopathy biomarkers were defined as >250 pg/mL for NT-proBNP and >34 mL/m2 for LAVI. Eligible patients were then assigned to 3 groups and infarct patterns were compared according to their atrial cardiopathy markers: Group 1 (no atrial cardiopathy markers), Group 2 (one marker), and Group 3 (both markers). RESULTS Among 194 eligible patients with ESUS (76 women; mean age, 69.2 years), simultaneous increases of NT-proBNP concentration and LAVI were identified in 39 (20.1%). Group 3 had a significantly larger infarct volume, relative to Group 1 and Group 2 (P=0.043) Multivariable logistic regression analyses revealed that these patients (Group 3) were significantly more likely to have multi-territorial infarcts (adjusted odds ratio [aOR]: 3.03, 95% confidence interval [CI]: 1.05-8.72; P=0.04), a maximal lesion diameter >15mm (aOR: 4.51, 95% CI: 1.70-11.93; P=0.001), and large cortical infarctions (aOR: 4.17, 95% CI: 1.75-9.96; P=0.001). CONCLUSION We found that simultaneously increased values for NT-proBNP concentration and LAVI were independently associated with multi-territorial and large cortical infarct patterns in patients with ESUS. These findings suggest that NT-proBNP and LAVI may be useful biomarkers for identifying cardioembolic subtypes and guiding treatment selection in patients with ESUS.
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Affiliation(s)
- Yoon-Kyung Lee
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea.
| | - Byung-Cheol Gwak
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea.
| | - Byeol-A Yoon
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea.
| | - Dae-Hyun Kim
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea.
| | - Jae-Kwan Cha
- Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea.
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10
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Yazawa Y, Itabashi R. Hypertrophic Pachymeningitis Related Brain Infarction in Synovitis-Acne-Pustulosis-Hyperostosis Osteomyelitis Syndrome. J Stroke Cerebrovasc Dis 2020; 30:105522. [PMID: 33307288 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/14/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022] Open
Abstract
A 50-year-old woman with a history of synovitis-acne-pustulosis-hyperostosis osteomyelitis (SAPHO) syndrome was admitted for left unilateral neglect, dysarthria, and left hemiparesis. Brain MRI showed multiple infarctions in the territory of the right middle cerebral artery and gadolinium enhancement of the thickened frontotemporal dura mater on the right side. MR angiography showed significant narrowing of the cavernous segment of the right internal carotid artery. The right internal carotid artery stenosis was thought to originate from hypertrophic pachymeningitis associated with SAPHO syndrome. This is the first report of brain infarction due to internal carotid artery stenosis caused by hypertrophic pachymeningitis associated with SAPHO syndrome.
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Affiliation(s)
- Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan.
| | - Ryo Itabashi
- Stroke Center, Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, Shiwa, Iwate, 028-3695, Japan
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11
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Wang K, Rong L, Wei X, Zhang Q. Analysis of Antiapoptosis Effect of Netrin-1 on Ischemic Stroke and Its Molecular Mechanism under Deleted in Colon Cancer/Extracellular Signal-Regulated Kinase Signaling Pathway. Biomed Res Int 2020; 2020:8855949. [PMID: 33274229 PMCID: PMC7683118 DOI: 10.1155/2020/8855949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
To analyze the regulatory effect of Netrin-1 in ischemic stroke and its influence on Deleted in Colon Cancer (DCC)/Extracellular Signal-regulated Kinase (ERK) signaling pathway, 20 male rats were selected to construct the rat model of middle cerebral artery occlusion (MCAO), 10 normal rats were selected as healthy controls (Normal Saline (NS)), and they were divided into the MCAO+Netrin-1 group, MCAO group, and NS group according to different treatment schemes. The positive expression of Netrin-1 was detected by immunostaining, magnetic resonance imaging (MRI) was adopted to detect the percentage of rat cerebral infarct volume in the cerebral hemispheres, and Modified Neurological Severity Score (mNSS) was adopted to evaluate postoperative neurological function in rats. Besides, a tunnel staining experiment was applied to detect the apoptosis rate of rat neurons, the sticker removal test was applied to evaluate the postoperative sensory function of rats, and fluorescence staining was adopted to detect the expression of DCC and ERK in rats. The results showed that the percentage of cerebral infarction volume in the cerebral hemispheres of the MCAO+Netrin-1 group was higher than that of the MCAO and NS groups (P < 0.05); in the MCAO+Netrin-1 group, the MCAO mNSS scoring and the time spent in the sticker removal test were lower than the MCAO group (P < 0.05); the apoptosis rate of rats in the MCAO+Netrin-1 group was lower than that in the MCAO group (P < 0.05); the average fluorescence intensity of DCC and p-ERK in the MCAO+Netrin-1 group was higher than that in the MCAO group (P < 0.05); the average fluorescence intensity of p-ERK in the MCAO+Netrin-1 group was higher than that in the MCAO group (P < 0.05). In short, Netrin-1 can effectively reduce the brain tissue damage in rats with ischemic stroke, improve the nerve function and sensory function of rats, and inhibit neuronal cell apoptosis. Netrin-1 can promote DCC expression and ERK phosphorylation, and the EPK signaling pathway may be involved in the antiapoptotic effect of Netrin-1.
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Affiliation(s)
- Kai Wang
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
| | - Xiu'e Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
| | - Qingxiu Zhang
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
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12
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Mahawish KM, Cariga P. Multi-territory infarcts caused by intracranial giant cell arteritis. N Z Med J 2020; 133:129-131. [PMID: 33119577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Karim M Mahawish
- Consultant in General Medicine and Stroke, Department of Internal Medicine, Midcentral DHB, Palmerston North Hospital
| | - Pietro Cariga
- Consultant Neurologist, Department of Neurology, Midcentral DHB, Palmerston North Hospital
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13
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Abstract
RATIONALE Acute ischemic stroke (AIS) is one of the most severe diseases that endanger human health. It is very common among middle-aged and elderly people, but it is rare in children. The treatment varies among children and adults, since the cause for AIS in children differs from that in adults. In adults with AIS, endovascular therapy has been recommended, but guidelines for endovascular therapy in children with AIS have not been established yet. In China, few relevant evidence is present so far in clinical research of mechanical thrombectomy in the treatment for children with AIS. PATIENT CONCERNS A 12-year-old boy without any special physical collision and trauma was admitted to emergency department of Changsha central hospital due to hemiplegia of left limbs for 3 hours. DIAGNOSES He was diagnosed with AIS after magnetic resonance imaging (MRI) examination and magnetic resonance angiography (MRA) examination. Cerebral infarction in the right parietal, temporal, insular, and frontal lobes was revealed by the MRI test. The MRA test detected occlusions in right internal carotid artery, A1 segment of right anterior cerebral artery, right middle cerebral artery, and distal branch. INTERVENTIONS Mechanic thrombectomy and antiplatelet aggregation therapy with clopidogrel helped the patient to recover, along with active rehabilitation training. OUTCOMES A significant improvement in muscle strength of his left limbs was proved. He walked by himself and had 2 of Modified Rankin Scale (MRS). At 1-year follow-up visit, he recovered well except feeling a bit pain of left lower limb when walking, with finally MRS of 1. CONCLUSIONS Mechanical thrombectomy can be performed safely for children with AIS, but needs a further research with large samples.
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Affiliation(s)
- Yuchai Huang
- Emergency Department of Changsha Central Hospital
| | - Zhen Wang
- Neurology Department of Changsha Central Hospital, Changsha, Hunan Province, China
| | - Changluo Li
- Emergency Department of Changsha Central Hospital
| | - Ning Ding
- Emergency Department of Changsha Central Hospital
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14
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Mitsui T, Yoda K, Harada M. Monochorea in chronic cerebral hypoperfusion with dopaminergic transmission disruption. Acta Neurol Belg 2020; 120:483-485. [PMID: 29663260 DOI: 10.1007/s13760-018-0921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Takao Mitsui
- Department of Neurology, Tokushima National Hospital, National Hospital Organization, 1354 Shikiji, Kamojima-cho, Yoshinogawa City, Tokushima, 776-0031, Japan.
- Department of Clinical Research, Tokushima National Hospital, National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, Tokushima, 776-0031, Japan.
| | - Keiji Yoda
- Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, 815-2 Shima, Ikeda-cho, Miyoshi City, Tokushima, 778-8503, Japan
| | - Masafumi Harada
- Department of Radiology, Institute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-3, Tokushima, 770-8503, Japan
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15
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Broocks G, Hanning U, Faizy TD, Scheibel A, Nawabi J, Schön G, Forkert ND, Langner S, Fiehler J, Gellißen S, Kemmling A. Ischemic lesion growth in acute stroke: Water uptake quantification distinguishes between edema and tissue infarct. J Cereb Blood Flow Metab 2020; 40:823-832. [PMID: 31072174 PMCID: PMC7168794 DOI: 10.1177/0271678x19848505] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 01/25/2019] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 01/31/2023]
Abstract
Infarct growth from the early ischemic core to the total infarct lesion volume (LV) is often used as an outcome variable of treatment effects, but can be overestimated due to vasogenic edema. The purpose of this study was (1) to assess two components of early lesion growth by distinguishing between water uptake and true net infarct growth and (2) to investigate potential treatment effects on edema-corrected net lesion growth. Sixty-two M1-MCA-stroke patients with acute multimodal and follow-up CT (FCT) were included. Ischemic lesion growth was calculated by subtracting the initial CTP-derived ischemic core volume from the LV in the FCT. To determine edema-corrected net lesion growth, net water uptake of the ischemic lesion on FCT was quantified and subtracted from the volume of uncorrected lesion growth. The mean lesion growth without edema correction was 20.4 mL (95% CI: 8.2-32.5 mL). The mean net lesion growth after edema correction was 7.3 mL (95% CI: -2.1-16.7 mL; p < 0.0001). Lesion growth was significantly overestimated due to ischemic edema when determined in early-FCT imaging. In 18 patients, LV was lower than the initial ischemic core volume by CTP. These apparently "reversible" core lesions were more likely in patients with shorter times from symptom onset to imaging and higher recanalization rates.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Scheibel
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and
Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D Forkert
- Department of Radiology, Hotchkiss Brain
Institute, University of Calgary, Calgary, Canada
| | - Soenke Langner
- Department of Neuroradiology, University of
Rostock, Rostock, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional
Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andre Kemmling
- Department of Neuroradiology, University
Hospital Schleswig-Holstein, Luebeck, Germany
- Department of Neurology, University Hospital
Münster, Münster, Germany
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16
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Grosser M, Gellißen S, Borchert P, Sedlacik J, Nawabi J, Fiehler J, Forkert ND. Improved multi-parametric prediction of tissue outcome in acute ischemic stroke patients using spatial features. PLoS One 2020; 15:e0228113. [PMID: 31978179 PMCID: PMC6980585 DOI: 10.1371/journal.pone.0228113] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction In recent years, numerous methods have been proposed to predict tissue outcome in acute stroke patients using machine learning methods incorporating multiparametric imaging data. Most methods include diffusion and perfusion parameters as image-based parameters but do not include any spatial information although these parameters are spatially dependent, e.g. different perfusion properties in white and gray brain matter. This study aims to investigate if including spatial features improves the accuracy of multi-parametric tissue outcome prediction. Materials and methods Acute and follow-up multi-center MRI datasets of 99 patients were available for this study. Logistic regression, random forest, and XGBoost machine learning models were trained and tested using acute MR diffusion and perfusion features and known follow-up lesions. Different combinations of atlas coordinates and lesion probability maps were included as spatial information. The stroke lesion predictions were compared to the true tissue outcomes using the area under the receiver operating characteristic curve (ROC AUC) and the Dice metric. Results The statistical analysis revealed that including spatial features significantly improves the tissue outcome prediction. Overall, the XGBoost and random forest models performed best in every setting and achieved state-of-the-art results regarding both metrics with similar improvements achieved including Montreal Neurological Institute (MNI) reference space coordinates or voxel-wise lesion probabilities. Conclusion Spatial features should be integrated to improve lesion outcome prediction using machine learning models.
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Affiliation(s)
- Malte Grosser
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
- * E-mail:
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Patrick Borchert
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Nils Daniel Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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17
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Junjappanavar AS, Chandrashekhar KV. Silent Brain Infarcts in Patients with Non Specific Neurological Symptoms. J Assoc Physicians India 2020; 68:59. [PMID: 31979633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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18
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Cheng CW, Feng CM, Chua CS. Invasive pyogenic infection and infective endocarditis due to Streptococcus anginosus: A case report. Medicine (Baltimore) 2019; 98:e18156. [PMID: 31770258 PMCID: PMC6890317 DOI: 10.1097/md.0000000000018156] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.
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Affiliation(s)
- Chiao-Wen Cheng
- Department of Transportation and Logistics Management, National ChiaoTung University, Taipei, Taiwan
| | - Cheng-Min Feng
- Department of Transportation and Logistics Management, National ChiaoTung University, Taipei, Taiwan
| | - Chian Sem Chua
- Physician, Gastroenterologist & Hepatologist, Western Medicine Division, Hospital Lam Wah Ee, Malaysia
- Department of Medicine, Penang Medical College, Penang, Malaysia
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Affiliation(s)
- Soyoun Choi
- Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chaewon Shin
- Department of Neurology, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea
| | - Tae-Beom Ahn
- Kyung Hee University College of Medicine, Seoul, Republic of Korea.
- Department of Neurology, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea.
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Abstract
PURPOSE OF REVIEW Subclinical cerebrovascular disease (sCVD) is highly prevalent in older adults. The main neuroimaging findings of sCVD include white matter hyperintensities and silent brain infarcts on T2-weighted MRI and cerebral microbleeds on gradient echo or susceptibility-weighted MRI. In this paper, we will review the epidemiology of sCVD, the current evidence for best medical management, and future directions for sCVD research. RECENT FINDINGS Numerous epidemiologic studies show that sCVD, in particular WMH, is an important risk factor for the development of dementia, stroke, worse outcomes after stroke, gait instability, late-life depression, and death. Effective treatment of sCVD could have major consequences for the brain health of a substantial portion of older Americans. Despite the link between sCVD and many vascular risk factors, such as hypertension or hyperlipidemia, the optimal medical treatment of sCVD remains uncertain. Given the clinical equipoise about the risk versus benefit of aggressive medical management for sCVD, clinical trials to examine pragmatic, evidence-based approaches to management of sCVD are needed. Such a trial could provide much needed guidance on how to manage a common clinical scenario facing internists and neurologists in practice.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Chelsea Meyer
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - J Scott McNally
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Lee Chung
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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Yusuke S, Norio H, Tomoko M, Shunichi M, Koichi U, Takayuki S, Haruyuki W, Toshihiro O, Akio O, Yoshito T. Voxel-based morphometry analysis of double inversion-recovery magnetic resonance imaging for detecting microscopic lesions: a simulation study. Radiol Phys Technol 2019; 12:149-155. [PMID: 30796738 DOI: 10.1007/s12194-019-00501-1] [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: 07/20/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Abstract
Double inversion-recovery (DIR) imaging has the potential to improve the detection of subcortical lesions through the use of voxel-based morphometry (VBM) analysis. The aim of this study was to clarify the characteristics of detectable lesions by performing a VBM analysis on DIR images of simulated lesions. Twenty healthy volunteers underwent magnetic resonance imaging using a head three-dimensional DIR sequence. The images were processed using SPM12; then, the selected images with simulated lesions were analyzed via VBM. The VBM results were evaluated using free-response receiver-operating characteristic curves and a receiver-operating characteristic analysis. The sensitivity was 100% (5/5), with 5.6 false-positive objects per case, in simulated lesions with a contrast of 0.6 and a size of 2.4 mm. The sensitivity was 80% (4/5), with 5.4 false-positive objects per case, in simulated lesions with a contrast of 0.5 and a size of 2.4 mm. The mean area under the curve value was increased from 0.783 to 0.883 using VBM, with a statistically significant difference (p < 0.01). The VBM analysis of the DIR images using SPM alone showed the potential to detect subcortical microscopic lesions. Early detection of Alzheimer's disease may be possible by adapting VBM in the clinical setting.
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Affiliation(s)
- Sato Yusuke
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki, Maebashi, Gunma, 371-0052, Japan.
| | - Hayashi Norio
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Maruyama Tomoko
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki, Maebashi, Gunma, 371-0052, Japan
| | | | - Ujita Koichi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Suto Takayuki
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Watanabe Haruyuki
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Ogura Toshihiro
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Ogura Akio
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Tsushima Yoshito
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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22
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Hur W, Kim BJ, Shin BS, Kang HG. Discrepancy between perfusion- and diffusion-weighted images in ischemic stroke: A case report. Medicine (Baltimore) 2018; 97:e13894. [PMID: 30593199 PMCID: PMC6314731 DOI: 10.1097/md.0000000000013894] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE With the development of multi-slice computed tomography (CT) technology, perfusion CT angiography (p-CTA) is now widely used for the diagnosis of acute cerebral infarction. Although p-CTA has the advantage of distinguishing between an ischemic penumbra and an infarct core, more research is needed with respect to its clinical use. PATIENT CONCERNS A healthy 36-year-old man experienced sudden dizziness while swimming. His dizziness persisted irrespective of the change in position, and then improved during transport. He had no neurological abnormality when he arrived at the emergency room. DIAGNOSES CT perfusion findings suggested left cerebellar infarction. P-CTA revealed a markedly delayed mean transit time, delayed time to peak, and increased cerebral blood volume in the left posterior inferior cerebellar artery territory at admission. However, the diffusion-weighted image (DWI) taken a few hours later revealed a large right cerebellar infarction. INTERVENTIONS Because of the time window, thrombolysis could not be performed and anti-platelet therapy was started. OUTCOMES Dysarthria and right-sided limb ataxia were newly developed before DWI (after p-CTA). Persistent foramen ovale was detected through transesophageal echography and identified as the cause of the stroke. LESSONS This case report suggests that dynamic image changes can occur within a short period of time depending on the vascular status and hemodynamic changes of the patients.
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Affiliation(s)
- Wook Hur
- Department of Neurology, Chosun University School of Medicine, Gwangju
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University School of Medicine, Seoul
| | - Byoung-Soo Shin
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, South Korea
| | - Hyun Goo Kang
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, South Korea
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Wang F, Hu XY, Wang T, Fang XM, Dai Z, Guo DL, Mao XQ, Cui ZM. Clinical and imaging features of vertebrobasilar dolichoectasia combined with posterior circulation infarction: A retrospective case series study. Medicine (Baltimore) 2018; 97:e13166. [PMID: 30508895 PMCID: PMC6283110 DOI: 10.1097/md.0000000000013166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to analyze the clinical and imaging features of vertebrobasilar dolichoectasia (VBD) combined with posterior circulation infarction, and to explore risk factors for the occurrence of posterior circulation infarction in VBD patients.VBD patients were divided into 2 groups, according to the results of the imaging examination: posterior circulation infarction group and nonposterior circulation infarction group. The demographics, vascular risk factors, imaging, and other clinical data of the VBD patients were collected and retrospectively compared, and the risk factors for the occurrence of posterior circulation infarction in VBD patients were analyzed. The relationship between imaging features of the VBD blood supply artery and the infarct site was also analyzed.A total of 56 VBD patients were included into the analysis. Among these patients, 26 patients had posterior circulation infarction. Infarction occurred in the blood supply area of the posterior cerebral artery in 14 patients. The difference in the height of the basilar artery bifurcation between patients with vertebrobasilar artery blood supply area infarction and patients with posterior cerebral artery supply area infarction was statistically significant. Hypertension and posterior circulation intracranial atherosclerosis were the risk factors for posterior circulation infarction in VBD patients.Elevated basilar artery bifurcation is a risk factor for infarction in the posterior cerebral artery supply area in VBD patients. Posterior circulation infarction in VBD may be the comprehensive result of multiple factors, such as congenital defects of the basilar artery wall, hypertension, and atherosclerotic lesions.
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Affiliation(s)
| | - Xiao-Yun Hu
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | | | - Xiang-Ming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | | | | | | | - Zhi-Ming Cui
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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24
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Mahawish KM. Cerebellar dysmetria treated using a wrist band. N Z Med J 2018; 131:84-86. [PMID: 30235196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Karim M Mahawish
- Consultant Physician, Older Persons Rehabilitations Unit, Rotorua Hospital, Bay of Plenty
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25
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Gardener H, Caunca M, Dong C, Cheung YK, Alperin N, Rundek T, Elkind MSV, Wright CB, Sacco RL. Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study. J Am Heart Assoc 2018; 7:e009544. [PMID: 30369305 PMCID: PMC6201403 DOI: 10.1161/jaha.118.009544] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022]
Abstract
Background The American Heart Association Life's Simple 7 metric defines ideal cardiovascular health (CVH) on 7 factors: smoking, diet, physical activity, body mass index, blood sugar, blood pressure, and cholesterol. This metric has been used to define optimal brain health, but data relative to subclinical imaging biomarkers of brain aging are lacking. This study examines the association between Life's Simple 7 with white matter hyperintensity volume, silent brain infarcts, and cerebral volume. Methods and Results A subsample of stroke-free participants from the population-based Northern Manhattan Study underwent brain magnetic resonance imaging an average of 7 years after baseline. Linear and logistic regression models were constructed to estimate associations between the number of ideal CVH metrics achieved with imaging biomarkers of brain aging, adjusting for sociodemographics. Among 1031 participants (mean age at magnetic resonance imaging=72±8, 40% men, 19% black, 16% white, and 65% Hispanic), no one had ideal status in all 7 factors, 1% had ideal status in 6 factors, 18% in 4 to 5 factors, 30% in 3 factors, 33% in 2 factors, and 18% in 0 to 1 factors. The number of ideal CVH factors achieved was inversely associated with white matter hyperintensity volume (beta per factor=-0.047; P=0.04) and silent brain infarct (odds ratio per factor=0.84; 95% confidence interval=0.72-0.97) and positively associated with cerebral volume (beta per factor=0.300; P=0.002). Conclusions An increasing ideal CVH score was associated with less white matter hyperintensity volume and silent brain infarcts and greater cerebral volumes, supporting the Life's Simple 7 metric as a useful measure to quantify optimal brain health. Monitoring and promoting achievement of Life's Simple 7 ideal CVH factors may improve subclinical and clinical brain health outcomes.
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Affiliation(s)
- Hannah Gardener
- Department of NeurologyUniversity of MiamiMiller School of MedicineMiamiFL
- Evelyn F. McKnight Brain InstituteUniversity of MiamiMiller School of MedicineMiamiFL
| | - Michelle Caunca
- Department of NeurologyUniversity of MiamiMiller School of MedicineMiamiFL
| | - Chuanhui Dong
- Department of NeurologyUniversity of MiamiMiller School of MedicineMiamiFL
- Evelyn F. McKnight Brain InstituteUniversity of MiamiMiller School of MedicineMiamiFL
| | - Ying Kuen Cheung
- Department of BiostatisticsMailman Public School of HealthColumbia UniversityNew YorkNY
| | - Noam Alperin
- Department of NeurologyUniversity of MiamiMiller School of MedicineMiamiFL
- Evelyn F. McKnight Brain InstituteUniversity of MiamiMiller School of MedicineMiamiFL
| | - Tatjana Rundek
- Department of NeurologyUniversity of MiamiMiller School of MedicineMiamiFL
- Evelyn F. McKnight Brain InstituteUniversity of MiamiMiller School of MedicineMiamiFL
| | - Mitchell S. V. Elkind
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | | | - Ralph L. Sacco
- Department of NeurologyUniversity of MiamiMiller School of MedicineMiamiFL
- Evelyn F. McKnight Brain InstituteUniversity of MiamiMiller School of MedicineMiamiFL
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Hui L, Shijun H, Tao L, Guoqiang W, Shixiong H. Bilateral thalamic and mesencephalic infarctions with hypopituitarism as long-term complications postradiotherapy: A case report. Medicine (Baltimore) 2018; 97:e11917. [PMID: 30142801 PMCID: PMC6113035 DOI: 10.1097/md.0000000000011917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Radiation is widely used as the first-line treatment for nasopharyngeal carcinoma (NPC) and improves survival. Nevertheless, radiation also places the patients at risk of radiation-induced adverse effects, such as transient ischemic attack, ischemic stroke, hypopituitarism, and cranial nerve and temporal lobe dysfunction. CASE REPORT A 54-year-old woman who had undergone radiation treatment for NPC 14 years earlier and had no cerebrovascular risk factors, visited our department 4 days after sudden onset of consciousness disturbance. Brain magnetic resonance imaging (MRI) revealed bilateral thalamic and left mesencephalic infarctions with empty sella. Meanwhile, MR angiography showed narrowing in the bilateral posterior cerebral artery. Furthermore, laboratory tests showed low total triiodothyronine (T3), thyroxine (T4), free T3, free T4, luteinizing hormone, estradiol, follicle-stimulating hormone, and serum natrium and normal thyroid-stimulating hormone, which indicated radiation-related hypopituitarism. Serologically, she had low hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, ferritin, and serum iron levels and elevated transferrin, manifesting microcytic anemia. The treatment, including aspirin, atorvastatin, levothyroxine, prednisone, saline infusion, and chalybeate, promoted the patient's recovery. CONCLUSION To our knowledge, this is the first report of bilateral thalamic and mesencephalic infarction together with hypopituitarism following radiotherapy for NPC.
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Caughey MC, Qiao Y, Windham BG, Gottesman RF, Mosley TH, Wasserman BA. Carotid Intima-Media Thickness and Silent Brain Infarctions in a Biracial Cohort: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens 2018; 31:869-875. [PMID: 29425278 PMCID: PMC6049000 DOI: 10.1093/ajh/hpy022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both hypertensive and atherosclerotic processes contribute to common carotid artery intima-media thickness (CCA-IMT). Elevated CCA-IMT may be indicative of subclinical cerebrovascular disease; however, its role in the absence of concomitant carotid artery plaque is uncertain, and few studies have examined associations in Black populations. MATERIALS AND METHODS At cohort visit 3 (1993-1995) a subset of stroke-free participants (641 Blacks and 702 Whites, mean age 63) from the Atherosclerosis Risk in Communities (ARIC) study was imaged by brain MRI and carotid ultrasound. A CCA-IMT >0.9 mm was considered elevated. Asymptomatic brain lesions ≥3 mm were considered silent brain infarctions (SBI). Subcortical SBI measuring 3 to <20 mm were considered lacunes. Associations between elevated CCA-IMT and SBI were analyzed with Poisson regression. RESULTS Elevated CCA-IMT was identified in 168 participants (16% of Blacks, 10% of Whites), and SBI were observed in 156 (15% of Blacks, 8% of Whites). Elevated CCA-IMT was strongly related to anterior circulation SBI, posterior circulation SBI, and lacunes. After adjustments, elevated CCA-IMT remained associated with greater number of lacunes in Blacks ([prevalence ratio, PR] = 1.60; 95% confidence interval [CI]: 1.02-2.51), but not Whites (PR = 0.85; 95% CI: 0.35-2.04); P value for interaction = 0.12. Among Black participants without concomitant carotid plaque, elevated CCA-IMT was associated with twice the number of lacunes (PR = 2.00; 95% CI: 1.05-3.82). CONCLUSIONS In older Black adults, elevated CCA-IMT is independently associated with lipohyalinosis of the cerebral small vessels, irrespective of concomitant carotid plaque and vascular risk factors.
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Affiliation(s)
- Melissa C Caughey
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ye Qiao
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Beverly Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Bruce A Wasserman
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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28
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Chi HY, Hsu CF, Chen AC, Su CH, Hu HH, Fu WM. Extracranial and Intracranial Ultrasonographic Findings in Posterior Circulation Infarction. J Ultrasound Med 2018; 37:1605-1610. [PMID: 29193196 DOI: 10.1002/jum.14501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/21/2017] [Revised: 08/21/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Patients with posterior circulation infarction are at higher risk of early recurrent stroke, especially those with vertebrobasilar stenosis or hypoplasia. The clinical presentations of this condition vary over a broad range, making diagnosis and treatment a challenge. Hemodynamic changes and stenosis detected by ultrasonography (US) are sensitive and important indicators for further evaluation. In this study, we correlated extracranial and intracranial US characteristics with brain magnetic resonance imaging (MRI) in patients with posterior circulation infarction. METHODS Inpatients with acute ischemic stroke who received both MRI and US were enrolled. Baseline characters, underlying disorders, the ischemic territory, and vascular stenosis on MRI were recorded. Series of US data, including flow volume, diameter, mean velocity, and pulsatility index, were analyzed. Patients with new infarction over the medulla, pons, midbrain, or cerebellum were enrolled as the posterior circulation infarction group. Patients with pure anterior circulation infarction were also enrolled. RESULTS A total of 210 patients with anterior circulation infarction (mean age ± SD, 66.24 ± 12.88 years) and 143 with posterior circulation infarction (mean age, 65.82 ± 11.39 years) were enrolled. Significant higher frequencies of vertebral artery hypoplasia and decreased intracranial vertebrobasilar velocity in the posterior circulation infarction group (44.75% and 64.33%, respectively) were documented (P < .0001; P = .035). Ischemic lesion distributions were correlated with vertebral artery hypoplasia (55.56 %) and low vertebral and basilar artery velocities (44.44% and 25.53%), as documented by US. A low vertebrobasilar velocity was highly correlated with MRI-documented vascular stenosis (53.06%). CONCLUSIONS Vertebral artery hypoplasia and a low velocity in the intracranial vertebrobasilar system on US might change the treatment of patients with posterior circulation infarction for primary and secondary prevention.
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Affiliation(s)
- Hsin-Yi Chi
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Pharmacological Institute, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Fu Hsu
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Su
- Department of Internal Medicine, Division of Cardiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Wen-Mei Fu
- Pharmacological Institute, College of Medicine, National Taiwan University, Taipei, Taiwan
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29
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Lee BC, Lin YH, Lee CW, Liu HM, Huang A. Prediction of Borderzone Infarction by CTA in Patients Undergoing Carotid Embolization for Carotid Blowout. AJNR Am J Neuroradiol 2018; 39:1280-1285. [PMID: 29773563 DOI: 10.3174/ajnr.a5672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Permanent common carotid artery and/or ICA occlusion is an effective treatment for carotid blowout syndrome. Besides postoperative thromboembolic infarction, permanent common carotid artery and/or ICA occlusion may cause borderzone infarction when the collateral flow to the deprived brain territory is inadequate. In this study, we aimed to test the predictive value of CTA for post-permanent common carotid artery and/or ICA occlusion borderzone infarction in patients with carotid blowout syndrome. MATERIALS AND METHODS In this retrospective study, we included 31 patients undergoing unilateral permanent common carotid artery and/or ICA occlusion for carotid blowout syndrome between May 2009 and December 2016. The vascular diameter of the circle of Willis was evaluated using preprocedural CTA, and the risk of borderzone infarction was graded as very high risk, high risk, intermediate risk, low risk, and very low risk. RESULTS The performance of readers' consensus on CTA for predicting borderzone infarction was excellent, with an area under receiver operating characteristic curve of 0.938 (95% confidence interval, 0.85-1.00). We defined very high risk, high risk, and intermediate risk as positive for borderzone infarction, the sensitivity, specificity, positive predictive value, and negative predictive value of CTA for borderzone infarction were 100% (7/7), 62.5% (15/24), 43.8% (7/16), and 100% (15/15), respectively. The interobserver reliability was excellent (κ = 0.807). No significant difference in the receiver operating characteristic curves was found between the 2 readers (P = .114). CONCLUSIONS CTA can be used to predict borderzone infarction after permanent common carotid artery and/or ICA occlusion by measuring the collateral vessels of the circle of Willis.
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Affiliation(s)
- B-C Lee
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-H Lin
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-W Lee
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-M Liu
- Department of Radiology (H.-M.L.), Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - A Huang
- Research Center for Adaptive Data Analysis (A.H.), National Central University, Jhongli, Taiwan
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30
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Lückl J, Lemale CL, Kola V, Horst V, Khojasteh U, Oliveira-Ferreira AI, Major S, Winkler MKL, Kang EJ, Schoknecht K, Martus P, Hartings JA, Woitzik J, Dreier JP. The negative ultraslow potential, electrophysiological correlate of infarction in the human cortex. Brain 2018; 141:1734-1752. [PMID: 29668855 PMCID: PMC5972557 DOI: 10.1093/brain/awy102] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 09/13/2017] [Revised: 01/20/2018] [Accepted: 02/17/2018] [Indexed: 12/19/2022] Open
Abstract
Spreading depolarizations are characterized by abrupt, near-complete breakdown of the transmembrane ion gradients, neuronal oedema, mitochondrial depolarization, glutamate excitotoxicity and activity loss (depression). Spreading depolarization induces either transient hyperperfusion in normal tissue; or hypoperfusion (inverse coupling = spreading ischaemia) in tissue at risk for progressive injury. The concept of the spreading depolarization continuum is critical since many spreading depolarizations have intermediate characteristics, as opposed to the two extremes of spreading depolarization in either severely ischaemic or normal tissue. In animals, the spreading depolarization extreme in ischaemic tissue is characterized by prolonged depolarization durations, in addition to a slow baseline variation termed the negative ultraslow potential. The negative ultraslow potential is initiated by spreading depolarization and similar to the negative direct current (DC) shift of prolonged spreading depolarization, but specifically refers to a negative potential component during progressive recruitment of neurons into cell death in the wake of spreading depolarization. We here first quantified the spreading depolarization-initiated negative ultraslow potential in the electrocorticographic DC range and the activity depression in the alternate current range after middle cerebral artery occlusion in rats. Relevance of these variables to the injury was supported by significant correlations with the cortical infarct volume and neurological outcome after 72 h of survival. We then identified negative ultraslow potential-containing clusters of spreading depolarizations in 11 patients with aneurysmal subarachnoid haemorrhage. The human platinum/iridium-recorded negative ultraslow potential showed a tent-like shape. Its amplitude of 45.0 (39.0, 69.4) mV [median (first, third quartile)] was 6.6 times larger and its duration of 3.7 (3.3, 5.3) h was 34.9 times longer than the negative DC shift of spreading depolarizations in less compromised tissue. Using Generalized Estimating Equations applied to a logistic regression model, we found that negative ultraslow potential displaying electrodes were significantly more likely to overlie a developing ischaemic lesion (90.0%, 27/30) than those not displaying a negative ultraslow potential (0.0%, 0/20) (P = 0.004). Based on serial neuroimages, the lesions under the electrodes developed within a time window of 72 (56, 134) h. The negative ultraslow potential occurred in this time window in 9/10 patients. It was often preceded by a spreading depolarization cluster with increasingly persistent spreading depressions and progressively prolonged DC shifts and spreading ischaemias. During the negative ultraslow potential, spreading ischaemia lasted for 40.0 (28.0, 76.5) min, cerebral blood flow fell from 57 (53, 65) % to 26 (16, 42) % (n = 4) and tissue partial pressure of oxygen from 12.5 (9.2, 15.2) to 3.3 (2.4, 7.4) mmHg (n = 5). Our data suggest that the negative ultraslow potential is the electrophysiological correlate of infarction in human cerebral cortex and a neuromonitoring-detected medical emergency.awy102media15775596049001.
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Affiliation(s)
- Janos Lückl
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Coline L Lemale
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vasilis Kola
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Viktor Horst
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uldus Khojasteh
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ana I Oliveira-Ferreira
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maren K L Winkler
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eun-Jeung Kang
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karl Schoknecht
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Jed A Hartings
- UC Gardner Neuroscience Institute, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
- Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
| | - Johannes Woitzik
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Berlin, Germany
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Miyata M, Kakeda S, Yoneda T, Ide S, Watanabe K, Moriya J, Korogi Y. Signal Change of Acute Cortical and Juxtacortical Microinfarction on Follow-Up MRI. AJNR Am J Neuroradiol 2018; 39:834-840. [PMID: 29599171 DOI: 10.3174/ajnr.a5606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Although the clinical importance of cortical microinfarcts has become well-recognized recently, the evolution of cortical microinfarcts on MR imaging is not fully understood. The aim of this study was to examine the temporal changes in acute cortical microinfarcts using susceptibility-weighted imaging and conventional MR imaging. MATERIALS AND METHODS Patients with acute infarcts located in the cortical and/or juxtacortical region measuring ≤10 mm in axial diameter based on diffusion-weighted imaging who had a follow-up 3T MR imaging were retrospectively included in the study. All lesions did not show hypointensity on initial T2*WI. For cortical and/or juxtacortical microinfarcts detected on initial DWI, 2 neuroradiologists evaluated the follow-up MR imaging (T2WI, FLAIR, T2*WI, and SWI) and assessed lesion signal intensities and locations (cortical microinfarcts or microinfarcts with juxtacortical white matter involvement). RESULTS On initial DWI, 2 radiologists observed 180 cortical and/or juxtacortical microinfarcts in 35 MR imaging examinations in 25 patients; on follow-up, the neuroradiologists identified 29 cortical microinfarcts (16%) on T2WI, 9 (5%) on FLAIR, 4 (2%) on T2*, and 97 (54%) on SWI. All cortical microinfarcts detected with any follow-up MR imaging showed hyperintensity on T2WI/FLAIR and/or hypointensity on T2*WI and SWI. CONCLUSIONS SWI revealed conversion (paramagnetic susceptibility changes) of acute cortical microinfarcts, suggesting that a substantial number of cortical microinfarcts may contain hemorrhagic components.
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Affiliation(s)
- M Miyata
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - S Kakeda
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - T Yoneda
- Department of Medical Physics in Advanced Biomedical Sciences (T.Y.), Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - S Ide
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - K Watanabe
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - J Moriya
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Y Korogi
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Rincón M, Díaz-López E, Selnes P, Vegge K, Altmann M, Fladby T, Bjørnerud A. Improved Automatic Segmentation of White Matter Hyperintensities in MRI Based on Multilevel Lesion Features. Neuroinformatics 2018; 15:231-245. [PMID: 28378263 DOI: 10.1007/s12021-017-9328-y] [Citation(s) in RCA: 12] [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: 11/25/2022]
Abstract
Brain white matter hyperintensities (WMHs) are linked to increased risk of cerebrovascular and neurodegenerative diseases among the elderly. Consequently, detection and characterization of WMHs are of significant clinical importance. We propose a novel approach for WMH segmentation from multi-contrast MRI where both voxel-based and lesion-based information are used to improve overall performance in both volume-oriented and object-oriented metrics. Our segmentation method (AMOS-2D) consists of four stages following a "generate-and-test" approach: pre-processing, Gaussian white matter (WM) modelling, hierarchical multi-threshold WMH segmentation and object-based WMH filtering using support vector machines. Data from 28 subjects was used in this study covering a wide range of lesion loads. Volumetric T1-weighted images and 2D fluid attenuated inversion recovery (FLAIR) images were used as basis for the WM model and lesion masks defined manually in each subject by experts were used for training and evaluating the proposed method. The method obtained an average agreement (in terms of the Dice similarity coefficient, DSC) with experts equivalent to inter-expert agreement both in terms of WMH number (DSC = 0.637 vs. 0.651) and volume (DSC = 0.743 vs. 0.781). It allowed higher accuracy in detecting WMH compared to alternative methods tested and was further found to be insensitive to WMH lesion burden. Good agreement with expert annotations combined with stable performance largely independent of lesion burden suggests that AMOS-2D will be a valuable tool for fully automated WMH segmentation in patients with cerebrovascular and neurodegenerative pathologies.
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Affiliation(s)
- M Rincón
- Department of Artificial Intelligence, UNED, Madrid, Spain.
| | - E Díaz-López
- Department of Artificial Intelligence, UNED, Madrid, Spain
| | - P Selnes
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - K Vegge
- Department of Radiology, Akershus University Hospital, Oslo, Norway
| | - M Altmann
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - T Fladby
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - A Bjørnerud
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
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Bacchin R, Macchione F, Cardellini D, Orlandi R, Gajofatto A, Zanusso G, Vattemi G. Levofloxacin-induced hemichorea-hemiballism in a patient with previous thalamic infarction. Neurol Sci 2018; 39:1483-1485. [PMID: 29511961 DOI: 10.1007/s10072-018-3298-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ruggero Bacchin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Francesco Macchione
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Davide Cardellini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Riccardo Orlandi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Gaetano Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Song D, Yoo J, Baek JH, Kim J, Lee HS, Kim YD, Nam HS, Heo JH. Infarct Core Expansion on Computed Tomography before and after Intravenous Thrombolysis. Yonsei Med J 2018; 59:310-316. [PMID: 29436201 PMCID: PMC5823835 DOI: 10.3349/ymj.2018.59.2.310] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Infarct core can expand rapidly in acute stroke patients receiving intravenous tissue plasminogen activator (IV t-PA). We investigated changes in the extent of infarct core during IV t-PA treatment, and explored the associative factors of this infarct core expansion in patients with proximal artery occlusion. MATERIALS AND METHODS We included patients who were considered for sequential intra-arterial therapy (IAT) due to occlusion of intracranial proximal artery after IV t-PA. Patients who had a baseline Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) ≥6 and who underwent two consecutive CT scans before and shortly after IV t-PA infusion were enrolled. Patients were classified into no, moderate, and marked expansion groups based on decreases in ASPECTS (0-1, 2-3, and ≥4, respectively) on follow-up CT. Collateral status was graded using CT angiography. RESULTS Of the 104 patients, 16 (15.4%) patients showed moderate and 13 (12.5%) patients showed marked infarct core expansion on follow-up CT scans obtained at 71.1±19.1 min after baseline CT scan. Sixteen (15.4%) patients had an ASPECTS value <6 on the follow-up CT. None of the patients with marked expansion were independent at 3 months. Univariate analysis and ordinal logistic regression analysis demonstrated that the infarct core expansion was significantly associated with collateral status (p<0.001). CONCLUSION Among patients who were considered for IAT after IV t-PA treatment, one out of every seven patients exhibited marked expansion of infarct core on follow-up CT before IAT. These patients tend to have poor collaterals and poor outcomes despite rescue IAT.
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Affiliation(s)
- Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jang Hyun Baek
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jinkwon Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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Abdelhamid N, Farooq S, Sarraj A. Acute Ischemic Stroke in a Young Woman With No Known Risk Factors. WMJ 2018; 117:42-44. [PMID: 29677415] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION We aim to highlight a potentially morbid consequence of foam-sclerotherapy for the treatment of varicose veins. CASE REPORT We report a case of a 41-year-old woman with no significant medical history who presented to the emergency department with sudden onset of focal neurologic deficits. She had undergone varicose vein treatment with foam sclerotherapy 2 days prior. Magnetic resonance imaging of the brain showed acute cerebellar infarct. Computed tomography angiography was unremarkable. Transesophageal echocardiography showed the presence of a very small patent foramen ovale. DISCUSSION Transient neurologic symptoms reported in patients undergoing venous foam sclerotherapy might have been transient ischemic attacks or acute ischemic strokes. The risk of these neurologic complications should be explained to all patients undergoing foam sclerotherapy so they can make an informed decision of screening echocardiography prior to the procedure. CONCLUSION Onset of neurologic symptoms can be immediate or delayed in patients undergoing venous foam sclerotherapy. Early recognition of neurologic deficits resulting from paradoxical gas embolism and its treatment with hyperbaric oxygen can prevent permanent disability.
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Affiliation(s)
- Noureldin Abdelhamid
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Salman Farooq
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas,
| | - Amrou Sarraj
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Dhamoon MS, Cheung YK, Gutierrez J, Moon YP, Sacco RL, Elkind MSV, Wright CB. Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. Stroke 2018; 49:549-555. [PMID: 29374104 PMCID: PMC5911688 DOI: 10.1161/strokeaha.117.019595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories. METHODS A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables. RESULTS Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant. CONCLUSIONS PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.
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Affiliation(s)
- Mandip S Dhamoon
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.).
| | - Ying-Kuen Cheung
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Jose Gutierrez
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Yeseon P Moon
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
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Abstract
An 84-year-old man presented to the emergency department following recurrent falls over several weeks and onset of new left-sided weakness. CT of the brain revealed a large air cavity (pneumatocoele) in the right frontal lobe thought to be secondary to an ethmoidal osteoma communicating through the cribriform plate allowing air to be forced into the skull under pressure. Subsequent MRI confirmed these findings and also revealed a small focal area of acute infarction in the adjacent corpus callosum. The patient had a prolonged hospital stay, declined neurosurgical intervention and was discharged home on secondary stroke prevention.
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Affiliation(s)
- Finlay Brown
- General Practice, Northern Ireland Medical and Dental Training Agency, Belfast, UK
| | - Djamil Vahidassr
- Care of The Elderly and Stroke, Antrim Area Hospital, Antrim, Co Antrim, UK
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Yin ZG, Wang QS, Yu K, Wang WW, Lin H, Yang ZH. Sex differences in associations between blood lipids and cerebral small vessel disease. Nutr Metab Cardiovasc Dis 2018; 28:28-34. [PMID: 29162363 DOI: 10.1016/j.numecd.2017.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 11/24/2016] [Revised: 07/31/2017] [Accepted: 10/01/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Dyslipidemia predicts higher risk of coronary events and stroke and might be associated with cerebral small vessel disease (SVD). Previous studies linking blood lipids and SVD have yielded inconsistent results, which may be attributable to sex differences in lipids metabolism. The aim of this study was to investigate the relationships between blood lipids and SVD in neurologically healthy men and women. METHODS AND RESULTS Consecutive 817 people aged 50 years or more were enrolled and underwent magnetic resonance imaging scans to evaluate the periventricular white matter lesions (PVWMLs), deep white matter lesions (DWMLs) and silent brain infarction (SBI). Fasting total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, apolipoprotein A-1 (apoA-1) and apolipoprotein B were assessed. Multivariable logistic regression analyses were performed to determine the associations of blood lipids with PVWMLs, DWMLs and SBI. HDL-C (for PVWMLs: OR 0.36, 95% CI 0.19-0.71; for DWMLs: OR 0.35, 95% CI 0.20-0.63) and apoA-1 (for PVWMLs: OR 0.27, 95% CI 0.11-0.66; for DWMLs: OR 0.22, 95% CI 0.10-0.48) were inversely associated with the severity of PVWMLs and DWMLs in women but not in men after adjustment for age, hypertension, diabetes, current smoking, daily drinking, body mass index and uric acid. Additionally, no blood lipids were significantly associated with SBI. CONCLUSIONS Our findings demonstrate that sex differences may exist in the associations between lipids and SVD. HDL-C and apoA-1 levels were inversely associated with the severity of PVWMLs and DWMLs in women.
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Affiliation(s)
- Z-G Yin
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Q-S Wang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China.
| | - K Yu
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - W-W Wang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - H Lin
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Z-H Yang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
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Emboli shower: Beware of the catastrophe!! J Paediatr Child Health 2018; 54:100. [PMID: 29314391 DOI: 10.1111/jpc.2_13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 11/30/2022]
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Tsur A, Deeb M, Shakeer N, Zangaria H, Agra M. Severe cognitive Disorders after Bilateral Infarction in the Cerebellum. Isr Med Assoc J 2017; 19:779-780. [PMID: 29235743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Atzmon Tsur
- Department of Rehabilitation, Galilee Medical Center, Nahariya, Israel
- Bar Ilan University Faculty of Medicine in the Galilee, Safed, Israel
| | - Marina Deeb
- Department of Rehabilitation, Galilee Medical Center, Nahariya, Israel
| | - Nael Shakeer
- Department of Rehabilitation, Galilee Medical Center, Nahariya, Israel
| | - Hossein Zangaria
- Department of Rehabilitation, Galilee Medical Center, Nahariya, Israel
| | - Michal Agra
- Institute of Occupational Therapy, Galilee Medical Center, Nahariya, Israel
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Abstract
RATIONALE Holmes' tremor is an uncommon neurologic disorder following brain insults, and its pathogenesis is undefined. The interruption of the dento-rubro-thalamic tract and secondary deterioration of the nigrostriatal pathway are both required to initiate Holmes' tremor. We used nuclear medicine imaging tools to analyze a patient with concurrent infarction in different zones of each side of the thalamus. Finding whether the paramedian nuclear groups of the thalamus were injured was a decisive element for developing Holmes' tremor. PATIENT CONCERNS A 36-year-old woman was admitted to our department due to a bilateral paramedian thalamic infarction. Seven months after the stroke, a unilaterally involuntary trembling with irregularly wavering motions occurring in both her left hand and forearm. DIAGNOSIS Based on the distinct features of the unilateral coarse tremor and the locations of the lesions on the magnetic resonance imaging (MRI), the patient was diagnosed with bilateral paramedian thalamic infarction complicated with a unilateral Holmes' tremor. INTERVENTIONS The patient refused our recommendation of pharmacological treatment with levodopa and other dopamine agonists based on personal reasons and was only willing to accept physical and occupational training programs at our outpatient clinic. OUTCOMES We utilized serial anatomic and functional neuroimaging of the brain to survey the neurologic deficit. A brain magnetic resonance imaging showed unequal recovery on each side of the thalamus. The residual lesion appeared larger in the right-side thalamus and had gathered in the paramedian area. A brain perfusion single-photon emission computed tomography (SPECT) revealed that the post-stroke hypometabolic changes were not only in the right-side thalamus but also in the right basal ganglion, which was anatomically intact. Furthermore, the brain Technetium-99m-labeled tropanes as a dopamine transporter imaging agents scan ( Tc-TRODAT-1) displayed a secondary reduction of dopamine transporters in the right nigrostriatal pathway which had resulted from the damage on the paramedian nuclear groups of the right-side thalamus. LESSONS Based on the functional images, we illustrated that a retrograde degeneration originating from the thalamic paramedian nuclear groups, and extending forward along the direct innervating fibers of the mesothalamic pathway, played an essential role towards initiating Holmes' tremor.
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Affiliation(s)
| | | | - Yu-Chun Lee
- Department of Pediatrics and Child Health Care, Taichung Veterans General Hospital, Taichung
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Delva M, Delva I. NEUROIMAGING CHARACTERISTICS AND POST-STROKE FATIGUE WITHIN THE FIRST 6 MONTHS AFTER ISCHEMIC STROKES. Georgian Med News 2017:91-95. [PMID: 29099708] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aim - identify neuroimaging characteristics associated with different post-stroke fatigue (PSF) domains within first 6 months after ischemic strokes. There were enrolled in the study 107 patients with acute ischemic strokes. General PSF and certain PSF domains (global, physical, mental, motivational, activity-related) were measured by multidimensional fatigue inventory-20 (MFI-20) scale at hospital stay, in 1, 3 and 6 months after stroke occurrence. Brain MRI studies included cerebral infarct localization, planimetric measurements of infarct volumes, measurement of brain atrophy indexes (bifrontal, bicaudate, cortical atrophy indexes, width of third ventricle) and evaluation of leukoaraiosis severity, according to Fazekas scale. In univariate logistic regression analysis infarcts volumes as well as brain atrophy indexes were not significantly associated with risk of any PSF domain at any time points within first 6 months after ischemic strokes. On the other hand, it had been found reliable associations between subcortical infarcts and increased risk of PSF domains which are related just to physical activity (physical PSF, activity-related PSF) in 1 month after stroke onset and later, as well as reliable associations between infratentorial infarcts and risk of global PSF domain in 3 months after stroke and later. Moreover, it have been revealed significant direct associations between severity of white matter lesions and risk of mental PSF in 3 months after stroke onset and later. Subcortical infarcts may be risk factors for development of physical PSF domain, infratentorial infarcts - risk factors for development of global PSF domain, leukoaraiosis extension - risk factor for development of mental PSF domain but not early than 1 month after stroke occurrence.
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Affiliation(s)
- M Delva
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - I Delva
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
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Abstract
RATIONALE A 33-year-old male presented with complete weakness of the right extremities due to corona radiata infarct. PATIENT CONCERNS The main concerns of the patient is recovery of hand function especially related to finger extension. DIAGNOSES Right corona radiata infarct. INTERVENTIONS He underwent physical therapy and occupational therapy at the outpatient clinic of the rehabilitation department of the same university hospital until 2 years after onset. In addition, he underwent neuromuscular electrical stimulation for the right finger extensors continuously until 4 years after onset. OUTCOMES At 6 months after onset, the weakness of his right side recovered to subnormal state except for the right finger extensors which were completely weak. At 1.5 years after onset, the right finger extensors began to show slow and continuous recovery. At 4 years after onset, the patient showed motor recovery in the right finger extensors to the extent that he was able to move against gravity. Discontinuation of the left corticospinal tract was observed on 2-month diffusion tensor tractography (DTT); however, the integrity of this discontinuation had recovered to the primary motor cortex on 4-year DTT. On 2-month transcranial magnetic stimulation (TMS), no motor-evoked potential was evoked; in contrast, motor-evoked potentials were obtained at the right-hand muscle on 4-year TMS study. LESSONS We demonstrated unusual delayed and long-term recovery of the affected finger extensors in a patient with corona radiata infarct using DTT and TMS.
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Yanagiha K, Ishii K, Ueno T, Marushima A, Tamaoka A. Medial medullary infarction caused by antineutrophil cytoplasmic antibody-related vasculitis: Case report and review of the literature. Medicine (Baltimore) 2017; 96:e7722. [PMID: 28816948 PMCID: PMC5571685 DOI: 10.1097/md.0000000000007722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Medial medullary infarction accounts for less than 1% of brain infarctions, and medial medullary infarctions is very rarely caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. PATIENT CONCERNS We report the case of a 76-year-old man at low risk of arteriosclerosis who presented with disorders on the left side including gaze-evoked nystagmus, paralysis of the extremities, pyramidal signs, sensory disturbance, and dysesthesia. Brain magnetic resonance imaging also showed right medial medullary infarction. DIAGNOSES Medial medullary infarction caused by ANCA-related vasculitis was diagnosed based on mild renal dysfunction and high levels of blood leukocytes, C-reactive protein (CRP), and myeloperoxidase (MPO)-ANCA. INTERVENTIONS AND OUTCOMES He underwent two 3-day courses of steroid pulse therapy involving daily 1000 mg doses of methylpredonine. He then received 30 mg/day (0.5 mg/kg/day) of prednisolone (PSL) without other immunosuppressants. Levels of MPO-ANCA and the inflammatory marker CRP decreased rapidly a month after admission. Once MPO-ANCA became undetectable, the PSL dose was carefully reduced to 10 mg/day. To treat his paralysis, we provided rehabilitation with a Hybrid Assistive Limb five times starting at a month post-onset. His Barthel index score rose from 45 to 70 points. LESSONS Medullary infarction is mostly caused by arteriosclerosis and vertebral arterial dissection. When systemic inflammatory findings are obtained, ANCA-associated vasculitis should be considered a potential cause, and steroid pulse therapy should be promptly administered.
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Affiliation(s)
| | | | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital
| | - Aiki Marushima
- Department of Emergency and Critical Care Medicine, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Abstract
RATIONALE Several studies using diffusion tensor tractography (DTT) have reported on injury in the dentato-rubro-thalamic tract (DRTT) in patients with brain injury. However, there is no study of injury in the DRTT following cerebellar infarct. We report on patients with injury in the DRTT following cerebellar infarct, demonstrated on DTT. PATIENT CONCERNS Three patients with cerebellar infarct were enrolled in this study. Diffusion tensor imaging data were acquired at 3 weeks (patient 1) and 2 weeks (patients 2 and 3) after onset and the DRTT was reconstructed. The Scale for Assessment and Rating of Ataxiaand the Functional Ambulation Category were used for evaluation of ataxia and gait function. DIAGNOSES AND OUTCOMES With clinical evaluation, patient 1 scored 18, patient 2 scored 22, and patient 3 scored 28 points on the Scale for Assessment and Rating of Ataxia. On the Functional Ambulation Category patient 1 scored 2, patient 2 scored 2, and patient 3 scored 1 point. DRTT abnormalities were as follows: discontinuation (the upper portion of the left DRTT in the patient 1), narrowing (the lower portion of the left DRTT in patient 2, and the whole right DRTT in the patient 3), and nonreconstruction (the left DRTT in the patient 3). LESSONS Using DTT, we demonstrated injury in the DRTT in 3 patients with severe ataxia following cerebellar infarct. We believe that evaluation of the DRTT would be helpful in patients who develop ataxia following cerebellar infarct.
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Affiliation(s)
- Sung Ho Jang
- College of Medicine, Department of Physical Medicine and Rehabilitation, Yeungnam University, Daegu
| | - Hyeok Gyu Kwon
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Gökcen E, Caltekin İ, Savrun A, Korkmaz H, Savrun ŞT, Yıldırım G. Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. Am J Emerg Med 2017; 35:1607-1611. [PMID: 28473274 DOI: 10.1016/j.ajem.2017.04.073] [Citation(s) in RCA: 11] [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] [Received: 12/19/2016] [Revised: 03/25/2017] [Accepted: 04/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed. METHODS The study included the patients over the age of 18 applying to the emergency department of Malatya State Hospital with the symptoms of stroke between the dates of 1/1/2015 and 1/9/2016. The patients diagnosed with stroke by means of clinical and neuroradiological imaging were examined in 4 subgroups according to Oxfordshire Community Stroke Project. The aim of the study is to predict the intracranial pressure (ICP) levels of the patients through ONSD measurement and CT images. RESULTS In the comparison of the right and left optic nerve sheath diameters of CVD group and control group, the obtained results were found to be statistically significant (p<0.001). When the CVD subgroups were compared with the control group in terms of right and left optic nerve sheath diameters, the highest right-left optic nerve sheath diameter was detected to be in TACI (Total Anterior Circulation Infarction) group (p<0.001). DISCUSSION/CONCLUSION In the early cases of CVD, mortality and morbidity can be decreased through the early diagnosis of the possible existence of ICP increase according to ONSD level.
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Affiliation(s)
- Emre Gökcen
- Emergency Department of Malatya State Hospital, Malatya, Turkey.
| | | | - Atakan Savrun
- Emergency Department of Dr. Nafiz Körez Sincan State Hospital, Sincan, Ankara, Turkey
| | - Hilal Korkmaz
- Physiology Department of Hacettepe University, Ankara, Turkey
| | - Şeyda Tuba Savrun
- Emergency Department of Ankara Atatürk Research and Training Hospital, Ankara, Turkey
| | - Gökhan Yıldırım
- Radiology Department of Malatya State Hospital, Malatya, Turkey
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Iyengar S, Chambers CJ, Millsop JW, Fung MA, Sharon VR. Purple patches in an immunocompromised patient: a report of secondary disseminated cutaneous mucormycosis in a man with chronic lymphocytic leukemia. Dermatol Online J 2017; 23:13030/qt8cm6m764. [PMID: 28329517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 06/06/2023] Open
Abstract
A 60-year-old man with chronic lymphocytic leukemiadeveloped a deeply violaceous annular patchwith a halo of erythema on the right thigh duringhospitalization for neutropenic fever. Associatedsymptoms included chronic cough and fatigue.Bilateral lung opacities with hilar lymphadenopathywere noted on chest computed tomographyscan. Punch biopsy and tissue culture confirmeda diagnosis of secondary disseminated cutaneousmucormycosis. Although rare, physicians shouldinclude mucormycosis in the differential diagnosisof purpuric patches in immunosuppressed patients.Prompt skin biopsy and tissue culture may optimizethe success of treatment.
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Affiliation(s)
| | | | | | | | - Victoria R Sharon
- Department of Dermatology, Hofstra Northwell School of Medicine, New Hyde Park, New York
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Abstract
A 49-year-old man was transferred to our hospital with chief complaint of global aphasia and weakness of right upper and lower limbs. Brain MRI showed ultra-acute cerebral infarction in left anterior cerebral artery and middle cerebral artery territory and MRA showed occlusion of A2 and M2. Although t-PA was administrated intravenously, symptoms didn't improve and giant internal carotid thrombus (size 6 × 7 × 17 mm) was recognized at left internal carotid artery by carotid ultrasonography. After started anticoagulant therapy, thrombus was miniaturized gradually and finally disappeared. Anticoagulant therapy is effective to internal carotid thrombus and carotid ultrasonography is useful to confirm the effectiveness. We suggest that clinicians should enforce anticoagulant therapy for the first choice to internal carotid thrombus.
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Affiliation(s)
- Shota Sakai
- Department of Cerebrovascular Medicine, Saga-ken Medical Centre Koseikan
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Kloppenborg RP. [7 Tesla MRI for visualisation of small cerebral vessels]. Ned Tijdschr Geneeskd 2017; 161:D552. [PMID: 28537536] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Due to its higher resolution, MRI in which a magnet with a field strength of 7 Tesla (7T MRI) is used, is able to image smaller abnormalities. 7T MRI is a promising tool for research into the causes of cerebral small vessel disease. Originally this technique was aimed at imaging the small perforating brain vessels and in particular at the micro-thrombi present there. Although 7T MRI has not proved effective in showing thrombi in small blood vessels, it has proved itself to be effective on other fronts. Functional measurements of the small brain vessels can be reliably determined and abnormalities of the vessel wall can be imaged. However, the most promising development is the possibility of diagnosing so-called micro-infarctions of the cortex. These extremely small infarctions are an expression of ischaemic damage in degenerating small brain vessels, which for this reason are an important marker of brain ageing.
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Funck T, Al‐Kuwaiti M, Lepage C, Zepper P, Minuk J, Schipper HM, Evans AC, Thiel A. Assessing neuronal density in peri-infarct cortex with PET: Effects of cortical topology and partial volume correction. Hum Brain Mapp 2017; 38:326-338. [PMID: 27614005 PMCID: PMC6866936 DOI: 10.1002/hbm.23363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 08/05/2016] [Accepted: 08/18/2016] [Indexed: 01/02/2023] Open
Abstract
The peri-infarct cortex (PIC) is the site of long-term physiologic changes after ischemic stroke. Traditional methods for delineating the peri-infarct gray matter (GM) have used a volumetric Euclidean distance metric to define its extent around the infarct. This metric has limitations in the case of cortical stroke, i.e., those where ischemia leads to infarction in the cortical GM, because the vascularization of the cerebral cortex follows the complex, folded topology of the cortical surface. Instead, we used a geodesic distance metric along the cortical surface to subdivide the PIC into equidistant rings emanating from the infarct border and compared this new approach to a Euclidean distance metric definition. This was done in 11 patients with [F-18]-Flumazenil ([18-F]-FMZ) positron emission tomography (PET) scans at 2 weeks post-stroke and at 6 month follow-up. FMZ is a PET radiotracer with specific binding to the alpha subunits of the type A γ-aminobutyric acid (GABAA) receptor. Additionally, we used partial-volume correction (PVC) of the PET images to compensate for potential cortical thinning and long-term neuronal loss in follow-up images. The difference in non-displaceable binding potential (BPND ) between the stroke unaffected and affected hemispheres was 35% larger in the geodesic versus the Euclidean peri-infarct models in initial PET images and 48% larger in follow-up PET images. The inter-hemispheric BPND difference was approximately 17-20% larger after PVC when compared to uncorrected PET images. PET studies of peri-infarct GM in cortical strokes should use a geodesic model and include PVC as a preprocessing step. Hum Brain Mapp 38:326-338, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thomas Funck
- Montreal Neurological Institute, McGill UniversityMontrealCanada
- Jewish General HospitalLady Davis InstituteMontrealCanada
| | - Mohammed Al‐Kuwaiti
- Montreal Neurological Institute, McGill UniversityMontrealCanada
- Jewish General HospitalLady Davis InstituteMontrealCanada
| | - Claude Lepage
- Montreal Neurological Institute, McGill UniversityMontrealCanada
| | - Peter Zepper
- Department of NeurologyTechnische Universität MünchenMunichGermany
| | - Jeffrey Minuk
- Jewish General HospitalLady Davis InstituteMontrealCanada
| | | | - Alan C. Evans
- Montreal Neurological Institute, McGill UniversityMontrealCanada
| | - Alexander Thiel
- Montreal Neurological Institute, McGill UniversityMontrealCanada
- Jewish General HospitalLady Davis InstituteMontrealCanada
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