Neurologist最新文献

{"title":"Validation of Empoli Embolic Stroke of Undetermined Source Atrial Fibrillation (E 2 AF) Score for Detecting Atrial Fibrillation in Patients With Embolic Stroke of Undetermined Source.","authors":"Luca Masotti, Elisa Grifoni, Alessia Baglini, Irene Sivieri, Marianna Mannini, Gina Iandoli, Elisa Maria Madonia, Eleonora Cosentino, Irene Micheletti, Ira Signorini, Elisa Cioni, Teresa Sansone, Giulia Pelagalli, Mariella Baldini, Sara Giannoni, Elisabetta Bertini, Ilaria Di Donato","doi":"10.1097/NRL.0000000000000497","DOIUrl":"10.1097/NRL.0000000000000497","url":null,"abstract":"","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"426-428"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9593207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Inflammation Response Index Predicts Clinical Outcomes in Patients With Acute Ischemic Stroke (AIS) After the Treatment of Intravenous Thrombolysis.","authors":"Yan-Fang Chen, Shuo Qi, Zi-Jian Yu, Jiang-Tao Li, Ting-Ting Qian, Ying Zeng, Peng Cao","doi":"10.1097/NRL.0000000000000492","DOIUrl":"10.1097/NRL.0000000000000492","url":null,"abstract":"Background: Intravenous thrombolysis (IVT) is one of the most important means of therapy for patients with acute ischemic stroke (AIS). After cerebral infarction, the inflammatory response fulfills an essential role in the pathobiology of stroke, affecting the process of recanalization. Hence, we evaluated the usefulness of the systemic inflammatory response index (SIRI) for the prognosis of patients with AIS. Methods: A total of 161 patients suffering from AIS were retrospectively analyzed. SIRI was introduced and calculated using the absolute neutrophil, monocyte, and lymphocyte numbers from the admission blood work. The study outcomes were determined using a modified Rankin Scale (mRS) at the 3-month timepoint, and a favorable clinical outcome was calculated in the mRS score range of 0 to 2. The analysis of receiver operating characteristic (ROC) curves was performed to determine the values of the optimal cutoff of SIRI for the prediction of clinical outcomes. In addition, multivariate analyses were performed to investigate the association between clinical outcomes and SIRI. Results: The ROC curve analysis revealed that the ideal SIRI cutoff was at 2.54 [area under the curve, 78.85%; 95% CI, 71.70% to 86.00%; sensitivity, 70.89%; and specificity, 84.14%]. Multivariate analysis indicated that SIRI ≤2.54 (odds ratio, 1.557, 95% CI, 1.269 to 1.840; P=0.021) was an independent predictor of favorable clinical outcomes in patients suffering from AIS after treatment with IVT. Conclusions: We preliminary speculate that SIRI may serve as an independent predictor of clinical outcomes with AIS following IVT.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"355-361"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Mechanism of Acute Ischemic Stroke in NAVF Patients With Prior Oral Anticoagulant Therapy.","authors":"Sufang Xue,&nbsp;Risu Na,&nbsp;Jing Dong,&nbsp;Min Wei,&nbsp;Qi Kong,&nbsp;Qiujia Wang,&nbsp;Xue Qiu,&nbsp;Fangyu Li,&nbsp;Haiqing Song","doi":"10.1097/NRL.0000000000000504","DOIUrl":"10.1097/NRL.0000000000000504","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to analyze the characteristics and mechanisms of acute ischemic stroke (AIS) in patients with nonvalvular atrial fibrillation (NVAF) who received prior anticoagulant therapy.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of patients with NVAF and AIS between January 2016 and December 2021. Patients were divided into non-anticoagulant, adequate anticoagulant, and insufficient anticoagulant groups according to their prior anticoagulant status. Patients with prior anticoagulant therapy were further divided into warfarin and direct oral anticoagulant groups.</p><p><strong>Results: </strong>A total of 749 patients (661 without anticoagulants, 33 with adequate anticoagulants, and 55 with insufficient anticoagulants) were included. Patients with adequate anticoagulant had a milder National Institute of Health Stroke Scale at presentation ( P =0.001) and discharge ( P =0.003), a higher proportion of Modified Rankin Scale (mRS) ≤2 at discharge ( P =0.011), and lower rates of massive infarction ( P =0.008) than patients without anticoagulant. Compared with the non-anticoagulant group, the proportion of intravenous thrombolysis was significantly lower in the adequate anticoagulant ( P <0.001) and insufficient anticoagulant ( P =0.009) groups. Patients in the adequate anticoagulant group had higher rates of responsible cerebral atherosclerotic stenosis ( P =0.001 and 0.006, respectively) and competing large artery atherosclerotic mechanisms ( P =0.006 and 0.009, respectively) than those in the other 2 groups. Compared with warfarin, direct oral anticoagulant was associated with higher rates of Modified Rankin Scale ≤2 at discharge ( P =0.003).</p><p><strong>Conclusions: </strong>Adequate anticoagulant therapy may be associated with milder stroke severity and better outcomes at discharge in patients with NVAF. Competing large artery atherosclerotic mechanisms may be associated with anticoagulant failure in patients with NAVF with prior adequate anticoagulant therapy.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"379-385"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10004009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Validating a New Model to Predict the Risk of Poor Neurological Status of Acute Ischemic Stroke After Intravenous Thrombolysis.","authors":"Lu Liu,&nbsp;Weiping Wang","doi":"10.1097/NRL.0000000000000506","DOIUrl":"10.1097/NRL.0000000000000506","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to develop and validate a predictive model for the risk of poor neurological status in in-hospital patients with acute ischemic stroke (AIS) after intravenous thrombolysis.</p><p><strong>Methods: </strong>This 2-center retrospective study included patients with AIS treated at the Advanced Stroke Center of the Second Hospital of Hebei Medical University and Baoding No.1 Central Hospital between January 2018 and January 2020). The neurological function status at day 7 of AIS onset was used as the endpoint of the study, which was evaluated using the National Institute of Health Stroke Scale (NIHSS) score.</p><p><strong>Results: </strong>A total of 878 patients were included in the study and divided into training (n=652) and validation (n=226) sets. Seven variables were selected as predictors to establish the risk model: age, NIHSS before thrombolysis (NIHSS1), NIHSS 24 hours after thrombolysis (NIHSS3), high-density lipoprotein, antiplatelet, cerebral computed tomography after thrombolysis (CT2), and lower extremity venous color Doppler ultrasound. The risk prediction model achieved good discrimination (the areas under the Receiver Operating Characteristic curve in the training and validation sets were 0.9626 and 0.9413, respectively) and calibration (in the training set Emax=0.072, Eavg=0.01, P =0.528, and in the validation set Emax=0.123, Eavg=0.019, P =0.594, respectively). The decision curve analysis showed that the model could achieve a good net benefit.</p><p><strong>Conclusions: </strong>The prediction model obtained in this study showed good discrimination, calibration, and clinical efficacy. This new nomogram can provide a reference for predicting the risk of poor neurological status in patients with acute ischemic stroke after intravenous thrombolysis.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"391-401"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Uncrossed Central Facial Paralysis\" Caused by Pontine Infarction: A Case Report.","authors":"Liwen Zhao,&nbsp;Bingcheng Ren","doi":"10.1097/NRL.0000000000000500","DOIUrl":"10.1097/NRL.0000000000000500","url":null,"abstract":"<p><strong>Introduction: </strong>We report a patient with extraordinary pontine infarction-induced contralateral central facial palsy and weakened limb strength.</p><p><strong>Case report: </strong>This is a 66-year-old man with left arm movement difficulty for 10 days and worsening over the last 1 day. His left nasolabial fold flattening and left arm strength and sensory were decreased. He could not complete the finger-nose test well with his right hand. Magnetic resonance and magnetic resonance angiography tests confirmed his right pontine acute infarction but without large vessel stenosis or occlusion.</p><p><strong>Conclusion: </strong>\"Uncrossed paralysis\" patients may present with contralateral face and body weakness with pontine infarcts, if the infarct occurs above the level of the facial nucleus head, and may be simmilar with the higher level pontine lesions or cerebrum semisphere infarction, which need particular attention during clinical practice.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"419-421"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Resolution Magnetic Resonance Imaging in Endovascular Treatment of Vertebrobasilar Junction Stenosis.","authors":"Rui Huang,&nbsp;Feng Gao,&nbsp;Dapeng Mo,&nbsp;Ming Yang,&nbsp;Zhikai Hou,&nbsp;Yifan Liu,&nbsp;Rongrong Cui,&nbsp;Kaijiang Kang,&nbsp;Weibin Gu,&nbsp;Zhongrong Miao,&nbsp;Ning Ma","doi":"10.1097/NRL.0000000000000494","DOIUrl":"10.1097/NRL.0000000000000494","url":null,"abstract":"<p><strong>Introduction: </strong>Vertebrobasilar junction (VBJ) stenosis is a challenge in endovascular treatment due to structural variants and complexities. The role of high-resolution magnetic resonance imaging (HRMRI) in endovascular treatment for patients with severe VBJ stenosis is uncertain.</p><p><strong>Case report: </strong>Four patients with symptomatic VBJ stenosis underwent HRMRI of the vessel wall before endovascular treatment. In 3 patients, the VBJ could not be visualized on luminal imaging. One of them had a hypoplastic artery and 2 of them had severe stenotic arteries on HRMRI. HRMRI showed an artery with a negative remodeling in a patient with a hypoplastic vertebral artery. One patient had intraplaque hemorrhage and calcification, and 2 patients had calcification in VBJ lesions. Endovascular treatment was performed utilizing HRMRI findings to guide the decision-making process.</p><p><strong>Conclusion: </strong>HRMRI provides additional information about the structure and angle of the VBJ, the characteristics and vulnerability of the plaques, and the lesion size, thus helping to improve the operation process and reduce the risk of complications.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"413-418"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder.","authors":"Tian T Griffin,&nbsp;Varun Bhave,&nbsp;Jack McNulty,&nbsp;Brandon R Christophe,&nbsp;Andrew L A Garton,&nbsp;Edward Sander Connolly","doi":"10.1097/NRL.0000000000000495","DOIUrl":"10.1097/NRL.0000000000000495","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms.</p><p><strong>Methods: </strong>Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores.</p><p><strong>Results: </strong>Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point.</p><p><strong>Conclusions: </strong>Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"362-366"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9415036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Urinary Kallidinogenase Plus Intravenous Recombinant Tissue Plasminogen Activator for Stroke Patients With Extended Window: A Retrospective Analysis.","authors":"Xueyuan Li,&nbsp;Xin Zhang,&nbsp;Ying Yang,&nbsp;Hongzhi Wang,&nbsp;Jingbo Zhang","doi":"10.1097/NRL.0000000000000499","DOIUrl":"10.1097/NRL.0000000000000499","url":null,"abstract":"<p><strong>Background: </strong>To assess the outcome of human urinary kallidinogenase (HUK) plus recombinant tissue plasminogen activator (rT-PA) intravenous thrombolysis for stroke patients with an extended time window(4.5 to 9 h).</p><p><strong>Methods: </strong>A total of 92 acute ischemic stroke patients who fulfilled the criteria were included in this study. All patients received basic treatment and intravenous rT-PA, and 49 patients received additional injections of HUK (HUK group) once a day for 14 consecutive days. Outcomes were indicated by the thrombolysis in cerebral infarction score as the primary endpoint and the National Institute of Health Stroke Scale, modified Rankin Scale, and Barthel Index as the secondary endpoints. The safety outcomes were the rate of symptomatic intracranial hemorrhage, bleeding, angioedema, and mortality.</p><p><strong>Results: </strong>The National Institute of Health Stroke Scale scores were significantly lower in the HUK group at hospital discharge (4.55 ± 3.78 vs 7.88 ± 7.31, P = 0.009) and day 90 (4.04 ± 3.51 vs 8.12 ± 9.53, P = 0.011). The improvements in the Barthel Index scores were more obvious in the HUK group. Patients in the HUK group achieved favorable functional independence (67.35% vs 46.51%; odds ratio: 2.37; 95% CI: 1.01-5.53) at 90 days. The recanalization rate of the HUK group was 64.10%, whereas that was 41.48% in the control group ( P = 0.050). The complete reperfusion rates were 42.9% and 23.3% in the HUK group and the control group, respectively. No significant differences were observed for adverse events between the two groups.</p><p><strong>Conclusions: </strong>Combination therapy of HUK plus rT-PA in patients with acute ischemic stroke with an extended time window can safely improve their functional outcomes.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"373-378"},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the ER to the OR: Initial Evaluation of Primary Central Nervous System Lymphoma: Erratum.","authors":"","doi":"10.1097/NRL.0000000000000502","DOIUrl":"10.1097/NRL.0000000000000502","url":null,"abstract":"","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"353"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9965558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Migraine With Aura Worsened After Starting Apixaban and Literature Review.","authors":"Nour Alhayek,&nbsp;Ehab Harahsheh,&nbsp;Oana Dumitrascu,&nbsp;Anthony L Green","doi":"10.1097/NRL.0000000000000513","DOIUrl":"10.1097/NRL.0000000000000513","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple medications have been related to triggering headache attacks or worsening headache frequency or severity in patients with migraine disease. However, the impact of direct oral anticoagulants on headache frequency and severity in patients with migraine disease is unclear. Current literature is scarce and controversial.</p><p><strong>Case report: </strong>A 45-year-old male with a history of migraine with aura for the last 20 years underwent percutaneous transcatheter closure of an atrial septal defect due to right ventricular enlargement and systolic dysfunction. The intervention was complicated by postprocedural atrial fibrillation, for which he was started on apixaban. Shortly after starting the apixaban, the patient experienced an increase in the frequency and severity of his migraine with aura episodes that were persistent until he discontinued this medication 7 months later. Following the discontinuation of apixaban, the patient's frequency and severity of migraine episodes returned to baseline almost immediately.</p><p><strong>Conclusion: </strong>Novel oral anticoagulants, including apixaban, may be associated with an increase in the frequency and severity of migraine attacks in patients with migraine disease. Larger observational studies are required to investigate further the impact of direct oral anticoagulants on migraine disease.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"335-337"},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10381086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}