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Phosphatidylserine trapped in the net: A new therapeutic target for the ischemic stroke?
Get PDFResumen no disponibleFil: Rodríguez Lucci, Federico. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Schattner, Mirta. Consejo Nacional de Investigaciones Científicas y Técnicas. Institute of Experimental Medicine. Laboratory of Experimental Thrombosis; Argentina
World-Wide FINGERS Network: A global approach to risk reduction and prevention of dementia
No full textReducing the risk of dementia can halt the worldwide increase of affected people. The multifactorial and heterogeneous nature of late-onset dementia, including Alzheimer's disease (AD), indicates a potential impact of multidomain lifestyle interventions on risk reduction. The positive results of the landmark multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) support such an approach. The World-Wide FINGERS (WW-FINGERS), launched in 2017 and including over 25 countries, is the first global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention. WW-FINGERS aims to adapt, test, and optimize the FINGER model to reduce risk across the spectrum of cognitive decline-from at-risk asymptomatic states to early symptomatic stages-in different geographical, cultural, and economic settings. WW-FINGERS aims to harmonize and adapt multidomain interventions across various countries and settings, to facilitate data sharing and analysis across studies, and to promote international joint initiatives to identify globally implementable and effective preventive strategies.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Crivelli, Lucía. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; ArgentinaFil: Kivipelto, Miia. Karolinska Institute. Department of Neurobiology Care Sciences and Society. Center for Alzheimer Research. Division of Clinical Geriatrics; Suecia. Karolinska University Hospital. Theme Aging; Suecia. University of Eastern Finland. Institute of Public Health and Clinical Nutrition; Finlandia. Karolinska University Hospital. Theme Aging; Suecia. Stockholms Sjukhem. Research & Development Unit; Suecia.
Imperial College London. School of Public Health. The Ageing Epidemiology Research Unit; Reino Unido.Fil: Mangialasche, Francesca. Karolinska Institutet. Department of Neurobiology Care Sciences and Society. Center for Alzheimer Research. Division of Clinical Geriatrics; Suecia. Karolinska Institutet and Stockholm University. Department of Neurobiology Care Sciences and Society. Center for Alzheimer Research. Aging Research Center; Suecia.Fil: Snyder, Heather M. Alzheimer's Association. Division of Medical and Scientific Relations; Estados Unidos.Fil: Andrieu, Sandrine. University of Toulouse. INSERM; Francia. Toulouse University Hospital. Department of Epidemiology and Public Health; Francia.Fil: Arai, Hidenori. National Center for Geriatrics and Gerontology; Japón.Fil: Baker, Laura. Wake Forest School of Medicine. Department of Internal Medicine - Geriatrics; Estados Unidos.Fil: Belleville, Sylvie. Universite de Montreal. Institute Universitaire de Geriatrie de Montreal; Canadá.Fil: Brodaty, Henry. UNSW Sydney. School of Psychiatry. Centre for Healthy Brain Ageing; Australia.Fil: Brucki, Sonia M. University of São Paulo Medical School. Department of Neurology; Brasil.Fil: Caramelli, Paulo. Universidade Federal de Minas Gerais. Faculty of Medicine. Department of Internal Medicine; Brasil.Fil: Chen, Christopher. National University of Singapore. Memory Aging and Cognition Centre; Singapur. National University of Singapore. Yong Loo Lin School of Medicine. Department of Pharmacology; Singapur.Fil: Chertkow, Howard. University of Toronto. Division of Medicine/Neurology; Canadá. Baycrest Health Sciences and Rotman Research Institute. Division of Cognitive Neurology and Innovation; Canadá.Fil: Chew, Effie. National University Hospital. University Medicine Cluster. Division of Neurology; Singapur.Fil: Choi, Seong H. Inha University School of Medicine. Department of Neurology; Corea.Fil: Chowdhary, Neerja. World Health Organization. Department of Mental Health and Substance Use. Brain Health Unit; Suiza.Fil: De La Torre, Rafael. Hospital del Mar Medical Research Institute (IMIM). Neurosciences Research Program. Integrative Pharmacology and Systems Neurosciences Research Group; España.Fil: Du, Yifeng. Shandong Provincial Hospital affiliated to Shandong University. Department of Neurology; China
Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results
No full textBackground: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.
Methods: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.
Results: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001).
Conclusion: In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.Fil: Alet, Matías Javier. Fleni. Departamento de Neurología. Centro Integral de Neurología Vascular; Argentina.Fil: Ghoreishi, Abdoreza. Zanjan University of Medical Sciences. School of Medicine. Vali-e-Asr hospital. Department of Neurology and Stroke Unit. Stroke Research Group; Irán.Fil: Arsang-Jang, Shahram. Zanjan University of Medical Sciences. School of Medicine. Department of Biostatistics and Epidemiology; Irán.Fil: Sabaa-Ayoun, Ziad. Western University. Robarts Research Institute. Stroke Prevention and Atherosclerosis Research Centre; Canadá. Western University. Schulich School of Medicine and Dentistry; Canadá.Fil: Yassi, Nawaf. University of Melbourne. Melbourne Brain Centre at The Royal Melbourne Hospital. Department of Medicine and Neurology; Australia. The Walter and Eliza Hall Institute of Medical Research. Population Health and Immunity Division; Australia.Fil: Sylaja, P N. Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST). Comprehensive Stroke Care Program; India.Fil: Akbari, Yama. University of California. Beckman Laser Institute & Medical Clinic. Departments of Neurology, Neurological Surgery, and Anatomy & Neurobiology; Estados Unidos.Fil: Divani, Afshin A. University of New Mexico. School of Medicine. Department of Neurology; México.Fil: Biller, Jose. Loyola University. Stritch School of Medicine. Department of Neurology; Estados Unidos.Fil: Phan, Thanh. Monash University. School of Clinical Sciences. Department of Neurology, Monash Health and Department of Medicine; Australia.Fil: Steinwender, Sandy. Western University. Health Information Science; Canada. London Health Sciences. Southwestern Ontario Stroke Network. Regional Stroke Prevention; Canada.Fil: Silver, Brian. University of Massachusetts Medical School. Department of Neurology; Estados Unidos.Fil: Zand, Ramin. Geisinger Medical Center. Neuroscience Institute. Department of Neurology; Estados Unidos.Fil: Bin Basri, Hamidon. UPM. Faculty of Medicine and Health Sciences. Department of Medicine; Malasia.Fil: Iqbal, Omer M. Loyola University Stritch School of Medicine. Center for Translational Research & Education. Department of Pathology and Ophthalmology; Estados Unidos.Fil: Ranta, Annemarei. University of Otago and Wellington Hospital. Department of Medicine and Neurology; Nueva Zelanda.Fil: Ruland, Sean. Boston University School of Medicine. Boston Medical Center; Estados Unidos.Fil: Macri, Elizabeth. Loyola University. Stritch School of Medicine. Department of Neurology; Estados Unidos.Fil: Ma, Henry. Monash University. School of Clinical Sciences. Monash Health and Department of Medicine.Department of Neurology; Australia.Fil: Nguyen, Thanh N. Boston University School of Medicine. Boston Medical Center; Estados Unidos.Fil: Abootalebi, Shahram. Dalhousie University. Dr. Everett Chalmers Regional Hospital; Canadá.Fil: Gupta, Animesh. University of New Mexico. School of Medicine. Department of Neurology; México
The antiphospholipid antibodies registry of the Argentinean Society of Rheumatology (GESAF-SAR): baseline data of the first 162 patients
No full textObjective: Antiphospholipid antibodies registry of the Argentinean Society of Rheumatology (GESAF-SAR) was created to study long-term disease characteristics and outcomes in persistently antiphospholipid antibody (aPL)-positive patients. The objective was to report baseline demographic, clinical, laboratory and treatment characteristics of aPL-positive patients enrolled in the registry.
Materials and Methods: GESAF-SAR is a multicenter, multidisciplinary and longitudinal study. Thirty centers from Argentina participated. Data collection was performed by review of medical records and interview with individuals/patients, after signing an informed consent. A web-based data capture system (ARTHROS) was used. Inclusion criteria: aPL with at least one positive determination of Lupus Anticoagulant (LAC) and/or positive Anticardiolipin Antibodies (aCL) and Anti-βeta 2 Glycoprotein I (aβ2GLPI) IgG and IgM greater 40 or positive aCL and/or aβ2GLPI with levels 20-40 GPL or MPL (at least two determinations) separated by 12 weeks. Patients were followed every 12±3 months. Descriptive cross-sectional analysis of data collected from May to October 2019 was performed.
Results: Overall 162 patients were enrolled, 139 (86%) were women with a mean age at entry of 40.3 years (SD 12.9); 76 (47%) patients were Mestizo, 72 (44%) Caucasians and 14 (9%) others. The socioeconomic level was Medium-Low in 47 patients (29%), Medium in 58 (36%) and Medium-High in 25 (15%). Seventy-four patients (46%) met classification criteria for Primary APS, 37 (23%) were APS associated with autoimmune disease and 2 (1%) were catastrophic APS (CAPS). Of the 111 APS patients, 50 (45%) presented thrombotic manifestations, 44 (40%) obstetric and 16 (15%) both. Forty-nine patients (30%) did not meet classification criteria of APS. A total of 40 (24.7%) venous events, 34 (21%) arterial, 70 (43.2%) obstetric morbidity and 55 (34%) non-criteria manifestations were recorded. Seventy-seven women presented at least one pregnancy with a total 265 gestations, resulting in 104 (39%) live births. Of all gestations, 80 (30%) were miscarriages <10 weeks, 53 (20%) premature births, 42 (16%) placental insufficiency, 24 (9%) preeclampsia and only 2 (1%) eclampsia. Based on aPL profile, 88 (54%) were positive for LAC, 110 (68%) aCL and 74 (46%) for aβ2GLPI. Regarding treatments, 117 (72%) patients received Aspirin, 71 (43.8%) oral anticoagulation, 53 (32.7%) prophylactic heparin, 46 (28.4%) therapeutic heparin, 92 (56.8%) hydroxychloroquine.
Conclusions: In our multi-center Argentinean aPL-positive cohort, at baseline: a) 30% of patients did not meet classification criteria of APS, b) 46% met classification criteria for Primary APS, c) one-fourth were APS associated with autoimmune disease, d) 45% presented thrombotic manifestations, e) the most frequent obstetric morbidity were miscarriages <10 weeks. Future longitudinal analysis of GESAF-SAR Registry will help clarify the risk profiles of aPL in Argentina.Fil: Antoniol, María Noelia. Fleni. Departamento de Medicina Interna. Sección de Reumatología; Argentina.Fil: Perandones, Carlos Edgardo. Fundación Favaloro; Argentina. Fleni. Departamento de Medicina Interna; Argentina.Fil: Porta, Sabrina. Hospital Ramos Mejia; Argentina. Centro Regional de Enfermedad Autoinmunes y Reumáticas; Argentina.Fil: Nieto, Romina. Hospital Ramos Mejia; Argentina. Hospital Provincial de Rosario; Argentina.Fil: Serrano, Rosa. Hospital Ramos Mejia; Argentina.Fil: Savio, Verónica. Hospital Córdoba; Argentina. Hospital Materno Neonatal; Argentina.Fil: Lema, Luis. Instituto Modelo de Cardiología; Argentina.Fil: Maldini, Carla. Instituto Modelo de Cardiología; Argentina.Fil: Perés, Silvia. Hospital Ramos Mejia; Argentina.Fil: Izaguirre, Pia. Hospital Ramos Mejia; Argentina.Fil: Bellomio, Verónica. Hospital Ángel C. Padilla; Argentina.Fil: Leguizamón, Maria Lilia. Hospital Ángel C. Padilla; Argentina.Fil: Sacnun, Monica. Hospital Provincial de Rosario; Argentina.Fil: Estevez, Adrián. Hospital El Cruce; Argentina.Fil: Avalo, Alejandra. Hospital El Cruce; Argentina.Fil: Etcheverri, Maira. Hospital El Cruce; Argentina.Fil: Goizueta, Cecilia. Sanatorio 9 de Julio; Argentina.Fil: Lobo, Victoria. Sanatorio 9 de Julio; Argentina.Fil: Gobbi, Carla. Sanatorio Allende; Argentina.Fil: Artesana, Pablo. Sanatorio Allende; Argentina
Arritmias auriculares distintas a fibrilación auricular en pacientes con miocardiopatía hipertrófica
No full textLa Fibrilación Auricular (FA), es la arritmia más frecuente en pacientes con Miocardiopatía
Hipertrófica (MCH), sin embargo, existe poca información sobre otras arritmias auriculares en
este grupo de pacientes. El objetivo del presente trabajo es conocer la prevalencia y las asociaciones comórbidas de las extrasístoles auriculares aisladas, pares auriculares, salvas auriculares
autolimitadas, y del aleteo auricular en pacientes con MCH.
Material y Método. Estudio observacional, descriptivo, transversal, retrospectivo, y de correlación
estadística de pacientes españoles y argentinos con MCH en quienes se realizó anamnesis, examen
físico, electrocardiograma, Ecocardiograma Doppler transtorácico y estudio Holter de 24 horas.
Resultados. Se incluyeron 116 pacientes, edad media 48 años, 56% de sexo masculino. La
prevalencia de extrasístoles auriculares aisladas fue del 78%, pares auriculares el 45%, salvas
auriculares autolimitadas el 39%, Aleteo Auricular 3%, y Alta Densidad de Arritmias Auriculares (ADAA) 54%. Comparativamente existió mayor prevalencia de tabaquismo y dislipemia en
hombres y de hipertensión arterial y obesidad en mujeres. Hubo correlación estadísticamente significativa entre alta densidad de arritmias auriculares con factores de riesgo como el tabaquismo
(p=0,002) y obesidad (p=0,04).
Conclusiones. En pacientes con Miocardiopatía Hipertrófica, las arritmias auriculares distintas a
Fibrilación Auricular evidenciaron elevada prevalencia. El tabaquismo y la obesidad fueron los factores de riesgo cardiovascular que se asociaron estadísticamente a la ADAA en la población estudiad
Author Correction: AHR is a Zika virus host factor and a candidate target for antiviral therapy
No full textFil: Giovannoni, Federico. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica. Laboratorio de Estrategias Antivirales; Argentina. CONICET-Instituto de Química Biológica; Argentina.Fil: Bosch, Irene. Massachusetts Institute of Technology. Institute for Medical Engineering and Science; Estados Unidos. Mount Sinai School of Medicine. Department of Medicine; Estados Unidos.Fil: Manganeli Polonio, Carolina. University of São Paulo. Immunology Department-ICB IV. Neuroimmune Interactions Laboratory; Brasil. University of São Paulo. Scientific Platform Pasteur-USP; Brasil.Fil: Torti, María F. University of São Paulo. Immunology Department-ICB IV. Neuroimmune Interactions Laboratory; Brasil. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica. Laboratorio de Estrategias Antivirales; Argentina. CONICET-Instituto de Química Biológica; Argentina.Fil: Wheeler, Michael A. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Li, Zhaorong. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Romorini, Leonardo. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina.Fil: Rodríguez Varela, María Soledad. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina.Fil: Rothhammer, Veit. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Barroso, Andreia. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Tjon, Emily C. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Sanmarco, Liliana M. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Takenaka, Maisa C. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Sadegh Modaresi, Seyed Mohamad. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Gutiérrez-Vázquez, Cristina. Harvard Medical School. Brigham and Women's Hospital. Ann Romney Center for Neurologic Diseases; Estados Unidos.Fil: Ghabdan Zanluqui, Nágela. University of São Paulo. Scientific Platform Pasteur-USP; Brasil. University of São Paulo. School of Medicine. Immunopathology and Allergy Post Graduate Program; Brasil.Fil: Barreto Dos Santos, Nilton. University of São Paulo. Institute of Biomedical Science. Department of Pharmacology; Brasil.Fil: Demarchi Munhoz, Carolina. University of São Paulo. Institute of Biomedical Science. Department of Pharmacology; Brasil.Fil: Wang, Zhongyan. Boston University School of Public Health. Dept. of Environmental Health; Estados Unidos.Fil: Damonte, Elsa B. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica. Laboratorio de Estrategias Antivirales; Argentina. CONICET-Instituto de Química Biológica; Argentina
Small vessel disease more than Alzheimer's disease determines diffusion MRI alterations in memory clinic patients
No full textIntroduction: Microstructural alterations as assessed by diffusion tensor imaging (DTI) are key findings in both Alzheimer's disease (AD) and small vessel disease (SVD). We determined the contribution of each of these conditions to diffusion alterations.
Methods: We studied six samples (N = 365 participants) covering the spectrum of AD and SVD, including genetically defined samples. We calculated diffusion measures from DTI and free water imaging. Simple linear, multivariable random forest, and voxel-based regressions were used to evaluate associations between AD biomarkers (amyloid beta, tau), SVD imaging markers, and diffusion measures.
Results: SVD markers were strongly associated with diffusion measures and showed a higher contribution than AD biomarkers in multivariable analysis across all memory clinic samples. Voxel-wise analyses between tau and diffusion measures were not significant.
Discussion: In memory clinic patients, the effect of SVD on diffusion alterations largely exceeds the effect of AD, supporting the value of diffusion measures as markers of SVD.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Finsterwalder, Sofia. LMU Munich. University Hospital. Institute for Stroke and Dementia Research; Alemania.Fil: Vlegels, Naomi. Utrecht University. University Medical Center Utrecht. UMC Utrecht Brain Center. Department of Neurology; Países Bajos.Fil: Gesierich, Benno. LMU Munich. University Hospital. Institute for Stroke and Dementia Research; Alemania.Fil: Araque Caballero, Miguel Á. LMU Munich. University Hospital. Institute for Stroke and Dementia Research; Alemania. German Center for Neurodegenerative Diseases (DZNE); Alemania.Fil: Weaver, Nick A. Utrecht University. University Medical Center Utrecht. UMC Utrecht Brain Center. Department of Neurology; Países Bajos.Fil: Franzmeier, Nicolai. LMU Munich. University Hospital. Institute for Stroke and Dementia Research; Alemania.Fil: Georgakis, Marios K. LMU Munich. University Hospital. Institute for Stroke and Dementia Research; Alemania.Fil: Konieczny, Marek J. LMU Munich. University Hospital. Institute for Stroke and Dementia Research; Alemania.Fil: Koek, Huiberdina L. University Medical Center Utrecht. Department of Geriatrics; Países Bajos.Fil: Karch, Celeste M. Washington University in St. Louis. Department of Psychiatry; Estados Unidos.Fil: Graff-Radford, Neill R. Mayo Clinic Jacksonville. Department of Neurology; Estados Unidos.Fil: Salloway, Stephen. Butler Hospital; Estados Unidos.Fil: Oh, Hwamee. Warren Alpert Medical School of Brown University. Department of Psychiatry and Human Behavior; Estados Unidos.Fil: Chhatwal, Jasmeer P. Harvard Medical School. Massachusetts General Hospital; Estados Unidos.Fil: Jessen, Frank. University of Cologne. Medical Faculty. Department of Psychiatry; Estados Unidos.Fil: Düzel, Emrah. German Center for Neurodegenerative Diseases (DZNE); Alemania. Otto-von-Guericke University. Institute of Cognitive Neurology and Dementia Research (IKND); Alemania.Fil: Dobisch, Laura. German Center for Neurodegenerative Diseases (DZNE); Alemania. Otto-von-Guericke University. Institute of Cognitive Neurology and Dementia Research (IKND); Alemania.Fil: Metzger, Coraline. German Center for Neurodegenerative Diseases (DZNE); Alemania. Otto-von-Guericke University. Institute of Cognitive Neurology and Dementia Research (IKND); Alemania. Otto-von-Guericke Universit. Department of Psychiatry and Psychotherapy; Alemania
Long‐term mortality, disability and stroke recurrence in patients with basilar artery occlusion
No full textBackground and purpose: The long-term outcomes and stroke recurrence after basilar artery occlusion (BAO) are largely unknown. We aimed to assess these variables in a comparatively large series of consecutive patients.
Methods: Adults with acute BAO were retrospectively identified from 1976 to 2011. Post-discharge records were reviewed to assess for stroke recurrences, mortality and disability. Exploratory analysis of survival was carried out using Kaplan-Meier and log-rank tests. Factors associated with survival time were determined using Cox models.
Results: A total of 86 patients (34% female, median age 72 [interquartile range (IQR), 60-79] years) with a median National Institutes of Health Stroke Scale score of 11 (IQR, 6-27) were included. Twenty-nine patients (34%) died during the initial hospitalization. Median modified Rankin Scale (mRS) score at discharge among survivors was 4 (IQR, 2.5-5.5). At 1 and 5 years, 70% of survivors ad a mRS ≤3. Seventeen patients had recurrent strokes during the hospitalization and 12 patients had 19 recurrent strokes after discharge. The median survival time was 52 days (IQR, 6-1846). Older age per decade on admission [adjusted hazard ratios (aHR), 1.32; 95% confidence interval (CI), 1.05-1.66, P = 0.02] and a higher mRS at discharge (aHR, 4.48; 95% CI, 2.72-7.39, P < 0.0001) were associated with mortality. Patients who were not treated with any reperfusion therapy had a trend towards reduced mortality (aHR, 0.39; 95% CI, 0.14-1.08, P = 0.07).
Conclusions: Survivors from BAO had severe short-term functional disability. Most deaths and stroke recurrences occurred within the first year following the initial event. The risk of death was higher in older and more disabled survivors. However, favorable long-term recovery was possible.https://doi.org/10.1111/ene.14126Fil: Hawkes, Maximiliano Alberto. Fleni. Departamento de Neurología; Argentina. Fleni. Departamento de Medicina Interna; Argentina. Mayo Clinic. Department of Neurology; Estados Unidos.Fil: Blaginykh, Elena. Kent State University. Department of Public Healt; Estados Unidos.Fil: Ruff, Michael W. Mayo Clinic. Department of Neurology; Estados Unidos.Fil: Burrus, Tamika. Avanti Hospitals. Department of Neurology; Estados Unidos.Fil: Wijdicks, E.F.M. Mayo Clinic. Department of Neurology; Estados Unidos.Fil: Rabinstein, A.A. Mayo Clinic. Department of Neurology; Estados Unidos
Petroclival intravascular papillary endothelial hyperplasia with psammoma body‐like structures
No full textMasson's tumor or intravascular papillary endothelial hyperplasia (IPEH) is considered a non‐neoplastic lesion. It is probably an unusual exaggerated reorganization of a thrombus. IPEH may be present as a secondary lesion in hemangiomas. Symptomatic osseous hemangiomas are rare tumors. Few cases of clival and petrous bone hemangiomas have been described. None of them shows secondary IPEH. So far, there are only four reported cases of cranial bone IPEHs in the literature, two in the skull, one in the clivus and one in the petrous apex. The aim of this study is to report an additional case of osseous hemangioma with secondary IPEH of the petroclival region. We review the literature and describe the main clinical features of IPEHs and hemangiomas of the clivus and the petrous bone. Additionally, we report an unusual histological feature observed in our case of IPEH, the presence of psammoma body‐like structures. This feature has been rarely mentioned previously in IPEH. We consider that IPEH should be included in the lesions that may present psammoma bodies to avoid misdiagnosing it as a tumor that commonly shows psammoma bodies, such as intraosseous meningioma or, less frequently, metastasis of thyroid or ovarian carcinoma.Fil: Mezmezian, Mónica Beatriz. Hospital Pirovano. División de Patología; Argentina.Fil: Arakaki, Naomi. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Fallaza Moya, Silvia. Hospital Pirovano. División de Patología; Argentina.Fil: Solé, Horacio. Hospital Pirovano. Unidad de Neurocirugía; Argentina.Fil: Olvi, Liliana. Laboratorio de Patología Ortopédica; Argentina
Single-subject grey matter network trajectories over the disease course of autosomal dominant Alzheimer's disease
No full textStructural grey matter covariance networks provide an individual quantification of morphological patterns in the brain. The network integrity is disrupted in sporadic Alzheimer's disease, and network properties show associations with the level of amyloid pathology and cognitive decline. Therefore, these network properties might be disease progression markers. However, it remains unclear when and how grey matter network integrity changes with disease progression. We investigated these questions in autosomal dominant Alzheimer's disease mutation carriers, whose conserved age at dementia onset allows individual staging based upon their estimated years to symptom onset. From the Dominantly Inherited Alzheimer Network observational cohort, we selected T1-weighted MRI scans from 269 mutation carriers and 170 non-carriers (mean age 38 ± 15 years, mean estimated years to symptom onset -9 ± 11), of whom 237 had longitudinal scans with a mean follow-up of 3.0 years. Single-subject grey matter networks were extracted, and we calculated for each individual the network properties which describe the network topology, including the size, clustering, path length and small worldness. We determined at which time point mutation carriers and non-carriers diverged for global and regional grey matter network metrics, both cross-sectionally and for rate of change over time. Based on cross-sectional data, the earliest difference was observed in normalized path length, which was decreased for mutation carriers in the precuneus area at 13 years and on a global level 12 years before estimated symptom onset. Based on longitudinal data, we found the earliest difference between groups on a global level 6 years before symptom onset, with a greater rate of decline of network size for mutation carriers. We further compared grey matter network small worldness with established biomarkers for Alzheimer disease (i.e. amyloid accumulation, cortical thickness, brain metabolism and cognitive function). We found that greater amyloid accumulation at baseline was associated with faster decline of small worldness over time, and decline in grey matter network measures over time was accompanied by decline in brain metabolism, cortical thinning and cognitive decline. In summary, network measures decline in autosomal dominant Alzheimer's disease, which is alike sporadic Alzheimer's disease, and the properties show decline over time prior to estimated symptom onset. These data suggest that single-subject networks properties obtained from structural MRI scans form an additional non-invasive tool for understanding the substrate of cognitive decline and measuring progression from preclinical to severe clinical stages of Alzheimer's disease.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Vermunt, Lisa. VU University. Alzheimer Center Amsterdam. Amsterdam Neuroscience. Department of Neurology; Países Bajos.Fil: Dicks, Ellen. VU University. Alzheimer Center Amsterdam. Amsterdam Neuroscience. Department of Neurology; Países Bajos.Fil: Wang, Guoqiao. Washington University in St. Louis. Division of Biostatistics; Estados Unidos.Fil: Dincer, Aylin. Washington University in St. Louis. Mallinckrodt Institute of Radiology; Estados Unidos.Fil: Flores, Shaney. Washington University in St. Louis. Mallinckrodt Institute of Radiology; Estados Unidos.Fil: Keefe, Sarah J. Washington University in St. Louis. Mallinckrodt Institute of Radiology; Estados Unidos.Fil: Berman, Sarah B. Alzheimer's Disease Research Center. Department of Neurology; Estados Unidos. University of Pittsburgh. Pittsburgh Institute for Neurodegenerative Diseases; Estados Unidos.Fil: Cash, David M. UCL Queen Square Institute of Neurology; Reino Unido.Fil: Chhatwal, Jasmeer P. Massachusetts General Hospital. Department of Neurology; Estados Unidos.Fil: Cruchaga, Carlos. Washington University in St. Louis. Department of Psychiatry; Estados Unidos. Washington University in St. Louis. Hope Center for Neurological Disorders; Estados Unidos. Washington University in St. Louis. NeuroGenomics and Informatics; Estados Unidos.Fil: Fox, Nick C. Department of Neurodegenerative Disease. Dementia Research Centre; Reino Unidos. UCL Institute of Neurology. Dementia Research Institute at UCL; Reino Unidos.Fil: Ghetti, Bernardino. Indiana University. Department of Pathology and Laboratory Medicine; Estados Unidos.Fil: Graff-Radford, Neill R. Mayo Clinic Florida; Estados Unidos.Fil: Hassenstab, Jason. Washington University in St. Louis. Knight Alzheimer's Disease Research Center; Estados Unidos. Washington University in St. Louis. Department of Neurology; Estados Unidos. Washington University in St. Louis. Department of Psychological & Brain Sciences; Estados Unidos.Fil: Karch, Celeste M. Washington University in St. Louis. Department of Psychiatry; Estados Unidos.Fil: Laske, Christoph. German Center for Neurodegenerative Diseases (DZNE); Alemania. University of Tübingen. Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy. Section for Dementia Research; Alemania.Fil: Levin, Johannes. Ludwig-Maximilians-Universität München; Alemania.Fil: Masters, Colin L. Florey Institute; Autralia. The University of Melbourne; Autralia