1,721,208 research outputs found
Hirnschlag: Akutbehandlung und Sekundärprophylaxe
No full textWelches sind die wichtigsten Massnahmen der Sekundärprophylaxe nach
einem Stroke? Was bringt eine intensive Nachbetreuung? Und warum ist
es so wichtig, dass Patienten mit Verdacht auf einen Hirnschlag möglichst rasch
ins Spital gelangen? Antworten auf diese Fragen lieferten am Symposium
«Neurologie für praktizierende Ärzte» PD Dr. med. Mirjam R. Heldner und
Prof. Dr. med. Simon Jung vom Inselspital Bern
Natalizumab in spinal multiple sclerosis in a daily clinical setting
No full textObjective: We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course in patients with and without spinal involvement.Methods: Annualized relapse rate (ARR), disability progression and occurrence of new brain and spinal T2 lesions (N2TL) in 68 spinal (S-P) versus 68 non-spinal matched patients (NS-P) were retrospectively collected and compared between before (2 years) and after NTZ treatment using multivariate regression models.Results: Mean duration of NTZ treatment was 31.3 ± 16.3 months in S-P and 32.1 ± 15.1 months in N-SP (p = 0.56). The mean ARR after NTZ treatment was similarly reduced in both S-P (0.07 ± 0.19) and N-SP (0.07 ± 0.16) (p < 0.001 for both). Disability progression after NTZ start was similarly low in S-P and NS-P. However, when compared to before NTZ start, disability progression was significantly reduced in S-P (p = 0.017), but not in NS-P (p = 0.68). This was largely mediated by a higher disability progression before NTZ start in S-P than N-SP. The risk of developing N2TL during NTZ was not different between S-P and NS-P (p = 0.10).Conclusions: NTZ similarly reduced the occurrence of relapses and NT2L in S-P and NS-P, whereas the effect on disability progression was particularly evident in the presence of spinal involvement. NTZ appears to be a treatment of high efficacy in both S-P and NS-P
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Cerebral venous sinus thrombosis associated with cancer: analysis of the ACTION-CVT study.
Full text linkNearly one fifth of patients with venous thromboembolism (VTE) have cancer. When both of these conditions occur, especially in cases of cerebral vein thrombosis (CVT), patient management is often challenging. The aim of this study was to compare the characteristics and event courses in patients affected by CVT with and without cancer. Consecutive patients with CVT from the ACTION-CVT cohort study were included if cancer status was reported. Risk factors as well as the clinical and radiological characteristics of patients were compared. Univariable and multivariable analyses were performed to assess variables associated with cancer. Kaplan-Meier method and log-rank test, logistic regression analysis, and propensity score matching were used to investigate any association between cancer-related CVT and study outcomes (primary outcome at 3-months: recurrent VTE or major hemorrhage; recurrent VTE; major hemorrhage; recanalization status; all-cause-death). Overall, 1,023 patients with CVT were included, of which 6.5% had cancer. Older age (adjusted odds ratio [aOR] 1.28 per decade increase; 95% confidence interval [CI] 1.08-1.52) and absence of headache (aOR 0.47; 95% CI 0.27-0.84) were independently associated with cancer. Patients with cancer had a higher risk of recurrent VTE or major hemorrhage (aOR 3.87; 95% CI 2.09-7.16), all-cause-death (aOR 7.56 95% CI 3.24-17.64), and major hemorrhage (aOR 3.70 95% CI 1.76-7.80). Recanalization rates, partial or complete, was not significantly different. CVT patients with cancer were more likely to be older, have no referred headache, and have worse outcomes compared to CVT patients without cancer
Weniger sichtbare Symptome. Wenn Multiple Sklerose das Verhalten, die Gefühle und die Kognition beeinflusst
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Ätiologie des Hirninfarkts
No full textDas pathogenetische Verständnis bei zerebralen Durchblutungsstörungen wächst. Durch die moderne
Diagnostik gelingt eine immer genauere Abgrenzung verschiedener Ursachen von Hirninfarkten.
Ursächlich kommen ein embolischer Gefässverschluss, eine lokale Thrombusbildung oder seltener
eine hämodynamische Insuffizienz aufgrund eines vorgeschalteten Strömungshindernisses in Betracht.
Die häufigste Emboliequelle stellt allerdings das Herz dar. Ziel der Abgrenzung ist eine ätiologische
Zuordnung und die adäquate Therapie
Reader response: Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA).
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