56 research outputs found
sj-docx-1-tan-10.1177_17562864231216637 – Supplemental material for The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy
No full textSupplemental material, sj-docx-1-tan-10.1177_17562864231216637 for The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy by Jeremy Molad, Hen Hallevi, Estelle Seyman, Einor Ben-Assayag, Tali Jonas-Kimchi, Udi Sadeh, Ofer Rotschild, Naaem Simaan, Anat Horev, Jose Cohen, Ronen R. Leker and Asaf Honig in Therapeutic Advances in Neurological Disorders</p
sj-docx-1-eso-10.1177_23969873221098857 – Supplemental material for Preventing post-stroke dementia. The MARCH Trial. Protocol and statistical analysis plan of a randomized clinical trial testing the safety and efficacy of Maraviroc in post-stroke cognitive impairment
No full textSupplemental material, sj-docx-1-eso-10.1177_23969873221098857 for Preventing post-stroke dementia. The MARCH Trial. Protocol and statistical analysis plan of a randomized clinical trial testing the safety and efficacy of Maraviroc in post-stroke cognitive impairment by Einor Ben Assayag, Jeremy Molad, Estelle Seyman, Ofer Rotschild, Ehud Zeltzer, Udi Sadeh-Gonik, Noa Bregman, Aviva Alpernas, Yahel Segal, Dafna Ben Bashat, Talya Nathan, Muhamad Hawwari, Oren Tene and Hen Hallevi in European Stroke Journal</p
Supplemental material for Impact of previous stroke on outcome after thrombectomy in patients with large vessel occlusion
No full textSupplemental Material for Impact of previous stroke on outcome after thrombectomy in patients with large vessel occlusion by Ronen R Leker, Jose E Cohen, Anat Horev, David Tanne, David Orion, Guy Raphaeli, Jacob Amsalem, Jonathan Y Streifler, Hen Hallevi, Natan M Bornstein, Nour E Yaghmour, Gregory Telman and On Behalf of the NASIS-REVASC Study Group: for the ECASS-4 study group in International Journal of Stroke</p
Walking and Sitting Time after a Stroke: A Comparison of Shifts and Changes over Time within an Acute Care Setting
No full textEarly activity post-stroke reduces secondary complications and improves rehabilitation outcomes. This study aimed to describe the physical activities of stroke patients in an acute hospital setting, compare activity patterns between working shifts, and assess associations between activity and clinical status. Twenty-one patients (mean age 69.4 ± 33.4 years,13 men) admitted due to acute ischemic stroke wore activity monitors for two weeks or until discharge. During the morning and evening shifts, the activity monitor collected daily data on walking and body position. The study discovered that patients’ overall activity levels were low and that activity was higher during morning shifts than evening shifts (sitting time: 185.31 ± 109.31 min and 91.8 ± 98.46 min, p = 0.002; number of steps: 58.3 ± 32.73 and 30.4 ± 17.6 steps, p < 0.001). Upright and sitting time increased in morning shifts (p = 0.002), while the number of steps increased in both morning and evening shifts (p = 0.002). In the evening shift, there was a fair (r = 0.28, p = 0.02) positive correlation between grip strength and the number of steps, such that patients with higher grip strength took more steps. In addition, there were poor (r = −0.2, p = 0.02) correlations between motor function (Trunk Control Test and Functional Ambulation Category) and time in an upright position, such that patients with lower functional ability sat longer. Clinical characteristics and level of activity did not show any other correlations. To conclude, the main out-of-bed activity of patients was sitting during morning shifts. The findings highlight the temporal differences in activity throughout the day, as well as the disconnect between clinical characteristics and activity levels
Classification of lesion area in stroke patients during the subacute phase: A multiparametric MRI study
No full textCase report: Cerebral sinus vein thrombosis in VEXAS syndrome
No full textVEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic) syndrome is a newly described hemato-inflammatory acquired monogenic entity that presents in adulthood. One of the main features of VEXAS syndrome is a high venous thromboembolism (VTE) burden, with approximately 30–40% experiencing lower extremity deep vein thrombosis and a lower incidence of pulmonary embolism at approximately 10%. To date, VEXAS syndrome has not been associated with rarer forms of VTE such as cerebral sinus vein thrombosis (CSVT) and Budd–Chiari syndrome, which are well-recognized vascular manifestations in Behcet’s disease, another autoinflammatory vasculitic disease. Herein, we describe a case of acute severe extensive and fatal CSVT in a patient with VEXAS syndrome. The event occurred during a period of apparently quiescent inflammatory status, while the patient was receiving tocilizumab and a low dose of glucocorticoids. Despite treatment with anticoagulation, high-dose glucocorticoids, endovascular thrombectomy, and intracranial pressure-lowering agents, the patient suffered severe neurologic damage and ultimately succumbed to the condition 3 weeks after the onset of CSVT. To the best of our knowledge, this is the first reported case of CVST in a patient with VEXAS syndrome
Intracranial Atherosclerosis Is Associated with Progression of Neurological Deficit in Subcortical Stroke
No full text<i>Background:</i> Progression of neurological deficit (PND) is a frequent complication of acute subcortical ischemic stroke (SCS). The role of intracranial atherosclerosis (IAS) in PND is controversial. Our goal was to evaluate IAS on admission, as predictor of PND in SCS patients. <i>Methods:</i> SCS patients were identified from our prospective database from 2004 to 2008. Clinical and laboratory data were collected from charts, and radiographic data from original radiographs. The proximal intracranial arteries were graded as patent, irregular, stenotic, or occlusion. IAS was defined as irregularity or stenosis. PND was defined as a change in the National Institutes of Health Stroke Scale >1 point. <i>Results:</i> Two hundred and two SCS patients were identified. In 14%, PND occurred at a median of 2 days from onset. Univariate analysis by infarct location showed the following to be associated with PND: for anterior circulation infarcts (centrum semiovale/basal ganglia), M1 atherosclerosis (p = 0.042); for posterior circulation infarcts, vertebral artery atherosclerosis (p = 0.018). For both groups, we found a non-significant association with age (p = 0.2) and HbA1c levels (p = 0.095). No association was found with admission glucose levels. Multivariate analysis showed the following association with PND: for anterior circulation infarcts, M1 atherosclerosis (OR 4.7; 95% CI 1.2–18.8; p = 0.03); for pontine infarcts, vertebral artery atherosclerosis (OR 5.8; 95% CI 1.1–29.4; p = 0.033). There was an increase in PND likelihood with an increasing number of atherosclerotic vessels. <i>Discussion:</i> In our cohort of SCS patients, PND was associated with IAS of the responsible vessels. These results suggest a role for IAS in the pathogenesis of PNF in SCS patients.</jats:p
Acute neurology simulation-based training boosts confidence and reduces anxiety in novice neurology residents and nursing staff
No full textAbstract Background Neurological emergencies pose a considerable challenge in emergency departments, with common misdiagnoses and delayed care. Given the growing role of neurology residents in emergency settings, targeted training is crucial. The Israeli-Neurological-Association(INA) has implemented a national Simulation-Based Medical Education(SBME) program for Post-Graduate-Year-2 neurology residents and nursing staff. This study aims to delineate the educational initiative and evaluate participant satisfaction, readiness, and anxiety levels. Methods This study included all individuals participating in the SBME training program from January2020- April2024. The curriculum involved five alternating scenarios(acute stroke, acute coma, meningoencephalitis, status epilepticus, and acute non-traumatic-weakness) using computer-enhanced mannequins and live actors. Following each scenario, a skilled instructor facilitated a debriefing session to consolidate knowledge acquisition. Participants used VAS scales and the validated State-Trait-Anxiety Inventory-6(STAI-6) questionnaires to assess satisfaction, general anxiety, and self-readiness before and after simulations. Results 79 medical professionals across 11 medical centers in Israel participated in the training. The cohort comprised 75.9% PGY-2 neurology residents and 24.1% nurses with varying clinical experience (range 0.2–22 years), mean age 33.94 years, and 55.7% female. Wilcoxon signed-rank test showed participants’ self-assessed readiness levels to identify and manage neurological emergencies increased (Z=-5.24,Z=-5.63,p < 0.001,respectively). Participants’ anxiety levels, as measured by both general anxiety and the STAI-6questionnaire, decreased post-intervention (Z=-3.44,p = 0.001and Z=-5.13,p < 0.001,respectively). Conclusion The multidisciplinary SBME training program for handling acute neurological emergencies enhanced participants’ self-readiness, confidence in managing such cases and reduced anxiety among medical staff. These results underscore the significance of integrating SBME into neurology training programs, with potential positive implications for physician well being, clinical performance and patient care
Increased rate of missense/in-frame mutations in individuals with NF1-related pulmonary stenosis: A novel genotype-phenotype correlation
No full textNeurofibromatosis type 1 (NF1) and its related disorders (NF1-Noonan syndrome (NFNS) and Watson syndrome (WS)) are caused by heterozygous mutations in the NF1 gene. Pulmonary stenosis (PS) occurs more commonly in NF1 and its related disorders than in the general population. This study investigated whether PS is associated with specific types of NF1 gene mutations in NF1, NFNS and WS. The frequency of different NF1 mutation types in a cohort of published and unpublished cases with NF1/NFNS/WS and PS was examined. Compared with NF1 in general, NFNS patients had higher rates of PS (9/35 26% vs 25/2322 1.1%, P valueo0.001). Stratification according to mutation type showed that the increased PS rate appears to be driven by the NFNS group with non-truncating mutations. Eight of twelve (66.7%) NFNS cases with non-truncating mutations had PS compared with a 1.1% PS frequency in NF1 in general (Po0.001); there was no increase in the frequency of PS in NFNS patients with truncating mutations. Eight out of eleven (73%) individuals with NF1 and PS, were found to have non-truncating mutations, a much higher frequency than the 19% reported in NF1 cohorts (Po0.015). Only three cases of WS have been published with intragenic mutations, two of three had non-truncating mutations. Therefore, PS in NF1 and its related disorders is clearly associated with non-truncating mutations in the NF1 gene providing a new genotype-phenotype correlation. The data indicate a specific role of non-truncating mutations on the NF1 cardiac phenotype. © 2013 Macmillan Publishers Limited All rights reserved
Intravenous Tissue Plasminogen Activator in Patients With Cocaine-Associated Acute Ischemic Stroke
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