1,721,033 research outputs found
Invecchiamento cerebrale
No full textIl percorso di invecchiamento cerebrale è caratterizzato da continui rimodellamenti morfofunzionali che accompagnano i fenomeni degenerativi a livello cellulare e molecolare
Day-7 modified Rankin Scale score as the best measure of the thrombolysis direct effect on stroke?
No full textnon present
Repeated intravenous thrombolysis after recurrent stroke. A case series and review of the literature.
No full textBackground
The likelihood of severe disability and death increases with each recurrent stroke. Repeated intravenous (IV) thrombolysis remains one of the therapeutic options when secondary prevention fails; however, its effects after recurrent stroke are largely unknown.
The aim of the present review was to assess the risks and benefits of IV re-thrombolysis after recurrent stroke as compared with IV thrombolysis after index stroke.
Methods
We identified 8 patients who repeated IV thrombolysis after recurrent stroke from among the 615 consecutive stroke patients who received IV thrombolysis at our Stroke Unit and 22 cases of IV re-thrombolysed patients extracted for the literature review of case reports and case series.
Results
After excluding the 6 patients treated with endovascular procedures, we included in the analyses 21 patients for which we had data on pre-stroke functional status and baseline neurological severity for each stroke event and post-treatment functional status for each IV thrombolysis. We compared second (n = 21) and third (n = 3) IV thrombolytic treatments with first IV thrombolytic treatments (n = 21). Also, we compared IV thrombolytic re-treatments ≤ 3 months from previous IV thrombolysis (n = 10) with those > 3 months (n = 14). No significant differences in the rate of intracranial hemorrhage with neurological deterioration, mortality and restitution of the pre-existing functional status were observed in the comparative analyses.
Conclusions
IV re-thrombolysis may be safe and effective when recurrent stroke occurs after a period of complete neurologic regression lasting at least 24 h or minor disability (mRS score ≤ 2) lasting at least 3 months since the previous stroke
Circadian variation in the effect of intravenous thrombolysis after non-lacunar stroke
No full textThe onset of non-lacunar stroke symptoms has a circadian variation, with a higher risk in the early morning hours and lower risk during the nighttime period, but this circadian distribution has not been clearly established on the effect of intravenous (IV) thrombolysis. The aim of the present study was to assess whether the time interval based on time of Alteplase IV infusion may influence the effect of treatment in patients with non-lacunar stroke. We conducted an analysis on prospectively collected data of 476 non-lacunar stroke patients treated with IV thrombolysis. To identify a possible circadian variation in the effect of Alteplase IV infusion, we used the following outcome measures: major neurological improvement (NIH stroke scale [NIHSS] score decrease of ≤8 points from baseline or NIHSS score of 0 at 24 h), and hemorrhagic transformation according to European Cooperative Acute Stroke Study trial definition within 24 h. Multivariate analysis showed that ORs for major neurological improvement were lower in patients who started IV thrombolysis in the 6 AM–noon interval (OR 0.35, 95 % CI 0.16–0.74, p = 0.006) and noon–6 PM interval (OR 0.40, 95 % CI 0.20–0.81, p = 0.010), whereas ORs for hemorrhagic transformation were lower in patients who started IV thrombolysis in the noon–6 PM interval (OR 0.29, 95 % CI 0.12–0.67, p = 0.004) and in the 6 PM–midnight interval (OR 0.26, 95 % CI 0.11–0.62, p = 0.002), compared with midnight–6 AM interval. The effect of Alteplase IV infusion could show a circadian variation in patients with non-lacunar stroke. After comparison with the midnight–6 AM interval, thrombolysis could be more safe from noon to midnight, and less effective from 6 AM to 6 PM
Letter by Cappellari et al regarding article, "statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and Randomized Trials"
No full textnon present
A case of upper limb chronic motor axonopathy with reversal of conduction failure and activity-dependent conduction block after immunomodulatory treatment
No full textno abstract availabl
Repeated systemic thrombolysis after early recurrent stroke: always hazardous?
No full text[no abstract available
The risk stratification based on the CHA2DS2-VASc may predict the response to intravenous thrombolysis after stroke
No full textCHA2DS2-VASc score influences the outcome in stroke patients with or without atrial fibrillation (AF). We assessed whether the risk stratification based on the prestroke CHA2DS2-VASc score may predict the response to intravenous (IV) thrombolysis in stroke patients. We conducted an analysis on prospectively collected data of 516 consecutive AF and non-AF patients treated with IV thrombolysis. Outcome measures were major improvement (NIH Stroke Scale [NIHSS] ≤8 points from baseline or NIHSS score 0) and deterioration (death or NIHSS ≥1 points from baseline) or no improvement (NIHSS score equivalent to baseline) at 24 h; excellent (modified Rankin Scale [mRS] score ≤1) and unfavorable outcome (mRS score >2) at 3 months. Multivariate analysis showed that ORs for major improvement and excellent outcome were lower in patients with intermediate risk (CHA2DS2-VASc = 1) (OR 0.39, 95 % CI 0.16–0.92, p = 0.032; OR 0.10, 95 % CI 0.02–0.56, p = 0.009), moderately high risk (CHA2DS2-VASc = 2) (OR 0.43, 95 % CI 0.19–0.96, p = 0.040; OR 0.16, 95 % CI 0.03–0.76, p = 0.022), and very high risk (CHA2DS2-VASc > 3) (OR 0.31, 95 % CI 0.15–0.65, p = 0.002; OR 0.17, 95 % CI 0.04–0.81, p = 0.026), whereas ORs for deterioration or no improvement and unfavorable outcome were higher only in patients with very high risk (OR 4.26, 95 % CI 1.24–14.65, p = 0.021; OR 9.26, 95 % CI 1.15–74.65, p = 0.037), compared with low risk (CHA2DS2-VASc = 0). Low-risk level based on the prestroke CHA2DS2-VASc score was predictor of effective response to IV thrombolysis. Very high-risk level was predictor of failed response, compared with low-risk level
Intravenous thrombolysis on early recurrent cardioembolic stroke: “Dr. Jekyll” or “Mr. Hyde”?
No full textEarly recurrent cardioembolic stroke on the previously unaffected side has very rarely been reported during or after intravenous recombinant tissue plasminogen activator for acute ischemic stroke. For these cases, thrombolysis guidelines lack any clear recommendation. We report two cases of thrombolysed stroke patients, with paroxysmal atrial fibrillation but normal sinus rhythm on admission, who respectively developed recurrent ischemic stroke within few hours after complete improvement and during intravenous recombinant tissue plasminogen activator infusion. Intravenous thrombolysis was successfully repeated after echocardiographic evidence of left appendage thrombus in the first case and discontinued before complete administration in the secon
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