1,721,009 research outputs found
Hemodynamic features of non-aneurysmal subarachnoid hemorrhage in a case of familial moyamoya disease. atranscranial doppler ultrasound study
No full textA very rare clinical manifestation of Moyamoya Disease (MMD) is subarachnoid hemorrhage, which is not due to the ruptured intracranial aneurysms (NASAH). This is an extremely rare condition and to our knowledge only five other cases [1,2,3,4,5] have been described in the literature; out of them only one was familial [3]. Moreover, there is currently no study reporting the hemodynamic features of intra and extracranial circulation assessed with ultrasound examination. We present data from a one-year Transcranial Doppler ultrasound (TCD) follow up, in the case of a 57-year-old woman admitted to our hospital for a sudden onset of headache followed by a partial seizure. Family history revealed that two of her cousins had been diagnosed with MMD, one of which deceased at the age of 52 for a subarachnoid hemorrhage (SAH) of unknown cause. On admission, a CT scan revealed SAH over the right frontal cortex and parieto-occipital cortex bilaterally. Digital Subtraction Angiography showed a bilateral stenosis of the supraclinoid segment of the ICAs (for artery acronyms see table 1 legend), and an anomalous Willis circle with absence of the ACAs and of L-MCA and multiple tortuous vessels branching from the R-MCA (‘moyamoya vessels'). No aneurysms or vascular malformations were found (fig. 1)
Right-to-eft Shunt detection sensitivity with air-saline and air-succinilgelatin transcranial doppler
No full textBACKGROUND: Air-saline transcranial Doppler is nowadays the first-choice examination to identify right-to-left shunt. To increase right-to-left shunt detection in echocardiography, cardiologists also use air-gelatin mixtures, which are more stable, more echogenic, and easier to be prepared.
AIM: We assessed the sensitivity of air-gelatin compared with air-saline for transcranial Doppler right-to-left shunt detection.
METHODS: Air-saline transcranial Doppler, during unilateral middle cerebral artery monitoring at rest and after Valsalva maneuver, was performed in patients referred to our neurosonology laboratory for right-to-left shunt detection. The same transcranial Doppler protocol was repeated with air-gelatin. To consider transcranial Doppler positive for cardiac right-to-left shunt, at least one embolic signal had to be detected within 20′′ from contrast injection. Later signals were interpreted of pulmonary origin. Trans-thoracic echocardiography was repeated with both air-saline and air-gelatin.
RESULTS: A total of 97 patients were enrolled; 46 had negative transcranial Doppler for cardiac right-to-left shunt with both air-saline and air-gelatin; out of these, four patients with air-saline plus two more patients with air-gelatin presented late, isolated microemboli, slightly more numerous with air-gelatin: these were interpreted as pulmonary shunts and confirmed with trans-thoracic echocardiography. In 28 patients with already early positive air-saline transcranial Doppler at rest, air-gelatin induced a marked right-to-left shunt increase, facilitating its visualization at trans-thoracic echocardiography. In 23 patients in whom air-saline transcranial Doppler was negative at rest and positive for cardiac right-to-left shunt only after Valsalva maneuver, air-gelatin was able to reveal shunt also at rest.
CONCLUSIONS: Air-gelatin increases right-to-left shunt detection sensitivity with transcranial Doppler in particular at rest, even in patients in whom air-saline mixture fails to identify the shunt. The choice of air-gelatin mixture should be considered for multicentric, clinical, and research trials
Efficacy, safety and indirect comparisons of lasmiditan, rimegepant, and ubrogepant for the acute treatment of migraine: A systematic review and network meta-analysis of the literature
No full textBackground: We performed a random-effects network meta-analysis to study the efficacy and safety of newly developed drugs for the acute treatment of migraine attacks. Methods: MEDLINE via PubMed, Embase and The Cochrane Register of Controlled Trials were searched from inception to 11 February 2022. Phase 3 randomized controlled trials examining all formulations of lasmiditan, rimegepant and ubrogepant for the acute treatment of adults with migraine, were included. Data were extracted following the PRISMA guidelines. Results: Seven studies (SAMURAI, SPARTAN, CENTURION, Study 302, Study 303, ACHIEVE I and II) involving n = 12,859 patients were included. All treatments were superior in efficacy to placebo. Lasmiditan 200 mg showed the highest two-hour pain freedom, while two-hour freedom from most bothersome symptom was equally achieved by the higher doses of lasmiditan (100 and 200 mg), rimegepant and the higher doses of ubrogepant (50 and 100 mg). The odds of treatment-emergent adverse events were greatest with all doses of lasmiditan. Conclusion: Lasmiditan 200 mg was the most effective intervention in the treatment of migraine attacks, although it was associated with high degrees of dizziness, nausea and somnolence. Rimegepant showed slightly lower, but similar efficacy rates to lasmiditan. Ubrogepant had overall the best tolerability profile. These conclusions are limited by the absence of head-to-head comparisons, limitations of individual trials and of the meta-analysis methodology itself.PROSPERO trial registration: CRD42022308224
Visual snow syndrome - a clinical and phenotypical description of 1100 cases
Full text linkObjective: To validate the current criteria of visual snow and to describe its common phenotype using a substantial clinical database.
Methods: We performed a web-based survey of patients with self-assessed visual snow (n = 1,104), with either the complete visual snow syndrome (n = 1,061) or visual snow without the syndrome (n = 43). We also describe a population of patients (n = 70) with possible hallucinogen persisting perception disorder who presented clinically with visual snow syndrome.
Results: The visual snow population had an average age of 29 years and had no sex prevalence. The disorder usually started in early life, and ≈40% of patients had symptoms for as long as they could remember. The most commonly experienced static was black and white. Floaters, afterimages, and photophobia were the most reported additional visual symptoms. A latent class analysis showed that visual snow does not present with specific clinical endophenotypes. Severity can be classified by the amount of visual symptoms experienced. Migraine and tinnitus had a very high prevalence and were independently associated with a more severe presentation of the syndrome.
Conclusions: Clinical characteristics of visual snow did not differ from the previous cohort in the literature, supporting validity of the current criteria. Visual snow likely represents a clinical continuum, with different degrees of severity. On the severe end of the spectrum, it is more likely to present with its common comorbid conditions, migraine and tinnitus. Visual snow does not depend on the effect of psychotropic substances on the brain
Neurophysiological aspects of ehlers-danlos hypermobility type patients affected by episodic migraine: a VEP/AEP study
No full textRight-to-Left Shunt detection sensitivity with Transcranial Doppler and saline or succinil-gelatin air mixture
No full textMigraine management in a population with chronic pain: a description of 33 cases of hypermobility type Ehlers-Danlos Syndrome.
No full textSerotonergic correlation with anger and aggressive behavior in acute stroke patients: an Intensity Dependence of Auditory evoked Potentials (IDAP) study
No full textAnger and aggressive behavior (AB) are two of the main post-stroke behavioral manifestations, which could imply both an anger trait (TA) or a state condition of anger (SA). Serotonergic system is thought to play an inhibitory control on aggressive impulse. Nevertheless, whether 5HT has the same role in TA and in SA, is still debated. Intensity dependence of auditory evoked potentials (IDAP) is thought to be inversely related to the central 5HT tone. The aim of this study was to evaluate, in acute stroke patients, the 5HT system involvement in AB by IDAP. Consecutive stroke patients were evaluated and compared with healthy controls. The Spielberger Trait Anger Scale (STAS) was used to assess AB, SA and TA. Patients with AB and TA showed a significantly increased IDAP value, whereas patients with SA had a significantly lower IDAP; this indicates an increased 5HT tone. In acute stroke patients with AB, there is a decreased central 5HT tone. Surprisingly, we found an opposite 5HT feature between patients with TA and those showing SA, suggesting that the hypothesis of aggression based on 5HT deficiency requires further investigations. This might open new strategies in the treatment of post-stroke AB
Moya Moya disease and subarachnoid hemorrhage:4-years transcranial Doppler ultrasound follow-up
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