Stroke etiology in young adults and older patient differs considerably, as well as epidemiology and clinical features vary according to geographical criteria. To improve clinical management and optimize diagnostic wor...Stroke etiology in young adults and older patient differs considerably, as well as epidemiology and clinical features vary according to geographical criteria. To improve clinical management and optimize diagnostic work-up of young adults with acute cerebrovascular events, we analyzed retrospectively data of 6-year stroke unit case series. In this hospital case series study, we enrolled 145 patients with acute cerebrovascular events aged 16 to 49, consecutively admitted to a Community Hospital Hub Stroke Unit. We studied risk factors for stroke, the distribution of acute cerebrovascular events, stroke subtype, length of stay and clinical outcome: 70% of patients were admitted for acute ischemic event (45 female-F, 57 male-M), 10.5% intracranial hemorrhages (5F, 10M), 2.7% subarachnoid hemorrhage (2F, 2M), 2% venous sinus thrombosis (3F), 14.5 for acute ischemic attack (12F, 9M). Among ischemic stroke patients, the etiology was as follows: atherothrombosis 29.4%, cardioembolism 19.6%, arterial dissection 13.7%, other determined causes 8.8%, lacunar stroke 5.8%, and undetermined causes 22.54%. 15% of ischemic young patients were treated with r-TPA. The majority of patients returned home at discharge, whereas 30% needed intensive rehabilitation programme to regain independence in the activity of daily living. Dedicated health care programme targeting prevention and optimizing treatment of acute cerebrovascular events in young adults are desirable to improve prognosis among this socioeconomically active age group.展开更多
BACKGROUND Several conditions may present with acute neurological symptoms,thus mimicking the presentation of stroke.Although the underlying disorder can be diagnosed after careful medical,neurological,and radiologica...BACKGROUND Several conditions may present with acute neurological symptoms,thus mimicking the presentation of stroke.Although the underlying disorder can be diagnosed after careful medical,neurological,and radiological examinations,a few conditions,such as Wernicke encephalopathy(WE),may present a particular diagnostic difficulty.WE is a neurological disorder caused by deficiency of thiamine(B1 vitamin),most often resulting from alcoholism,malnutrition,hyperemesis gravidarum or bariatric surgery.The diagnosis of WE in a certain historical,clinical setting is easily suggested,but in a few cases presenting with acute neurological deficits,it can be particularly challenging.CASE SUMMARY We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities,dizziness and a confusional state,which had lasted for approximately 30 minutes.The patient had a similar episode of a confusional state approximately two months earlier;at that time,a transient ischemic attack was suspected and he was started on aspirin.The initial clinical evaluation and imaging findings were unremarkable for stroke,but the patient’s symptoms,history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE.Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.CONCLUSION Through this case report,we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke,especially when the presentation is atypical or when risk factors for thiamine deficiency are present.Since intravenous thiamine significantly improves outcomes,delayed recognition and treatment in some cases might be deleterious.展开更多
Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assi...Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning(biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals(HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or activeassisted modes(where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan? robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off(SAT) before(T1) and immediately after(T2) training on days 1 and 2(T3 and T4). The change in SAT after 2 days of training(T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode(T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied "as-needed." This study was approved by the local ethical committee(Comité d'éthique médicale, CHU UCL Namur, MontGodinne, Yvoir, Belgium;Internal number: 54/2010, Eudra CT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov(Identifier: NCT03974750) on June 5, 2019.展开更多
Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.</span><span style="font-family:Verdana;">&...Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The literature reports some cases of association between Eustachian valve and PFO and is known that the prominent Eustachian valve can represent a way facilitating systemic embolism.</span><span style="font-family:""></span><span style="font-family:Verdana;">Several studies also investigated the role of Eustachian valve in the pathophysiology of both migraine and cerebral embolism.</span><span style="font-family:Verdana;"> </span><span style="font-family:""><span style="font-family:Verdana;">In addiction is known how Eustachian valve may increase the risk of endocarditis, which mostly affects intravenous drug abusers or those with implanted medical devices or central venous catheters. The most commonly identified organism is </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (approximately 53% of cases).</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We present a case of a 46-year-old woman with known migraine. She was</span><span style="font-family:Verdana;"> hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patent foramen ovale with right-to-left shunt with a fenestration of atrial septum and a voluminous Eustachian valve detected with transesophageal echocardiography;she developed fever with a blood cultures positive for methicillin-resis</span><span style="font-family:Verdana;">- </span><span style="font-family:""><span style="font-family:Verdana;">tant </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (MRSA), even if without evidence of endocarditis vegetations.</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In summary</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the objective of our paper is to present an example of a correlation between the persistence of the Eustachian valve with bothcryptogenetic stroke, possible valve infection and migraine.展开更多
Celiac disease(CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homoz...Celiac disease(CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homozygous 5,10-methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia,was affected by two occipital ischemic strokes within a period of 5 mo.At the time of the second stroke,while she was being treated with folic acid,acetylsalicylic acid and a gluten-free diet,she had left hemianopsia,left hemiparesthesias,and gait imbalance.Brain magnetic resonance imaging showed a subacute right occipital ischemic lesion,which was extended to the dorsal region of the right thalamus and the ipsilateral thalamocapsular junction.Antitransglutaminase and deamidated gliadin peptide antibodies were no longer present,while antinuclear antibodies,antineuronal antibodies and immune circulating complexes were only slightly elevated.Since the patient was taking folic acid,her homocysteine levels were almost normal and apparently not sufficient alone to explain the clinical event.A conventional cerebral angiography showed no signs of vasculitis.Finally,rare causes of occipital stroke in young patients,such as Fabry's disease and mitochondrial myopathy,encephalomyopathy,lactic acidosis and stroke-like symptoms,were also excluded by appropriate tests.Thus,the most probable cause for the recurrent strokes in this young woman remained CD,although the mechanisms involved are still unknown.The two main hypotheses concern malabsorption(with consequent deficiency of vitamins known to exert neurotrophic and neuroprotective effects) and immunemediated mechanisms.CD should be kept in mind in the differential diagnosis of ischemic stroke in young patients.展开更多
Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. ...Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. We describe the features of the first six Senegalese cases diagnosed at the Neurology Department of the Fann Teaching Hospital in Dakar. Patients and Method: It was a preliminary retrospective and prospective study conducted at the Neurology department of Fann teaching hospital (Dakar-Senegal). The symptomatic CW diagnosis was based on angioCT-scan of the neck arteries. The National Institute of Health Stroke Scale (NIHSS) and the modified-Rankin Scale (mRS) were used to assess the severity of the IS and the functional disability after the event, respectively. Results: CW was causing a left sylvian infarction in 4 patients. The mean age of the patients at the IS diagnosis was 41 ± 6 years with a sex ratio of 1. The mean time to diagnosis of CW was 13 months. Smoking (1/6), hypertension (1/6), and obesity (1/6) were the main vascular risk factors. The mean LDL cholesterol level was 1.52 g/L ± 0.49. The mean initial NIHSS was 15 ± 6 (8-22). Half of the patients had a severe infarction (NIHSS ≥ 15). For secondary prevention, half of the patients were treated with aspirin and the other half with acenocoumarol. After 18 months ± 17 of follow-up, the mean mRS score was 2 ± 1 (1-3). Conclusion: CW is an unknown cause of IS in young black patients. An early and appropriate multidisciplinary management could help to reduce the risk of recurrences.展开更多
Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually </span></span><span style="white-space:normal;"><span style="font-family:"">asympto...Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually </span></span><span style="white-space:normal;"><span style="font-family:"">asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization</span></span><span style="white-space:normal;"><span style="font-family:"">,</span></span><span style="white-space:normal;"><span style="font-family:""> a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome).</span></span><span style="white-space:normal;"><span style="font-family:""> These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.展开更多
The etiologic diagnosis of cerebrovascular diseases requires non-routine complementary examinations to be performed. Thus, in specific cases, after neuroimaging(computed tomography/magnetic resonance imaging cerebral ...The etiologic diagnosis of cerebrovascular diseases requires non-routine complementary examinations to be performed. Thus, in specific cases, after neuroimaging(computed tomography/magnetic resonance imaging cerebral scan sequences) and neurosonology(Doppler test of the supra-aortic trunks, transcranial echography and echocardiography), which academically allow us to classify the patients according to their etiologic stroke subtype, further examinations must be used to make a correct etiologic diagnostic. The present review aims to update knowledge about the usefulness of the different tests of blood and urine, plain chest radiography, X-ray of the spine, skull and abdomen, lumbar puncture, electroencephalography, evoked potentials, polysomnography, and pathologic examination after biopsy of the artery, skin, muscles, nerves, meninges, and brain, in the management of patients who have suffered an acute stroke.展开更多
<b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The number of people with stroke increases worldwide. The stroke s</s...<b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The number of people with stroke increases worldwide. The stroke s</span><span style="font-family:""><span style="font-family:Verdana;">urvivors live with disabilities and those influence their quality of life (QOL). This study was aimed to investigate the association between clinical characteristics and QOL of th</span><span style="font-family:Verdana;">e older people with st</span><span style="font-family:Verdana;">roke at discharge from the hospital. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is a cross-sectional study. The participants were 113 stroke survivors aged 60 years and older admitted to the stroke unit. Quality of life was the study’s outcome which measured by using the abbreviated version of t</span><span style="font-family:Verdana;">he </span><span style="font-family:Verdana;">World Health Organization Quality of Life (WHOQOL-BREF). Primary clinical characteristics were measured by the National Institute of Health Stroke</span> <span style="font-family:Verdana;">Scale (NIHSS), Barthel Index (BI), and Modified Rankin Scale (mRS). Po</span><span style="font-family:Verdana;">tential confounding factors were age, sex, education levels, marital status, curre</span><span style="font-family:Verdana;">nt occupation, and comorbidity (hypertension, diabetes mellitus, dyslipi</span><span style="font-family:Verdana;">demia, and heart disease). Multiple linear regression was used for data analys</span><span style="font-family:Verdana;">is</span><span style="font-family:Verdana;">.</span><span> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The main effects of clinical outcomes were high BI Score that had a significant difference association with QOL (</span></span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.312, 95%</span><span style="font-family:""> </span><span style="font-family:Verdana;">CI =</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.042,</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.296,</span><span style="font-family:Verdana;"> <i></span><span style="font-family:Verdana;"> <i>P</i></span><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;"> = 0.009), lower mRS score also had significant difference association with QOL (</span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;">= </span><span style="font-family:""><span style="font-family:Verdana;">-0.</span><span style="font-family:Verdana;">371, 95%CI = </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">5.394, </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">1.162, </span></span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:""> </span><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;">= 0.003) after all adjusting. Additional risk factor in this study was marital status (currently married) (</span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;">= </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.155, 95%</span><span style="font-family:""> </span><span style="font-family:Verdana;">CI = </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.226, 8.666, </span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"></i></span><i><span style="font-family:""> </span></i><span style="font-family:""><span style="font-family:Verdana;">= 0.039). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Low function status and </span><span style="font-family:Verdana;">severe stroke disability as the clinical characteristics were associated with QOL in</span><span style="font-family:Verdana;"> older people with stroke at hospital discharge. An additional factor was marital status (currently married).展开更多
Pure motor stroke(PMS), also known as pure motor hemiparesis, is the most common of any lacunar form(between one half and two thirds of cases, depending on the series). In an acute stroke registry, 733 patients presen...Pure motor stroke(PMS), also known as pure motor hemiparesis, is the most common of any lacunar form(between one half and two thirds of cases, depending on the series). In an acute stroke registry, 733 patients presented a lacunar infarct and PMS accounted for 12.7%(n = 342) of all first-ever stroke patients and for 48% of all lacunar syndromes. The posterior limb of the internal capsule, corona radiata, and pons are the most frequent brain topographies. Infarcts in the mesencephalus or medullary pyramid have been exceptionally reported. This present update is focused on the clinical evidence and mechanisms underlying the relationship between PMS and different stroke etiologies.展开更多
BACKGROUND The World Health Organization defined long coronavirus disease 2019(COVID-19)as the continuation or development of new symptoms 3 months after the initial severe acute respiratory syndrome coronavirus 2 inf...BACKGROUND The World Health Organization defined long coronavirus disease 2019(COVID-19)as the continuation or development of new symptoms 3 months after the initial severe acute respiratory syndrome coronavirus 2 infection,with these symptoms lasting for at least 2 months with no other explanation.AIM To evaluate the potential laboratory and instrumental findings(short-term and long-term)resulting from COVID-19.METHODS This longitudinal observational COVID-19 cohort study(March 1,2020-March 1,2021)was carried out on patients≥18 years old who were admitted to the University Hospitals of Pisa,Siena and Careggi and the Azienda USL Toscana Nord Ovest,Sud Est and USL Centro Toscana and were subjected to follow-up.Follow-up was conducted between 0 day and 89 days,90 days and 179 days,180 days and 269 days,270 days and 359 days,and more than 360 days after hospitalization.RESULTS Of 2887 patients(58.5%males,average age 66.2 years)hospitalized in the study period(March 1,2020-March 1,2021)carrying out at least one follow-up examination within 12 months of discharge,a total of 1739 patients(705 males,average age 66 years)underwent laboratory tests,of whom 714 patients(470 males,average age 63 years)underwent spirometry.Some laboratory test results remained above the threshold even at follow-up beyond 360 days(C-reactive protein:36%,fibrin degradation fragment:48.8%,gamma-glutamyl transferase:16.8%),while others showed a return to normal range more quickly in almost all patients.Alterations in liver enzymes,hematocrit,hemoglobin,lymphocytes and neutrophils were associated with the risk of requiring oxygen therapy or forced expiratory volume in one second/forced vital capacity alterations at follow-up.CONCLUSION Alterations in liver enzymes,hematocrit or hemoglobin,lymphocytes and neutrophils were associated with risk outcomes(need for oxygen therapy or spirometry alterations).These imbalanced conditions may contribute to pulmonary dysfunction.展开更多
Intracerebral hemorrhage （ICH） is the most severe cerebrovascular disease, which represents a leading cause of death and disability in developed countries. However, therapeutic options are limited, so is mandatory t...Intracerebral hemorrhage （ICH） is the most severe cerebrovascular disease, which represents a leading cause of death and disability in developed countries. However, therapeutic options are limited, so is mandatory to investigate repairing processes after stroke in order to develop new therapeutic strategies able to promote brain repair processes. Therapeutic angiogenesis and vasculogenesis hold promise to improve outcome of ICH patients. In this regard, circulating endothelial progenitor cells （EPCs） have recently been suggested to be a marker of vascular risk and endothelial function. Moreover, EPC levels have been associated with good neurological and functional outcome as well as reduced residual hematoma volume in ICH patients. Finally, experimental and clinical studies indicate that EPC might mediate endothelial cell regeneration and neovascularization. Therefore, EPC-based therapy could be an excellent therapeutic option in ICH. In this mini-review, we discuss the present status of knowledge about the possible therapeutic role of EPCs in ICH, molecular mechanisms, and the future perspectives and strategies for their use in clinical practice.展开更多
文摘Stroke etiology in young adults and older patient differs considerably, as well as epidemiology and clinical features vary according to geographical criteria. To improve clinical management and optimize diagnostic work-up of young adults with acute cerebrovascular events, we analyzed retrospectively data of 6-year stroke unit case series. In this hospital case series study, we enrolled 145 patients with acute cerebrovascular events aged 16 to 49, consecutively admitted to a Community Hospital Hub Stroke Unit. We studied risk factors for stroke, the distribution of acute cerebrovascular events, stroke subtype, length of stay and clinical outcome: 70% of patients were admitted for acute ischemic event (45 female-F, 57 male-M), 10.5% intracranial hemorrhages (5F, 10M), 2.7% subarachnoid hemorrhage (2F, 2M), 2% venous sinus thrombosis (3F), 14.5 for acute ischemic attack (12F, 9M). Among ischemic stroke patients, the etiology was as follows: atherothrombosis 29.4%, cardioembolism 19.6%, arterial dissection 13.7%, other determined causes 8.8%, lacunar stroke 5.8%, and undetermined causes 22.54%. 15% of ischemic young patients were treated with r-TPA. The majority of patients returned home at discharge, whereas 30% needed intensive rehabilitation programme to regain independence in the activity of daily living. Dedicated health care programme targeting prevention and optimizing treatment of acute cerebrovascular events in young adults are desirable to improve prognosis among this socioeconomically active age group.
文摘BACKGROUND Several conditions may present with acute neurological symptoms,thus mimicking the presentation of stroke.Although the underlying disorder can be diagnosed after careful medical,neurological,and radiological examinations,a few conditions,such as Wernicke encephalopathy(WE),may present a particular diagnostic difficulty.WE is a neurological disorder caused by deficiency of thiamine(B1 vitamin),most often resulting from alcoholism,malnutrition,hyperemesis gravidarum or bariatric surgery.The diagnosis of WE in a certain historical,clinical setting is easily suggested,but in a few cases presenting with acute neurological deficits,it can be particularly challenging.CASE SUMMARY We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities,dizziness and a confusional state,which had lasted for approximately 30 minutes.The patient had a similar episode of a confusional state approximately two months earlier;at that time,a transient ischemic attack was suspected and he was started on aspirin.The initial clinical evaluation and imaging findings were unremarkable for stroke,but the patient’s symptoms,history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE.Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.CONCLUSION Through this case report,we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke,especially when the presentation is atypical or when risk factors for thiamine deficiency are present.Since intravenous thiamine significantly improves outcomes,delayed recognition and treatment in some cases might be deleterious.
基金supported by the following grants Fonds de la Recherche Scientifique–FNRS 1.R.506.161.R.506.18&1.R.506.20+8 种基金Fonds de la Recherche Scientifique Médicale(FRSM)3.4.525.08.FFonds Spécial de Recherche(FSR)from the UCLouvainFondation Van Goethem-BrichantFondation Mont-Godinnesupported by the following grants FRNS-FRIA n°F3/5/5-MCF/ROI/BC-19727 and F3/5/5-MCF/XH/FC-17514Fondation Mont-Godinne 2018supported by grants from the Fondation Mont-Godinne 2015-2016Fonds Spécial de Recherche(FSR)of the UCLouvain 2016-2018Fondation Roi Baudouin/Fonds Amélie 2018-2019。
文摘Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning(biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals(HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or activeassisted modes(where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan? robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off(SAT) before(T1) and immediately after(T2) training on days 1 and 2(T3 and T4). The change in SAT after 2 days of training(T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode(T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied "as-needed." This study was approved by the local ethical committee(Comité d'éthique médicale, CHU UCL Namur, MontGodinne, Yvoir, Belgium;Internal number: 54/2010, Eudra CT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov(Identifier: NCT03974750) on June 5, 2019.
文摘Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The literature reports some cases of association between Eustachian valve and PFO and is known that the prominent Eustachian valve can represent a way facilitating systemic embolism.</span><span style="font-family:""></span><span style="font-family:Verdana;">Several studies also investigated the role of Eustachian valve in the pathophysiology of both migraine and cerebral embolism.</span><span style="font-family:Verdana;"> </span><span style="font-family:""><span style="font-family:Verdana;">In addiction is known how Eustachian valve may increase the risk of endocarditis, which mostly affects intravenous drug abusers or those with implanted medical devices or central venous catheters. The most commonly identified organism is </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (approximately 53% of cases).</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We present a case of a 46-year-old woman with known migraine. She was</span><span style="font-family:Verdana;"> hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patent foramen ovale with right-to-left shunt with a fenestration of atrial septum and a voluminous Eustachian valve detected with transesophageal echocardiography;she developed fever with a blood cultures positive for methicillin-resis</span><span style="font-family:Verdana;">- </span><span style="font-family:""><span style="font-family:Verdana;">tant </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (MRSA), even if without evidence of endocarditis vegetations.</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In summary</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the objective of our paper is to present an example of a correlation between the persistence of the Eustachian valve with bothcryptogenetic stroke, possible valve infection and migraine.
文摘Celiac disease(CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homozygous 5,10-methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia,was affected by two occipital ischemic strokes within a period of 5 mo.At the time of the second stroke,while she was being treated with folic acid,acetylsalicylic acid and a gluten-free diet,she had left hemianopsia,left hemiparesthesias,and gait imbalance.Brain magnetic resonance imaging showed a subacute right occipital ischemic lesion,which was extended to the dorsal region of the right thalamus and the ipsilateral thalamocapsular junction.Antitransglutaminase and deamidated gliadin peptide antibodies were no longer present,while antinuclear antibodies,antineuronal antibodies and immune circulating complexes were only slightly elevated.Since the patient was taking folic acid,her homocysteine levels were almost normal and apparently not sufficient alone to explain the clinical event.A conventional cerebral angiography showed no signs of vasculitis.Finally,rare causes of occipital stroke in young patients,such as Fabry's disease and mitochondrial myopathy,encephalomyopathy,lactic acidosis and stroke-like symptoms,were also excluded by appropriate tests.Thus,the most probable cause for the recurrent strokes in this young woman remained CD,although the mechanisms involved are still unknown.The two main hypotheses concern malabsorption(with consequent deficiency of vitamins known to exert neurotrophic and neuroprotective effects) and immunemediated mechanisms.CD should be kept in mind in the differential diagnosis of ischemic stroke in young patients.
文摘Introduction: Carotid web (CW), a rare and probably unknown arterial cause of ischemic stroke (IS), is commonly reported in young black patients, although most of the published cases resided in a non-African country. We describe the features of the first six Senegalese cases diagnosed at the Neurology Department of the Fann Teaching Hospital in Dakar. Patients and Method: It was a preliminary retrospective and prospective study conducted at the Neurology department of Fann teaching hospital (Dakar-Senegal). The symptomatic CW diagnosis was based on angioCT-scan of the neck arteries. The National Institute of Health Stroke Scale (NIHSS) and the modified-Rankin Scale (mRS) were used to assess the severity of the IS and the functional disability after the event, respectively. Results: CW was causing a left sylvian infarction in 4 patients. The mean age of the patients at the IS diagnosis was 41 ± 6 years with a sex ratio of 1. The mean time to diagnosis of CW was 13 months. Smoking (1/6), hypertension (1/6), and obesity (1/6) were the main vascular risk factors. The mean LDL cholesterol level was 1.52 g/L ± 0.49. The mean initial NIHSS was 15 ± 6 (8-22). Half of the patients had a severe infarction (NIHSS ≥ 15). For secondary prevention, half of the patients were treated with aspirin and the other half with acenocoumarol. After 18 months ± 17 of follow-up, the mean mRS score was 2 ± 1 (1-3). Conclusion: CW is an unknown cause of IS in young black patients. An early and appropriate multidisciplinary management could help to reduce the risk of recurrences.
文摘Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually </span></span><span style="white-space:normal;"><span style="font-family:"">asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization</span></span><span style="white-space:normal;"><span style="font-family:"">,</span></span><span style="white-space:normal;"><span style="font-family:""> a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome).</span></span><span style="white-space:normal;"><span style="font-family:""> These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.
文摘The etiologic diagnosis of cerebrovascular diseases requires non-routine complementary examinations to be performed. Thus, in specific cases, after neuroimaging(computed tomography/magnetic resonance imaging cerebral scan sequences) and neurosonology(Doppler test of the supra-aortic trunks, transcranial echography and echocardiography), which academically allow us to classify the patients according to their etiologic stroke subtype, further examinations must be used to make a correct etiologic diagnostic. The present review aims to update knowledge about the usefulness of the different tests of blood and urine, plain chest radiography, X-ray of the spine, skull and abdomen, lumbar puncture, electroencephalography, evoked potentials, polysomnography, and pathologic examination after biopsy of the artery, skin, muscles, nerves, meninges, and brain, in the management of patients who have suffered an acute stroke.
文摘<b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The number of people with stroke increases worldwide. The stroke s</span><span style="font-family:""><span style="font-family:Verdana;">urvivors live with disabilities and those influence their quality of life (QOL). This study was aimed to investigate the association between clinical characteristics and QOL of th</span><span style="font-family:Verdana;">e older people with st</span><span style="font-family:Verdana;">roke at discharge from the hospital. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is a cross-sectional study. The participants were 113 stroke survivors aged 60 years and older admitted to the stroke unit. Quality of life was the study’s outcome which measured by using the abbreviated version of t</span><span style="font-family:Verdana;">he </span><span style="font-family:Verdana;">World Health Organization Quality of Life (WHOQOL-BREF). Primary clinical characteristics were measured by the National Institute of Health Stroke</span> <span style="font-family:Verdana;">Scale (NIHSS), Barthel Index (BI), and Modified Rankin Scale (mRS). Po</span><span style="font-family:Verdana;">tential confounding factors were age, sex, education levels, marital status, curre</span><span style="font-family:Verdana;">nt occupation, and comorbidity (hypertension, diabetes mellitus, dyslipi</span><span style="font-family:Verdana;">demia, and heart disease). Multiple linear regression was used for data analys</span><span style="font-family:Verdana;">is</span><span style="font-family:Verdana;">.</span><span> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The main effects of clinical outcomes were high BI Score that had a significant difference association with QOL (</span></span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.312, 95%</span><span style="font-family:""> </span><span style="font-family:Verdana;">CI =</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.042,</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.296,</span><span style="font-family:Verdana;"> <i></span><span style="font-family:Verdana;"> <i>P</i></span><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;"> = 0.009), lower mRS score also had significant difference association with QOL (</span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;">= </span><span style="font-family:""><span style="font-family:Verdana;">-0.</span><span style="font-family:Verdana;">371, 95%CI = </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">5.394, </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">1.162, </span></span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:""> </span><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;">= 0.003) after all adjusting. Additional risk factor in this study was marital status (currently married) (</span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;"></i></span><span style="font-family:Verdana;">= </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.155, 95%</span><span style="font-family:""> </span><span style="font-family:Verdana;">CI = </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.226, 8.666, </span><span style="font-family:Verdana;"><i></span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"></i></span><i><span style="font-family:""> </span></i><span style="font-family:""><span style="font-family:Verdana;">= 0.039). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Low function status and </span><span style="font-family:Verdana;">severe stroke disability as the clinical characteristics were associated with QOL in</span><span style="font-family:Verdana;"> older people with stroke at hospital discharge. An additional factor was marital status (currently married).
文摘Pure motor stroke(PMS), also known as pure motor hemiparesis, is the most common of any lacunar form(between one half and two thirds of cases, depending on the series). In an acute stroke registry, 733 patients presented a lacunar infarct and PMS accounted for 12.7%(n = 342) of all first-ever stroke patients and for 48% of all lacunar syndromes. The posterior limb of the internal capsule, corona radiata, and pons are the most frequent brain topographies. Infarcts in the mesencephalus or medullary pyramid have been exceptionally reported. This present update is focused on the clinical evidence and mechanisms underlying the relationship between PMS and different stroke etiologies.
基金Supported by Regione Toscana,No.D55H20000210002.
文摘BACKGROUND The World Health Organization defined long coronavirus disease 2019(COVID-19)as the continuation or development of new symptoms 3 months after the initial severe acute respiratory syndrome coronavirus 2 infection,with these symptoms lasting for at least 2 months with no other explanation.AIM To evaluate the potential laboratory and instrumental findings(short-term and long-term)resulting from COVID-19.METHODS This longitudinal observational COVID-19 cohort study(March 1,2020-March 1,2021)was carried out on patients≥18 years old who were admitted to the University Hospitals of Pisa,Siena and Careggi and the Azienda USL Toscana Nord Ovest,Sud Est and USL Centro Toscana and were subjected to follow-up.Follow-up was conducted between 0 day and 89 days,90 days and 179 days,180 days and 269 days,270 days and 359 days,and more than 360 days after hospitalization.RESULTS Of 2887 patients(58.5%males,average age 66.2 years)hospitalized in the study period(March 1,2020-March 1,2021)carrying out at least one follow-up examination within 12 months of discharge,a total of 1739 patients(705 males,average age 66 years)underwent laboratory tests,of whom 714 patients(470 males,average age 63 years)underwent spirometry.Some laboratory test results remained above the threshold even at follow-up beyond 360 days(C-reactive protein:36%,fibrin degradation fragment:48.8%,gamma-glutamyl transferase:16.8%),while others showed a return to normal range more quickly in almost all patients.Alterations in liver enzymes,hematocrit,hemoglobin,lymphocytes and neutrophils were associated with the risk of requiring oxygen therapy or forced expiratory volume in one second/forced vital capacity alterations at follow-up.CONCLUSION Alterations in liver enzymes,hematocrit or hemoglobin,lymphocytes and neutrophils were associated with risk outcomes(need for oxygen therapy or spirometry alterations).These imbalanced conditions may contribute to pulmonary dysfunction.
基金supported by grants from the Spanish Ministry of Economy and Competitiveness(SAF2014-56336)the Instituto de Salud Carlos III(PI13/00292&PI14/01879)+5 种基金the Spanish Research Network on Cerebrovascular Diseases(RETICS INVICTUSRD12/0014)the Xunta de Galicia(Department of Education,GRC2014/027)the European Union program FEDERF.Campos(CP14/00154)TS(CP12/03121)are recipients of a research contract from Miguel Servet Program of Instituto de Salud Carlos III
文摘Intracerebral hemorrhage （ICH） is the most severe cerebrovascular disease, which represents a leading cause of death and disability in developed countries. However, therapeutic options are limited, so is mandatory to investigate repairing processes after stroke in order to develop new therapeutic strategies able to promote brain repair processes. Therapeutic angiogenesis and vasculogenesis hold promise to improve outcome of ICH patients. In this regard, circulating endothelial progenitor cells （EPCs） have recently been suggested to be a marker of vascular risk and endothelial function. Moreover, EPC levels have been associated with good neurological and functional outcome as well as reduced residual hematoma volume in ICH patients. Finally, experimental and clinical studies indicate that EPC might mediate endothelial cell regeneration and neovascularization. Therefore, EPC-based therapy could be an excellent therapeutic option in ICH. In this mini-review, we discuss the present status of knowledge about the possible therapeutic role of EPCs in ICH, molecular mechanisms, and the future perspectives and strategies for their use in clinical practice.
