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Background: Postpartum depression (PPD) is considered the most widespread puerperium complication. The associations of major depressive disorder with certain types of cerebrovascular diseases and cognitive function have been proposed, but the potential causal effects of PPD on these phenotypes are still unknown. Methods: A Mendelian randomization (MR) research design with variousmethods (e.g., inverse-variance weighted method and MR pleiotropy residual sum and outlier test) was adopted to establish a causal relationship between PPD with cerebrovascular diseases and cognitive impairment. Results: No causal relationship between PPD with carotid intima media thickness and cerebrovascular diseases (i.e., stroke, ischemic stroke, and cerebral aneurysm) was found. However, MR analyses indicated a causal association between PPD and decreased cognitive function (P = 3.55×10-3), which remained significant even after multiple comparison corrections using the Bonferroni method. Sensitivity analyses using weighted median and MR-Egger methods indicated a consistent direction of the association. Conclusion: The causal association between PPD and cognitive impairment indicates that cognitive impairment is a critical aspect of PPD and thus cannot be regarded as an epiphenomenon. Addressing cognitive impairment and lessening the symptoms associated with PPD independently play significant roles in the treatment of PPD. [ABSTRACT FROM AUTHOR]

The determinants of blood pressure variability (BPV) are complex. We aimed to evaluate whether circulating high-sensitivity C-reactive protein (hsCRP) is associated with short-term BPV during the subacute stage of ischemic stroke. In this observational study, a consecutive series of acute ischemic stroke patients who underwent 24 h ambulator blood pressure monitoring (ABPM) during day 4 to 10 after onset were enrolled. Multivariable linear regression models were constructed to assess relationships between hsCRP and BPV. Among a total of 325 patients analyzed, the mean age was 60 years old and 72% were male. The SD, CV, ARV of 24 h SBP and DBP were more likely to be higher in patients with hsCRP ≥ 2 mg/L, and these predispositions remained unchanged in linear regression analyses after adjusting for possible confounding factors, with a dose-response relationship when patients were additionally categorized into quartiles according to hsCRP levels using the lowest quartile as a reference category. In contrast, similar results were observed for the mean of SBP but not the mean of DBP. These results indicate that hsCRP is dose-dependently associated with short-term BPV during the subacute stage of ischemic stroke. These findings suggested that patients with a higher level of hsCRP tended to have larger blood pressure fluctuations. [ABSTRACT FROM AUTHOR]

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular transitory condition characterized by severe headache, possible concomitant acute neurological symptoms, evidence of diffuse multifocal segmental constriction of cerebral arteries, and usually spontaneously resolving within 3 months. Putative causes and/or precipitating factors are vasoactive drugs—e.g., antidepressants, α-sympathomimetics, triptans—post-partum, and immunosuppressants. Case presentation: We report the case of a middle-aged woman referred to the emergency room (ER) with a 7-day long intense headache and vomit. Cerebral non-contrast computed tomography (CT) was negative for acute ischemic lesions or intracranial bleedings. She was again referred to ER 7 days later with additional fluctuating episodes of weakness in left arm and both lower limbs. A new brain CT was negative. Due to worsening headache, a transcranial color-coded Doppler (TCCD) was performed, which showed diffuse multifocal blood flow acceleration in all principal intracranial vessels, and particularly on the right hemisphere. These findings were subsequently confirmed at MR angiogram and digital subtraction angiography. Conclusion: TCCD imaging is a non-invasive and relatively inexpensive tool which provides real-time information on cerebrovascular function, blood flow velocities, and hemodynamic changes. TCCD may be a powerful tool in the early detection of acute infrequent cerebrovascular conditions, as well as in monitoring their course and the therapeutic response. [ABSTRACT FROM AUTHOR]

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) has a heterogenous clinical and radiological presentation. We investigated whether RCVS complications vary according to age. Patients and methods: In a pooled French cohort of 345 patients with RCVS, we assessed (1) rates of clinical and radiological complications, and (2) the functional outcome at 3 months according to age as a continuous variable, and in young patients aged ≤ 49 years versus those aged ≥ 50 years. The Commission Nationale Informatique et Liberté and the local ethics committee approved this study (registration number: 202100733). Results: The risk for any focal deficit and for any brain lesion were independently associated with increasing age (OR 1.4, 95% CI 1.1–1.8; p = 0.014, and OR 1.6, 95% CI 1.2–2.1; p < 0.001, respectively). Subtypes of brain lesions independently associated with increasing age were subarachnoid haemorrhage (OR 1.7, 95% CI 1.3–2.3; p < 0.001) and intracerebral haemorrhage (OR 1.5, 95% CI 1.1–2.2; p = 0.023). Frequency of cervical artery dissections peaked at age 30–39, and young age was independently associated with cervical artery dissections (OR 13.6, 95% CI 2.4–76.6; p = 0.003). Age had no impact on the functional outcome, with a modified Rankin scale score of 0–1 in > 96% of patients. Conclusion: Age seems to influence rates and types of complications of RCVS, with young age being associated with cervical artery dissections, and increasing age with haemorrhagic complications. If confirmed in larger prospective studies, recognition of age-specific patterns might help to guide clinical management and to identify complications in cases of RCVS and vice versa. [ABSTRACT FROM AUTHOR]

Background: The occurrence of obstructive sleep apnea (OSA) and its health-related issues, especially cardiovascular diseases (CVD), are increasing in developing countries. With a 3-year follow-up study, the present study aimed to determine the incidence of cardiovascular events in patients with OSA in an Iranian population.Methods: In this prospective cohort study, 415 adults (300 patients with OSA and 115 patients without OSA) with a history of snoring and/or witnessed apneas or other suspected sleep breathing disorders were consecutively enrolled and followed up for three successive years to evaluate the development of cardiovascular events including acute coronary syndrome, cerebrovascular accidents (including ischemic or hemorrhagic strokes or transient ischemic attacks), death due to cardiac causes and all-cause mortality. Results: 415 patients were studied with a mean age of 56.2 ±15.7 years, 211 (50.8) of whom were male. Cardiovascular events developed in 15 participants (5%) of the OSA group, and 3 participants (2.6 %) of the OSA negative group. No significant differences were observed between the two groups in terms of the incidence of any of these events (P-value> 0.05). Using multiple logistic regression model (with P-value

The most important component of the treatment effectiveness is the adherence of patients to the recommendations of the attending physician, which can affect the course and prognosis of the disease. The problem of adherence in cerebrovascular disease (CVD), depending on the clinical picture of the disease and comorbid diseases, is currently poorly studied.Objective: to assess the degree of adherence to treatment in patients with the main diagnosis of CVD and to determine the factors influencing it.Material and methods. 161 patients with cerebrovascular pathology aged 58–70 years (mean age 64 years) were examined. The assessment of somatic and neurological status, neuropsychological examination, assessment of adherence to therapy using standardized national questionnaires: the Russian Scale of Quantitative Assessment Adherence to Treatment (QAA-25) and the Domestic Therapy Adherence Questionnaire (DTAQ), laboratory studies were performed. The influence of cognitive impairments (CI), background and comorbidities, as well as drug therapy in the framework of the prevention of cardiovascular diseases were evaluated.Results. In patients with CVD, according to the results of the QAA-25 questionnaire, adherence to medical support was 33.4 [26.3; 57.5] %, drug therapy – 44.4 [29.7; 59.0] %, the lifestyle modifications – 31 [26; 55] %, overall adherence to treatment – 31 [26; 56] %. The proportion of patients with low adherence according to the DTAQ test reached 19.9%. In patients with a low adherence, the result on the Montreal Cognitive Assessment Test (MoCA) was 21 points, in patients with very high adherence – 26 points. An increase in the total number of prescribed basic drugs was accompanied by a decrease in adherence according to the results of DTAQ (p=0.041) and QAA-25 (p

A common tool for detecting mild cognitive impairment (MCI) is the Montreal Cognitive Assessment (MoCA). An extension of the standard MoCA testing – MoCA-Memory Index Score (MoCA-MIS; Memory Index, MI) – allows a deeper study of the mechanisms of MCI formation. We consider the drug Prospecta as an effective measure to prevent the progression of MCI.Objective: to study the efficacy and safety of Prospecta in the treatment of MCI in patients with cerebrovascular disease (CVD) in real clinical practice.Material and methods. The observational program PRIORITET included 192 patients of both sexes aged 40 to 74 years inclusive (mean age 63.6±8.8 years) with MCI and CVD, they were prescribed Prospecta, two tablets twice a day during 24 weeks. The presence of MCI was confirmed by testing on the MoCA scale; MI was assessed additionally`. At the end of treatment, the condition of patients was assessed using the Overall Clinical Impression Scale and the safety of the therapy.Results. The change in the mean score on the MoCA scale after 24 weeks of therapy with Prospecta was 5.3 (p26 points), reached 48.9%. Additionally, patients were divided into groups depending on the results of testing on the MoCA scale and MI. During therapy with Prospecta, the number of patients in the MIS

New predictors of ischemic incidents are constantly sought since they raise the awareness of patients and their doctors of stroke occurrence. The goal was to verify whether Advanced Glycation End Products (AGEs), in particular AGE10, could be one of them. The AGE10 measurement was conducted using a non-commercial ELISA assay in the blood serum of neurological patients without cerebrovascular event (n = 24), those with transient brain attack (TIA) (n = 17), and severe ischemic stroke (n = 35). Twice as many of the people with TIA or severe stroke presented high AGE10 serum concentrations compared to the patients with other neurological conditions (χ2 = 8.2, p = 0.004; χ2 = 8.0, p = 0.005, respectively). The risk of ischemic incident was significantly risen in people with higher levels of AGE10 (OR = 6.5, CI95%: 1.7–24.8; OR = 4.7, CI95%: 1.5–14.5 for TIA and stroke subjects, respectively). We observed a positive correlation (r = 0.40) between high AGE10 levels and diabetes. Moreover, all the diabetic patients that had a high AGE10 content experienced either a severe ischemic stroke or TIA. The patients with high levels of AGE10 exhibited higher grades of disability assessed by the NIHSS scale (r = 0.35). AGE10 can be considered a new biomarker of ischemic stroke risk. Patients with diabetes presenting high AGE10 levels are particularly prone to the occurrence of cerebrovascular incidents.

Ceramide, a bioactive sphingolipid, serves as an important second messenger in cell signal transduction. Under stressful conditions, it can be generated from de novo synthesis, sphingomyelin hydrolysis, and/or the salvage pathway. The brain is rich in lipids, and abnormal lipid levels are associated with a variety of brain disorders. Cerebrovascular diseases, which are mainly caused by abnormal cerebral blood flow and secondary neurological injury, are the leading causes of death and disability worldwide. There is a growing body of evidence for a close connection between elevated ceramide levels and cerebrovascular diseases, especially stroke and cerebral small vessel disease (CSVD). The increased ceramide has broad effects on different types of brain cells, including endothelial cells, microglia, and neurons. Therefore, strategies that reduce ceramide synthesis, such as modifying sphingomyelinase activity or the ratelimiting enzyme of the de novo synthesis pathway, serine palmitoyltransferase, may represent novel and promising therapeutic approaches to prevent or treat cerebrovascular injury-related diseases. [ABSTRACT FROM AUTHOR]

Inflammation plays an important role in cerebrovascular diseases, including intracerebral hemorrhage. Assessing the prognosis of such hemorrgage at early stage adds significance to treatment outcome. In this study, for the first time, we used neutrophil/lymphocyte (N/L) ratio and mean platelet volume (MPV) values as early markers in assessing the prognosis of patients with aneurysmal subarachnoid hemorrhage (SAH). This retrospective study included 50 patients with aneurysmal SAH who were diagnosed, hospitalized, treated, and follow-up with angiography between 2015 and 2016 (Gr. I). Blood count parameters and their clinical status after application (the first-arrival Glasgow coma score [GCS]) and at discharge (Glasgow outcome score [GOS]) were examined. The MPV value and N/L ratio were compared with that of the nonaneurysmatic control group (group 2, n = 50). The N/L ratio of Gr. I (median: 10.80) was significantly higher than that of the control group (median: 2.20) (P <0.05). The GCS (median: 10.0) and GOS (median: 3.0) of Gr. I were significantly lower than those of the control group (median GCS: 15.00, median GOS: 5.00) (P <0.05). MPV values were not different between the two groups (P >0.05). In the aneurysm group, the higher the N/L ratio, the lower the GCS and GOS, while the lower the N/L ratio, the higher the GCS and GOS. In patients with aneurysmal SAH, the inflammation level was associated with disease severity, which can be considered as an early treatment and prognostic marker. The initial application of the N/L ratio may be important in assessing the prognosis, and a lower N/L ratio may be used as a simple, effective, and important marker to estimate the better prognosis of patients with aneurysmal SAH. [ABSTRACT FROM AUTHOR]

Work is an occupation of great concern for younger stroke survivors. Given the high rate of people not working after stroke, there is a need to explore work after stroke from a long-term perspective, including not just an initial return to work, but also the ability to retain employment and how this may affect everyday life after stroke. Therefore, the objective of this study was to explore experiences relating to work and to work incapacity among long-term stroke survivors. This study used thematic analysis on data gathered through individual semi-structured interviews with long-term stroke survivors. The analysis resulted in four themes that together comprised the main theme 'The centrality of work in everyday life', containing descriptions of how everyday life was affected by aspects of work both for those who did work and those who did not return to work after stroke. The results highlight the importance of addressing return to work not just as an isolated outcome but as part of everyday life after stroke. The results indicate a need for a more flexible approach to supporting return to work that continues past the initial return. [ABSTRACT FROM AUTHOR]

Background: Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time‐dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. Methods: One hospital‐based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset‐to‐door time (ODT) in the first 50%, while the door‐to‐needle time (DNT) was in the last quartile. DNT (in‐hospital delay) was further subdivided into several time intervals [door‐to‐examination time (DET), door‐to‐imaging time (DIT), door‐to‐laboratory time (DLT), and decision‐making time (DMT) of the patients or their proxies. Results: A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p >.05). For the comparisons of the time intervals, DIT (26 versus 15 min, p =.001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p >.05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036–1.118; p <.001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415–10.735; p =.008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096–0.907; p =.033), and having medical insurance (OR, 0.350; 95% CI, 0.132–0.931; p =.035) were negatively associated with the deadline effect. Conclusions: A speed‐safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID‐19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect. [ABSTRACT FROM AUTHOR]

The gut microbiome is critically involved in maintaining normal physiological function in the host. Recent studies have revealed that alterations in the gut microbiome contribute to the development and progression of cerebrovascular disease via the microbiota-gut-brain axis (MGBA). As a broad communication network in the human body, MGBA has been demonstrated to have significant interactions with various factors, such as brain structure and function, nervous system diseases, etc. It is also believed that the species and composition of gut microbiota and its metabolites are intrinsically linked to vascular inflammation and immune responses. In fact, in fecal microbiota transplantation (FMT) research, specific gut microbiota and downstream-related metabolites have been proven to not only participate in various physiological processes of human body, but also affect the occurrence and development of cerebrovascular diseases directly or indirectly through systemic inflammatory immune response. Due to the high mortality and disability rate of cerebrovascular diseases, new treatments to improve intestinal dysbacteriosis have gradually attracted widespread attention to better ameliorate the poor prognosis of cerebrovascular diseases in a noninvasive way. This review summarizes the latest advances in the gut microbiome and cerebrovascular disease research and reveals the profound impact of gut microbiota dysbiosis and its metabolites on cerebrovascular diseases. At the same time, we elucidated molecular mechanisms whereby gut microbial metabolites regulate the expression of specific interleukins in inflammatory immune responses. Moreover, we further discuss the feasibility of novel therapeutic strategies targeting the gut microbiota to improve the outcome of patients with cerebrovascular diseases. Finally, we provide new insights for standardized diagnosis and treatment of cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Background: According to the Global Burden of Disease Study (GBD), cerebrovascular diseases are the second leading cause of death in the world. This is a cross-sectional study on deaths due to cerebrovascular diseases in southern Iran. Methods: In this cross-sectional study, data on all deaths caused by cerebrovascular diseases in the Fars province between 2004 and 2019 was extracted from the Electronic Death Registry System (EDRS). To eliminate or minimize the influence of age composition, standardized mortality rate was used based on the 2013 Segi standard populations of low- and middle-income countries. In order to measure the years of life lost (YLL) from cerebrovascular diseases, the standardized life table was considered. The Joinpoint Regression method was used to examine the trend of the crude and standardized mortality rate and the YLL rate. Results: Over the study period, 24,051 deaths occurred due to cerebrovascular diseases in Fars with 12,586 cases in men (52.3%). The trend of standardized mortality rate in males and females was decreasing (P value = 0.001 and < 0.001 for males and females, respectively). All YLL due to premature mortality from cerebrovascular disease during the 16-year study period were 119,436 (3.8 per 1000 persons) in men, and 111,172 (3.6 per 1000 persons) in women. Based on the joinpoint regression, the 16-year trend of YLL rate due to premature death was decreasing: annual percent change (APC) was -1.6% (95% CI -3.4 to 0.3, P = 0.098) for males, and -2.0% (95% CI -3.6 to -0.4, P = 0.017) for females. Conclusion: The trend of mortality rate and YLL caused by cerebrovascular diseases has decreased in our study. Necessary measures, mainly primary and secondary prevention, should be taken to continue the diminishing trend of cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Negative & No Positive Results is the property of Research & Science S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In recent years, with the development of artificial intelligence, especially deep learning technology, researches on automatic detection of cerebrovascular diseases on medical images have made tremendous progress and these models are gradually entering into clinical practice. However, because of the complexity and flexibility of the deep learning algorithms, these researches have great variability on model building, validation process, performance description and results interpretation. The lack of a reliable, consistent, standardized design protocol has, to a certain extent, affected the progress of clinical translation and technology development of computer aided detection systems. After reviewing a large number of literatures and extensive discussion with domestic experts, this position paper put forward recommendations of standardized design on the key steps of deep learning-based automatic image detection models for cerebrovascular diseases. With further research and application expansion, this position paper would continue to be updated and gradually extended to evaluate the generalizability and clinical application efficacy of such tools.

Aim. To study the severity of atherosclerosis of the carotid arteries during the period of hospitalization and one year after acute coronary syndrome (ACS) in elderly patients and to determine the factors influencing the progression of the atherosclerotic process.Materials and methods. The study included 105 patients with ACS aged 75 and over and with the presence of atherosclerosis of the carotid arteries according to duplex scanning. The data of 86 patients were re-analyzed one year after ACS. The degree of stenosis of the carotid arteries, the structure of atherosclerotic plaques (ASP) with the determination of signs of instability were assessed during the period of hospitalization and one year after ACS.Results. One year after ACS, 56,9 % patients had adverse clinical outcomes, including death. Progression of the atherosclerotic process was detected in 31,4 %, regression – 7,2 %, unchanged – 61,4 %. During the period of hospitalization and one year after ACS, the regression of signs of instability was found when assessing the structure of ASP: heterogenous structure – 29 and 19,5 % (p = 0,019), irregular surface – 9,2 and 4,9 % (p = 0,605), hypoechogenic component – 27,6 and 17,3 % (p = 0,012), signs of local calcification – 14,7 and 8,8 % (p = 0,075), ulcerated ASP – 2,8 and 1,3 % (p = 0,329). The relationship between the progression of atherosclerosis and adherence to therapy was found. The presence of stenoses of the carotid arteries of 50 % and more: OR = 2,53 (95 % CI: 0,65–9,86, p

Cardio-cerebrovascular disease, related to high mortality and morbidity worldwide, is a type of cardiovascular or cerebrovascular dysfunction involved in various processes. Therefore, it is imperative to conduct additional research into the pathogenesis and new therapeutic targets of cardiovascular and cerebrovascular disorders. Long non-coding RNAs (lncRNAs) have multiple functions and are involved in nearly all cellular biological processes, including translation, transcription, signal transduction, and cell cycle control. LncR-Meg3 is one of them and is becoming increasingly popular. By binding proteins or directly or competitively binding miRNAs, LncR-Meg3 is involved in apoptosis, inflammation, oxidative stress, endoplasmic reticulum stress, epithelialmesenchymal transition, and other processes. Recent research has shown that LncR-Meg3 is associated with acute myocardial infarction and can be used to diagnose this condition. This article examines the current state of knowledge regarding the expression and regulatory function of LncR-Meg3 in relation to cardiovascular and cerebrovascular diseases. The abnormal expression of LncRMeg3 can influence neuronal cell death, inflammation, apoptosis, smooth muscle cell proliferation, etc., thereby aggravating or promoting the disease. In addition, we review the bioactive components that target lncR-Meg3 and propose some potential delivery vectors. A comprehensive and in-depth analysis of LncR-Meg3’s role in cardiovascular disease suggests that targeting LncR-Meg3 may be an alternative therapy in the near future, providing new options for slowing the progression of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke. [ABSTRACT FROM AUTHOR]

BACKGROUND: The occurrence of obstructive sleep apnea (OSA) and its health-related issues, especially cardiovascular diseases (CVD), are increasing in developing countries. With a 3-year follow-up study, the present study aimed to determine the incidence of cardiovascular events in patients with OSA in an Iranian population. METHODS: In this prospective cohort study, 415 adults (300 patients with OSA and 115 patients without OSA) with a history of snoring and/or witnessed apneas or other suspected sleep breathing disorders were consecutively enrolled and followed up for three successive years to evaluate the development of cardiovascular events including acute coronary syndrome, cerebrovascular accidents (including ischemic or hemorrhagic strokes or transient ischemic attacks), death due to cardiac causes and all-cause mortality. RESULTS: 415 patients were studied with a mean age of 56.2 ±15.7 years, 211 (50.8) of whom were male. Cardiovascular events developed in 15 participants (5%) of the OSA group, and 3 participants (2.6 %) of the OSA negative group. No significant differences were observed between the two groups in terms of the incidence of any of these events (P-value> 0.05). Using multiple logistic regression model (with P-value <0.2 as the significance level), age, OSA, and history of CVD remained as significant predictors for the development of cardiac composite events (incidence of CVD, CVA, death due to cardiac causes, and all-cause mortality) with the odds ratios of (95% confidence interval) 1.03 (1.01, 1.06), 2.41 (1.02, 5.76), and 7.40 (2.91, 18.67), respectively. CONCLUSIONS: The present study showed that OSA is associated with a more than twofold increased risk of cardiovascular events. Thus, obstructive sleep apnea should be considered an independent cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

Apelin, an endogenous ligand for the G protein-coupled receptor APJ, is extensively expressed in various systems, especially the nervous system. This article reviews the role of apelin/APJ system in neurological diseases. In detail, apelin/APJ system can relieve acute brain injury including subarachnoid hemorrhage, traumatic brain injury, and ischemic stroke. Also, apelin/APJ system has therapeutic effects on chronic neurodegenerative disease models, involving the regulation of neurotrophic factors, neuroendocrine, oxidative stress, neuroinflammation, neuronal apoptosis, and autophagy. In addition, through different routes of administration, apelin/APJ system has a biphasic effect on depression, epilepsy, and pain. However, apelin/APJ system exacerbates the proliferation and invasion of glioblastoma. Thus, apelin/APJ system is expected to be a therapeutic target for the treatment of nervous system diseases. [ABSTRACT FROM AUTHOR]

Cerebral cavernous malformation (CCM) or cavernoma is a major vascular disease of genetic origin, whose main phenotypes occur in the central nervous system, and is currently devoid of pharmacological therapeutic strategies. Cavernomas can remain asymptomatic during a lifetime or manifest with a wide range of symptoms, including recurrent headaches, seizures, strokes, and intracerebral hemorrhages. Loss-of-function mutations in KRIT1/CCM1 are responsible for more than 50% of all familial cases, and have been clearly shown to affect cellular junctions, redox homeostasis, inflammatory responses, and angiogenesis. In this study, we investigated the therapeutic effects of multidrug-loaded lipid nanoemulsions in rescuing the pathological phenotype of CCM disease. The pro-autophagic rapamycin, antioxidant avenanthramide, and antiangiogenic bevacizumab were loaded into nanoemulsions, with the aim of reducing the major molecular dysfunctions associated with cavernomas. Through Western blot analysis of biomarkers in an in vitro CCM model, we demonstrated that drug-loaded lipid nanoemulsions rescue antioxidant responses, reactivate autophagy, and reduce the effect of pro-angiogenic factors better than the free drugs. Our results show the importance of developing a combinatorial preventive and therapeutic approach to reduce the risk of lesion formation and inhibit or completely revert the multiple hallmarks that characterize the pathogenesis and progression of cavernomas. [ABSTRACT FROM AUTHOR]

Neurons are the basic building blocks of the human body's neurological system. Atrophy is defined by the disintegration of the connections between cells that enable them to communicate. Peripheral neuropathy and demyelinating disorders, as well as cerebrovascular illnesses and central nervous system (CNS) inflammatory diseases, have all been linked to brain damage, including Parkinson's disease (PD). It turns out that these diseases have a direct impact on brain atrophy. However, it may take some time after the onset of one of these diseases for this atrophy to be clearly diagnosed. With the emergence of the Coronavirus disease 2019 (COVID-19) pandemic, there were several clinical observations of COVID-19 patients. Among those observations is that the virus can cause any of the diseases that can lead to brain atrophy. Here we shed light on the research that tracked the relationship of these diseases to the COVID-19 virus. The importance of this review is that it is the first to link the relationship between the Coronavirus and diseases that cause brain atrophy. It also indicates the indirect role of the virus in dystrophy. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) are the leading cause of death and illness in Europe and worldwide, responsible for a staggering 47% of deaths in Europe. Over the past few years, there has been increasing evidence pointing to bioactive sphingolipids as drivers of CVDs. Among them, most studies place emphasis on the cardiovascular effect of ceramides and sphingosine-1-phosphate (S1P), reporting correlation between their aberrant expression and CVD risk factors. In experimental in vivo models, pharmacological inhibition of de novo ceramide synthesis averts the development of diabetes, atherosclerosis, hypertension and heart failure. In humans, levels of circulating sphingolipids have been suggested as prognostic indicators for a broad spectrum of diseases. This article provides a comprehensive review of sphingolipids' contribution to cardiovascular, cerebrovascular and metabolic diseases, focusing on the latest experimental and clinical findings. Cumulatively, these studies indicate that monitoring sphingolipid level alterations could allow for better assessment of cardiovascular disease progression and/or severity, and also suggest them as a potential target for future therapeutic intervention. Some approaches may include the down-regulation of specific sphingolipid species levels in the circulation, by inhibiting critical enzymes that catalyze ceramide metabolism, such as ceramidases, sphingomyelinases and sphingosine kinases. Therefore, manipulation of the sphingolipid pathway may be a promising strategy for the treatment of cardio- and cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cerebral proliferative angiopathy (CPA) is a rare cerebrovascular disease comprised of a diffuse network of blood vessels, often spread over several lobes. Due to the presence of normal brain tissue within the malformation, complete resection is not desirable. Several imaging characteristics help to distinguish CPA from brain arteriovenous malformations. We report the case of a patient diagnosed with CPA five years after a spontaneous intraventricular hemorrhage and an initial negative angiogram. Teaching Point: The radiologist should be able to differentiate CPA from brain AVM to prevent potentially harmful treatment. [ABSTRACT FROM AUTHOR]

Acute spontaneous intracerebral hemorrhage (ICH) is the most severe stroke subtype, with a high risk of death, dependence, and dementia. Knowledge about the clinical profile and early outcomes of ICH patients with lobar versus deep subcortical brain topography remains limited. In this study, we investigated the effects of ICH topography on demographics, cerebrovascular risk factors, clinical characteristics, and early outcomes in a sample of 298 consecutive acute ICH patients (165 with lobar and 133 with subcortical hemorrhagic stroke) available in a single-center-based stroke registry over 24 years. The multiple logistic regression analysis shows that variables independently associated with lobar ICH were early seizures (OR 6.81, CI 95% 1.27–5.15), chronic liver disease (OR 4.55, 95% CI 1.03–20.15), hemianopia (OR 2.55, 95% CI 1.26–5.15), headaches (OR 1.90, 95% CI 1.90, 95% IC 1.06–3.41), alcohol abuse (>80 gr/day) (OR 0–10, 95% CI 0.02–0,53), hypertension (OR 0,41, 95% CI 0.23–0–70), sensory deficit (OR 0.43, 95% CI 0.25–0.75), and limb weakness (OR: 0.47, 95% CI 0.24–0.93). The in-hospital mortality was 26.7% for lobar and 16.5% for subcortical ICH. The study confirmed that the clinical spectrum, prognosis, and early mortality of patients with ICH depend on the site of bleeding, with a more severe early prognosis in lobar intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Abstract Background Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time‐dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. Methods One hospital‐based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset‐to‐door time (ODT) in the first 50%, while the door‐to‐needle time (DNT) was in the last quartile. DNT (in‐hospital delay) was further subdivided into several time intervals [door‐to‐examination time (DET), door‐to‐imaging time (DIT), door‐to‐laboratory time (DLT), and decision‐making time (DMT) of the patients or their proxies. Results A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036–1.118; p

Background: Existing studies have already shown a connection between nitrogen dioxide (NO2) exposure and cerebrovascular mortality. However, the differential effects of NO2 on cerebrovascular disease and its subtypes remain unclear and require further exploration. Methods: Daily stroke mortality data between 2013 and 2021 in Shanghai, China were collected. Residential daily air pollution data for each decedent were predicted from a satellite model. An individual-level, time-stratified, case-crossover design was applied to examine the relationship between NO2 exposure and cerebrovascular mortality. A combination of conditional logistic regression and distributed lag models with a maximum lag of 7 days was used for data analysis. Results: A total of 219,147 cases of cerebrovascular mortality were recorded. Among them, the proportion of sequelae of cerebrovascular disease, hemorrhagic stroke and ischemic stroke was 50.7%, 17.1% and 27.5%, respectively. The monotonic increases in mortality risks of cerebrovascular diseases, sequelae of cerebrovascular disease and ischemic stroke were observed, without any discernible thresholds. Each 10 μg/m3 increase in NO2 concentration was associated with increments of 3.62% [95% confidence interval (CI): 2.56%, 4.69%] for total cerebrovascular mortality, 4.29% (95% CI: 2.81%, 5.80%) for sequelae of cerebrovascular disease mortality and 4.30% (95% CI: 2.30%, 6.33%) for ischemic stroke mortality. No positive associations between NO2 exposure and hemorrhagic stroke mortality were observed. A greater risk of NO2 was observed in the warm season, in patients with less than 9 years of education and in those with single marital status. The effects of NO2 were robust to mutual adjustment of co-pollutants. Conclusions: Short-term exposures to NO2 may increase the risk of cerebrovascular mortality, specifically for ischemic stroke and sequelae of cerebrovascular disease.

Background: Cerebral cavernous malformations (CCMs) are a major type of cerebrovascular lesions of proven genetic origin that occur in either sporadic (sCCM) or familial (fCCM) forms, the latter being inherited as an autosomal dominant condition linked to loss-of-function mutations in three known CCM genes. In contrast to fCCMs, sCCMs are rarely linked to mutations in CCM genes and are instead commonly and peculiarly associated with developmental venous anomalies (DVAs), suggesting distinct origins and common pathogenic mechanisms. Case report: A hemorrhagic sCCM in the right frontal lobe of the brain was surgically excised from a symptomatic 3 year old patient, preserving intact and pervious the associated DVA. MRI follow-up examination performed periodically up to 15 years after neurosurgery intervention demonstrated complete removal of the CCM lesion and no residual or relapse signs. However, 18 years after surgery, the patient experienced acute episodes of paresthesia due to a distant recurrence of a new hemorrhagic CCM lesion located within the same area as the previous one. A new surgical intervention was, therefore, necessary, which was again limited to the CCM without affecting the pre-existing DVA. Subsequent follow-up examination by contrast-enhanced MRI evidenced a persistent pattern of signal-intensity abnormalities in the bed of the DVA, including hyperintense gliotic areas, suggesting chronic inflammatory conditions. Conclusions: This case report highlights the possibility of long-term distant recurrence of hemorrhagic sCCMs associated with a DVA, suggesting that such recurrence is secondary to focal sterile inflammatory conditions generated by the DVA. [ABSTRACT FROM AUTHOR]

Background: While healthy sleep is suggested to promote glymphatic clearance in the brain, poorer sleep may be associated with higher enlarged perivascular spaces (ePVS) burden, potentially representing impaired perivascular drainage. This study aims to evaluate the association between ePVS burden and polysomnographic sleep characteristics in a large community-based sample.Methods: 552 dementia and stroke-free Framingham Heart Study participants (age: 58.6 ± 8.9 years; 50.4% men) underwent a full-night in-home polysomnography. Three years later on average, participants underwent a brain MRI. ePVS were rated in the basal ganglia and centrum semiovale, and dichotomized as low burden (<20 counts, grades 1 and 2) or high burden (>20 counts, grades 3 and 4). Logistic regression analyses relating sleep variables to subsequent ePVS burden were used, adjusted for age, sex, time interval between polysomnography and MRI, ApoE ε4 allele carrier status, hypertension, and smoking.Results: Longer N1 sleep and shorter N3 sleep duration were associated with higher ePVS burden in the centrum semiovale. When stratifying these associations by subpopulations, longer N1 sleep duration with ePVS burden was observed especially in older individuals and hypertensive participants. Associations between ePVS burden and other sleep characteristics such as total sleep time and REM sleep duration varied according to ApoE ε4 allele carrier status.Conclusions: Lighter sleep, as characterized by longer N1 sleep and shorter slow-wave sleep, is associated with higher ePVS burden. These findings suggest that sleep architecture may be involved in glymphatic clearance and cerebral small vessel disease, which could be an important biological link between sleep and dementia risk. [ABSTRACT FROM AUTHOR]

Detection and diagnosis of a disease with a single image can be tedious and difficult for doctors but with the adaptation of medical image fusion, a path for additional improvements can be paved. The objective of this research is to implement different fusion algorithms based on conventional and proposed hybrid techniques. Based on performance metrics it has been observed that the novel method, Discrete Component Wavelet Transform (DCWT) shows remarkable results in comparison to the traditional techniques. As per the enhancement methods, Binarization, Median Filter, and Contrast Stretching have been considered to compare the contrast performance with Contrast Limited Adaptive Histogram Equalization. Certain modifications to each enhancement method were made related to the selection of parameters. Thus, better qualitative and quantitative values were observed in Discrete Component Wavelet Transform. The different attributes were calculated from the fused images which were classified using various machine learning techniques. Maximum accuracy of 97.87% and 95.74% is obtained using Discrete Component Wavelet Transform for Support Vector Machine (SVM) and k Nearest Neighbor (kNN) (k = 4) respectively considering the combination of both features Grey Level Difference Statistics and shape. [ABSTRACT FROM AUTHOR]

The search for effective pharmaceutical agents which possess high antiaggregant and antioxidant activity, and simultaneously, lack negative side effects, is a highly relevant task for modern science. In this regard, we evaluated the antiplatelet activity of a new conjugated compound from acetylsalicylic acid and carnosine—salicyl-β-alanil-L-histidine (salicyl-carnosine, SC) and investigate the antioxidant activity of SC in an in vitro model of Fe2+-induced chemoluminiscence of low and very low density lipoproteins, acquired from blood of patients with chronic cerebrovascular diseases (CCVD). The acquired results indicate that the effectiveness of SC in reducing ADP-induced thrombocyte aggregation in vitro is comparable to that of acetylsalicylic acid. At the same time, carnosine and salicylic acid failed to demonstrate any significant antiaggregant effect. All investigated compounds had a similar effect on lipid hydro-peroxides levels, and effectively decreased them in a range of concentrations from 50 to 500 µM. The observed antioxidant activity of compounds, occurred proportionately to their concentration. In conclusion, SC possesses both antiaggregant and antioxidant activity, which is maintained in CCVD patient blood samples in vitro. This new compound has the potential to become an effective pharmaceutical agent for treating cerebrovascular disease. [ABSTRACT FROM AUTHOR]

A unique structure of care for neurological inpatients with significant palliative care (PC) needs was established in the Department of Neurology at the Charité—Universitätsmedizin Berlin in 2021: a specialized neuropalliative care (NPC) unit. After one year, we provide an overview of the concept and the patients' characteristics. Methods: We retrospectively analyzed the characteristics of patients treated in our NPC unit between February 2021–February 2022. Data were extracted from medical records and PC assessment including diagnosis, mode of admission and discharge, length of stay, and palliative symptoms. Data are presented as averages with a 95% confidence interval [lower limit; upper limit] or percentage (absolute number). Results: We included 143 patients (52% (75) female, 67.9 years [65.6; 70.2]). Patients were admitted from general wards (48%; 68), their homes (22%; 32), intensive care units (16%; 23) or emergency departments (14%; 20). The main diagnoses were tumors of the nervous system (39%; 56), neurodegenerative diseases (30%; 43), neurologic complications (13%; 19) and cerebrovascular diseases (12%; 17). Complaints most frequently rated as severely to overwhelmingly burdensome were motor- or fatigue-associated problems, problems communicating, dysphagia and pain. The average length of stay was 13.7 days [12.2; 15.2]. Forty-five percent (64) of patients were discharged without further PC, 17% (24) were referred to a hospice and 13% (18) were discharged with outpatient PC. Five percent (7) were referred to neurorehabilitation and 21% (30) of patients died. Conclusions: Our NPC unit is a new model of care for neurological patients with substantial PC needs especially within the structures of a highly specialized and individualized medicine. [ABSTRACT FROM AUTHOR]

Introduction: Intra‐ or peri‐procedural aneurysm rupture is one of the most feared adverse effects associated with embolization. Our aim was to report the characteristics of patients suffering intra‐ or peri‐procedural ruptures during embolization of cerebral aneurysms. Patients and methods: Between March 1994 and October 2021, 648 consecutive cerebral aneurysms were treated by endovascular procedure at our facility. Medical records were reviewed retrospectively with emphasis on procedure description, potential risk factors, and clinical outcomes related to intra‐ or peri‐procedural rupture. Results: Of the 648 patients, 17 (2.6%) suffered an intra‐ or peri‐procedural hemorrhagic event. The most common location was the anterior communicating artery. There was no significant difference between previously ruptured and unruptured aneurysms in the incidence of bleeding. In four patients, bleeding was evident within 24 h after the procedure. The clinical evolution at three months was poor and only four patients presented a positive evolution. There were 11 deaths (64.71%). Balloon remodeling was associated with an increased frequency of ruptures, while stenting was a safer treatment. Conclusion: Aneurysmal rupture during endovascular therapy is unpredictable, and its occurrence can be devastating. The incidence is quite low although the outcome is frequently poor. Early detection and proper management, including prompt occlusion of the aneurysm, are important to achieve a positive outcome. Anterior communicating artery aneurysms and those treated with balloon catheters have a higher incidence of rupture. A small number of ruptures of uncertain origin occur that go unnoticed in digital subtraction angiograms. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of death and disability. Some patients may present with atypical symptoms. One of the very rare presentations of stroke is initial neurogenic pain. Rare painful presentations include, amongst others, acute trigeminal neuralgia, atypical facial pain, hemi‐sensory pain, and episodic pain. Based on the available literature, the pain at presentation may be episodic, transient, or persistent, and it may herald other debilitating stroke symptoms such as hemiparesis. Pain quality is often described as burning; less often as sharp. Patients often have accompanying focal symptoms and findings on neurological examination. However, in several of the reviewed cases, these were discrete or non‐existent. In patients with pain located in the trunk and/or extremities, lesions may involve the thalamus, lateral medulla oblongata, insula, or parietal lobe. In patients with atypical facial or orbital pain (including the burning "salt and pepper" sensation), the stroke lesions are typically located in the pons. In this narrative review, we included studies/case series of patients who had pain at the time of onset, shortly before or within 24 h of stroke symptoms (on the day of admission). Cases with pain related to aortic or cervical vessel dissection, cerebral venous sinus thrombosis, subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, and CNS vasculitis were excluded. With this review, we aim to summarize the current knowledge on stroke presenting with acute pain. [ABSTRACT FROM AUTHOR]

Cerebrovascular disease is one of the leading causes of disability and death worldwide, and seeking a potential treatment is essential. Trilinolein (TriL) is a natural triacylglycerol presented in several plants. The effects of TriL on cerebrovascular diseases such as cerebral ischemia and carotid stenosis have never been studied. Accordingly, we investigated the protection of TriL on cerebral ischemia/reperfusion (I/R) and vascular smooth muscle cell (VSMC) migration in vivo and in vitro. The cerebral infarction area, the intima to media area (I/M ratio), and proliferating cell nuclear antigen (PCNA)-staining of the carotid artery were measured. Platelet-derived growth factor (PDGF)-BB-stimulated A7r5 cell migration and potential mechanisms of TriL were investigated by wound healing, transwell, and Western blotting. TriL (50, 100, and 200 mg/kg, p.o.) reduced: the cerebral infarction area; neurological deficit; TUNEL-positive apoptosis; intimal hyperplasia; and PCNA-positive cells in rodents. TriL (5, 10, and 20 µM) significantly inhibited PDGF-BB-stimulated A7r5 cell migration and reduced matrix metalloproteinase-2 (MMP-2), Ras, MEK, and p-ERK protein levels in PDGF-BB-stimulated A7r5 cells. TriL is protective in models of I/R-induced brain injury, carotid artery ligation-induced intimal hyperplasia, and VSMC migration both in vivo and in vitro. TriL could be potentially efficacious in preventing cerebral ischemia and cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Pressure ulcer (PU) is a localized injury to the skin or underlying tissues usually over a bony prominence, which results due to pressure or pressure in combination with shear. It is an expensive health care problem that have deterring impact on the length of hospitalization and cause extra nursing care time. Moreover, PUs negatively impacts patients' health related quality of life. High PUs prevalence figures were found in specialized hospital units such as intensive care unit (ICU), orthopedics, surgery, and also in stroke patients in medical units. The major purpose of this study is to assess the frequency of pressure ulcers in stroke patients at Ayub teaching hospital. The methodology used for carrying out the research was cross-sectional study conducted during months of September, October, and November 2020. Questionnaire was used to collect the data and well-informed written consent was taken from the patients. A total of 120 stroke patients were initially included with the intention to study the frequency of PUs among them. Different age groups were taken but majority (48.3%) belonged to the age group 31–60 years. Maximum patients were hypertensive (65%), while few of them were diabetic (35%). From the results of proposed work, it is found that out of 120 stroke patients, 75.8% presented with ischemic stroke while 24.2% presented with hemorrhagic stroke. 8.3% that is 10 out of 120 stroke patients developed pressure ulcers of grade 1 (1.7%), grade 2 (1.7%), grade 3 (2.5%), and grade 4 (2.5%) mostly in the sacral region (6.7%) and also on ankle (0.8%), and shoulder (0.8%) respectively. Patients in the study group had unsatisfactory hygiene (6.7%) were malnourished (11.7%) and were not using preventive mattresses (79.2%). Those at the risk of developing pressure ulcers were not being repositioned (6.7%) and did not had awareness (10%). Prevention and treatment used in ward is 100%. Conclusively, the frequency of pressure ulcers in stroke patients was determined to be 8.3% and the most frequent localization was sacrum. The PU care in this hospital is appropriate but still could be improved further by improving risk assessment, prevention specially use of air mattress and patient education regarding PUs. The main objective of the study is to identify the frequency of PUs in stroke patients and to highlight various factors that would avoid PUs development. • The quality of pressure ulcer care in stroke patients. • This paper provides the frequency of pressure ulcers in stroke patients was determined. • This paper highlights various factors that would avoid PUs development. [ABSTRACT FROM AUTHOR]

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Neurological diseases such as stroke and multiple sclerosis are associated with high morbidity and mortality, long-term disability, and social and economic burden. Therefore, they represent a major challenge for medical treatment. Numerous evidences support the beneficial effects of polyphenols from olive trees, which can alleviate or even prevent demyelination, neurodegeneration, cerebrovascular diseases, and stroke. Polyphenols from olive oils, especially extra virgin olive oil, olive leaves, olive leaf extract, and from other olive tree derivatives, alleviate inflammation and oxidative stress, two major factors in demyelination. In addition, they reduce the risk of stroke due to their multiple anti-stroke effects, such as anti-atherosclerotic, antihypertensive, antioxidant, anti-inflammatory, hypocholesterolemic, hypoglycemic, and anti-thrombotic effects. In addition, olive polyphenols have beneficial effects on the plasma lipid profiles and insulin sensitivity in obese individuals. This review provides an updated version of the beneficial properties and mechanisms of action of olive polyphenols against demyelination in the prevention/mitigation of multiple sclerosis, the most common non-traumatic neurological cause of impairment in younger adults, and against cerebral insult with increasing incidence, that has already reached epidemic proportions. [ABSTRACT FROM AUTHOR]

Background: Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited. Objectives: In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated. Methods: A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry. Results: Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24–9.64), nausea or vomiting (OR 4.48, CI 95% 2.95–6.82), medulla (OR 2.87, CI 95% 1.31–6.30), pons (OR 2.39, CI 95% 1.26–4.51), basilar artery (OR 2.36, CI 95% 1.33–4.17), ataxia (OR 2.33, CI 95% 1.41–3.85), and headache (OR 2.31, CI 95% 1.53–3.49). Conclusion: The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem. [ABSTRACT FROM AUTHOR]

Background: Enteral nutrition is often prescribed in acute stroke to meet energy and fluid needs in patients with dysphagia. Tubes clogging represent a common complication of enteral formula delivery, requiring substitution and influencing nutrition administration. Frequent water flushes are recommended as one of the most effective procedures to prevent tube occlusion, but it might be time demanding and not consistently performed by the healthcare staff. This study aimed to assess the efficacy of an automatic flush pump, compared to a manual flush system, to prevent tubes' occlusions in acute-stroke patients, as this might affect nutrition and hydration. Methods: Gastrointestinal symptoms, nutrition and hydration biomarkers were also monitored to determine the different devices' safety. Sixty-two patients were included in the study and allocated to the "manual" or "automatic" flushes device. Results: The mean duration of data collection was 7 ± 2 days. Tube occlusions occurred in 22.6% of the patients in the "manual" group, whereas only one tube clogging was reported in the "automatic" group (p = 0.023). No significant differences between groups were reported for constipation and diarrhea frequency nor nutrition and hydration status. When the nurses were asked to simulate manual flush administration at the same frequency of the automatic device, they were able to meet the recommendations only 10% of the time. Conclusion: This preliminary study suggests the efficacy of automatic flush systems to prevent enteral tube clogging, without affecting health status compared to standard manual flush systems. [ABSTRACT FROM AUTHOR]

The review & discussion of research articles, journals, and some books help us to understand the neuro-navigation system. This review article may help to understand What is a navigation system? What are the capabilities of the navigation system? What is the method of a neuro navigation system? What are the clinical applications of neuronavigation? What are the techniques of neuro-navigation? What are the advantages & disadvantages of a neuro-navigation system? Neuro-navigation method came to be advanced for image-guided neurosurgery to help in the exact incision of brain carcinoma. The capability to execute real-time intraoperative guidance during cranial and/or spinal surgery is known as neuro-navigation, also known as frameless stereotactic surgery. This capability improves the precision and safety of neurosurgery, and such technology is quickly becoming the norm in this field. Neuro-navigation, a regular procedure in neurosurgery, has not yet undergone a thorough evaluation in direct comparison to traditional microsurgical methods. New imaging techniques have made it possible to see the intricate details of the brain's design. Every invisible component becomes visible when using a microscope. But navigating this intricate system is difficult. Today, it is all made feasible via neuronavigation. Modern neurosurgery places a strong emphasis on neuro-navigation. It supports spatial orientation and enables intraoperative visualization of tools and threedimensional imaging data. As a result, it makes it possible to shorten and simplify complicated surgical operations. It is obvious how important it is to understand neuronavigation accuracy and dependability given how widely used and important it has become. Several undetected influences from several elements during surgery could deceive the surgeon. Every neurosurgeon must be well-versed in the systems' weaknesses in addition to optimizing them as much as possible. [ABSTRACT FROM AUTHOR]

Microglia are considered core regulators for monitoring homeostasis in the brain and primary responders to central nervous system (CNS) injuries. Autophagy affects the innate immune functions of microglia. Recently some evidence suggests that microglial autophagy is closely associated with brain function in both ischemic stroke and hemorrhagic stroke. Herein, we will discuss the interaction between autophagy and other biological processes in microglia under physiological and pathological conditions and highlight the interaction between microglial metabolism and autophagy. In the end, we focus on the effect of microglial autophagy in cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Background: Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates. Materials and Methods: We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study. Results: Patients with a pc-ASPECT score <7 were more likely to present with impaired consciousness (P <0.001), multiple posterior circulation infarcts (P <0.001), hydrocephalus (P <0.001), lesions of the vermis (P =0.028), and peduncle (P =0.024), perfusion deficits in the total of posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery (P <0.05), and basilar artery stenosis (P =0.005), ischemia in additional anatomical structures in the posterior circulation (P <0.001) compared with those with a score ≥7. Conclusions: Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the National Institutes of Health Stroke Scale (NIHSS) score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiologic parameters predicting long-term prognosis. [ABSTRACT FROM AUTHOR]