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The current study included examination of 100 stool sample from human was collected from AL-Qadisiyah province, from September 2018 until February 2019.the Microscopic examination result showed that oval or spherical shaped with dark pink color or red oocyst on blue ground and 22(22%) positive sample out 100 case . It was recorded that the highest rate 30% (3/10) was seen in September , but the lowest infection rate 13.3% (2/15) was seen in the month of December with no significant differences at level (p<0.05.) regarding to age the high rate of infection 26.31%(10/38)was found in the group less than a year , but the lowest infection rate was observed in the group( >12 years). There is no significant differences at p<0.05.between man and women . In this study the N- PCR in molecular examination were used ,the positive sample was13 (59.09%) out of 22 stool sample. Sequencing of a fragment of the (18s rRNA) gene (834 bp) that separated from many different area in ALQadisiyah government recorded (75%)9/12 samplerelated to NCBI - Blast Cryptosporidium hominis isolates ,( 25%) 3/12 sampledisplay closed related to NCBI -Blast Cryptosporidium parvum .In Conclusion The current study concluded that phylogenetic tree and the homology sequences identity gives a clear differentiation of the types of Cryptosporidium parasites which can be isolated at high rates of human in AL- Diwaniyah province, which is likely to lead to an outbreak of Cryptosporidiosis in this province. [ABSTRACT FROM AUTHOR]

Pressure vessels designed in accordance with the ASME BPVC code are protected against local ductile failure. Recent work has shown that local ductile failure highly depends on the stress state characterized by both stress triaxiality (T) and the Lode parameter (L). In this paper, the effect of stress state on the ductility of a tubular steel is studied. Two ring specimen configurations were optimized to allow the determination of the ductile failure locus at both tensile and plane strain loadings. The geometry of both ring specimen configurations was optimized to achieve a plane strain (L=0) condition and a generalized tension (L=-1) condition. Notches with different radii were machined on both types to achieve a wide range of stress triaxiality. Specimens were manufactured from SA-106 carbon tubular steel and were tested to determine the ductile failure loci as a function of T and L. Failure locus of SA-106 steel was constructed based on the failure instants and was found to be independent of the Lode parameter. The ASME-BPVC local failure criterion showed close agreement with experimental results (EXP). [ABSTRACT FROM AUTHOR]

Background: Patients with Parkinson's disease (PD) have been reported to exhibit unusual bouts of creativity (e.g., painting, writing), in particular in the context of treatment with dopaminergic agents. Here we investigated divergent and convergent thinking thought to underlie creativity. In addition we assessed cognitive estimation., Method: Twenty PD patients and 20 matched healthy control participants were subjected to the Guilford Alternate Uses task (divergent thinking), the remote associates task (convergent thinking) and two tests of cognitive estimation., Results: No group differences were found for the convergent thinking task, while the Guilford Alternate Uses task revealed a decreased number of correct responses and a reduced originality for PD patients. Originality in PD was correlated to total daily dose of dopaminergic medication. Moreover, both tasks of cognitive estimation showed an impairment in PD., Conclusion: Only minor effects were found for psychometric indices of subprocesses of creative thinking, while estimation, relying on executive functioning, is impaired in PD. We suggest to take a product oriented view of creativity in further research on altered creative processes in PD., (© 2024. The Author(s).)

Background and Aim: Cerebellar infarction (CI) is a serious cerebrovascular disease that may present with non-focal neurological deficits, leading to delay of clinical recognition and treatment. The aim of this study is to investigate the variability of symptoms, diagnostic outcomes and early prognosis in patients with cerebellar infarction compared with pontine infarction (PI)., Methods: Between 2012 and 2014, a total of 79 patients (68 ± 14 years, female sex 42%, median NIHSS score: 5) with CI (43) and PI (36) were included and analyzed., Results: CI patients were admitted to emergency department one hour earlier compared with patients with PI. The most common symptoms in CI were dysarthria (67%), impaired coordination (61%), limb weakness (54%), dizziness/vertigo (49%), gait and stance uncertainty (42%), nausea or/and vomiting (42%), nystagmus (37%), dysphagia (30%) and headache (26%). Nineteen patients (44%) had symptomatic stenosis and two patients had vertebral artery dissection on duplex sonography and MR angiography.Four patients (9%) received a systemic intravenous thrombolysis with rt-PA and three patients received mechanical thrombectomy.Three months after the event, five patients (12%) had died and 15 (40) had disability with mRS (3-5)., Conclusions: Cerebellar infarction occurs with a high variability of symptoms and should be considered when non-focal symptoms are present., Competing Interests: The authors declare no conflict of interest. We thank all medical staff involved in the treatment of stroke patients at the department of Neurology, University of Lübeck., (© 2023 The Authors.)

The present study investigated the association between pre-treatment with a cholesterol-lowering drug (statin) or new setting hereon and the effect on the mortality rate in patients with acute ischemic stroke who received intravenous systemic thrombolysis. During a 5-year period (starting in October 2008), 542 consecutive stroke patients who received intravenous systemic thrombolysis with recombinant tissue plasminogen activator (rt-PA) at the Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany, were included. Patients were characterized according to statins. The primary endpoint was mortality; it was assessed twice: in hospital and 3 months after discharge. The secondary outcome was the rate of symptomatic intracerebral hemorrhage. Of the 542 stroke patients examined (mean age 72 ± 13 years; 51% women, mean National Institutes of Health Stroke Scale (NIHSS) score 11), 138 patients (25.5%) had been pre-treated with statin, while in 190 patients (35.1%) statin therapy was initiated during their stay in hospital, whereas 193 (35.6%) never received statins. Patients pre-treated with statin were older and more frequently had previous illnesses (arterial hypertension, diabetes mellitus and previous cerebral infarctions), but were comparably similarly affected by the stroke (NIHSS 11 vs. 11; P = 0.76) compared to patients who were not on statin treatment at the time of cerebral infarction. Patients pretreated with statin did not differ in 3-month mortality from those newly treated to a statin (7.6% vs. 8%; P = 0.9). Interestingly, the group of patients pretreated with statin showed a lower rate of in hospital mortality (6.6% vs. 17.0; P = 0.005) and 3-month mortality (10.7% vs. 23.7%; P = 0.005) than the group of patients who had no statin treatment at all. The same effect was seen for patients newly adjusted to a statin during the hospital stay compared to patients who did not receive statins (3-month mortality: 7.1% vs. 23.7%; P < 0.001). With a good functional outcome (mRS ≤ 2), 60% of patients were discharged, the majority (69.6%; P < 0.001) of whom received a statin at discharge. The rate of symptomatic intracerebral hemorrhages in the course of cranial computed tomography was independent of whether the patients were pretreated with a statin or not (8.8% vs. 8.7%, P = 0.96). Pre-treatment with statin as well as new adjustment could reveal positive effect on prognosis of intravenous thrombolyzed stroke patients. Further investigations are required. The study was approved by the Ethic Committee of the University of Lübeck (approval No. 4-147)., Competing Interests: None

Background and Purpose: Hemorrhagic stroke, particularly nontraumatic spontaneous intracerebral hemorrhage (SICH), is a cerebrovascular condition with unfavorable outcomes. The aims of the present study were to evaluate patients who suffered from SICH and investigate the early outcomes in a single-center study., Methods: During a study -period of 6 years (2008-2014), 613 consecutive patients (mean age, 72 ± 12.7 years; 51.1% female), who suffered from nontraumatic SICH and were treated at the Department of Neurology at the University Hospital of Schleswig-Holstein, Campus Lübeck, Germany, were included and prospectively analyzed., Results: During a mean hospitalization time of 12 days, 148 patients (24.1%) died, 47% of those within the first 2 days and 79% within the first week. The patients who died stayed at the hospital for a shorter time (3) than those who survived (p < .001). In the multivariate logistic regression, following parameters were found to be associated with the in-hospital mortality: female sex (OR, 2.0; 95%-CI, 1.2-3.4; p = .009), a NIHSS score> 10 (OR, 10.5; 95%-CI, 5.6-19.5; p < .001), history of hypertension (OR, 0.35; 95%-CI, 0.19-0.64; p = .001), previous oral anticoagulation (OR, 2; 95%-CI, 1.0-3.8; p = .032), and intraventricular extension of hemorrhage (OR, 2.8; 95%-CI, 1.7-4.7; p = .001). At discharge, 192 patients (41.2%) showed favorable outcomes (mRS ≤ 2) whereas the median mRS of patients who survived was 3 (IQR 2-4). The good functional outcome at discharge from the acute hospital was decreased by an age> 70 years (OR, 0.56; 95%-CI, 0.35-0.9; p = .017), NIHSS score> 10 at admission (OR, 0.07; 95%-CI, 0.04-0.13; p < .001), and development of pneumonia during hospitalization (OR, 0.35; 95%-CI, 0.2-0.6; p < .001)., Conclusion: The present study showed that SICH is a serious disease causing high mortality and disability, particularly in the early period after event., (© 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Objective: To investigate automatic auditory-change detection in patients with Parkinson disease (pwPD)., Background: Previous results regarding changes in preattentive processing in pwPD have been inconclusive., Methods: We employed a paradigm assessing the preattentive processing of sequences of auditory tones containing deviants at either the local or global level, or at both levels. Twenty pwPD and 20 age-matched healthy controls were exposed to the tone series while they performed a visual task and had their event-related potentials recorded by electroencephalogram., Results: Event-related potentials showed a mismatch negativity, which was largest for the double-deviant stimuli, of intermediate amplitude for the local deviant stimuli, and smallest for the global deviant stimuli. The mismatch negativity was of similar size in the patients and controls, with the exception of the double-deviant condition (larger in controls). By contrast, the subsequent positive component was more pronounced for the Parkinson disease group than controls, particularly for the double-deviant condition., Conclusions: The larger positivity suggests that pwPD are more prone to distraction than healthy controls, probably because dopaminergic medication shifts the stability-flexibility balance toward cognitive flexibility with increased distractibility.

Transient ischemic attack (TIA) is a warning signal for stroke. A comprehensive evaluation of TIA may reduce the risk for subsequent stroke. Data on the findings of cardiac evaluation with transesophageal echocardiography (TEE) in patients with TIA are sparse. Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA (i.e., transient neurological symptoms without evidence of infarction). During a 4-year period (2011-2014), 1071 patients (mean age, 70 ± 13 years; female, 49.7%) with TIA were included in a prospective study and evaluated. Of 1071 consecutive patients suffering from TIA, 288 patients (27%) underwent TEE. The median time between admission and TEE was 6 days. Patients with TIA who were evaluated by TEE were younger (67 vs. 71 years, P < 0.001) than those who were not evaluated by TEE. They had a higher rate of sensibility disturbance as a TIA symptom (39% vs. 31%, P = 0.012) but a lower rate of previous stroke (15% vs. 25%, P = 0.001) and atrial fibrillation (2% vs. 21%, P < 0.001) than those who did not. Foramen ovale was detected in 71 patients (25.7%), atrial septal aneurysm in 13 patients (4.6%), and severe atherosclerotic plaques (grade 4 and 5) in the aortic arch in 25 patients (8.7%). One patient (0.3%) had a fibroma detected by TEE. In 17 of the 288 patients (6%) who underwent TEE, the indication for anticoagulation therapy was based on the TEE results, and 1 patient with fibroma underwent heart surgery. During hospitalization, 7 patients experienced a subsequent stroke, and 27 patients had a recurrent TIA. At 3 months following discharge, the rates of readmission, stroke, recurrent TIA, and death were 19%, 2.7%, 4.2%, and 1.6%, respectively. The rates of mortality (0.9% vs. 1.8%, P = 0.7), stroke risk (1.9% vs. 3.0%, P = 0.8), and recurrent TIA (5.0% vs. 3.9%, P = 0.8) were similar in patients who underwent TEE and in those who did not. Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation., Competing Interests: The authors reported that they have no any conflicts of interest

Objectives: Endovascular treatment (ET), in addition to a therapy with intravenous recombinant tissue plasminogen activator IV rt-PA in patients with acute ischemic stroke, has been found to improve outcome. However, data about ET in patients who have not received therapy with rt-PA due to contraindications for IV rt-PA are sparse. Comparison of ET with IV rt-PA versus ET alone in patients with stroke is done using a proximal intracranial arterial occlusion (internal carotid artery, middle cerebral artery (M1-Segment))., Methods: During a 5-year period (2011-2016), 236 patients (mean age, 69 ± 14 years; 46% women; median NIHSS score 13 ± 5) who were treated at the Department of Neurology and Neuroradiology at the University of Lübeck, undergoing ET with or without IV rt-PA were included and analyzed., Results: A total of 144 patients (61%) underwent ET + IV rt-PA, and 92 patients (39%) underwent ET only. The ET with IV rt-PA is associated with a higher rate of favorable functional outcomes (mRS≤2) at discharge from hospital (51.4% vs. 23.1%, p <  .001) and lower rate of in-hospital mortality (9% vs. 19.6%, p =  .019) and symptomatic intracerebral hemorrhage [sICH] (2.1% vs. 8.7%; p  =   .019) compared to ET, whereas the modified treatment in cerebral infarction score (mTICI) did not differ between the groups.In the adjusted logistic regression analysis, the ET + IV rt-PA was associated with an increased probability of favorable functional outcome (OR, 4.3; 95% confidence interval [CI], 2.2-8.5; p  <   .001). For the in-hospital mortality (OR, 0.74; 95% CI, 0.29-1.9; p =  .76) and sICH (OR, 0.3; 95% CI, 0.07-1.2; p  =   .09), no differences were found., Conclusion: Recanalization results after endovascular treatment are not relevantly improved in patients receiving rt-PA. However, an additional therapy with IV rt-PA has a positive impact on functional outcome.

Speech impairment is a frequent and often serious symptom of Parkinson's disease (PD), characterized by a disorder of phonation, articulation and prosody. While research on the pathogenesis of the prominent limb motor symptoms has made considerable progress in recent years, the pathophysiology of PD speech impairment is still incompletely understood. To investigate the neural correlates of speech production in PD, EEG was recorded in 14 non-demented patients with idiopathic PD and preserved verbal fluency on regular dopaminergic medication (8 women; mean age ± SD: 69.5 ± 8.0 years). The control group consisted of 15 healthy age-matched individuals (7 women; age: 69.7 ± 7.0 years). All participants performed a visually-cued, overt speech production task; required utterances were papapa and pataka . During the preparatory phase of speech production, in a time window of 200-400 ms after presentation of the visual cue, β-power was significantly increased in PD patients compared to healthy controls. Previous research has shown that the physiological decrease of β-power preceding limb movement onset is delayed and smaller in PD patients off medication and normalizes under dopaminergic treatment. By contrast, our study demonstrates that β-power during preparation for speech production is higher in patients on dopaminergic therapy than controls. Thus, our results suggest that the mechanisms that regulate β-activity preceding limb movement and speech production differ in PD. The pathophysiological role of this increase in β-power during speech preparation needs to be determined.

Background and Purpose: Symptomatic carotid stenosis (sCS), a common cause of transient ischemic attack (TIA), is correlated with higher stroke risk. We investigated the frequency and associated factors of sCS in patients with TIA and the association between sCS and stroke risk following TIA., Methods: Over a three-year period (2011-2013), 861 consecutive patients with TIA, who were admitted to the Department of Neurology at the University of Lübeck, Germany, were included in a monocenter study and prospectively evaluated. Diagnosis of TIA was in accordance with the tissue-based definition (transient neurological symptoms without evidence of infarction by brain imaging)., Results: Of 827 patients (mean age, 70 ± 13.2 years; 49.7% women), 64 patients (7.7%; 95% confidence interval [CI], 5.9%-9.7%) exhibited sCS and 3 patients (0.3%) showed an occlusion of the corresponding internal carotid artery. Logistic regression revealed that sCS was associated with male sex (odds ratio [OR], 2.7; 95% CI, 1.2-3.6; p = 0.012), amaurosis fugax (OR, 8.1; 95% CI, 3.4-19-4; p < 0.001), unilateral weakness (OR, 3.4; 95% CI, 1.9-6.1; p < 0.001), symptom duration less than 1 h (OR, 2.0; 95% CI, 1.1-3.4; p = 0.019) and previous stroke (OR, 2.7; 95% CI, 1.5-4.7; p = 0.001). During hospitalization (mean, 6.6 days), five patients (0.6%; 95% CI, 0.1%-1.2%) suffered from stroke. The stroke risk was higher in patients with sCS than in those without sCS (6.3% vs. 0.1%; p < 0.001), whereas the recurrent TIA risk (2.6%) did not differ between the groups (4.7% vs. 2.5%; p = 0.29)., Conclusion: SCS appears to be associated with a higher risk of stroke in patients with TIA defined according to the tissue-based definition.

Background: Transient ischemic attack (TIA) management requires a cardiac evaluation with a Holter electrocardiogram (ECG), preferably a long-term (24 h) electrocardiogram (LT-ECG), to detect atrial fibrillation (AF), which places patients at higher risk of cerebrovascular events. The aim of this study was to determine the frequency of AF using ECG and LT-ECG in patients with tissue-based TIA., Methods: During a three-year period (starting in 2011), all consecutive patients with tissue-based TIA (no evidence of infarction by brain imaging) were included and prospectively evaluated., Results: Of 861 patients (mean age, 70 ± 13 years; 49.7% women), 854 patients (99.2%) had an ECG at admission, and 338 patients (39.3%) underwent 24-h LT-ECG monitoring during hospitalization. Patients who underwent LT-ECG monitoring were significantly younger (68 vs. 71 years; P=0.001) and experienced longer symptom duration (143 vs. 79 minutes; P=0.024) compared with those who did not. Furthermore, they had lower rates of unilateral weakness (32% vs. 39%; P=0.034) and previous strokes (18% vs. 26%; P=0.007). The LT-ECG investigation was also associated with longer hospitalization (7.9 vs. 5.7 days; P<0.001). A total of 77 patients (8.9%) exhibited AF on the ECG at admission. The LT-ECG revealed AF among seven patients (2.1%); five of these received a new treatment with oral anticoagulation based on the LT-ECG findings. Using the logistic regression, the presence of AF was associated with the following: age over 65 years (odds ratio [OR], 20.6; 95% confidence interval [CI], 2.8-152; P=0.003), hypertension (OR, 3.1; 95% CI: 1-8.9; P=0.041) and increased glucose level >6.05 mmol/L) on admission (OR, 1.9; 95% CI: 1-3.5; P=0.036)., Conclusion: Cardiac evaluation with LT-ECG appears to increase the rate of detected AF and may lead to a change in secondary prophylaxis in patients with tissue-based TIA.

Background: Patients with acute ischemic strokes frequently take an acetylsalicylic acid (ASA) premedication. We determined the impact of ASA on different thrombolysis strategies in vitro., Methods: For two clot types made from platelet-rich plasma (one with and one without ASA) lysis rates were measured by weight loss after 1 h for five different groups: in control group A clots were solely placed in plasma; in groups B and C clots were treated with rt-PA (60 kU/ml), and in groups D and E clots were treated with desmoteplase (DSPA; 2 µg/ml). Ultrasound (2 MHz, 0.179 W/cm2) was included in groups C and E. The fibrin mesh structures of the clots were investigated by electron microscopy., Results: For both clot types lysis rates increased significantly for all treatment strategies compared to their control group (each p < 0.001). The addition of ASA significantly increased the lysis rate in all 5 groups (each p < 0.001) and led to a ceiling effect concerning the treatment. A semiquantitative analysis of transmission electron micrographs revealed a decreased fibrin density for clots with ASA. For both clot types DSPA and ultrasound led to a significant dissolution of the fibrin mesh (both p = 0.029)., Conclusions: In vitro ASA pretreatment leads to significantly increased lysis rates due to a weaker fibrin mesh in platelet-rich plasma clots., (© 2016 S. Karger AG, Basel.)

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes., Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability., Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2)., Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability., (© 2016 S. Karger AG, Basel.)

Background and Purpose: Early seizures (ESs) in patients with nontraumatic spontaneous intracerebral hemorrhage (sICH) are a frequent complication. The aims of this study were to determine the frequency of ESs in patients with sICH and to investigate the association of ESs with outcomes in a monocenter study., Methods: During a 5-year period (2009-2013), 484 consecutive patients (mean age 72.3 ± 12.6; female sex 51%) with sICH who were admitted to the Department of Neurology at the University of Lübeck, Germany were enrolled and prospectively evaluated., Results: A total of 52 patients (10.7%; 95% CI 8-14) experienced ESs during a mean hospitalization of 12 days. Patients with ESs were less affected on the National Institutes of Health Stroke Scale at admission than those without ESs (7 vs. 10; p = 0.02). With the exception of the localization of hemorrhage (p = 0.008), differences in the baseline characteristics between patients with ESs and those without ESs were not found. The logistic regression analysis revealed an increased ES rate in patients with cortical hemispheric sICH (OR 3.5; 95% CI 1.8-6.7; p < 0.001). During hospitalization, 109 patients (23%) died and the in-hospital mortality was lower in patients with ESs than those without (9.6 vs. 24.0%, respectively; p = 0.02). An association between ESs and good functional outcome on the modified Rankin Scale ≤ 2 was not found (p = 0.3)., Conclusion: ESs appear to be correlated with hemorrhage localization and associated with survival of the sICH., (© 2015 S. Karger AG, Basel.)

Background: Impulse control disorders in Parkinson's disease are a potential consequence of dopaminergic therapy. Impulse control problems might be revealed by intertemporal choice tasks which entail to forgo an immediately available reward in favor of a larger but later reward. The steepness of the discounting curve can be quantified by the parameter k., Methods: Participants (37 Parkinson patients [13 de novo, 24 medicated], 24 patients with restless legs syndrome, and 22 controls) were offered 54 choices between immediate smaller rewards and delayed larger and the k value was estimated from the participants' responses. Participants had the chance of winning one of their decisions. None of the participants had impulse control disorders., Results: Unmedicated Parkinson patients had a higher discounting rate than controls and medicated patients with restless legs syndrome. The k values of medicated Parkinson patients and patients with restless legs syndrome did not differ from those of controls. No correlation was found between the k value and the dopamine agonist dose., Conclusion: Impulsive decision making in patients with Parkinson's disease may occur as part of the disease rather than as a consequence of dopamine agonist therapy., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Stroke-associated pneumonia often negatively influences the prognosis of stroke patients. The aims of this study were to determine the frequency of pneumonia and to investigate the correlation between pneumonia and prognosis in stroke patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (IV thrombolysis)., Methods: Between 2008 and 2013, 538 consecutive stroke patients (mean age, 72 ± 13 years; 50.4% women) receiving IV thrombolysis at the Department of Neurology, University of Lübeck, were investigated., Results: Pneumonia occurred among 122 patients (23%; 95% confidence interval [CI], 19.1-26.2). Pneumonia patients were older (76 versus 71 years; P < .001), more severely affected at admission (National Institutes of Health Stroke Scale [NIHSS] score, 13 versus 9; P < .001), and more likely to have atrial fibrillation (54% versus 42%; P = .02) than patients without pneumonia. They had also a longer hospitalization (15 versus 10 days; P < .001). Using logistic regression analysis, the occurrence of pneumonia was associated with male sex (odds ratio [OR], 1.9; 95% CI, 1.2-3.1; P = .006), neurologic deficit severity (NIHSS score ≥10; OR, 4.4; 95% CI, 2.5-7.4; P < .0019), previous stroke (OR, 1.5; 95% CI, 1.0-2.2; P = .06), and occurrence of symptomatic intracerebral hemorrhage (OR, 1.6; 95% CI, 1.0-3.2; P = .048). Mortality rates (in-hospital mortality [18.9% versus 7.0; P < .0019]; 3-month mortality [34.3% versus 10.6%; P < .001], and 12-month mortality [53.6% versus 19.6%; P < .001]) were higher in pneumonia patients than those without. A favorable outcome (modified Rankin Scale score ≤2) was more likely in patients without pneumonia than those with pneumonia (42% versus 7%; P < .001)., Conclusion: Pneumonia was correlated with increased age, male sex, neurologic deficit severity, and a less favorable prognosis., (Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

The prerequisite for an earlier diagnosis of Parkinson's disease (PD) are markers that are both sensitive and specific for clinically definite PD and its prediagnosic phases. Promising candidates include enlarged hyperechogenicity of the substantia nigra (SN+) on transcranial sonography (TCS) and hyposmia. However, despite good sensitivity and specificity, both markers have yet failed to yield reliable predictions. We pursue the possibility of combined use in an ongoing population-based cohort. Subjects were recruited from 10,000 inhabitants of Luebeck/Germany aged 50 to 79 years and additional PD patients from our outpatient clinic. After neurological examination, 715 subjects were grouped into clinically definite PD (n = 106), possible prediagnostic PD (ppPD; n = 73), and a control group subdivided into healthy individuals (n = 283) and controls with diseases other than PD (n = 253). Subjects underwent TCS and smell testing. Sensitivity and specificity of SN+ and hyposmia were good for PD; however, positive predictive values (PPV) of both SN+ (5.2%) and olfaction (2.5%) were low. At least one positive/both positive markers were present in 33%/1% of healthy controls, 33%/2% of diseased controls, 62%/7% of ppPD, and 94%/51% of PD. When combining SN+ and hyposmia, PPV increased to 17.6%, with a sensitivity of 51% and a specificity of 98%. Both SN+ and hyposmia offer good enrichment towards PD and ppPD, are stable against other diseases, and the combination of markers highly increases specificity. However, if the combination of SN+ and hyposmia were used as criterion for PD diagnosis, almost half of clinically definite PD and more than 90% of ppPD would have been missed., (© 2014 International Parkinson and Movement Disorder Society.)

Background and Purpose: We aimed to investigate the association of statin treatment with outcomes in patients with acute ischemic stroke., Methods: Over a 4.5-year period (starting November 2007), 12 781 patients (mean age, 72·8 ± 12·6 years; 48·6% women) with acute ischemic stroke from 15 hospitals in Schleswig-Holstein, Germany, were enrolled in a population-based study and prospectively evaluated. The primary outcomes were the mortality during hospitalization and the disability (modified Rankin Scale score ≥2) at discharge from hospital. The secondary outcomes were the mortality and disability at three-months after discharge., Results: A total of 7535 patients (59%) with acute ischemic stroke were treated with statins. During hospitalization (mean, nine-days), the in-hospital mortality rate (4·7%; 95% confidence interval, 4·3-5·1%) was lower in patients treated with statins than in those without statins (2·3% vs. 7·9%, respectively; P < 0·001). At three-months after discharge, the mortality rate (6·9%; 95% confidence interval, 6·4-7·5%) was lower in patients treated with statins than in those without statins (5·0% vs. 10·6%, respectively; P < 0·001). Adjusted logistic regression analysis showed that statin treatment was associated with reduced rates of in-hospital mortality (odds ratio, 0·39; 95% confidence interval, 0·31-0·48; P < 0·001) and three-month mortality (odds ratio, 0.47; 95% confidence interval, 0·34-0·63; P < 0·001). A comparison of the patient groups revealed that patients on statins were likely to have lower disability rates at discharge (59% vs. 67%, respectively; P < 0·001) and after three-months (33% vs. 42%, respectively; P < 0·001) in patients who had survived the stroke., Conclusion: Statin treatment may improve the outcomes in patients with acute ischemic stroke. Further studies are necessary to confirm this finding., (© 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.)

Background and Purpose: This study aimed to determine the frequency and associated factors of acute brain infarction (ABI) detected by noncontrast cranial computed tomography (CCT) in patients with transient ischemic attack (TIA) of symptom duration <1 h and to investigate the association between evidence of ABI and short-term risk of stroke., Methods: During a 54-month period (starting November 2007), consecutive patients with TIA (symptom duration <1 h) admitted and imaged with CCT were prospectively evaluated. Adjusted logistic regression was used to estimate odds ratios (ORs)., Results: Of 1021 patients (mean age, 74.5 ± 11 years; 52% female) with TIA (symptom duration <1 h) imaged with CCT at admission, 68 patients (6.7%; 95% CI, 5.3-8.3%) exhibited TIA-related ABI. Adjusted logistic regression showed that ABI was independently correlated with atrial fibrillation (AF) (OR, 3.3; 95% CI, 1.4-7.9; p = 0.006) and time between onset and CT assessment >6 h (OR, 2.5; 95% CI, 1.1-6.1; p = 0.034). During hospitalization (5 ± 3 d), 22 patients (2.2%; 95% CI, 1.4-3.1%) developed a stroke. Patients with ABI had higher stroke rates than those without (10.3% and 1.6%, respectively; p < 0.001). Adjusted logistic regression revealed that stroke risk was independently correlated with ABI (OR, 5.3; 95% CI, 1.8-15.0; p = 0.002) and AF (OR, 2.6; 95% CI, 1.1-6.4; p = 0.026)., Conclusions: Detection of ABI by CCT in TIA patients with symptom duration <1 h may depend on timing of CCT assessment and presence of AF. Evidence of ABI indicates an elevated stroke risk during hospitalization.

Background: The aim of this population-based study was to determine the short-term prognosis of patients treated conservatively for spontaneous intracerebral hemorrhage (ICH), a disease with a high rate of mortality., Methods: During a 39-month period beginning in October 2007, 594 patients (mean age 72 ± 12 years; 52% female; median National Institutes of Health Stroke Scale [NIHSS] score 9) with spontaneous ICH were enrolled in this prospective, population-based study., Results: Of 594 patients, 74 (12%) died during hospitalization (10.3 ± 7 days). Adjusted logistic regression analyses revealed that the in-hospital mortality rate was significantly associated with age >80 years (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.3-7.5; P = .01), NIHSS score >15 (OR 3.3; 95% CI 1.4-9.7; P = .007), unconsciousness at admission (OR 5.3; 95% CI 2.0-13.6; P = .001), and cerebral edema detected by cranial computed tomography at admission (OR 14.7; 95% CI 6.2-34.6; P < .001). At hospital discharge, 329 patients (63%) agreed to participate in the inquiry. At 3 months of follow-up, 55 (18%) of 309 patients died. The 3-month mortality rate correlated significantly with age >80 years (OR 3.5; 95% CI 1.4-8.7; P = .008), previous stroke (OR 4.1; 95% CI 1.6-10.3; P = .002), unconsciousness at admission (OR 5.7; 95% CI 2.4-13.9; P = .001), pneumonia suffered during hospitalization (OR 3.3; 95% CI 1.2-9.6; P = .02), and cerebral edema (OR 5.7; 95% CI 2.3-13.8; P < .001)., Conclusions: Our study may help clinicians estimate the short-term prognosis of patients treated conservatively for ICH., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: The German Stroke Society (GSS) recommends early hospitalization of patients with transient ischemic attack (TIA) regardless of ABCD(2) score. This population-based study determined the rate of stroke during hospitalization and within 3 months after discharge, as well as the rates of mortality and readmission during the 3 months after discharge in patients with TIA., Methods: During a 36-month period (starting November 2007), 2200 consecutive patients (mean age, 70.6 ± 12.8 years; 49% women) with TIA from 15 hospitals in the Federal State of Schleswig-Holstein (1 of the 16 states in Germany) were prospectively evaluated during hospitalization and a follow-up time of 3 months after discharge. The primary outcomes were stroke during hospitalization and 3 months after discharge, as well as readmission and mortality at 3 months. Odds ratios (ORs) were calculated by the adjusted logistic regression analysis., Results: Of 2200 patients (median time of admission, 6 hours from symptom onset), 24 patients (1.1%; 95% confidence interval [CI], 0.7%-1.5%) experienced a stroke during hospitalization (mean, 6 days), and of 1335 patients, 38 (2.8%; 95% CI, 2.1%-3.8%) experienced a stroke during the 3 months after discharge. Stroke during hospitalization was independently correlated with male sex (OR, 3.5) and acute brain infarction detected by brain imaging (OR, 2.6), whereas stroke within 3 months correlated with age greater than 65 years (OR, 3.0). The readmission rate (11.1%; 95% CI, 9.3%-12.7%) was increased in patients who had had previous stroke (OR, 1.7) but decreased in patients who were discharged with statin medication (OR, 0.6). The 3-month mortality (1.4%; 95% CI, 0.9%-1.9%) was independently correlated with unilateral weakness (OR, 2.6) and atrial fibrillation (AF) (OR, 2.6)., Conclusions: These findings may help clinicians to estimate the TIA prognosis in patients who were hospitalized early with TIA., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)