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Introduction: Establishment of a prospective stroke registry may promote the documentation and improvement of acute stroke care. We present the status of stroke management in Greece using the Registry of Stroke Care Quality (RES-Q) dataset. Methods: Consecutive patients with acute stroke were prospectively registered in RES-Q registry by contributing sites in Greece during the years 2017–2021. Demographic and baseline characteristics, acute management, and clinical outcomes at discharge were recorded. Stroke quality metrics, with a specific interest in the association between acute reperfusion therapies and functional recovery in ischemic stroke patients are presented. Results: A total of 3590 acute stroke patients were treated in 20 Greek sites (61% men, median age 64 years; median baseline NIHSS 4; 74% ischemic stroke). Acute reperfusion therapies were administered in almost 20% of acute ischemic stroke patients, with a door to needle and door to groin puncture times of 40 and 64 min, respectively. After adjustment for contributing sites, the rates of acute reperfusion therapies were higher during the time epoch 2020–2021 compared to 2017–2019 (adjusted OR 1.31; 95% CI 1.04–1.64; p Conclusions: Implementation and maintenance of a nationwide stroke registry in Greece may guide the stroke management planning, so that prompt patient transportation, acute reperfusion therapies, and stroke unit hospitalization become more widely accessible, improving the functional outcomes of stroke patients.

Introduction Idiopathic Intracranial Hypertension (IIH) with normal opening cerebrospinal fluid (CSF) pressure comprises a rare IIH variant. Case Report We report the case of a non-obese Caucasian woman, who presented with asymmetrical papilledema, typical IIH-findings on optic nerve sonography and brain magnetic resonance imaging (MRI), and was diagnosed with IIH despite normal opening CSF pressure. Following treatment with acetazolamide, a complete remission of her symptoms was achieved, accompanied by significant improvement of the fundoscopy findings. Conclusion Although normal opening CSF pressure in IIH patients is rare, clinicians should be aware of this IIH variant and promptly indicate IIH treatment in patients presenting with typical clinical symptoms and neuroimaging findings suggestive of IIH.

Background and ObjectivesAcute arterial ischemic stroke (AIS) has been reported as a rare adverse event following coronavirus disease 2019 (COVID-19) vaccination with messenger RNA (mRNA) or viral vector vaccines. However, data are sparse regarding the risk of postvaccination AIS and its potential association with thrombotic-thrombocytopenia syndrome (TTS).MethodsA systematic review and meta-analysis of randomized controlled clinical trials (RCTs), pharmacovigilance registries, registry-based studies, observational cohorts, and case-series was performed with the aim to calculate the following: (1) the pooled proportion of patients presenting with AIS following COVID-19 vaccination; (2) the prevalence of AIS after mRNA and vector-based vaccination; and (3) the proportion of TTS among postvaccination AIS cases. Patient characteristics were assessed as secondary outcomes.ResultsTwo RCTs, 3 cohort studies, and 11 registry-based studies comprising 17,481 AIS cases among 782,989,363 COVID-19 vaccinations were included in the meta-analysis. The pooled proportion of AIS following exposure to any COVID-19 vaccine type was 4.7 cases per 100,000 vaccinations (95% CI 2.2–8.1; I2 = 99.9%). The pooled proportion of AIS following mRNA vaccination (9.2 cases per 100,000 vaccinations; 95% CI 2.5–19.3; I2 = 99.9%) did not differ compared with adenovirus-based vaccination (2.9 cases per 100,000 vaccinations; 95% CI 0.3–7.8; I2 = 99.9%). No differences regarding demographics were disclosed between patients with AIS following mRNA-based or vector-based vaccination. The pooled proportion of TTS among postvaccination AIS cases was 3.1% (95% CI 0.7%–7.2%; I2 = 78.8%).DiscussionThe pooled proportion of AIS following COVID-19 vaccination is comparable with the prevalence of AIS in the general population and much lower than the AIS prevalence among severe acute respiratory syndrome coronavirus 2–infected patients. TTS is very uncommonly reported in patients with AIS following COVID-19 vaccination.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 infection. Over the last 2 years the virus has spread worldwide with enormous implications on the healthcare systems. COVID-19 patients suffer from mild upper-airway manifestations to pneumonia and severe acute respiratory distress syndrome and their hospitalizations are often prolonged. Neurological manifestations of the disease are common. Neurosonology (transcranial Doppler & cervical duplex ultrasound) is an easily repeatable diagnostic imaging modality that can be simply applied at the bedside of COVID-19 patients with cerebrovascular diseases or in critically ill patients in the intensive care unit. Neurosonology may provide hemodynamic assessment of cerebral circulation, quantitative evaluation of increased intracranial pressure and detection of micro-embolic signals in real-time. Consequently, it may assist substantially in the diagnosis, risk stratification and therapeutic approach of COVID-19 patients with or without cerebrovascular complications. In the present narrative review, we discuss the emerging clinical utility of neurosonology during COVID-19 pandemic and highlight the upgraded role of neurosonology resulting from the combination of the established applications coupled with the reduced risk of virus spreading during ultrasound evaluation compared to other imaging modalities including computed tomography and magnetic resonance imaging.

BACKGROUND Differences have been noted in the clinical presentation and mutational spectrum of CADASIL among various geographical areas. The aim of the present study was to investigate the mode of clinical presentation and genetic mutations reported in Greece. METHODS After a systematic literature search, we performed a pooled analysis of all published CADASIL cases from Greece. RESULTS We identified 14 studies that reported data from 14 families comprising 54 patients. Migraine with aura was reported in 39%, ischemic cerebrovascular diseases in 68%, behavioral-psychiatric symptoms in 47% and cognitive decline in 60% of the patients. The mean (±SD) age of onset for migraine with aura, ischemic cerebrovascular diseases, behavioral-psychiatric symptoms and cognitive decline was 26.2 ± 8.7, 49.3 ± 14.6, 47.9 ± 9.4 and 42.9 ± 10.3, respectively; the mean age at disease onset and death was 34.6 ± 12.1 and 60.2 ± 11.2 years. With respect to reported mutations, mutations in exon 4 were the most frequently reported (61.5% of all families), with the R169C mutation being the most common (30.8% of all families and 50% of exon 4 mutations), followed by R182C mutation (15.4% of all families and 25% of exon 4 mutations). CONCLUSIONS The clinical presentation of CADASIL in Greece is in accordance with the phenotype encountered in Caucasian populations, but differs from the Asian phenotype, which is characterized by a lower prevalence of migraine and psychiatric symptoms. The genotype of Greek CADASIL pedigrees is similar to that of British pedigrees, exhibiting a high prevalence of exon 4 mutations, but differs from Italian and Asian populations, where mutations in exon 11 are frequently encountered.

Fibromyalgia (FM) and generalized anxiety disorder (GAD) share common clinical features: they both affect women more than men, their diagnosis is based solely on clinical criteria, and some of the symptoms such as anxiety, aches and muscle tension, sleep disorders, and cognitive dysfunction occur in both diseases. For both conditions, an underlying dysregulation of the autonomic nervous system (ANS) has been proposed. The aims of this study were to investigate ANS dysfunction in FM and GAD and compare them with controls. Sympathetic skin response (SSR) from palm and sole and cross-sectional area (CSA) of bilateral vagus nerves (VN) were measured in 28 healthy controls, 21 FM patients, and 24 GAD patients. CSA of VN was significantly smaller in FM patients (right: 1.97 ± 0.74mm2, left: 1.75 ± 0.65 mm2) and GAD patients (right: 2.12 ± 0.97mm2, left: 1.71 ± 0.86 mm2) compared to controls (right: 3.21 ± 0.75 mm2, left: 2.65 ± 1.13 mm2, p

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA 2 DS 2 -VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P =0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P =0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P =0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P =0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P =0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.

Background: Fabry disease (FD) is an inherited lysosomal storage disorder, leading to multisystemic manifestations and causing significant morbidity and mortality. Objective: The aim of this narrative review is to present the current and novel therapeutic strategies in FD, including symptomatic and specific treatment options. Methods: A systematic literature search was conducted to identify relevant studies, including completed and ongoing randomized-controlled clinical trials (RCTs), prospective or retrospective cohort studies, case series and case reports that provided clinical data regarding FD treatment. Results: A multidisciplinary symptomatic treatment is recommended for FD patients, personalized according to disease manifestations and their severity. During the last two decades, FD-specific treatments, including two enzyme-replacement-therapies (agalsidase alfa and agalsidase beta) and chaperone treatment with migalastat have been approved for use and allowed for symptoms’ stabilization or even disease burden reduction. More therapeutic agents are currently under investigation. Substrate reduction therapies, including lucerastat and venglustat, have shown promising results in RCTs and may be used either as monotherapy or as complementary therapy to established enzyme-replacement-therapies. More stable enzyme-replacement-therapy molecules that are associated with less adverse events and lower likelihood of neutralizing antibodies formation have also been developed. Ex-vivo and in-vivo gene therapy is being tested in animal models and pilot human clinical trials, with preliminary results showing a favorable safety and efficacy profile.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs, and thus ALS is considered a multisystem disorder. The aim of this study is to investigate autonomous nervous system involvement in ALS.We investigated 21 ALS patients and 28 age-matched controls. ALS patients were assessed for disease severity with the Revised-ALS Functional Rating Scale (ALSFSR) and for the presence of autonomic symptoms with the Composite Autonomic Symptom Score scale. Sympathetic nervous system was evaluated by sympathetic skin response (SSR) and parasympathetic nervous system by ultrasonography of vagus nerve (VN) at the level of the thyroid gland.SSR latencies were shorter and SSR amplitudes were higher in controls compared to ALS patients. The cross-sectional area (CSA) of the VN was significantly smaller in ALS patients (mean CSA right/left: 1.73±0.62 mmThis study confirms the presence of autonomic dysfunction in ALS patients and provides evidence of VN atrophy that correlates with disease severity and duration and is independent of bulbar involvement. Degeneration of dorsal nucleus neurons of the VN is hypothesized.

We describe the clinical presentation, radiological findings, treatment and outcomes of three patients with delayed leukoencephalopathy occurring after endovascular treatment (EVT) for cerebral aneurysms—a rare, albeit recurring, complication. The symptoms occurred 6 to 12 months following the EVT of the cerebral aneurysm. Characteristic imaging findings included high-signal changes on T2 images in the white matter without diffusion restriction predominantly at the distribution of the vascular territory of the catheterized arteries, coupled with patchy gadolinium enhancement or low susceptibility weighted imaging (SWI) signals within the white-matter lesions. Steroid pulse therapy is the treatment of choice and promptly improves clinical and imaging findings. Tapering or cessation of steroids may result in clinical and imaging relapses; close- and long-term follow-up for patients presenting this complication is warranted.

Background and purpose Cerebral venous sinus thrombosis (CVST) has been described after vaccination against SARS‐CoV‐2. The clinical characteristics of 213 post‐vaccination CVST cases notified to the European Medicines Agency are reported. Methods Data on adverse drug reactions after SARS‐CoV‐2 vaccination notified until 8 April 2021 under the Medical Dictionary for Regulatory Activities Term ‘Central nervous system vascular disorders’ were obtained from the EudraVigilance database. Post‐vaccination CVST was compared with 100 European patients with CVST from before the COVID‐19 pandemic derived from the International CVST Consortium. Results In all, 213 CVST cases were identified: 187 after AstraZeneca/Oxford (ChAdOx1 nCov‐19) vaccination and 26 after a messenger RNA (mRNA) vaccination (25 with Pfizer/BioNTech, BNT162b2, and one with Moderna, mRNA‐1273). Thrombocytopenia was reported in 107/187 CVST cases (57%, 95% confidence interval [CI] 50%–64%) in the ChAdOx1 nCov‐19 group, in none in the mRNA vaccine group (0%, 95% CI 0%–13%) and in 7/100 (7%, 95% CI 3%–14%) in the pre‐COVID‐19 group. In the ChAdOx1 nCov‐19 group, 39 (21%) reported COVID‐19 polymerase chain reaction tests were performed within 30 days of CVST symptom onset, and all were negative. Of the 117 patients with a reported outcome in the ChAdOx1 nCov‐19 group, 44 (38%, 95% CI 29%–47%) had died, compared to 2/10 (20%, 95% CI 6%–51%) in the mRNA vaccine group and 3/100 (3%, 95% CI 1%–8%) in the pre‐COVID‐19 group. Mortality amongst patients with thrombocytopenia in the ChAdOx1 nCov‐19 group was 49% (95% CI 39%–60%). Conclusions Cerebral venous sinus thrombosis occurring after ChAdOx1 nCov‐19 vaccination has a clinical profile distinct from CVST unrelated to vaccination. Only CVST after ChAdOx1 nCov‐19 vaccination was associated with thrombocytopenia., We used the EudraVigilance database of the European Medicines Agency to identify 213 CVST cases after COVID‐19 vaccination ‐ 187 after AstraZeneca/Oxford (ChAdOx1 nCov‐19) vaccination and 26 after a mRNA vaccination (25 with Pfizer/BioNTech [BNT162b2] and one with Moderna [mRNA‐1273]). Only CVST after vaccination with ChAdOx1 nCov‐19 was associated with thrombocytopenia. We compared post‐vaccination CVST to 100 European patients with CVST from before the COVID‐19 pandemic and showed that CVST occurring after ChAdOx1 nCov‐19 vaccination has a clinical profile distinct from CVST unrelated to vaccination.

A 65-year-old man developed subacute horizontal diplopia due to left abducens nerve (AN) palsy and excessive left eye tearing. Brain MRI revealed a hyperintense T2 lesion with an elongated course within the left carotid canal, presenting homogenous contrast enhancement (figure 1). The imaging findings were characteristic for an internal carotid artery sympathetic plexus (ICSP) schwannoma compressing the left AN. Subsequent irritation of the deep petrosal nerve originating directly from ICSP and continuing as the Vidian nerve may have led to the lacrimal gland edema and excessive left eye tearing (figure 2). Thorough case presentation and a figure demonstrating the relevant anatomy are available from Dryad at [doi.org/10.5061/dryad.pzgmsbck6][1]. [1]: https://doi.org/10.5061/dryad.pzgmsbck6

Introduction Among congenital anomalies of the carotid artery circulation, the presence of a non-bifurcating carotid artery is extremely rare. Relevant cases with unilateral non-bifurcating carotid artery have scarcely been described in the literature. After extensive literature review, only one case with asymptomatic bilateral non-bifurcating carotid arteries associated with persistent proatlantal artery was identified. Methods We present the case of a 40-year-old man with recurrent cerebrovascular events presenting non-bifurcating carotid arteries bilaterally. Results A 40-year-old man presented in the emergency department with a transient ischemic attack. Past medical history included prior ischemic stroke of unknown etiology in the distribution of the left middle cerebral artery, untreated hyperlipidemia and tobacco use. Complete work-up in order to identify the underlying mechanism of the patient’s recurrent cerebrovascular events was negative, except for the finding of non-bifurcating carotid arteries bilaterally, associated with an extensive intracranial anastomosing arterial network. Long-term antiplatelet therapy and statins were administered as secondary stroke prevention therapy. Discussion Previous reports suggest that non-bifurcating carotid arteries may be associated with atherosclerotic plaque formation in symptomatic cases due to shear stress, tortuosity or other local factors. However, in the absence of atherosclerosis, the pathogenic association of bilateral non-bifurcating carotid arteries with cerebrovascular events remains questionable, but may be considered when other stroke etiologies are excluded.

Accumulating evidence points toward a very high prevalence of prolonged neurological symptoms among coronavirus disease 2019 (COVID-19) survivors. To date, there are no solidified criteria for ‘long-COVID’ diagnosis. Nevertheless, ‘long-COVID’ is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Involvement of the central or peripheral nervous system is noted in more than one-third of patients with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while an approximately threefold higher incidence of neurological symptoms is recorded in observational studies including patient-reported data. The most frequent neurological manifestations of ‘long-COVID’ encompass fatigue; ‘brain fog’; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. Although very limited evidence exists to date on the pathophysiological mechanisms implicated in the manifestation of ‘long-COVID’, neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological ‘long-COVID’ sequelae. In this narrative review, we sought to present a comprehensive overview of our current understanding of clinical features, risk factors, and pathophysiological processes of neurological ‘long-COVID’ sequelae. Moreover, we propose diagnostic and therapeutic algorithms that may aid in the prompt recognition and management of underlying causes of neurological symptoms that persist beyond the resolution of acute COVID-19. Furthermore, as causal treatments for ‘long-COVID’ are currently unavailable, we propose therapeutic approaches for symptom-oriented management of neurological ‘long-COVID’ symptoms. In addition, we emphasize that collaborative research initiatives are urgently needed to expedite the development of preventive and therapeutic strategies for neurological ‘long-COVID’ sequelae.

Εισαγωγή: Το χειρουργείο αποτελεί ένα ιδιαίτερο περιβάλλον έντασης εργασίας στοχώρο του νοσοκομείου. Μελέτες έχουν αποτυπώσει τη συσχέτιση των εργασιακώνπαραγόντων κινδύνου για μυοσκελετικές κακώσεις στο νοσηλευτικό προσωπικό,όμως ελάχιστες έχουν διερευνήσει τη σχέση τους με τους περιεγχειρητικούςνοσηλευτές και το επιστημονικό αυτό κενό κάλυψε η παρούσα διατριβή.Σκοπός: Σκοπός της παρούσας διδακτορικής διατριβής ήταν να διερευνηθεί και στηχώρα μας ο επιπολασμός των μυοσκελετικών παθήσεων στους περιεγχειρητικούςνοσηλευτές, να εκτιμηθούν οι επαγγελματικοί παράγοντες κινδύνου, καθώς επίσης ναδιερευνηθούν οι γνώσεις και αντιλήψεις τους για τα μυοσκελετικά προβλήματα καιπόσο αυτές βελτιώνονται έπειτα από μια εκπαιδευτική παρέμβαση.Υλικό και Μέθοδος: Στην έρευνα συμμετείχαν 402 περιεγχειρητικοί νοσηλευτές,που εργάζονταν σε δημόσια νοσοκομεία της Ελλάδας και 134 οι οποίοι αποτέλεσαντο δείγμα της εκπαιδευτικής παρέμβασης. Για τη συλλογή των δεδομένωνχρησιμοποιήθηκαν ανώνυμα αυτοσυμπληρούμενα ερωτηματολόγια, ένα για τηνδιερεύνηση του επιπολασμού και των επιβαρυντικών παραγόντων τωνμυοσκελετικών παθήσεων στο χώρο του χειρουργείου το οποίο αποτελούνταν απότρία μέρη (διερεύνηση μυοσκελετικών συμπτωμάτων, περιγραφή της εργασίας,ψυχομετρική αξιολόγηση) και ένα για τη διερεύνηση γνώσεων. Οι απαντήσεις από ταερωτηματολόγια καταχωρήθηκαν σε προσωπικό υπολογιστή στο στατιστικό πακέτογια τις κοινωνικές επιστήμες (SPSS, έκδοση 19). Για τη στατιστική ανάλυση τωνδεδομένων χρησιμοποιήθηκαν οι εξής δοκιμασίες: το το Wilcoxonsignedtest, τοMcNemartest, το Pearson’sχ2test ή το Fisher'sexacttest, το Mann-Whitneytest, τοPairedt-test, το Student’st-test, η ανάλυσης διασποράς και η διόρθωση Bonferroni, οσυντελεστής συσχέτισης του Spearman και η πολλαπλή βηματική γραμμικήπαλινδρόμηση. Το επίπεδο σημαντικότητας τέθηκε στο 0,05.Αποτελέσματα: Η μέση ηλικία των περιεγχειρητικών νοσηλευτών του δείγματοςήταν 42,3 έτη (SD=7,8 έτη), με υψηλό ποσοστό (78,7%) να είναι γυναίκες. Το 88%ήταν εργαλειοδότες και το 88,4% νοσηλευτές κίνησης. Τα πιο συνηθισμέναπροβλήματα που αναφέρθηκαν ήταν η εργασία στην ίδια θέση για μεγάλες χρονικέςπεριόδους (73,8%), η μετακίνηση και ανύψωση βαρέων αντικειμένων και εξοπλισμού (71,0%), η παραμονή τους στην εργασία, ενώ αισθάνονταν πόνο (70,8%), η εργασίασε περίεργη άβολη θέση (63,8%) και η εργασιακή απασχόληση για πολλές ώρες ή σεβάρδιες (63,3%).Επιπλέον 61,0% των συμμετεχόντων ανέφερε κατά το τελευταίο έτος μυοσκελετικάσυμπτώματα στην οσφυϊκή μοίρα, 54,6% στην αυχενική, 41,0% στον ώμο, 34,4% στογόνατο και 33,1% στον καρπό. Όσον αφορά τις τελευταίες 7 ημέρες το 43,0% τωνσυμμετεχόντων ανέφερε μυοσκελετικά συμπτώματα στην οσφυϊκή μοίρα, 33,3%στην αυχενική, 24,2% στον ώμο, 18,0% στο γόνατο και 17,4% στην πλάτη.Οι υποκλίμακες «Περιβάλλον» και «Προσωπικές προτιμήσεις» είχαν υψηλότερεςτιμές και στις δύο κλίμακες κατάταξης και βαθμολόγησης, αναφέροντας ότι είχανμεγαλύτερη σημασία. Οι υποκλίμακες «Εργαλεία και μέσα» και «Πολιτικές καιδιαδικασίες χειρουργείου» είχαν χαμηλότερη βαθμολογία υποδεικνύοντας ότι ήτανμικρότερης σημασίας. Όσον αφορά τις υποκλίμακες «Περιβάλλον», «Θερμοκρασία»και «Ομάδα εργασίας» είχαν παρόμοια κατάταξη. Η «Διαρρύθμιση τουχειρουργείου» κατετάγη ως σημαντική και η «Διοικητική καθυστέρηση» ως λιγότεροσημαντική. Όσον αφορά την υποκλίμακα «Προσωπικές προτιμήσεις» το«Καθιστός/Όρθιος» κατετάγη ως το πιο σημαντικό.Επιπροσθέτως 134 περιεγχειρητικοί νοσηλευτές έλαβαν μέρος σε μια εκπαιδευτικήπαρέμβαση. Μετά τη λήξη της όλοι οι παράγοντες επηρέαζαν περισσότερο τηνεργασία των συμμετεχόντων. Εξαίρεση αποτέλεσαν η ταχύρυθμη εργασία, οιψυχοκοινωνικοί παράγοντες και η έλλειψη προσωπικού που δεν είχαν καμία αλλαγήγιατί αναγνωρίστηκαν ως σημαντικοί από την αρχή. Μετά την παρέμβαση οιπεριεγχειρητικοί νοσηλευτές υποστήριξαν ότι γνώριζαν περισσότερα για τιςμυοσκελετικές παθήσεις, την εργονομία και τη χειρωνακτική διακίνηση φορτίων, απόότι γνώριζαν πριν. Τα ποσοστά των σωστών απαντήσεων κυμαίνονταν πριν τηνπαρέμβαση από 10,5% έως 95,55 και μετά από 61,4% έως 100%.Οι γυναίκες είχαν σημαντικά μεγαλύτερη αύξηση στη βαθμολογία γνώσεων, δηλαδήαπέκτησαν σημαντικά περισσότερες γνώσεις μετά την παρέμβαση, σε σύγκριση μετους άντρες. Επίσης, η αύξηση της βαθμολογίας ήταν σημαντικά μεγαλύτερη στουςνοσηλευτές που ήταν κάτω από 30 ετών, σε σύγκριση με τους νοσηλευτές που ήτανάνω των 40 ετών (p=0,004). Η αύξηση των γνώσεων ήταν σημαντικά μεγαλύτερηστους νοσηλευτές που δεν είχαν δεύτερο πτυχίο και η αύξηση της βαθμολογίας ήταν σημαντικά μεγαλύτερη στους νοσηλευτές που εργάζονταν στον παρόντα χώρο τοπολύ 4 έτη, σε σύγκριση με τους νοσηλευτές που εργάζονταν πάνω από 10 έτη(p=0,039). Αντίθετα, σημαντικά μικρότερη ήταν η αύξηση της βαθμολογίας γνώσεωνστους νοσηλευτές που αναγνώριζαν όλους τους παράγοντες κινδύνου στη δουλειάτους για μυοσκελετικές παθήσεις, καθώς και σε αυτούς που κατανοούσαν ότι είναιπολύ σημαντικό να λαμβάνουν τα κατάλληλα μέτρα πρόληψης.Συμπεράσματα: Η μελέτη αποτύπωσε έναν υψηλό επιπολασμό μυοσκελετικώνπαθήσεων στους Έλληνες περιεγχειρητικούς νοσηλευτές. Επιβεβαίωσε ότι τοπεριβάλλον εργασίας στο χειρουργείο και οι δραστηριότητες που εκτελούνται απότους περιεγχειρητικούς νοσηλευτές, όπως η παρατεταμένη εργασία από την ίδια θέσηγια μεγάλο χρονικό διάστημα, η μετακίνηση και ανύψωση βαρέων αντικειμένων καιεξοπλισμού, η άβολη θέση εργασίας και η για πολλές ώρες εργασιακή απασχόληση ήσε βάρδιες, είναι τα κύρια προβλήματα που συμβάλλουν καθημερινά στηνδημιουργία και την επικράτηση των μυοσκελετικών παθήσεων.Η παρούσα διατριβή κατέδειξε ότι μία εκπαιδευτική παρέμβαση μπορεί να βελτιώσεισημαντικά τις γνώσεις και δεξιότητες των περιεγχειρητικών νοσηλευτών και νααποτελέσει σημαντικό παράγοντα στην πρόληψη και αντιμετώπιση τωνμυοσκελετικών παθήσεων.Λέξεις κλειδιά: Μυοσκελετικές παθήσεις, περιεγχειρητικοί νοσηλευτές,εκπαιδευτική παρέμβαση, νοσοκομείο, χειρουργείο, μυοσκελετικά συμπτώματα.

Fibromyalgia (FM) and generalized anxiety disorder (GAD) share common clinical features: they both affect women more than men, their diagnosis is based solely on clinical criteria, and some of the symptoms such as anxiety, aches and muscle tension, sleep disorders, and cognitive dysfunction occur in both diseases. For both conditions, an underlying dysregulation of the autonomic nervous system (ANS) has been proposed.The aims of this study were to investigate ANS dysfunction in FM and GAD and compare them with controls.Sympathetic skin response (SSR) from palm and sole and cross-sectional area (CSA) of bilateral vagus nerves (VN) were measured in 28 healthy controls, 21 FM patients, and 24 GAD patients.CSA of VN was significantly smaller in FM patients (right: 1.97 ± 0.74mmThis study confirms similar ANS abnormalities in FM and GAD that fairly distinguish them from controls and support the hypothesis of a common pathophysiological substrate underlying both conditions.

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

Introduction: Glycemic variability (GV) has been associated with worse prognosis in critically ill patients. We sought to evaluate the potential association between GV indices and clinical outcomes in acute stroke patients. Methods: Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke patients underwent regular, standard-of-care finger-prick measurements and continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were obtained from CGM data. Clinical outcomes during hospitalization and follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by CGM but missed by finger-prick measurements were also documented. Results: A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%, nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute glucose (MAG) values was associated with a lower likelihood of neurological improvement during hospitalization before and after adjusting for potential confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022). There was no association of GV indices with 3-month clinical outcomes. During CGM recording, 32 hypoglycemic episodes were detected in 17 nondiabetic patients. None of these episodes were identified by the periodic blood glucose measurements and therefore they were not treated. Conclusions: Greater GV of acute stroke patients may be related to lower odds of neurological improvement during hospitalization. No association was disclosed between GV indices and 3-month clinical outcomes.

Background and purpose In recent years, the use of coiling has gained increased popularity for the treatment of intracranial aneurysms, and stroke physicians are confronted with rare pathologies associated with this relatively new and evolving treatment method, such as embolization of pieces of the polymeric filaments from the coils and a subsequent inflammatory response. In particular, white matter enhancing lesions are a rare complication after aneurysm endovascular therapy (EVT), suggesting a foreign body reaction to shedding of hydrophilic coating from the endovascular devices into the blood stream. The description of such a case aims to raise the clinicians' awareness of the symptomatic delayed and recurring inflammatory changes that may occur after endovascular aneurysmal treatment with the use of coiling devices. Case description A 64-year-old woman underwent coiling of a ruptured right posterior communicating artery aneurysm. She was asymptomatic after EVT. One year later, she presented with headache, acoustic hallucinations, paresthesias and left arm weakness. Brain magnetic resonance imaging (MRI) revealed multiple enhancing white matter lesions in the right hemisphere. She was treated with pulse intravenous methylprednisolone, followed by oral prednisolone; all clinical symptoms resolved and imaging findings improved substantially. Two years after tapering the steroids, follow-up symptoms recurred and repeat brain MRI revealed new enhancing white matter lesions. Discussion and conclusions There is an increasing number of similar reports of enhancing white matter lesions after coiling of intracranial aneurysms, with the incidence estimated to be between 0.5% and 2.3% in different cohort studies. Close monitoring for the appearance of new neurologic symptoms that could suggest delayed brain reactivity should be recommended.

Giant cell arteritis (GCA) is a systemic inflammatory arteriopathy of medium and large-sized arteries, predominantly affecting branches of the external carotid artery. Ischemic stroke has been reported in 2.8-7% of patients diagnosed with GCA. The majority of ischemic strokes may involve the posterior circulation as a result of vertebral and/or, less frequently, of basilar artery vasculitis. Prompt diagnosis is crucial since high-dose corticosteroid treatment is highly effective in preventing the occurrence or recurrence of ischemic complications, including posterior circulation ischemic stroke in cases with vertebrobasilar involvement. Cervical duplex sonography (CDS) of the temporal arteries is a powerful diagnostic tool with high sensitivity and specificity for the diagnosis of GCA. In cases with clinical suspicion or a temporal artery ultrasonographic confirmation of GCA, a detailed evaluation of the cervical, axillary, and intracranial arteries with CDS and transcranial-duplex-sonography, respectively, should be part of the ultrasound examination protocol. Specifically, signs of extracranial vertebral artery wall inflammation ("halo" sign) and focal luminar stenoses may be accurately depicted by ultrasounds in high-risk patients or individuals with ischemic stroke attributed to GCA. In this review, we present three cases of GCA and posterior circulation ischemic complications that were initially evaluated with comprehensive neurosonology protocol and were promptly diagnosed with GCA based on the characteristic "halo" sign in the temporal and vertebral arteries. In addition, we discuss the relevant literature concerning the utility of CDS for the early diagnosis of GCA, focusing on the subtype with extracranial arterial involvement, particularly that of the vertebral arteries.

The cerebral cavernous malformations are benign vascular hamartomas, with thin and dilated vascular walls and therefore constantly susceptible to hemorrhage. Clinically, they present with recurrent headaches, acute intracranial hemorrhage and focal neurological deficits. They are considered as angiographically occult vascular malformations and the imaging technique of choice for their diagnosis is magnetic resonance tomography. We present the case of a female patient with acute-onset symptomatology, congruent with a lesion in the basal pons. Her medical history included an intracranial hemorrhage due to a cavernoma, which was surgically removed. The magnetic resonance imaging of the brain revealed two new cavernomas, which were not identified in the imaging conducted in the past. In literature, the cases of de novo appearance of cavernomas are considered highly rare, especially in patients with no consistent family history or medical history of radiation therapy. Resultantly, they should be considered as dynamic lesions, regarding their number, size and behavior.

Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation of extracranial vasculature. CDU has the advantages of a low cost, easily applicable, bed side examination with high temporal and spatial resolution and without exposing the patients to any significant complications. It represents an easily repeatable test that can be performed in the emergency room as a first-line examination of cervical artery pathology. CDU provides well validated estimates of the type of the atherosclerotic plaque, the degree of stenosis, as well as structural and hemodynamic information directly about extracranial vessels (e.g., subclavian steal syndrome) and indirectly about intracranial circulation. CDU may also aid the diagnosis of non-atherosclerotic lesions of vessel walls including dissections, arteritis, carotid-jugular fistulas and fibromuscular dysplasias. The present narrative review outlines all potential applications of CDU in acute stroke management and also highlights its potential therapeutic implications.

Owing to the variety of its clinical presentations, amyotrophic lateral sclerosis (ALS) may mimic several neurological syndromes and even lead to inappropriate surgical procedures. We wished to assess the impact of unnecessary surgical treatments among ALS patients, and therefore we retrospectively reviewed medical records of 164 consecutive ALS patients. We collected data on the clinical presentation of ALS at onset, the initial symptom that led the patients to seek medical care, the timing of diagnosis and surgical procedures attributed to the onset of symptoms. Results showed that among 164 consecutive patients with ALS, 13 (7.9%) were surgically treated as a consequence of false diagnosis. Despite this, these patients showed no statistically significant difference in time of diagnosis compared to non-operated patients. In conclusion, a small but not negligible number of ALS patients are misdiagnosed. The diagnostic pathway of these patients includes often specialists other than neurologists who should be more aware of this disease in order to avoid inappropriate surgical treatments and provide the patients the appropriate diagnostic and therapeutic procedure by referring them promptly to a neurologist.

Background: The use of anticonvulsant drugs for the prevention of migraine in children and adolescents has been supported in the past. Aims: To evaluate the available evidence for the efficacy and safety of anticonvulsants; drugs in the prevention of migraine attacks in children and adolescents. Methods: Studies were selected through a comprehensive literature search. We included all types of study designs (controlled and uncontrolled) due to the limited evidence. Monthly migraine frequency was used as the primary outcome measure in most of the studies. Studies were classified into levels of evidence according to their design. Results: Fourteen studies were included with a total of 939 patients. Topiramate (4 randomized controlled trials [RCT], two uncontrolled trials), sodium valproate/divalproex sodium (two RCTs, one uncontrolled trial, two retrospective chart reviews) levetiracetam and zonisamide (both only uncontrolled Studies) are the anticonvulsants that have been reported in the literature. The findings show that valproate is not different from placebo and topiramate may not be different but further randomized trials are needed. All drugs were well tolerated in this age group with no serious events reported. Conclusions: The use of anticonvulsants in the prevention of migraine in children and adolescents is not adequately supported by methodologically sound RCTs. More research is needed in the future to establish the efficacy and safety of specific agents. (C) 2008 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved. European Journal of Pain

Background Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial. Methods We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the efficacy and acceptability of SSRIs in the treatment of depression in PD. Results Ten studies were included. In the comparison between SSRIs and Placebo (n = 6 studies), the combined risk ratio (random effects) was 1.08 (95% confidence interval: 0.77 - 1.55, p = 0.67). In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37). An acceptability analysis showed that SSRIs were generally well tolerated. Conclusions These results suggest that there is insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD. Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded. The comparison between SSRIs and TCAs is based on only three studies and further trials with more pragmatic design are needed.