34 results on '"Grisendi, I."'
Search Results
2. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke
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Sallustio, Fabrizio, Pracucci, Giovanni, Cappellari, Manuel, Saia, Valentina, Mascolo, Alfredo Paolo, Marrama, Federico, Gandini, Roberto, Koch, Giacomo, Diomedi, Marina, D’Agostino, Federica, Rocco, Alessandro, Da Ros, Valerio, Wlderk, Andrea, Nezzo, Marco, Argirò, Renato, Morosetti, Daniele, Renieri, Leonardo, Nencini, Patrizia, Vallone, Stefano, Zini, Andrea, Bigliardi, Guido, Pitrone, Antonio, Grillo, Francesco, Bracco, Sandra, Tassi, Rossana, Bergui, Mauro, Naldi, Andrea, Carità, Giuseppe, Casetta, Ilaria, Gasparotti, Roberto, Magoni, Mauro, Simonetti, Luigi, Haznedari, Nicolò, Paolucci, Matteo, Mavilio, Nicola, Malfatto, Laura, Menozzi, Roberto, Genovese, Antonio, Cosottini, Mirco, Orlandi, Giovanni, Comai, Alessio, Franchini, Enrica, Pedicelli, Alessandro, Frisullo, Giovanni, Puglielli, Edoardo, Casalena, Alfonsina, Cester, Giacomo, Baracchini, Claudio, Castellano, Davide, Di Liberto, Alessandra, Ricciardi, Giuseppe Kenneth, Chiumarulo, Luigi, Petruzzellis, Marco, Lafe, Elvis, Persico, Alessandra, Cavasin, Nicola, Critelli, Adriana, Semeraro, Vittorio, Tinelli, Angelica, Giorgianni, Andrea, Carimati, Federico, Auteri, William, Rizzuto, Stefano, Biraschi, Francesco, Nicolini, Ettore, Ferrari, Antonio, Melis, Maurizio, Calia, Stefano, Tassinari, Tiziana, Nuzzi, Nunzio Paolo, Corato, Manuel, Sacco, Simona, Squassina, Guido, Invernizzi, Paolo, Gallesio, Ivan, Ruiz, Luigi, Dui, Giovanni, Carboni, Nicola, Amistà, Pietro, Russo, Monia, Maiore, Mario, Zanda, Bastianina, Craparo, Giuseppe, Mannino, Marina, Inzitari, Domenico, Toni, Danilo, Mangiafico, Salvatore, Gasparotti, R., Inzitari, D., Mangiafico, S., Toni, D., Vallone, S., Zini, A., Bergui, M., Causin, F., Ciccone, A., Nencini, P., Saletti, A., Sallustio, F., Tassi, R., Thyrion, F. Zappoli, Pracucci, G., Saia, V., Gandini, R., Da Ros, V., Greco, L., Morosetti, D., Diomedi, M., Nappini, S., Limbucci, N., Renieri, L., Fainardi, E., Verganti, L., Sacchetti, F., Zelent, G., Bigliardi, G., Dell’Acqua, M. L., Picchetto, L., Vandelli, L., Pentore, R., Maffei, S., Nichelli, P., Longo, M., Pitrone, A., Vinci, S. L., Velo, M., Caragliano, A., Tessitore, A., Bonomo, O., Musolino, R., La Spina, P., Casella, C., Fazio, M. C., Grillo, F., Cotroneo, M., Dell’Aera, C., Francalanza, I., Bracco, S., Cioni, S., Gennari, P., Vallone, I. M., Cerase, A., Martini, G., Stura, G., Daniele, D., Cerrato, P., Naldi, A., Onofrio, M., De Vito, A., Azzini, C., Casetta, I., Mardighian, D., Frigerio, M., Magoni, M., Costa, A., Simonetti, L., Cirillo, L., Taglialatela, F., Isceri, S., Princiotta, C., Dall’Olio, M., Cellerini, M., Gentile, M., Piccolo, L., Migliaccio, L., Brancaleoni, L., Naldi, F., Romoli, M., Zaniboni, A., Ruggiero, M., Sanna, A., Haznedari, N., Commodaro, C., Longoni, M., Biguzzi, S., Cordici, F., Malatesta, E., Castellan, L., Mavilio, N., Salsano, G., Malfatto, L., Finocchi, C., Menozzi, R., Piazza, P., Epifani, E., Andreone, A., Scoditti, U., Castellini, P., Latte, L., Grisendi, I., Cosottini, M., Puglioli, M., Lazzarotti, G., Lauretti, D., Mancuso, M., Giannini, N., Maccarone, M., Orlandi, G., Comai, A., Bonatti, G., Nano, G., Ferro, F., Bonatti, M., Dall’Ora, E., Dossi, R. Currò, Turri, E., Turri, M., Colosimo, C., Pedicelli, A., D’Argento, F., Alexandre, A., Frisullo, G., Di Egidio, V., Puglielli, E. G., Ruggero, L., Assetta, M., Casalena, A., Cester, G., Baracchini, C., Viaro, F., Pieroni, A., Vaudano, G., Comelli, C., Di Maggio, L., Castellano, D., Cavallo, R., Duc, E., Chianale, G., Ciceri, E. F. M., Plebani, M., Augelli, R., Zampieri, P., Grazioli, A., Cappellari, M., Forlivesi, S., Tomelleri, G., Micheletti, N., Chiumarulo, L., Zimatore, D. S., Federico, F., Petruzzelli, M., Zappoli, F., Lafe, E., Sanfilippo, G., Sgreccia, A., Martignoni, A., Cavallini, A., Denaro, F., Persico, A., Cagliari, E., Cavasin, N., Quatrale, R., Critelli, A., Burdi, N., Semeraro, V., Lucarelli, N., Ganimede, M. P., Internò, S., Tinelli, A., Prontera, M. P., Pesare, A., Cotroneo, E., Pampana, E., Ricciardi, F., Gigli, R., Pezzella, F. R., Corsi, F., Giorgianni, A., Baruzzi, F., Pellegrino, C., Terrana, A., Versino, M., Delodovici, M. L., Carimati, F., Cariddi, L. Princiotta, Auteri, W., Di Benedetto, O., Silvagni, U., Perrotta, P., Crispino, E., Petrone, A., Stancati, F., Rizzuto, S., Pugliese, P., Pisani, E., Siniscalchi, A., Gaudiano, C., Pirritano, D., Del Giudice, F., Piano, M., Agostoni, E., Motto, C., Gatti, A., Guccione, A., Tortorella, R., Stecco, A., Guzzardi, G., Del Sette, B., Coppo, L., Baldan, J., Romano, D., Siani, A., Locatelli, G., Saponiero, R., Napolitano, R., De Gregorio, M., Volpe, G., Tenuta, M., Guidetti, G., Biraschi, F., Wulbek, A., Falcou, A., Anzini, A., Mancini, A., De Michele, M., Fausti, S., Di Mascio, M. T., Durastanti, L., Sbardella, E., Mellina, V., Nicolini, E., Comelli, S., Ganau, C., Corraine, S., Fusaro, F., Ferrari, A., Schirru, F., Ledda, V., Secci, S., Melis, M., Piras, V., Moller, J., Padolecchia, R., Allegretti, L., Caldiera, V., Calia, S., Ganci, G., Tassinari, T., Sugo, A., De Nicola, M., Giannoni, M., Bruni, S., Gambelli, E., Provinciali, L., Nuzzi, N. P., Marcheselli, S., Corato, M., Scomazzoni, F., Simionato, F., Roveri, L., Filauri, P., Sacco, S., Orlandi, B., De Santis, F., Tiseo, C., Notturno, F., Ornello, R., Pavia, M., Squassina, G., Cobelli, M., Morassi, M., Magni, E., Invernizzi, P., Pepe, F., Bigni, B., Costa, P., Crabbio, M., Griffini, S., Palmerini, F., Piras, M. P., Gallesio, I., Barbero, S., Ferrandi, D., Dui, G., Fancello, M. C., Zedda, S., Ticca, A., Saddi, M. V., Deiana, G., Rossi, R., Carboni, N., Mela, A., Amistà, P., Russo, M., Iannucci, G., Pinna, V., Di Clemente, L., Santi, M., De Boni, A., De Luca, C., Natrella, M., Fanelli, G., Cristoferi, M., Bottacchi, E., Corso, G., Tosi, P., Sessa, M., Giossi, A., Baietti, Null, Romano, G., Meineri, P., Armentano, A., Versace, P., Arcudi, L., Galvano, G., Petralia, B., Feraco, P., Luppi, G., Giometto, B., Bignamini, V., Piffer, S., Meloni, G. B., Fabio, C., Maiore, M., Pintus, F., Pischedda, A., Manca, A., Mongili, C., Zanda, B., Baule, A., Florio, F., Ciccarese, G., Leone, M., Di Viesti, P., Pappalardo, M. P., Craparo, G., Gallo, C., Monaco, S., Mannino, M., Muto, M., Guarnieri, Gl., Andreone, V., Passalacqua, G., Allegritti, M., Caproni, S., Filizzolo, M., Salmaggi, A., Giordano, A., Marini, C., Frattale, I., Lucente, G., Nozzoli, C., and Lupo, F. A.
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Stent ,Acute stroke ,Settore MED/37 - Neuroradiologia ,Acute stroke Internal carotid artery diseases Stent Thrombectomy ,Neurology (clinical) ,General Medicine ,Settore MED/26 ,Internal carotid artery diseases ,Thrombectomy - Abstract
The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage.Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively.Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.
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- 2022
3. Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration
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Filioglo, A, Simaan, N, Honig, A, Heldner, M R, von Rennenberg, R, Pezzini, A, Padjen, V, Rentzos, A, Altersberger, V L, Baumgartner, P, Zini, A, Grisendi, I, Aladdin, S, Gomori, J M, Pilgram-Pastor, S M, Scheitz, J F, Magoni, M, Berisavac, I, Nordanstig, A, Psychogios, M, Luft, A, Gentile, M, Assenza, F, Arnold, M, Nolte, C H, Gamba, M, Ercegovac, M, Jood, K, Engelter, S T, Wegener, S, Forlivesi, S, Zedde, M, Gensicke, H, Tatlisumak, T, Cohen, J E, and Leker, R R
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Endovascular Procedures ,eye diseases ,Brain Ischemia ,Cohort Studies ,Stroke ,stomatognathic diseases ,Treatment Outcome ,Neurology ,Fibrinolytic Agents ,Reperfusion ,Humans ,Thrombolytic Therapy ,Neurology (clinical) ,610 Medicine & health ,Thrombectomy - Abstract
BACKGROUND Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (��bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p��=��0.044) and proximal ACA occlusions (43% vs. 24%, p��=��0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p��=��0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.
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- 2021
4. MOIA MOIA LIKE ARTERIOPATHY: NEUROSONOLOGICAL SUSPICION AND PROGNOSIS IN ADULT ASYMPTOMATIC PATIENTS: O8
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Malferrari, G., Zedde, M., De Berti, G., Maggi, M., Dallari, A., Nucera, A., Biguzzi, S., Grisendi, I., and Marcello, N.
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- 2011
5. Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries: The Italian Registry of Endovascular Treatment in Acute Stroke
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Simona Marcheselli, Giovanni Orlandi, Sara Biguzzi, Marta Iacobucci, Marco Nezzo, Jessica Moller, Alfredo Paolo Mascolo, Valerio Da Ros, Raffaele Augelli, Marco Pavia, Sandro Zedda, Manuela De Michele, Andrea Boghi, Edoardo Puglielli, Alessandro De Vito, Federico Marrama, Lucio Castellan, Roberto Gandini, Rosario Rossi, Piera Tosi, Christian Commodaro, Alessandro Sgreccia, Ilaria Grisendi, Vittorio Semeraro, Paolo Invernizzi, Mauro Magoni, Giovanni Boero, Roberto Menozzi, Simona Sacco, Monia Russo, Francesco D'Argento, Patrizia Nencini, Marco Petruzzellis, Salvatore Mangiafico, Andrea Wlderk, Guido Bigliardi, Leonardo Renieri, Mauro Bergui, Francesco Causin, Andrea Saletti, Renato Argirò, Pierfrancesco Pugliese, Laura Malfatto, Giacomo Koch, Lucia Princiotta Cariddi, Giovanni Pracucci, Daniele Morosetti, Marina Mannino, Rossana Tassi, Adriana Critelli, Mirco Cosottini, Giovanni Frisullo, Nicola Cavasin, Manuel Cappellari, Nunzio Paolo Nuzzi, Olindo Di Benedetto, Francesco Vizzari, Enrica Franchini, Danilo Toni, Alessandra Sanna, Marina Diomedi, Andrea Zini, Federico Fusaro, Alessio Comai, Alfonsina Casalena, Andrea Naldi, Tiziana Tassinari, Stefano Vallone, Isabella Francalanza, Alessandro Rocco, Domenico Inzitari, Fabrizio Sallustio, Roberto Gasparotti, Antonio Caragliano, Francesco Pintus, Pietro Amistà, Luigi Ruiz, Claudio Baracchini, Valentina Saia, Luigi Chiumarulo, Giuseppe Craparo, Federica D’Agostino, Ivan Gallesio, Gigliola Chianale, Sandra Bracco, Luca Allegretti, Luigi Cirillo, and Sallustio F., Saia V., Marrama F., Pracucci G., Gandini R., Koch G., Mascolo A.P., D'Agostino F., Rocco A., Argiro' R., Nezzo M., Morosetti D., Wlderk A., Da Ros V., Diomedi M., Renieri L., Nencini P., Vallone S., Zini A., Bigliardi G., Caragliano A., Francalanza I., Bracco S., Tassi R., Bergui M., Naldi A., Saletti A., De Vito A., Gasparotti R., Magoni M., Cirillo L., Commodaro C., Biguzzi S., Castellan L., Malfatto L., Menozzi R., Grisendi I., Cosottini M., Orlandi G., Comai A., Franchini E., D'Argento F., Frisullo G., Puglielli E., Casalena A., Causin F., Baracchini C., Boghi A., Chianale G., Augelli R., Cappellari M., Chiumarulo L., Petruzzellis M., Sgreccia A., Tosi P., Cavasin N., Critelli A., Semeraro V., Boero G., Vizzari F., Cariddi L.P., Di Benedetto O., Pugliese P., Iacobucci M., De Michele M., Fusaro F., Moller J., Allegretti L., Tassinari T., Nuzzi N.P., Marcheselli S., Sacco S., Pavia M., Invernizzi P., Gallesio I., Ruiz L., Zedda S., Rossi R., Amista P., Russo M., Pintus F., Sanna A., Craparo G., Mannino M., Inzitari D., Mangiafico S., Toni D.
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medicine.medical_specialty ,Cervical Artery ,Settore MED/26 ,Registries Retrospective Studies Stroke/diagnostic imaging/surgery Thrombectomy Treatment Outcome Circle of Willis Endovascular treatment ,030218 nuclear medicine & medical imaging ,Brain Ischemia ,NO ,03 medical and health sciences ,0302 clinical medicine ,Settore MED/36 ,Internal medicine ,medicine.artery ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Endovascular treatment ,Registries ,cardiovascular diseases ,Neuroradiology ,Aged ,Retrospective Studies ,Thrombectomy ,Outcome ,Univariate analysis ,Circle of Willi ,business.industry ,Endovascular Procedures ,Odds ratio ,Stroke ,Circle of Willis, Stroke severity, Large vessel occlusion, Endovascular treatment, Outcome ,Stroke severity ,Carotid Arteries ,Treatment Outcome ,Italy ,Carotid artery occlusion ,Cardiology ,Circle of Willis ,Large vessel occlusion ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
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- 2020
6. Type III Percheron's variant in thalamic-mesencephalic infarction: the unexpected anastomosis.
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Zedde M, Grisendi I, Assenza F, Moratti C, Napoli M, Valzania F, and Pascarella R
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Purpose: Arterial supply of thalamus is complex and highly variable. In particular, the distribution pattern of thalamoperforating arteries received more attention some decades ago than in recent years., Methods: We are presenting the case of a 46-year-old patient with wake-up drowsiness, complex oculomotor disorder and dysarthria. He was investigated in the acute phase using non-contrast brain Computed Tomography (NCCT), CT Angiography (CTA), and in the following days Digital Subtraction Angiography (DSA) was performed Results. The NCCT showed a subacute ischemic stroke in the right anterior thalamus and rostral midbrain with normal findings on CTA. DSA imaged a variant of thalamic supply (Percheron type III), constituted by perforating branches arising from an artery bridging the P1 segments of both Posterior Cerebral Arteries (PCAs)., Results: The thalamus has a complex and variable arterial supply, mainly in the pattern of paramedian thalamic-mesencephalic perforating arteries. The most reported variant is Percheron type IIb and supplies the paramedian thalami and the rostral midbrain. Type IIb occlusion usually causes a bilateral paramedian thalamic stroke, but rostral midbrain and anterior thalamus are involved in 57% and 19% cases. The rarer Type III variant probably prevented the bilateral extension of infarction and involved the territory of tuberothalamic and paramedian perforating arteries., Conclusions: Currently, DSA allows directly imaging variants in thalamic vascularization and better understanding the stroke mechanisms. In particular, in the presented case, a medium-sized vessel occlusion rather than a small vessel occlusion mechanism might be raised, leading to a different diagnostic pathway., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2024
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7. Cerebellar mutism syndrome caused by bilateral cerebellar hemorrhage in adults: a case report and review of the literature.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Di Cecco G, Pavone C, Bonacini L, D'Aniello S, Pezzella FR, Romano A, Pavesi G, Valzania F, and Pascarella R
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- Humans, Male, Adult, Cerebellar Diseases etiology, Cerebellar Diseases diagnostic imaging, Intracranial Hemorrhages etiology, Intracranial Hemorrhages diagnostic imaging, Intracranial Hemorrhages complications, Middle Aged, Mutism etiology
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Cerebellar mutism syndrome (CMS) is a frequent complication of surgical intervention on posterior fossa in children. It has been only occasionally reported in adults and its features have not been fully characterized. In children and in young adults, medulloblastoma is the main reason for neurosurgery. A single case of postsurgical CMS is presented in an adult patient with a cerebellar hemorrhage and a systematic review of the published individual cases of CMS in adults was done. Literature review of individual cases found 30 patients, 18/30 (60%) males, from 20 to 71 years at diagnosis. All but one case was post-surgical, but in one of the post-surgical cases iatrogenic basilar artery occlusion was proposed as cause for CMS. The causes were: primary tumors of the posterior fossa in 16/22 (72.7%) metastasis in 3/30 (10%), ischemia in 3/30 (10%) cerebellar hemorrhage in 3/30 (10%), and benign lesions in 2/30 (6.7%) patients. 8/30 patients (26.7%) were reported as having persistent or incomplete resolution of CMS within 12 months. CMS is a rare occurrence in adults and spontaneous cerebellar hemorrhage has been reported in 3/30 (10%) adult patients. The generally accepted hypothesis is that CMS results from bilateral damage to the dentate nucleus or the dentate-rubro-thalamic tract, leading to cerebro-cerebellar diaschisis. Several causes might contribute in adults. The prognosis of CMS is slightly worse in adults than in children, but two thirds of cases show a complete resolution within 6 months., (© 2024. Fondazione Società Italiana di Neurologia.)
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- 2024
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8. Early seizures and risk of epilepsy and death after intracerebral haemorrhage: The MUCH Italy.
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Pezzini A, Tarantino B, Zedde M, Marcheselli S, Silvestrelli G, Ciccone A, DeLodovici ML, Princiotta Cariddi L, Vidale S, Paciaroni M, Azzini C, Padroni M, Gamba M, Magoni M, Del Sette M, Tassi R, De Franco IG, Cavallini A, Calabrò RS, Cappellari M, Giorli E, Giacalone G, Lodigiani C, Zenorini M, Valletta F, Cutillo G, Bonelli G, Abrignani G, Castellini P, Genovese A, Latte L, Trapasso MC, Ferraro C, Piancatelli F, Pascarella R, Grisendi I, Assenza F, Napoli M, Moratti C, Acampa M, and Grassi M
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- Humans, Male, Female, Italy epidemiology, Aged, Middle Aged, Aged, 80 and over, Risk Factors, Cerebral Hemorrhage mortality, Cerebral Hemorrhage complications, Seizures mortality, Seizures epidemiology, Epilepsy mortality, Epilepsy epidemiology
- Abstract
Introduction: It is unclear which patients with non-traumatic (spontaneous) intracerebral haemorrhage (ICH) are at risk of developing acute symptomatic seizures (provoked seizures occurring within the first week after stroke onset; early seizures, ES) and whether ES predispose to the occurrence of remote symptomatic seizures (unprovoked seizures occurring more than 1 week after stroke; post-stroke epilepsy, PSE) and long-term mortality., Patients and Methods: In the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) we examined the risk of ES and whether they predict the occurrence of PSE and all-cause mortality in a cohort of patients with first-ever spontaneous ICH and no previous history of epilepsy, consecutively hospitalized in 12 Italian neurological centers from 2002 to 2014., Results: Among 2570 patients (mean age, 73.4 ± 12.5 years; males, 55.4%) 228 (8.9%) had acute ES (183 (7.1%) short seizures and 45 (1.8%) status epilepticus (SE)). Lobar location of the hematoma (OR, 1.49; 95% CI, 1.06-2.08) was independently associated with the occurrence of ES. Of the 2,037 patients who were followed-up (median follow-up time, 68.0 months (25th-75th percentile, 77.0)), 155 (7.6%) developed PSE. ES (aHR, 2.34; 95% CI, 1.42-3.85), especially when presenting as short seizures (aHR, 2.35; 95% CI, 1.38-4.00) were associated to PSE occurrence. Unlike short seizures, SE was an independent predictor of all-cause mortality (aHR, 1.50; 95% CI, 1.005-2.26)., Discussion and Conclusion: The long-term risk of PSE and death after an ICH vary according to ES subtype. This might have implications for the design of future clinical trials targeting post-ICH epileptic seizures., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Ciccone reports grants from Daiichi-Sankyo; grants from Italfarmaco; and grants from Alexion Pharmaceuticals.Dr Paciaroni reports compensation from SANOFI-AVENTIS U.S. LLC for other services; compensation from PFIZER CANADA INC for other services; compensation from iRhythm Technologies for other services; compensation from Daiichi Sankyo Europe GmbH for other services; and compensation from Bristol-Myers Squibb for other services.The other Authors have nothing to disclose.
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- 2024
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9. Combining Intravenous Thrombolysis and Dual Antiplatelet Treatment in Patients With Minor Ischemic Stroke: A Propensity Matched Analysis of the READAPT Study Cohort.
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Ornello R, Foschi M, De Santis F, Romoli M, Tassinari T, Saia V, Cenciarelli S, Bedetti C, Padiglioni C, Censori B, Puglisi V, Vinciguerra L, Guarino M, Barone V, Zedde M, Grisendi I, Diomedi M, Bagnato MR, Petruzzellis M, Mezzapesa DM, Di Viesti P, Inchingolo V, Cappellari M, Zivelonghi C, Candelaresi P, Andreone V, Rinaldi G, Bavaro A, Cavallini A, Moraru S, Querzani P, Terruso V, Mannino M, Pezzini A, Frisullo G, Muscia F, Paciaroni M, Mosconi MG, Zini A, Leone R, Palmieri C, Cupini LM, Marcon M, Tassi R, Sanzaro E, Paci C, Viticchi G, Orsucci D, Falcou A, Beretta S, Tarletti R, Nencini P, Rota E, Sepe FN, Ferrandi D, Caputi L, Volpi G, La Spada S, Beccia M, Rinaldi C, Mastrangelo V, Di Blasio F, Invernizzi P, Pelliccioni G, De Angelis MV, Bonanni L, Ruzza G, Caggia EA, Russo M, Tonon A, Acciarri MC, Anticoli S, Roberti C, Manobianca G, Scaglione G, Pistoia F, Fortini A, De Boni A, Sanna A, Chiti A, Barbarini L, Caggiula M, Masato M, Del Sette M, Passarelli F, Bongioanni MR, Toni D, Ricci S, De Matteis E, and Sacco S
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- Humans, Female, Male, Aged, Prospective Studies, Middle Aged, Treatment Outcome, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Time Factors, Administration, Intravenous, Risk Assessment, Drug Therapy, Combination, Aged, 80 and over, Risk Factors, Ischemic Stroke diagnosis, Ischemic Stroke drug therapy, Propensity Score, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Thrombolytic Therapy methods, Thrombolytic Therapy adverse effects, Dual Anti-Platelet Therapy methods
- Abstract
Background: The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS., Methods and Results: This is a prespecified propensity score-matched analysis from a prospective multicentric real-world study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]). We included patients with MIS (National Institutes of Health Stroke Scale score at admission ≤5), without prestroke disability (modified Rankin scale [mRS] score ≤2). The primary outcomes were 90-day mRS score of 0 to 2 and ordinal mRS distribution. The secondary outcomes included 90-day risk of stroke and other vascular events and 24-hour early neurological improvement or deterioration (≥2-point National Institutes of Health Stroke Scale score decrease or increase from the baseline, respectively). From 1373 patients with MIS, 240 patients treated with IVT plus DAPT were matched with 427 patients treated with DAPT alone. At 90 days, IVT plus DAPT versus DAPT alone showed similar frequency of mRS 0 to 2 (risk difference, 2.3% [95% CI -2.0% to 6.7%]; P =0.295; risk ratio, 1.03 [95% CI 0.98-1.08]; P =0.312) but more favorable ordinal mRS scores distribution (odds ratio, 0.57 [95% CI 0.41-0.79]; P <0.001). Compared with patients treated with DAPT alone, those combining IVT and DAPT had higher 24-hour early neurological improvement (risk difference, 20.9% [95% CI 13.1%-28.6%]; risk ratio, 1.59 [95% CI 1.34-1.89]; both P <0.001) and lower 90-day risk of stroke and other vascular events (hazard ratio, 0.27 [95% CI 0.08-0.90]; P =0.034). There were no differences in safety outcomes., Conclusions: According to findings from this observational study, patients with MIS may benefit in terms of better functional outcome and lower risk of recurrent events from combining IVT and DAPT versus DAPT alone without safety concerns., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05476081.
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- 2024
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10. Persistent intracranial steno-occlusion from calcified embolism: a treatment challenge.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Di Cecco G, Pavone C, Bonacini L, D'Aniello S, Valzania F, and Pascarella R
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- Humans, Male, Middle Aged, Aged, Calcinosis complications, Calcinosis diagnostic imaging, Infarction, Middle Cerebral Artery diagnostic imaging, Infarction, Middle Cerebral Artery complications, Intracranial Embolism etiology, Intracranial Embolism diagnostic imaging
- Abstract
Introduction: Calcified arterial cerebral embolism is a rare occurrence among large and medium vessel occlusions causing ischemic stroke and its diagnosis and treatment is a challenge. The sources of calcified embolism might be a calcific atheroma from the aortic arch and carotid artery, but also heart valve disease has been reported in the literature. Calcified embolism is frequently simultaneous on multiple vascular territories. The prognosis of patients is usually poor, including patients treated by using endovascular thrombectomy (EVT) and this diagnosis could be easily missed in the acute phase. In addition, the optimal secondary prevention has not been yet fully stated., Methods: We are presenting two cases of acute stroke due to calcified embolism in the middle cerebral artery (MCA) coming from a complicated carotid atheroma, non-stenosing in the first case (a 49 years old man) and stenosing in the second case (a 71 years old man) without clinical indications to intravenous thrombolysis and/or EVT, extensively investigated in the acute phase and followed-up for over 12 months with a favorable clinical course and the persisting steno-occlusion in the involved MCA. In both cases, antiplatelet treatment and targeting of vascular risk factors were done without recurrences in the follow-up period., Discussion: Cerebral calcified embolism has been reported in 5.9% of cases of acute ischemic stroke in a single center series and only in 1.2% of a large retrospective cohort of EVT-treated patients. In both series the prognosis was poor and only one third of EVT-treated patients had functional independence at 3-months follow-up. The natural history of these subtype of ischemic stroke is relatively poorly understood and both etiological diagnosis and treatment have not yet defined. It is possible that some cases might be underdiagnosed and underreported., Conclusions: Calcified cerebral embolism is a rare cause of stroke, but it is largely underreported and both acute phase and secondary preventive treatment have to be defined., (© 2024. Fondazione Società Italiana di Neurologia.)
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- 2024
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11. Spontaneous Non-Aneurysmal Convexity Subarachnoid Hemorrhage: A Scoping Review of Different Etiologies beyond Cerebral Amyloid Angiopathy.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Pavone C, Bonacini L, Cecco GD, D'Aniello S, Pezzella FR, Merlino G, Piazza F, Pezzini A, Morotti A, Fainardi E, Toni D, Valzania F, and Pascarella R
- Abstract
Spontaneous convexity subarachnoid hemorrhage (cSAH) is a vascular disease different from aneurysmal SAH in neuroimaging pattern, causes, and prognosis. Several causes might be considered in individual patients, with a limited value of the patient's age for discriminating among these causes. Cerebral amyloid angiopathy (CAA) is the most prevalent cause in people > 60 years, but reversible cerebral vasoconstriction syndrome (RCVS) has to be considered in young people. CAA gained attention in the last years, but the most known manifestation of cSAH in this context is constituted by transient focal neurological episodes (TFNEs). CAA might have an inflammatory side (CAA-related inflammation), whose diagnosis is relevant due to the efficacy of immunosuppression in resolving essudation. Other causes are hemodynamic stenosis or occlusion in extracranial and intracranial arteries, infective endocarditis (with or without intracranial infectious aneurysms), primary central nervous system angiitis, cerebral venous thrombosis, and rarer diseases. The diagnostic work-up is fundamental for an etiological diagnosis and includes neuroimaging techniques, nuclear medicine techniques, and lumbar puncture. The correct diagnosis is the first step for choosing the most effective and appropriate treatment.
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- 2024
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12. Statin use and long-term risk of recurrent intracerebral haemorrhage: the MUCH-Italy.
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Pezzini A, Tarantino B, Zedde ML, Marcheselli S, Silvestrelli G, Ciccone A, Delodovici ML, Princiotta Cariddi L, Vidale S, Paciaroni M, Azzini C, Padroni M, Gamba M, Magoni M, Del Sette M, Tassi R, de Franco IG, Cavallini A, Calabrò RS, Cappellari M, Giorli E, Giacalone G, Lodigiani C, Zenorini M, Valletta F, Pascarella R, Abrignani G, Castellini P, Genovese A, Latte L, Trapasso MC, Grisendi I, Assenza F, Napoli M, Moratti C, Beccattini S, Acampa M, Valzania F, Grassi M, and Gentilini D
- Abstract
Background: Whether statin use after spontaneous intracerebral haemorrhage (ICH) increases the risk of recurrent ICH is uncertain., Methods: In the setting of the Multicentric Study on Cerebral Haemorrhage in Italy we followed up a cohort of 30-day ICH survivors, consecutively admitted from January 2002 to July 2014, to assess whether the use of statins after the acute event is associated with recurrent cerebral bleeding., Results: 1623 patients (mean age, 73.9±10.3 years; males, 55.9%) qualified for the analysis. After a median follow-up of 40.5 months (25th to 75th percentile, 67.7) statin use was not associated with increased risk of recurrent ICH either in the whole study group (adjusted HR, 0.99; 95% CI 0.64 to 1.53) or in the subgroups defined by haematoma location (deep ICH, adjusted HR, 0.74; 95% CI 0.35 to 1.57; lobar ICH, adjusted HR, 1.09; 95% CI 0.62 to 1.90), intensity of statins (low-moderate intensity statins, adjusted HR, 0.93; 95% CI 0.58 to 1.49; high-intensity statins, adjusted HR, 1.48; 95% CI 0.66 to 3.31) and use of statins before the index event (adjusted HR, 0.66; 95% CI 0.38 to 1.17)., Conclusions: Statin use appears to be unrelated to the risk of ICH recurrence., Competing Interests: Competing interests: AC reports grants from Daiichi-Sankyo; grants from Italfarmaco; and grants from Alexion Pharmaceuticals. MP reports compensation from SANOFI-AVENTIS US LLC for other services; compensation from PFIZER CANADA for other services; compensation from iRhythm Technologies for other services; compensation from Daiichi Sankyo Europe GmbH for other services; and compensation from Bristol-Myers Squibb for other services. The other authors have nothing to disclose., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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13. Neurovascular Issues in Antiphospholipid Syndrome: Arterial Vasculopathy from Small to Large Vessels in a Neuroradiological Perspective.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Lara B, Di Cecco G, D'Aniello S, Pavone C, Pezzella FR, Candelaresi P, Andreone V, Valzania F, and Pascarella R
- Abstract
Antiphospholipid syndrome (APS) is an autoimmune prothrombotic condition characterized by venous thromboembolism, arterial thrombosis, and pregnancy morbidity. Among neurological manifestations, arterial thrombosis is only one of the possible associated clinical and neuroradiological features. The aim of this review is to address from a neurovascular point of view the multifaceted range of the arterial side of APS. A modern neurovascular approach was proposed, dividing the CNS involvement on the basis of the size of affected arteries, from large to small arteries, and corresponding clinical and neuroradiological issues. Both large-vessel and small-vessel involvement in APS were detailed, highlighting the limitations of the available literature in the attempt to derive some pathomechanisms. APS is a complex disease, and its neurological involvement appears multifaceted and not yet fully characterized, within and outside the diagnostic criteria. The involvement of intracranial large and small vessels appears poorly characterized, and the overlapping with the previously proposed inflammatory manifestations is consistent.
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- 2024
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14. Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack.
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De Matteis E, Ornello R, De Santis F, Foschi M, Romoli M, Tassinari T, Saia V, Cenciarelli S, Bedetti C, Padiglioni C, Censori B, Puglisi V, Vinciguerra L, Guarino M, Barone V, Zedde M, Grisendi I, Diomedi M, Bagnato MR, Petruzzellis M, Mezzapesa DM, Di Viesti P, Inchingolo V, Cappellari M, Zenorini M, Candelaresi P, Andreone V, Rinaldi G, Bavaro A, Cavallini A, Moraru S, Querzani P, Terruso V, Mannino M, Pezzini A, Frisullo G, Muscia F, Paciaroni M, Mosconi MG, Zini A, Leone R, Palmieri C, Cupini LM, Marcon M, Tassi R, Sanzaro E, Paci C, Viticchi G, Orsucci D, Falcou A, Diamanti S, Tarletti R, Nencini P, Rota E, Sepe FN, Ferrandi D, Caputi L, Volpi G, Spada S, Beccia M, Rinaldi C, Mastrangelo V, Di Blasio F, Invernizzi P, Pelliccioni G, De Angelis MV, Bonanni L, Ruzza G, Caggia EA, Russo M, Tonon A, Acciarri MC, Anticoli S, Roberti C, Manobianca G, Scaglione G, Pistoia F, Fortini A, De Boni A, Sanna A, Chiti A, Barbarini L, Caggiula M, Masato M, Del Sette M, Passarelli F, Roberta Bongioanni M, Toni D, Ricci S, and Sacco S
- Abstract
Background and Purpose: Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs., Methods: READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD
2 score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment., Results: We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score ⩽5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24 h after symptom onset was associated with a lower likelihood of bleeding., Conclusions: In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AZ reports compensation from Angels Initiative, Boehringer-Ingelheim, Daiichi Sankyo, CSL Behring, Bayer, and Astra Zeneca; and he is member of ESO guidelines, ISA-AII guidelines, and IRETAS steering committee. RO reports compensations from Novartis and Allergan, Teva Pharmaceutical Industries, Eli Lilly and Company, SS reports compensations from Novartis, NovoNordisk, Allergan, AstraZeneca, Pfizer Canada, Inc, Eli Lilly and Company, Teva Pharmaceutical Industries, H. Lundbeck A/S, and Abbott Canada; employment by Università degli Studi dell’Aquila. MPa reports compensation from Daiichi Sankyo Company, Bristol Myers Squibb, Bayer, and Pfizer Canada, Inc. DT reports compensation from Alexion, AstraZeneca, Medtronic, and Pfizer. The other authors report no conflicts.- Published
- 2024
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15. RNF213 Polymorphisms in Intracranial Artery Dissection.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Pavone C, Bonacini L, Di Cecco G, D'Aniello S, Stoenoiu MS, Persu A, Valzania F, and Pascarella R
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- Humans, Aortic Dissection genetics, Asian People genetics, Genetic Predisposition to Disease, Intracranial Aneurysm genetics, Moyamoya Disease genetics, Polymorphism, Single Nucleotide, Adenosine Triphosphatases genetics, Ubiquitin-Protein Ligases genetics
- Abstract
The ring finger protein 213 gene (RNF213) is involved in several vascular diseases, both intracranial and systemic ones. Some variants are common in the Asian population and are reported as a risk factor for moyamoya disease, intracranial stenosis and intracranial aneurysms. Among intracranial vascular diseases, both moyamoya disease and intracranial artery dissection are more prevalent in the Asian population. We performed a systematic review of the literature, aiming to assess the rate of RNF213 variants in patients with spontaneous intracranial dissections. Four papers were identified, providing data on 53 patients with intracranial artery dissection. The rate of RNF213 variants is 10/53 (18.9%) and it increases to 10/29 (34.5%), excluding patients with vertebral artery dissection. All patients had the RNF213 p.Arg4810Lys variant. RNF213 variants seems to be involved in intracranial dissections in Asian cohorts. The small number of patients, the inclusion of only patients of Asian descent and the small but non-negligible coexistence with moyamoya disease familiarity might be limiting factors, requiring further studies to confirm these preliminary findings and the embryological interpretation.
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- 2024
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16. Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study.
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Yaghi S, Shu L, Mandel D, Leon Guerrero CR, Henninger N, Muppa J, Affan M, Ul Haq Lodhi O, Heldner MR, Antonenko K, Seiffge D, Arnold M, Salehi Omran S, Crandall R, Lester E, Lopez Mena D, Arauz A, Nehme A, Boulanger M, Touze E, Sousa JA, Sargento-Freitas J, Barata V, Castro-Chaves P, Brito MT, Khan M, Mallick D, Rothstein A, Khazaal O, Kaufmann JE, Engelter ST, Traenka C, Aguiar de Sousa D, Soares M, Rosa S, Zhou LW, Gandhi P, Field TS, Mancini S, Metanis I, Leker RR, Pan K, Dantu V, Baumgartner K, Burton T, Von Rennenberg R, Nolte CH, Choi R, MacDonald J, Bavarsad Shahripour R, Guo X, Ghannam M, Almajali M, Samaniego EA, Sanchez S, Rioux B, Zine-Eddine F, Poppe A, Fonseca AC, Baptista MF, Cruz D, Romoli M, De Marco G, Longoni M, Keser Z, Griffin K, Kuohn L, Frontera J, Amar J, Giles J, Zedde M, Pascarella R, Grisendi I, Nzwalo H, Liebeskind DS, Molaie A, Cavalier A, Kam W, Mac Grory B, Al Kasab S, Anadani M, Kicielinski K, Eltatawy A, Chervak L, Chulluncuy-Rivas R, Aziz Y, Bakradze E, Tran TL, Rodrigo-Gisbert M, Requena M, Saleh Velez F, Ortiz Gracia J, Mudassani V, de Havenon A, Vishnu VY, Yaddanapudi S, Adams L, Browngoehl A, Ranasinghe T, Dunston R, Lynch Z, Penckofer M, Siegler J, Mayer S, Willey J, Zubair A, Cheng YK, Sharma R, Marto JP, Mendes Ferreira V, Klein P, Nguyen TN, Asad SD, Sarwat Z, Balabhadra A, Patel S, Secchi T, Martins S, Mantovani G, Kim YD, Krishnaiah B, Elangovan C, Lingam S, Quereshi A, Fridman S, Alvarado A, Khasiyev F, Linares G, Mannino M, Terruso V, Vassilopoulou S, Tentolouris V, Martinez-Marino M, Carrasco Wall V, Indraswari F, El Jamal S, Liu S, Alvi M, Ali F, Sarvath M, Morsi RZ, Kass-Hout T, Shi F, Zhang J, Sokhi D, Said J, Simpkins AN, Gomez R, Sen S, Ghani M, Elnazeir M, Xiao H, Kala N, Khan F, Stretz C, Mohammadzadeh N, Goldstein E, and Furie K
- Subjects
- Humans, Platelet Aggregation Inhibitors therapeutic use, Anticoagulants therapeutic use, Fibrinolytic Agents therapeutic use, Retrospective Studies, Hemorrhage chemically induced, Arteries, Treatment Outcome, Carotid Artery, Internal, Dissection complications, Carotid Artery, Internal, Dissection drug therapy, Stroke epidemiology, Stroke etiology, Stroke prevention & control, Ischemic Stroke drug therapy, Aortic Dissection, Atrial Fibrillation complications
- Abstract
Background: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation., Methods: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-treated crossover approach and only included outcomes occurring with the above treatments., Results: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P =0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P =0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P =0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P =0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; P
interaction =0.009)., Conclusions: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings., Competing Interests: Disclosures Disclosures provided by Dr Nguyen in compliance with American Heart Association annual Journal Editor Disclosure Questionnaire are available at https://www.ahajournals.org/editor-coi-disclosures. Dr Arnold reports compensation from Boehringer Ingelheim, AstraZeneca, Bayer, Bristol-Myers Squibb, Covidien, Daiichi Sankyo, Novartis, Sanofi, Pfizer, Medtronic, Novo Nordisk, and Amgen for consultant services. Dr Lester reports a provisional patent for Methods and compositions for disrupting tau aggregates. Dr Touze reports compensation from Elsevier for other services and employment by Caen. J.E. Kaufman reports grants from Goldschmidt Jacobson-Stiftung. Dr Traenka reports travel support from Bayer Healthcare. Dr Aguiar de Sousa reports compensation from Daiichi Sankyo, Bayer, AstraZeneca, Johnson & Johnson, and Fundação Bial for other services; compensation from the University of British Columbia for data and safety monitoring services; compensation from Organon & Co for consultant services. Dr Rosa reports grants from Merck Sharp & Dohme Corporation. Dr Field reports compensation from HLS Therapeutics, AstraZeneca Canada, and Roche for consultant services; service as a board member for Destine Health; and compensation from the Canadian Medical Protective Association for expert witness services; and grants from Bayer. Dr Leker reports compensation from Medtronic, Ischemaview, Bayer, Abbott Diabetes Care, Biogen, Janssen Biotech, and Boehringer Ingelheim for other services. Dr Nolte reports compensation from Daiichi Sankyo Europe GmbH, Boehringer Ingelheim, Pfizer, Bristol-Myers Squibb, and Alexion Pharmaceuticals for consultant services; and compensation from AstraZeneca, Abbott Canada, Deutsches Zentrum für Neurodegenerative Erkrankungen, Novartis, Portola Pharmaceuticals, Deutsches Zentrum für Herz-Kreislaufforschung, and Novartis for other services. Dr Poppe reports grants from Foundation Brain Canada, Heart and Stroke Foundation of Canada, and Stryker; and compensation from Roche for other services. Dr Liebeskind reports compensation from Medtronic, Genentech, Cerenovus, Stryker, and Rapid Medical Ltd, for consultant services. B. Mac Grory reports grants from the National Institutes of Health; employment by Duke University Medical Center; compensation from Bayer for other services; grants from the American Heart Association, Duke Bass Connections, and the Duke Office of Physician Scientist Development. Dr Al Kasab reports compensation from Stryker for other services and employment by Medical University of South Carolina. Dr Kicielinski reports compensation from Stryker, Penumbra Inc, Medtronic, and MicroVention Inc, for other services; travel support from MicroVention Inc; and employment by Medical University of South Carolina and Elsevier. Dr de Havenon reports stock options in TitinKM and Certus; grants from the National Institutes of Health; and compensation from Novo Nordisk for consultant services. Dr Siegler reports grants from Philips and employment by the University of Chicago. Dr Willey reports compensation from Edwards Lifesciences Corporation and Abbott Fund for end point review committee services; compensation from Uptodate for other services; and compensation from the Abbott Laboratories for consultant services. Dr Sharma reports a provisional patent for a stroke etiology classifier algorithm and grants from the National Institutes of Health Clinical Center. Dr Martins reports compensation from Pfizer, Medtronic, Servier Affaires Medicales, Daiichi Sankyo, Bayer, Novo Nordisk, Novartis, Penumbra Inc, and Boehringer Ingelheim for other services. Dr Simpkins reports grants from the National Institutes of Health. Dr Stretz reports grants from Massachusetts General Hospital. Dr Furie reports compensation from Janssen Biotech for consultant services. The other authors report no conflicts- Published
- 2024
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17. Stroke-Induced Secondary Neurodegeneration of the Corticospinal Tract-Time Course and Mechanisms Underlying Signal Changes in Conventional and Advanced Magnetic Resonance Imaging.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Di Cecco G, D'Aniello S, Valzania F, and Pascarella R
- Abstract
Secondary neurodegeneration refers to the final result of several simultaneous and sequential mechanisms leading to the loss of substance and function in brain regions connected to the site of a primary injury. Stroke is one of the most frequent primary injuries. Among the subtypes of post-stroke secondary neurodegeneration, axonal degeneration of the corticospinal tract, also known as Wallerian degeneration, is the most known, and it directly impacts motor functions, which is crucial for the motor outcome. The timing of its appearance in imaging studies is usually considered late (over 4 weeks), but some diffusion-based magnetic resonance imaging (MRI) techniques, as diffusion tensor imaging (DTI), might show alterations as early as within 7 days from the stroke. The different sequential pathological stages of secondary neurodegeneration provide an interpretation of the signal changes seen by MRI in accordance with the underlying mechanisms of axonal necrosis and repair. Depending on the employed MRI technique and on the timing of imaging, different rates and thresholds of Wallerian degeneration have been provided in the literature. In fact, three main pathological stages of Wallerian degeneration are recognizable-acute, subacute and chronic-and MRI might show different changes: respectively, hyperintensity on T2-weighted sequences with corresponding diffusion restriction (14-20 days after the injury), followed by transient hypointensity of the tract on T2-weighted sequences, and by hyperintensity and atrophy of the tract on T2-weighted sequences. This is the main reason why this review is focused on MRI signal changes underlying Wallerian degeneration. The identification of secondary neurodegeneration, and in particular Wallerian degeneration, has been proposed as a prognostic indicator for motor outcome after stroke. In this review, the main mechanisms and neuroimaging features of Wallerian degeneration in adults are addressed, focusing on the time and mechanisms of tissue damage underlying the signal changes in MRI.
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- 2024
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18. The Prepetrous Segment of the Internal Carotid Artery as a Neglected Site of Symptomatic Atherosclerosis: A Single-Center Series.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Bonacini L, Di Cecco G, D'Aniello S, Pavone C, Merlino G, Putaala J, Valzania F, and Pascarella R
- Abstract
(1) Background: Non-stenotic complicated plaques are a neglected cause of stroke, in particular in young patients. Atherosclerosis has some preferential sites in extracranial arteries and the prepetrous segment of the internal carotid artery has been rarely described as site of atheroma in general and of complicated atheroma in stroke patients. The aim of this study is to describe the rate of the prepetrous internal carotid artery's (ICA) involvement in a single-center case series of young stroke patients. (2) Methods: All patients < 50 years old with acute ischemic stroke admitted to a single-center Stroke Unit during two time periods (the first one from 1 January 2018 to 31 December 2019, and the second one from 1 January 2021 to 30 June 2022), were prospectively investigated as part of a screening protocol of the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO) study [ClinicalTrials.gov ID NCT01934725], including extracranial vascular examination by using computed tomography (CT) or magnetic resonance imaging (MRI). (3) Results: Two out of ninety-three consecutive patients (2.15%) had a complicated atheroma in the prepetrous ICA as the cause of stroke and both CT angiography and high-resolution vessel wall MRI were applied to document the main features of positive remodeling, cap rupture, ulceration, intraplaque hemorrhage, and a transient thrombus superimposed on the atheroma. The two patients had a different evolution of healing in the first case and a persisting ulceration at 12 months in the second case. (4) Conclusions: The prepetrous ICA is a rarely described location of complicated atheroma in stroke patients at all ages and it represents roughly 2% of causes of acute stroke in this single-center case series in young people.
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- 2024
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19. Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis.
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Zedde M, Napoli M, Moratti C, Pavone C, Bonacini L, Di Cecco G, D'Aniello S, Grisendi I, Assenza F, Boulouis G, Nguyen TN, Valzania F, and Pascarella R
- Abstract
Primary Angiitis of the Central Nervous System (PACNS) is a rare disease and its diagnosis is a challenge for several reasons, including the lack of specificity of the main findings highlighted in the current diagnostic criteria. Among the neuroimaging pattern of PACNS, a tumefactive form (t-PACNS) is a rare subtype and its differential diagnosis mainly relies on neuroimaging. Tumor-like mass lesions in the brain are a heterogeneous category including tumors (in particular, primary brain tumors such as glial tumors and lymphoma), inflammatory (e.g., t-PACNS, tumefactive demyelinating lesions, and neurosarcoidosis), and infectious diseases (e.g., neurotoxoplasmosis). In this review, the main features of t-PACNS are addressed and the main differential diagnoses from a neuroimaging perspective (mainly Magnetic Resonance Imaging-MRI-techniques) are described, including conventional and advanced MRI.
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- 2024
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20. Long-Term Risk of Arterial Thrombosis After Intracerebral Hemorrhage: MUCH-Italy.
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Pezzini A, Iacoviello L, Di Castelnuovo A, Costanzo S, Tarantino B, de Gaetano G, Zedde M, Marcheselli S, Silvestrelli G, Ciccone A, DeLodovici ML, Princiotta Cariddi L, Paciaroni M, Azzini C, Padroni M, Gamba M, Magoni M, Del Sette M, Tassi R, De Franco IG, Cavallini A, Calabrò RS, Cappellari M, Giorli E, Giacalone G, Lodigiani C, Zenorini M, Valletta F, Pascarella R, Grisendi I, Assenza F, Napoli M, Moratti C, Acampa M, and Grassi M
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- Humans, Male, Cerebral Hemorrhage diagnostic imaging, Cerebral Hemorrhage epidemiology, Cerebral Hemorrhage complications, Risk Factors, Female, Atrial Fibrillation complications, Myocardial Infarction complications, Stroke epidemiology, Thrombosis etiology, Thrombosis complications
- Abstract
Background: The identification of patients surviving an acute intracerebral hemorrhage who are at a long-term risk of arterial thrombosis is a poorly defined, crucial issue for clinicians., Methods: In the setting of the MUCH-Italy (Multicenter Study on Cerebral Haemorrhage in Italy) prospective observational cohort, we enrolled and followed up consecutive 30-day intracerebral hemorrhage survivors to assess the long-term incidence of arterial thrombotic events, to assess the impact of clinical and radiological variables on the risk of these events, and to develop a tool for estimating such a risk at the individual level. Primary end point was a composite of ischemic stroke, myocardial infarction, or other arterial thrombotic events. A point-scoring system was generated by the β-coefficients of the variables independently associated with the long-term risk of arterial thrombosis, and the predictive MUCH score was calculated as the sum of the weighted scores., Results: Overall, 1729 patients (median follow-up time, 43 months [25th to 75th percentile, 69.0]) qualified for inclusion. Arterial thrombotic events occurred in 169 (9.7%) patients. Male sex, diabetes, hypercholesterolemia, atrial fibrillation, and personal history of coronary artery disease were associated with increased long-term risk of arterial thrombosis, whereas the use of statins and antithrombotic medications after the acute intracerebral hemorrhage was associated with a reduced risk. The area under the receiver operating characteristic curve of the MUCH score predictive validity was 0.716 (95% CI, 0.56-0.81) for the 0- to 1-year score, 0.672 (95% CI, 0.58-0.73) for the 0- to 5-year score, and 0.744 (95% CI, 0.65-0.81) for the 0- to 10-year score. C statistic for the prediction of events that occur from 0 to 10 years was 0.69 (95% CI, 0.64-0.74)., Conclusions: Intracerebral hemorrhage survivors are at high long-term risk of arterial thrombosis. The MUCH score may serve as a simple tool for risk estimation., Competing Interests: Disclosures Dr Ciccone reports grants from Daiichi Sankyo, Italfarmaco, and Alexion Pharmaceuticals. Dr Paciaroni reports compensation from Sanofi-Aventis U.S. LLC, Pfizer Canada, Inc, iRhythm Technologies, Daiichi Sankyo Europe GmbH, and Bristol Myers Squibb for other services. The other authors report no conflicts.
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- 2024
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21. Posterior reversible encephalopathy syndrome and acute ischemic stroke: an underreported association.
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Zedde M, Grisendi I, Assenza F, Vandelli G, Napoli M, Moratti C, Valzania F, and Pascarella R
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- Humans, Male, Magnetic Resonance Imaging methods, Posterior Leukoencephalopathy Syndrome complications, Posterior Leukoencephalopathy Syndrome diagnostic imaging, Ischemic Stroke complications, Hypertension complications, White Matter, Stroke, Lacunar complications, Stroke, Lacunar diagnostic imaging
- Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a rare and complex disorder with variable clinical presentation and a typical magnetic resonance imaging (MRI) pattern of vasogenic edema with typical and atypical locations. It is often triggered by other diseases and drugs and the most prototypical association is with persistently elevated arterial pressure values. Among the potential cerebrovascular complications, intracranial bleeding has been described, but ischemic stroke is uncommonly reported., Methods: We are presenting a case of a male patient with prolonged and sustained arterial hypertension acutely presenting with lacunar ischemic stroke involving the right corona radiata and composite MRI findings with the association of chronic small vessel disease (SVD) markers, acute symptomatic lacunar stroke, and atypical, central variant, posterior fossa dominant PRES. In the MRI follow-up, the white matter hyperintensities in T2-fluid attenuated inversion recovery (FLAIR sequences) due to PRES., Discussion: The pathophysiology of PRES is not yet fully known, but the association with markedly increased values of arterial pressure is typical. In this context, ischemic stroke has not been considered in the clinical and neuroradiological manifestations of PRES and it has been only occasionally reported in the literature. In this case, the main hypothesis is that sustained hypertension may have triggered both manifestations, PRES, and ischemic stroke and the last one allowed to diagnose the first one., Conclusions: Atypical variants of PRES are not so rare and it may also occur in typical triggering situations. The association with ischemic stroke is even rarer and it may add some clues to the pathomechanisms of PRES., (© 2023. Fondazione Società Italiana di Neurologia.)
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- 2024
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22. Prevalence of Fabry disease and GLA variants in young patients with acute stroke: The challenge to widen the screening. The Fabry-Stroke Italian Registry.
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Romani I, Sarti C, Nencini P, Pracucci G, Zedde M, Cianci V, Nucera A, Moller J, Orsucci D, Toni D, Palumbo P, Casella C, Pinto V, Barbarini L, Bella R, Scoditti U, Ragno M, Mezzapesa DM, Tassi R, Volpi G, Diomedi M, Bigliardi G, Cavallini AM, Chiti A, Ricci S, Cecconi E, Linoli G, Sacco S, Rasura M, Giordano A, Bonetti B, Melis M, Cariddi LP, Dossi RC, Grisendi I, Aguglia U, Di Ruzza MR, Melis M, Sbardella E, Vista M, Valenti R, Musolino RF, Passarella B, Direnzo V, Pennisi G, Genovese A, Di Marzio F, Sgobio R, Acampa M, Nannucci S, Dagostino F, Dell'Acqua ML, Cuzzoni MG, Picchioni A, Calchetti B, Notturno F, Di Lisi F, Forlivesi S, Delodovici ML, Buechner SC, Biagini S, Accavone D, Manna R, Morrone A, and Inzitari D
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- Female, Humans, Male, Italy epidemiology, Mutation, Prevalence, Prospective Studies, Adolescent, Young Adult, Adult, Middle Aged, alpha-Galactosidase genetics, Fabry Disease diagnosis, Fabry Disease epidemiology, Fabry Disease genetics, Ischemic Attack, Transient diagnosis, Ischemic Attack, Transient epidemiology, Ischemic Stroke diagnosis, Ischemic Stroke epidemiology, Ischemic Stroke genetics
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Background: Fabry disease (FD) is a treatable X-linked lysosomal storage disorder caused by GLA gene variants leading to alpha-galactosidase A deficiency. FD is a rare cause of stroke, and it is still controversial whether in stroke patients FD should be searched from the beginning or at the end of the diagnostic workup (in cryptogenic strokes)., Methods: Fabry-Stroke Italian Registry is a prospective, multicentric screening involving 33 stroke units. FD was sought by measuring α-galactosidase A activity (males) and by genetic tests (males with reduced enzyme activity and females) in patients aged 18-60 years hospitalized for TIA, ischemic stroke, or intracerebral hemorrhage. We diagnosed FD in patients with 1) already known pathogenic GLA variants; 2) novel GLA variants if additional clinical, laboratory, or family-derived criteria were present., Results: Out of 1906 patients, we found a GLA variant in 15 (0.79%; 95%CI 0.44-1.29) with a certain FD diagnosis in 3 (0.16%; 95%CI 0.03-0.46) patients, none of whom had hemorrhage. We identified 1 novel pathogenic GLA variant. Ischemic stroke etiologies in carriers of GLA variants were: cardioaortic embolism (33%), small artery occlusion (27%), other causes (20%), and undetermined (20%). Mild severity, recurrence, previous TIA, acroparesthesias, hearing loss, and small artery occlusion were predictors of GLA variant., Conclusion: In this large multicenter cohort the frequency of FD and GLA variants was consistent with previous reports. Limiting the screening for GLA variants to patients with cryptogenic stroke may miss up to 80% of diagnoses. Some easily recognizable clinical features could help select patients for FD screening., Competing Interests: Declaration of competing interest IR received travel grants and speaker's honoraria from Takeda, Sanofi, and Amicus; PN received speaker's honoraria from Takeda, Sanofi, and Amicus; MZ received fees as consultant and advisory board member from Takeda, Sanofi, and Amicus; SS received personal fees as speaker or advisor (Abbott, Allergan-Abbvie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva), research grants (Allergan, Novartis, Uriach), and fees for CME/education (Medscape, Neurodiem Ology Medical Education); UA received speaker's fees and honoraria from EISAI; AM received speaker's honoraria and travel grants from Takeda, Sanofi, and Amicus; DI received speaker's honoraria from Takeda. Other authors declared that they have no competing interests for FSIR study., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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23. Secondary neurodegeneration of ipsilateral substantia nigra in acute ischemic stroke.
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Valzania F, and Pascarella R
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- Humans, Corpus Striatum pathology, Magnetic Resonance Imaging, Substantia Nigra diagnostic imaging, Substantia Nigra pathology, Ischemic Stroke pathology, Stroke complications, Stroke diagnostic imaging, Stroke pathology
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Introduction: Secondary neurodegeneration after stroke is a complex phenomenon affecting remote and synaptically linked cerebral areas. The involvement of the substantia nigra in this process has been rarely described in infarcts involving the striatum., Methods: We are presenting a case of ischemic stroke involving the right striatum due to atrial fibrillation and associated in a few days with the neuroimaging finding of hyperintensity of the ipsilateral substantia nigra and striatonigral tract on T2-fluid attenuated inversion recovery and diffusion-weighted imaging sequences of brain magnetic resonance imaging. This finding was not related to clinical manifestations and substantially disappeared within 3 months from stroke onset., Discussion: The pathophysiology of secondary degeneration of the substantia nigra is poorly understood and it relies on animal models and autoptic studies. The main putative mechanism is not ischemic but excitotoxic with a different role of the internal and external globus pallidus and a different effect on the pars compacta and pars reticularis of the substantia nigra. In animal models, inflammatory mechanisms seem play a role only in the late phase. The main studies on humans were presented in detail., Conclusions: A better understanding of the secondary degeneration of the substantia nigra has the potentiality to offer a chance for neuroprotection in acute stroke, but further studies are needed., (© 2023. Fondazione Società Italiana di Neurologia.)
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- 2023
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24. The Venular Side of Cerebral Amyloid Angiopathy: Proof of Concept of a Neglected Issue.
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Zedde M, Grisendi I, Assenza F, Vandelli G, Napoli M, Moratti C, Lochner P, Seiffge DJ, Piazza F, Valzania F, and Pascarella R
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Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteries, arterioles, capillaries, and venules in the brain. One of the most relevant and prevalent SVDs is cerebral amyloid angiopathy (CAA), whose pathological hallmark is the deposition of amyloid fragments in the walls of small cortical and leptomeningeal vessels. CAA frequently coexists with Alzheimer's Disease (AD), and both are associated with cerebrovascular events, cognitive impairment, and dementia. CAA and AD share pathophysiological, histopathological and neuroimaging issues. The venular involvement in both diseases has been neglected, although both animal models and human histopathological studies found a deposition of amyloid beta in cortical venules. This review aimed to summarize the available information about venular involvement in CAA, starting from the biological level with the putative pathomechanisms of cerebral damage, passing through the definition of the peculiar angioarchitecture of the human cortex with the functional organization and consequences of cortical arteriolar and venular occlusion, and ending to the hypothesized links between cortical venular involvement and the main neuroimaging markers of the disease.
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- 2023
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25. Intravenous Thrombolysis 4.5-9 Hours After Stroke Onset: A Cohort Study from the TRISP Collaboration.
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Altersberger VL, Sibolt G, Enz LS, Hametner C, Scheitz JF, Henon H, Bigliardi G, Strambo D, Martinez-Majander N, Stolze LJ, Heldner MR, Grisendi I, Jovanovic DR, Bejot Y, Pezzini A, Leker RR, Kägi G, Wegener S, Cereda CW, Ntaios G, De Marchis GM, Bonati LH, Psychogios M, Lyrer P, Räty S, Tiainen M, Wouters A, Caparros F, Heyse M, Erdur H, Padjen V, Zedde M, Arnold M, Nederkoorn PJ, Michel P, Zini A, Cordonnier C, Nolte CH, Ringleb PA, Curtze S, Engelter ST, and Gensicke H
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- Humans, Cohort Studies, Prospective Studies, Thrombolytic Therapy methods, Intracranial Hemorrhages etiology, Treatment Outcome, Fibrinolytic Agents therapeutic use, Stroke diagnostic imaging, Stroke drug therapy, Ischemic Stroke complications, Brain Ischemia diagnostic imaging, Brain Ischemia drug therapy, Brain Ischemia complications
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Objective: To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5-9 hours after stroke onset, and the relevance of advanced neuroimaging for patient selection., Methods: Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage, poor 3-month functional outcome (modified Rankin scale 3-6) and mortality. We compared: (i) IVT >4.5-9 hours versus 0-4.5 hours after stroke onset and (ii) within the >4.5-9 hours group baseline advanced neuroimaging (computed tomography perfusion, magnetic resonance perfusion or magnetic resonance diffusion-weighted imaging fluid-attenuated inversion recovery) versus non-advanced neuroimaging., Results: Of 15,827 patients, 663 (4.2%) received IVT >4.5-9 hours and 15,164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5 and 9 hours. Using propensity score weighted binary logistic regression analysis (onset-to-treatment time >4.5-9 hours vs onset-to-treatment time 0-4.5 hours), the probability of symptomatic intracranial hemorrhage (OR
adjusted 0.80, 95% CI 0.53-1.17), poor functional outcome (ORadjusted 1.01, 95% CI 0.83-1.22), and mortality (ORadjusted 0.80, 95% CI 0.61-1.04) did not differ significantly between both groups. In patients treated between >4.5 and 9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared with non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51, 95% CI 0.33-0.79)., Interpretation: This study showed no evidence in difference of symptomatic intracranial hemorrhage, poor outcome, and mortality in selected stroke patients treated with IVT between >4.5 and 9 hours after stroke onset compared with those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. ANN NEUROL 2023;94:309-320., (© 2023 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)- Published
- 2023
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26. Perfusion Status in Lacunar Stroke: A Pathophysiological Issue.
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, and Pascarella R
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The pathophysiology of lacunar infarction is an evolving and debated field, where relevant information comes from histopathology, old anatomical studies and animal models. Only in the last years, have neuroimaging techniques allowed a sufficient resolution to directly or indirectly assess the dynamic evolution of small vessel occlusion and to formulate hypotheses about the tissue status and the mechanisms of damage. The core-penumbra concept was extensively explored in large vessel occlusions (LVOs) both from the experimental and clinical point of view. Then, the perfusion thresholds on one side and the neuroimaging techniques studying the perfusion of brain tissue were focused and optimized for LVOs. The presence of a perfusion deficit in the territory of a single small perforating artery was negated for years until the recent proposal of the existence of a perfusion defect in a subgroup of lacunar infarcts by using magnetic resonance imaging (MRI). This last finding opens pathophysiological hypotheses and triggers a neurovascular multidisciplinary reasoning about how to image this perfusion deficit in the acute phase in particular. The aim of this review is to summarize the pathophysiological issues and the application of the core-penumbra hypothesis to lacunar stroke.
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- 2023
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27. CT Perfusion in Lacunar Stroke: A Systematic Review.
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, and Pascarella R
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Background: The main theory underlying the use of perfusion imaging in acute ischemic stroke is the presence of a hypoperfused volume of the brain downstream of an occluded artery. Indeed, the main purpose of perfusion imaging is to select patients for endovascular treatment. Computed Tomography Perfusion (CTP) is the more used technique because of its wide availability but lacunar infarcts are theoretically outside the purpose of CTP, and limited data are available about CTP performance in acute stroke patients with lacunar stroke., Methods: We performed a systematic review searching in PubMed and EMBASE for CTP and lacunar stroke with a final selection of 14 papers, which were examined for data extraction and, in particular, CTP technical issues and sensitivity, specificity, PPV, and NPV values., Results: A global cohort of 583 patients with lacunar stroke was identified, with a mean age ranging from 59.8 to 72 years and a female percentage ranging from 32 to 53.1%.CTP was performed with different technologies (16 to 320 rows), different post-processing software, and different maps. Sensitivity ranges from 0 to 62.5%, and specificity from 20 to 100%., Conclusions: CTP does not allow to reasonable exclude lacunar infarct if no perfusion deficit is found, but the pathophysiology of lacunar infarct is more complex than previously thought.
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- 2023
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28. Acute Onset Quadriplegia and Stroke: Look at the Brainstem, Look at the Midline.
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Zedde M, Grisendi I, Pezzella FR, Napoli M, Moratti C, Valzania F, and Pascarella R
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Acute onset quadriplegia with or without facial sparing is an extremely rare vascular syndrome, and the main focus of attention is on the cervical and upper thoracic spinal cord as the putative site of the damage. Quadriplegia has been occasionally reported in brainstem strokes within well-defined lesion patterns, but these reports have gained little attention so far because of the rarity of this clinical syndrome. The clinical, neuroanatomical and neuroimaging features of ischemic stroke locations associated with quadriplegia have been collected and reviewed in a pragmatical view, which includes a detailed description of the neurological signs associated with the damage of the pyramidal pathways. Two clinical examples have been added to raise practical suggestions in neurovascular practice. Ischemic stroke sites determining quadriplegia have some main well-defined midline locations in the brainstem, involving the pyramidal pathways of both sides in a single synchronous ischemic lesion in the medulla oblongata and in the pons. Several accompanying neurological signs have been described when the ischemic lesion involves tracts and nuclei other than the pyramidal pathways, and they can be useful as localizing clues. In some cases, the typical neuroimaging appearance of the ischemic lesion on Magnetic Resonance Imaging (MRI) has been reported as being a "heart appearance sign". This last sign has been described in midbrain strokes too, but this location is not associated with quadriplegia. The main etiology is atherothrombosis involving the intradural segment of the vertebral artery (VA) and their perforating branches. Two clinical examples of these rare vascular syndromes have been chosen to support a pragmatical discussion about the management of these cases. A midline ischemic stroke in the brainstem is a very rare vascular syndrome, and the acute onset quadriplegia is a distinctive feature of it. The awareness of this cerebrovascular manifestation might help to recognize and treat these patients.
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- 2022
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29. Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration.
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Altersberger VL, Rusche N, Martinez-Majander N, Hametner C, Scheitz JF, Henon H, Dell'Acqua ML, Strambo D, Stolp J, Heldner MR, Grisendi I, Jovanovic DR, Bejot Y, Pezzini A, Leker RR, Kägi G, Wegener S, Cereda CW, Lindgren E, Ntaios G, Piot I, Polymeris AA, Lyrer PA, Räty S, Sibolt G, Tiainen M, Heyse M, Erdur H, Kaaouana O, Padjen V, Zedde M, Arnold M, Nederkoorn PJ, Michel P, Bigliardi G, Zini A, Cordonnier C, Nolte CH, Ringleb PA, Curtze S, Engelter ST, and Gensicke H
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- Aged, 80 and over, Aged, Humans, Thrombolytic Therapy methods, Cohort Studies, Prospective Studies, Treatment Outcome, Intracranial Hemorrhages chemically induced, Intracranial Hemorrhages epidemiology, Intracranial Hemorrhages drug therapy, Fibrinolytic Agents adverse effects, Brain Ischemia drug therapy, Ischemic Stroke, Stroke drug therapy
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Background: The probability to receive intravenous thrombolysis (IVT) for treatment of acute ischemic stroke declines with increasing age and is consequently the lowest in very elderly patients. Safety concerns likely influence individual IVT treatment decisions. Using data from a large IVT registry, we aimed to provide more evidence on safety of IVT in the very elderly., Methods: In this prospective multicenter study from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry, we compared patients ≥90 years with those <90 years using symptomatic intracranial hemorrhage (ECASS [European Cooperative Acute Stroke Study]-II criteria), death, and poor functional outcome in survivors (modified Rankin Scale score 3-5 for patients with prestroke modified Rankin Scale score ≤2 and modified Rankin Scale score 4-5 for patients prestroke modified Rankin Scale ≥3) at 3 months as outcomes. We calculated adjusted odds ratio with 95% CI using logistic regression models., Results: Of 16 974 eligible patients, 976 (5.7%) were ≥90 years. Patients ≥90 years had higher median National Institutes of Health Stroke Scale on admission (12 versus 8) and were more often dependent prior to the index stroke (prestroke modified Rankin Scale score of ≥3; 45.2% versus 7.4%). Occurrence of symptomatic intracranial hemorrhage (5.7% versus 4.4%, odds ratio
adjusted 1.14 [0.83-1.57]) did not differ significantly between both groups. However, the probability of death (odds ratioadjusted 3.77 [3.14-4.53]) and poor functional outcome (odds ratioadjusted 2.63 [2.13-3.25]) was higher in patients aged ≥90 years. Results for the sample of centenarians (n=21) were similar., Conclusions: The probability of symptomatic intracranial hemorrhage after IVT in very elderly patients with stroke did not exceed that of their younger counterparts. The higher probability of death and poor functional outcome during follow-up in the very elderly seems not to be related to IVT treatment. Very high age itself should not be a reason to withhold IVT.- Published
- 2022
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30. Bow hunter's syndrome successfully treated with a posterior surgical decompression approach: A case report and review of literature.
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Orlandi N, Cavallieri F, Grisendi I, Romano A, Ghadirpour R, Napoli M, Moratti C, Zanichelli M, Pascarella R, Valzania F, and Zedde M
- Abstract
Background: Bow hunter's syndrome (BHS) is a rare but surgically treatable cause of vertebrobasilar insufficiency due to dynamic rotational occlusion of the vertebral artery. Typically, patients present with posterior circulation transient ischaemic symptoms such as presyncope, syncope, vertigo, diplopia, and horizontal nystagmus, but irreversible deficits, including medullary and cerebellar infarctions, have also been described., Case Summary: A 70-year-old patient presented an acute onset of vertigo and gait instability triggered by right head rotation. His medical history included previous episodes of unilateral left neck and occipital pain followed by light-headedness, sweating, and blurred vision when turning his head, and these episodes were associated with severe degenerative changes in the atlanto-dens and left atlanto-axial facet joints and right rotation of the C2 cervical vertebrae. Brain magnetic resonance imaging revealed the presence of acute bilateral cerebellar ischaemic lesions, while static vascular imaging did not reveal any vertebral artery abnormalities. Dynamic ultrasonography and angiography were performed and confirmed the presence of a dynamic occlusion of the vertebral artery V3-V4 segment when the head was rotated to the right secondary to left C1-C2 bone spur compression. Surgical decompression led to complete resolution of paroxysmal symptoms without neurological sequelae., Conclusion: BHS should be considered in cases of repeated posterior circulation transient ischaemic attack or ischaemic stroke, particularly when associated with high cervical spine abnormalities., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2022
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31. Increased Stroke Risk in Patients with Parkinson's Disease with LRRK2 Mutations.
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Grisanti S, Ferri L, Cavallieri F, Fioravanti V, Vincenzi C, Toschi G, Grisendi I, Sabadini R, Paul JJ, Bauer P, Zedde M, and Valzania F
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- Glucosylceramidase genetics, Humans, Leucine-Rich Repeat Serine-Threonine Protein Kinase-2 genetics, Mutation genetics, Parkinson Disease complications, Parkinson Disease genetics
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- 2022
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32. Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries : The Italian Registry of Endovascular Treatment in Acute Stroke.
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Sallustio F, Saia V, Marrama F, Pracucci G, Gandini R, Koch G, Mascolo AP, D'Agostino F, Rocco A, Argiro' R, Nezzo M, Morosetti D, Wlderk A, Da Ros V, Diomedi M, Renieri L, Nencini P, Vallone S, Zini A, Bigliardi G, Caragliano A, Francalanza I, Bracco S, Tassi R, Bergui M, Naldi A, Saletti A, De Vito A, Gasparotti R, Magoni M, Cirillo L, Commodaro C, Biguzzi S, Castellan L, Malfatto L, Menozzi R, Grisendi I, Cosottini M, Orlandi G, Comai A, Franchini E, D'Argento F, Frisullo G, Puglielli E, Casalena A, Causin F, Baracchini C, Boghi A, Chianale G, Augelli R, Cappellari M, Chiumarulo L, Petruzzellis M, Sgreccia A, Tosi P, Cavasin N, Critelli A, Semeraro V, Boero G, Vizzari F, Cariddi LP, Di Benedetto O, Pugliese P, Iacobucci M, De Michele M, Fusaro F, Moller J, Allegretti L, Tassinari T, Nuzzi NP, Marcheselli S, Sacco S, Pavia M, Invernizzi P, Gallesio I, Ruiz L, Zedda S, Rossi R, Amistà P, Russo M, Pintus F, Sanna A, Craparo G, Mannino M, Inzitari D, Mangiafico S, and Toni D
- Subjects
- Aged, Carotid Arteries, Humans, Italy, Registries, Retrospective Studies, Treatment Outcome, Brain Ischemia diagnostic imaging, Brain Ischemia surgery, Endovascular Procedures, Stroke diagnostic imaging, Stroke surgery, Thrombectomy
- Abstract
Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion., Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated., Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome., Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
- Published
- 2021
- Full Text
- View/download PDF
33. ICHD-3: what changes do we need regarding migraine?
- Author
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Manzoni GC, Grisendi I, and Torelli P
- Subjects
- Humans, International Classification of Diseases standards, Migraine Disorders classification, Migraine Disorders diagnosis, Migraine with Aura diagnosis, Migraine without Aura diagnosis, International Classification of Diseases trends, Migraine with Aura classification, Migraine without Aura classification, Severity of Illness Index
- Abstract
Based on publications on migraine in the medical literature after 2004, the third edition of the International Classification of Headache Disorders (ICHD-3), with publication date early in 2013, will provide a framework to systematize those migraine forms that the second edition (ICHD-2) included in its Appendix. The most needed changes concern so-called chronic migraine. The revised ICHD-2 (ICHD-2R) did introduce appreciable changes to the ICHD-2 diagnostic criteria for chronic migraine. To be more relevant to actual clinical practice, the classification should discriminate between forms of migraine without aura depending on low, medium, or high frequency of attacks. The classification should include transformed migraine, an appellation that seems preferable to chronic migraine, in the group of migraine complications using extended time parameters compared with those currently used in ICHD-2R for chronic migraine. Finally, it should assess the opportunity of a different classification for medication-overuse headache., (© Springer Science+Business Media, LLC 2011)
- Published
- 2011
- Full Text
- View/download PDF
34. Reversible cerebral vasoconstriction phenomena following indomethacin administration.
- Author
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Lambru G, Manzoni GC, Torelli P, Grisendi I, and Zanferrari C
- Subjects
- Aged, Cerebral Angiography, Cerebrovascular Circulation drug effects, Dyslipidemias complications, Dyslipidemias drug therapy, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Ultrasonography, Doppler, Transcranial, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Indomethacin adverse effects, Migraine with Aura drug therapy, Vasospasm, Intracranial chemically induced
- Abstract
We report a case of reversible cerebral vasoconstriction, possibly secondary to the use of indomethacin to relieve pain during a migraine with aura attack. Non-steroidal anti-inflammatory drugs are not reported among substances precipitating secondary forms of reversible cerebral vasoconstriction. A transcranial Doppler sonography study, performed during the phase with headache and the other neurological deficits, suggested the presence of distal cerebral vasospasm, which normalized when all symptoms regressed completely (<24 hours). We speculated that indomethacin might represent the trigger factor of these particular phenomena, by acting either directly on distal cerebral vessels, or under certain predisposing conditions, such as migraine with aura attacks., (© 2010 American Headache Society.)
- Published
- 2011
- Full Text
- View/download PDF
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