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20. Clinical outcome predictors in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy

Author

Lucia, Kristin, Reitz, Sarah, Hattingen, Elke, Steinmetz, Helmuth, Seifert, Volker, Czabanka, Marcus Alexander, Lucia, Kristin, Reitz, Sarah, Hattingen, Elke, Steinmetz, Helmuth, Seifert, Volker, and Czabanka, Marcus Alexander

Abstract

Oral e-Poster Presentations - Booth 1: Vascular 3, September 27, 2023, 10:00 AM - 10:40 AM Background: Despite current clinical guidelines recommending suboccipital decompressive craniectomy (SDC) in patients with space-occupying cerebellar infarction when neurological deterioration occurs, the precise definition of such deterioration remains unclear. The current study aimed at characterizing whether clinical outcomes can be predicted by the GCS score immediately prior to SDC, and whether higher GCS scores are associated with better clinical outcomes. We aimed to characterize whether clinical outcomes can be predicted by the GCS score immediately prior to SDC, and if higher GCS scores are associated with better clinical outcomes. Methods: In a single-center, retrospective analysis of 51 patients treated with SDC for space-occupying cerebellar infarction clinical and imaging data were evaluated at the timepoints of symptom onset, hospital admission and preoperatively. Clinical outcome was measured by mRS at the last available follow-up. Preoperative GCS scores were stratified into three groups (GCS 3-8, 9-11 and 12-15). Univariate and multivariate Cox regression analyses were performed using clinical and radiological parameters as predictors of clinical outcome. Results: In Cox-regression analysis using mRS of 1-2 as a positive clinical outcome we found a significant increase in the proportional hazard ratio (HR) of 6.581 [CI 1.839-36.414]; p=0.031 for GCS scores of 12-15 prior to SDC. Clinical outcomes (mRS 3-6) were associated with infarct volume above 6.0 cm3 (HR 2.473 [CI 1.209-5.057]; p=0.013), tonsillar herniation (HR: 0.279 [CI 0.083-0.933]; p=0.038), brainstem compression (HR 0.304 [CI 0.123-0.749]; p=0.010) and a preoperative GCS score of 3-8 (HR 2.386 [CI 1.160-4.906]; p=0.018). Conclusions: SDC should be considered in patients with infarct volumes above 6.0 cm3 with GCS scores higher than previously described in the literature, as these patients may show b

Published
2023

30. <scp>COVID</scp> ‐19 Vaccine‐Associated Cerebral Venous Thrombosis in Germany

Author

Schulz, Jörg B, Berlit, Peter, Steinmetz, Helmuth, Thiele, Thomas, Kurth, Tobias, Group, German Society of Neurology SARS-CoV-2 Vaccination Study, Alonso, Angelika, Bartsch, Thorsten, Baumsteiger, Christoph, Bode, Felix, Cangür, Hakan, Daffertshofer, Michael, Diener, Hans-Christoph, Dafotakis, Manuel, Dieterich, Marianne, Fabian, Friederike, Fousse, Mathias, Godau, Jana, Grond, Martin, Günther, Albrecht, Gutschalk, Alexander, Hagemann, Georg, Hartmann, Corinna, Gerloff, Christian, Hilker-Roggendorf, Rüdiger, Höglinger, Günter, Ikenberg, Benno, Ismail, Fatme Seval, Jesse, Sarah, Kallmünzer, Bernd, Kern, Rolf, Klietz, Martin, Knauß, Samuel, Knier, Benjamin, Greinacher, Andreas, Limmroth, Volker, Mengel, Annerose, Meyne, Johannes, Morgenthaler, Martin, Müller, Matthias, Nagel, Simon, Niels, Ralf Dittrich, Onur, Oezguer A, Pelz, Johann, Plenge, Johannes, Klein, Christine, Poli, Sven, Roth, Christian, Röther, Joachim, Saß, Christian, Schönenberger, Silvia, Schubert, Roger, Simon, Ole, Agaplesion, Ina Specht, Sperfeld, Anne, Spreer, Annette, Petzold, Gabor C, Steinbrecher, Andreas, Steiner, Jochen, Stetefeld, Henning, Trendelenburg, George, Vatankhah, Nils Bijan, Wahl, Christoph Michael, Wartenberg, Katja, Witt, Karsten, Wittstock, Matthias, Wolf, Björn, Piccininni, Marco, Wolf, Joachim, Zimmermann, Julian, and Röhrig, Rainer

Subjects
Male, Pediatrics, Neurology, Medizin, etiology [Intracranial Thrombosis], BNT162 vaccine, epidemiology [Cerebral Hemorrhage], Rate ratio, etiology [Ischemic Stroke], Germany, Surveys and Questionnaires, epidemiology [Ischemic Stroke], epidemiology [Venous Thrombosis], Research Articles, etiology [Venous Thrombosis], Venous Thrombosis, Aged, 80 and over, education.field_of_study, Incidence, Incidence (epidemiology), Age Factors, Middle Aged, etiology [Cerebral Hemorrhage], Vaccination, Venous thrombosis, Female, Research Article, Adult, medicine.medical_specialty, COVID-19 Vaccines, Coronavirus disease 2019 (COVID-19), Population, epidemiology [Germany], Young Adult, Sex Factors, ChAdOx1 nCoV-19, medicine, adverse effects [COVID-19 Vaccines], Humans, ddc:610, education, BNT162 Vaccine, Cerebral Hemorrhage, Ischemic Stroke, Aged, epidemiology [Intracranial Thrombosis], business.industry, medicine.disease, Confidence interval, ChAdOx1 COVID-19 vaccine, Neurology (clinical), Intracranial Thrombosis, business
Abstract

OBJECTIVE We aimed to estimate the incidence of cerebral sinus and venous thrombosis (CVT) within 1 month from first dose administration and the frequency of vaccine-induced immune thrombotic thrombocytopenia (VITT) as the underlying mechanism after vaccination with BNT162b2, ChAdOx1, and mRNA-1273, in Germany. METHODS A web-based questionnaire was e-mailed to all departments of neurology. We requested a report of cases of CVT occurring within 1 month of a COVID-19 vaccination. Other cerebral events could also be reported. Incidence rates of CVT were calculated by using official statistics of 9 German states. RESULTS A total of 45 CVT cases were reported. In addition, 9 primary ischemic strokes, 4 primary intracerebral hemorrhages, and 4 other neurological events were recorded. Of the CVT patients, 35 (77.8%) were female, and 36 (80.0%) were younger than 60 years. Fifty-three events were observed after vaccination with ChAdOx1 (85.5%), 9 after BNT162b2 (14.5%) vaccination, and none after mRNA-1273 vaccination. After 7,126,434 first vaccine doses, the incidence rate of CVT within 1 month from first dose administration was 0.55 (95% confidence interval [CI] = 0.38-0.78) per 100,000 person-months (which corresponds to a risk of CVT within the first 31 days of 0.55 per 100,000 individuals) for all vaccines and 1.52 (95% CI = 1.00-2.21) for ChAdOx1 (after 2,320,535 ChAdOx1 first doses). The adjusted incidence rate ratio was 9.68 (95% CI = 3.46-34.98) for ChAdOx1 compared to mRNA-based vaccines and 3.14 (95% CI = 1.22-10.65) for females compared to non-females. In 26 of 45 patients with CVT (57.8%), VITT was graded highly probable. INTERPRETATION Given an incidence of 0.02 to 0.15 per 100,000 person-months for CVT in the general population, these findings point toward a higher risk for CVT after ChAdOx1 vaccination, especially for women. ANN NEUROL 2021;90:627-639.

Published
2021
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32. Diskussion

Author

Dilthey, Ulrich, Steinmetz, Helmuth, Fürstner, Alois, Dilthey, Ulrich, Steinmetz, Helmuth, and Fürstner, Alois

Published
1997
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37. Simulation-based training improves process times in acute stroke care (STREAM)

Author

Bohmann, Ferdinand O., Gruber, Katharina, Kurka, Natalia, Willems, Laurent M., Herrmann, Eva, du Mesnil de Rochemont, Richard, Scholz, Peter, Rai, Heike, Zickler, Philipp, Ertl, Michael, Berlis, Ansgar, Poli, Sven, Mengel, Annerose, Ringleb, Peter, Nagel, Simon, Pfaff, Johannes, Wollenweber, Frank A., Kellert, Lars, Herzberg, Moriz, Koehler, Luzie, Haeusler, Karl Georg, Alegiani, Anna, Schubert, Charlotte, Brekenfeld, Caspar, Doppler, Christopher E. J., Onur, Ozgur A., Kabbasch, Christoph, Manser, Tanja, Steinmetz, Helmuth, Pfeilschifter, Waltraud, Bohmann, Ferdinand O., Gruber, Katharina, Kurka, Natalia, Willems, Laurent M., Herrmann, Eva, du Mesnil de Rochemont, Richard, Scholz, Peter, Rai, Heike, Zickler, Philipp, Ertl, Michael, Berlis, Ansgar, Poli, Sven, Mengel, Annerose, Ringleb, Peter, Nagel, Simon, Pfaff, Johannes, Wollenweber, Frank A., Kellert, Lars, Herzberg, Moriz, Koehler, Luzie, Haeusler, Karl Georg, Alegiani, Anna, Schubert, Charlotte, Brekenfeld, Caspar, Doppler, Christopher E. J., Onur, Ozgur A., Kabbasch, Christoph, Manser, Tanja, Steinmetz, Helmuth, and Pfeilschifter, Waltraud

Abstract

Background The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care. Methods The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre- and post-interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct-to-center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke-specific in situ simulation training. Primary outcome measure was the 'door-to-needle' time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre-existing treatment algorithm. Results The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre-intervention (interquartile range [IQR] 25-43 min) to 33 min (IQR 23-39 min, p = 0.03) post-intervention achieved by simulation-experienced stroke teams. Concerning EVT, we found significantly shorter door-to-groin times in patients who were treated by teams with simulation experience as compared to simulation-naive teams in the post-interventional phase (-21 min, simulation-naive: 95 min, IQR 69-111 vs. simulation-experienced: 74 min, IQR 51-92, p = 0.04). Conclusion An intervention combining workflow refinement and simulation-based stroke team training has the potential to improve process times in acute stroke care.

Published
2022

38. Exploring contraindications for thrombolysis: risk of hemorrhagic transformation and neurological deterioration after thrombolysis in mice with recent ischemic stroke and hyperglycemia

Author

Gelhard, Sarah, Kestner, Roxane-Isabelle, Armbrust, Moritz, Steinmetz, Helmuth, Förch, Christian, Bohmann, Ferdinand, Gelhard, Sarah, Kestner, Roxane-Isabelle, Armbrust, Moritz, Steinmetz, Helmuth, Förch, Christian, and Bohmann, Ferdinand

Abstract

(1) Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke is limited because of several contraindications. In routine clinical practice, patients with a recent stroke are typically not treated with rt-PA in case of a recurrent ischemic event. The same applies to its use in the context of pulmonary artery embolism and myocardial infarction with a recent stroke. In this translational study, we evaluated whether rt-PA treatment after experimental ischemic stroke with or without additional hyperglycemia increases the risk for hemorrhagic transformation (HT) and worsens functional outcome regarding the old infarct area. (2) In total, 72 male C57BL/6N mice were used. Ischemic stroke (index stroke) was induced by transient middle cerebral artery occlusion (tMCAO). Mice received either rt-PA or saline 24 h or 14 days after index stroke to determine whether a recent ischemic stroke predisposes to HT. In addition to otherwise healthy mice, hyperglycemic mice were analyzed to evaluate diabetes as a second risk factor for HT. Mice designated to develop hyperglycemia were pre-treated with streptozotocin. (3) The neurological outcome in rt-PA and saline-treated normoglycemic mice did not differ significantly, either at 24 h or at 14 days. In contrast, hyperglycemic mice treated with rt-PA had a significantly worse neurological outcome (at 24 h, p = 0.02; at 14 days, p = 0.03). At 24 h after rt-PA or saline treatment, HT scores differed significantly (p = 0.02) with the highest scores within hyperglycemic mice treated with rt-PA, where notably only small petechial hemorrhages could be detected. (4) Thrombolysis after recent ischemic stroke does not increase the risk for HT or worsen the functional outcome in otherwise healthy mice. However, hyperglycemia as a second risk factor leads to neurological deterioration after rt-PA treatment, which cannot be explained by an increase of HT alone. Direct neurotoxic effects of

Published
2022

40. Brain‐specific biomarkers in urine as a non‐invasive approach to monitor neuronal and glial damage.

Author

Kohlhase, Konstantin, Frank, Franziska, Wilmes, Christian, Koerbel, Kimberly, Schaller‐Paule, Martin A., Miles, Martha, Betz, Christoph, Steinmetz, Helmuth, and Foerch, Christian

Subjects
GLIAL fibrillary acidic protein, DEUBIQUITINATING enzymes, TAU proteins, CREATININE, HEMORRHAGIC stroke, STROKE patients, URINE
Abstract

Background and purpose: This study evaluates the quantitative measurability of glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), ubiquitin carboxy‐terminal hydrolase L1 (UCH‐L1) and total tau (t‐tau) in urine of patients with acute cerebral damage. Methods: Serum and urine samples were prospectively collected from patients with an acute ischemic stroke or intracerebral hemorrhage (target group) and compared to healthy subjects (control group); samples were measured using ultrasensitive single‐molecule arrays (Simoa®). Glomerular barrier function was assessed based on albumin–creatinine ratio (ACR); biomarker–creatinine ratios were calculated for correction of urine dilution. Results: Ninety‐three urine–serum pairs in the target group and 10 urine–serum pairs in the control group were measured. The mean absolute concentration ± standard deviation in urine of the target and control groups were 184.7 ± 362.4 pg/ml and 27.3 ± 24.1 pg/ml for GFAP (r = 0.3 [Wilcoxon effect size], p = 0.007), 17.5 ± 38.6 pg/ml and 0.9 ± 0.3 pg/ml for NfL (r = 0.4, p < 0.005), 320.2 ± 443.3 pg/ml and 109.6 ± 116.8 pg/ml for UCH‐L1 (r = 0.26, p = 0.014), and 219.5 ± 255.8 pg/ml and 21.1 ± 27.1 pg/ml for t‐tau (r = 0.37, p < 0.005), respectively, whereas biomarker–creatinine ratio was significantly different only for NfL (r = 0.29, p = 0.015) and t‐tau (r = 0.32, p < 0.01). In patients with intact glomerular barrier (ACR < 30 mg/g), only NfL in urine was significantly different between the target and control group and showed a significant correlation with the respective serum concentrations (r = 0.58 [Pearson's correlation‐coefficient], p < 0.005). Conclusion: All four investigated biomarkers could be measured in urine, with NfL and t‐tau showing the strongest effect size after correction for urine dilution. NfL revealed the most accurate relation between serum and urine concentrations in patients with intact kidney function. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Common variant near the endothelin receptor type A (EDNRA) gene is associated with intracranial aneurysm risk

Author

Yasuno, Katsuhito, Bakırcıoğlu, Mehmet, Low, Siew-Kee, Bilgüvar, Kaya, Gaál, Emília, Ruigrok, Ynte M., Niemelä, Mika, Hata, Akira, Bijlenga, Philippe, Kasuya, Hidetoshi, Jääskeläinen, Juha E., Krex, Dietmar, Auburger, Georg, Simon, Matthias, Krischek, Boris, Ozturk, Ali K., Mane, Shrikant, Rinkel, Gabriel J. E., Steinmetz, Helmuth, Hernesniemi, Juha, Schaller, Karl, Zembutsu, Hitoshi, Inoue, Ituro, Palotie, Aarno, Cambien, François, Nakamura, Yusuke, Lifton, Richard P., and Günel, Murat

Published
2011

45. Introduction

Author

Zanella, Friedhelm E., Steinmetz, Helmuth, Seifert, Volker, Hattingen, Elke, editor, Weidauer, Stefan, editor, Setzer, Matthias, editor, Klein, Johannes C., editor, and Vrionis, Frank, editor

Published
2015
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47. Inflammatory markers and extent and progression of early atherosclerosis: Meta-analysis of individual-participant-data from 20 prospective studies of the PROG-IMT collaboration

Author

Willeit, Peter, Thompson, Simon G, Agewall, Stefan, Bergström, Göran, Bickel, Horst, Catapano, Alberico L, Chien, Kuo-Liong, de Groot, Eric, Empana, Jean-Philippe, Etgen, Thorleif, Franco, Oscar H, Iglseder, Bernhard, Johnsen, Stein H, Kavousi, Maryam, Lind, Lars, Liu, Jing, Mathiesen, Ellisiv B, Norata, Giuseppe D, Olsen, Michael H, Papagianni, Aikaterini, Poppert, Holger, Price, Jackie F, Sacco, Ralph L, Yanez, David N, Zhao, Dong, Schminke, Ulf, Bülbül, Alpaslan, Polak, Joseph F, Sitzer, Matthias, Hofman, Albert, Grigore, Liliana, Dörr, Marcus, Su, Ta-Chen, Ducimetière, Pierre, Xie, Wuxiang, Ronkainen, Kimmo, Kiechl, Stefan, Rundek, Tatjana, Robertson, Christine, Fagerberg, Björn, Bokemark, Lena, Steinmetz, Helmuth, Ikram, Arfan M, Völzke, Henry, Lin, Hung-Ju, Plichart, Matthieu, Tuomainen, Tomi-Pekka, Desvarieux, Moise, McLachlan, Stela, Schmidt, Caroline, Kauhanen, Jussi, Willeit, Johann, Lorenz, Matthias W, and Sander, Dirk

Published
2016
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50. Multicenter prospective analysis of hypertrophic olivary degeneration following infratentorial stroke (HOD-IS): evaluation of disease epidemiology, clinical presentation, and MR-imaging aspects

Author

Schaller-Paule, Martin A., Steidl, Eike, Shrestha, Manoj, Deichmann, Ralf, Steinmetz, Helmuth, Seiler, Alexander, Lapa, Sriramya, Steiner, Thorsten, Thonke, Sven, Weidauer, Stefan, Konczalla, Jürgen, Hattingen, Elke, and Förch, Christian

Subjects
ddc:610
Abstract

Introduction: Ischemic and hemorrhagic strokes in the brainstem and cerebellum with injury to the functional loop of the Guillain-Mollaret triangle (GMT) can trigger a series of events that result in secondary trans-synaptic neurodegeneration of the inferior olivary nucleus. In an unknown percentage of patients, this leads to a condition called hypertrophic olivary degeneration (HOD). Characteristic clinical symptoms of HOD progress slowly over months and consist of a rhythmic palatal tremor, vertical pendular nystagmus, and Holmes tremor of the upper limbs. Diffusion Tensor Imaging (DTI) with tractography is a promising method to identify functional pathway lesions along the cerebello-thalamo-cortical connectivity and to generate a deeper understanding of the HOD pathophysiology. The incidence of HOD development following stroke and the timeline of clinical symptoms have not yet been determined in prospective studies—a prerequisite for the surveillance of patients at risk. Methods and Analysis: Patients with ischemic and hemorrhagic strokes in the brainstem and cerebellum with a topo-anatomical relation to the GMT are recruited within certified stroke units of the Interdisciplinary Neurovascular Network of the Rhine-Main. Matching lesions are identified using a predefined MRI template. Eligible patients are prospectively followed up and present at 4 and 8 months after the index event. During study visits, a clinical neurological examination and brain MRI, including high-resolution T2-, proton-density-weighted imaging, and DTI tractography, are performed. Fiberoptic endoscopic evaluation of swallowing is optional if palatal tremor is encountered. Study Outcomes: The primary endpoint of this prospective clinical multicenter study is to determine the frequency of radiological HOD development in patients with a posterior fossa stroke affecting the GMT at 8 months after the index event. Secondary endpoints are identification of (1) the timeline and relevance of clinical symptoms, (2) lesion localizations more prone to HOD occurrence, and (3) the best MR-imaging regimen for HOD identification. Additionally, (4) DTI tractography data are used to analyze individual pathway lesions. The aim is to contribute to the epidemiological and pathophysiological understanding of HOD and hereby facilitate future research on therapeutic and prophylactic measures.

Published
2021

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