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2. Sex differences in ischemic stroke during COVID-19 first outbreak in northern Italy

Author

Sangalli, D, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Canella, S, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Martinelli-Boneschi, F, Salmaggi, A, Sangalli D., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Canella S., Zanferrari C., Grampa G., d'Adda E., Peverelli L., Colombo A., Martinelli-Boneschi F., Salmaggi A., Sangalli, D, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Canella, S, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Martinelli-Boneschi, F, Salmaggi, A, Sangalli D., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Canella S., Zanferrari C., Grampa G., d'Adda E., Peverelli L., Colombo A., Martinelli-Boneschi F., and Salmaggi A.

Abstract

Introduction: COVID-19 pandemic had a great impact on outcome in SARS-CoV-2 positive patients with ischemic stroke during the first wave in Italy. Few data are available on outcome stratified by sex. Methods: The Italian Society of Hospital Neuroscience conducted a multi-center, retrospective, observational study on neurological complications in COVID-19 patients with ischemic stroke. All the patients admitted from March 1st to April 30th, 2020 in 20 Neurology Units in Northern Italy were recruited. Demographical and clinical features, treatment and outcome data were compared focusing on sex differences. Results: 812 patients with ischemic stroke were enrolled, of whom 129 with COVID-19; males were 53.8%. In-hospital mortality in COVID-19 patients was 35.3% in males and 27.9% in females while 8.5% in male and 5.8% in female patients without COVID-19. SARS-CoV-2 positive patients had a higher frequency of stroke of undetermined etiology, than negative ones (32.8% vs 22.5%; p = 0.02), especially in females compared to males (36.1% vs 27.9%), albeit without statistical significance. Male patients with SARS-CoV-2 were more likely to require cPAP (30.9% vs 14.8%; p = 0.03), endotracheal tube (14.9% vs 3.3%; p = 0.02) and reperfusion strategies (29.4% vs 11.5%; p = 0.01) than females, as well as to have a higher CRP and D-dimer. These elements together with older age, a total anterior circulation stroke and lymphopenia were predictors of a worse outcome. Discussion: Our study detected some differences due to sex in ischemic stroke with and without COVID-19, supporting the possibility to perform sex analyses for SARS-CoV-2 positive patients for a better clinical management.

Published
2023

3. COVID-19-associated Guillain-Barré syndrome in the early pandemic experience in Lombardia (Italy)

Author

Martinelli-Boneschi, F, Colombo, A, Bresolin, N, Sessa, M, Bassi, P, Grampa, G, Magni, E, Versino, M, Ferrarese, C, Zarcone, D, Albanese, A, Micieli, G, Zanferrari, C, Cagnana, A, Ferrante, C, Zilioli, A, Locatelli, D, Calloni, M, Delodovici, M, Pozzato, M, Patisso, V, Bortolan, F, Foresti, C, Frigeni, B, Canella, S, Xhani, R, Crabbio, M, Clemenzi, A, Mauri, M, Beretta, S, La Spina, I, Bernasconi, S, De Santis, T, Cavallini, A, Ranieri, M, D'Adda, E, Fruguglietti, M, Peverelli, L, Agosti, E, Leoni, O, Rigamonti, A, Salmaggi, A, Martinelli-Boneschi F., Colombo A., Bresolin N., Sessa M., Bassi P., Grampa G., Magni E., Versino M., Ferrarese C., Zarcone D., Albanese A., Micieli G., Zanferrari C., Cagnana A., Ferrante C., Zilioli A., Locatelli D., Calloni M. V., Delodovici M. L., Pozzato M., Patisso V., Bortolan F., Foresti C., Frigeni B., Canella S., Xhani R., Crabbio M., Clemenzi A., Mauri M., Beretta S., La Spina I., Bernasconi S., De Santis T., Cavallini A., Ranieri M., D'Adda E., Fruguglietti M. E., Peverelli L., Agosti E., Leoni O., Rigamonti A., Salmaggi A., Martinelli-Boneschi, F, Colombo, A, Bresolin, N, Sessa, M, Bassi, P, Grampa, G, Magni, E, Versino, M, Ferrarese, C, Zarcone, D, Albanese, A, Micieli, G, Zanferrari, C, Cagnana, A, Ferrante, C, Zilioli, A, Locatelli, D, Calloni, M, Delodovici, M, Pozzato, M, Patisso, V, Bortolan, F, Foresti, C, Frigeni, B, Canella, S, Xhani, R, Crabbio, M, Clemenzi, A, Mauri, M, Beretta, S, La Spina, I, Bernasconi, S, De Santis, T, Cavallini, A, Ranieri, M, D'Adda, E, Fruguglietti, M, Peverelli, L, Agosti, E, Leoni, O, Rigamonti, A, Salmaggi, A, Martinelli-Boneschi F., Colombo A., Bresolin N., Sessa M., Bassi P., Grampa G., Magni E., Versino M., Ferrarese C., Zarcone D., Albanese A., Micieli G., Zanferrari C., Cagnana A., Ferrante C., Zilioli A., Locatelli D., Calloni M. V., Delodovici M. L., Pozzato M., Patisso V., Bortolan F., Foresti C., Frigeni B., Canella S., Xhani R., Crabbio M., Clemenzi A., Mauri M., Beretta S., La Spina I., Bernasconi S., De Santis T., Cavallini A., Ranieri M., D'Adda E., Fruguglietti M. E., Peverelli L., Agosti E., Leoni O., Rigamonti A., and Salmaggi A.

Abstract

Objective: To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia. Methods: Adult patients admitted to 20 Neurological Units between 1/3–30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). Results: Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. Conclusions: We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures.

Published
2023

4. Correction to: COVID‐19‐associated Guillain‐Barré syndrome in the early pandemic experience in Lombardia (Italy) (Neurological Sciences, (2023), 44, 2, (437-446), 10.1007/s10072-022-06429-6)

Author

Martinelli-Boneschi F., Martinelli-Boneschi, F, Colombo, A, Bresolin, N, Sessa, M, Bassi, P, Grampa, G, Magni, E, Versino, M, Ferrarese, C, Zarcone, D, Albanese, A, Micieli, G, Zanferrari, C, Cagnana, A, Ferrante, C, Zilioli, A, Locatelli, D, Calloni, M, Delodovici, M, Pozzato, M, Patisso, V, Bortolan, F, Foresti, C, Frigeni, B, Canella, S, Xhani, R, Crabbio, M, Clemenzi, A, Mauri, M, Beretta, S, La Spina, I, Bernasconi, S, De Santis, T, Cavallini, A, Ranieri, M, D'Adda, E, Fruguglietti, M, Peverelli, L, Agosti, E, Leoni, O, Rigamonti, A, Salmaggi, A, Martinelli-Boneschi F., Colombo A., Bresolin N., Sessa M., Bassi P., Grampa G., Magni E., Versino M., Ferrarese C., Zarcone D., Albanese A., Micieli G., Zanferrari C., Cagnana A., Ferrante C., Zilioli A., Locatelli D., Calloni M. V., Delodovici M. L., Pozzato M., Patisso V., Bortolan F., Foresti C., Frigeni B., Canella S., Xhani R., Crabbio M., Clemenzi A., Mauri M., Beretta S., La Spina I., Bernasconi S., De Santis T., Cavallini A., Ranieri M., D'Adda E., Fruguglietti M. E., Peverelli L., Agosti E., Leoni O., Rigamonti A., Salmaggi A., Martinelli-Boneschi F., Martinelli-Boneschi, F, Colombo, A, Bresolin, N, Sessa, M, Bassi, P, Grampa, G, Magni, E, Versino, M, Ferrarese, C, Zarcone, D, Albanese, A, Micieli, G, Zanferrari, C, Cagnana, A, Ferrante, C, Zilioli, A, Locatelli, D, Calloni, M, Delodovici, M, Pozzato, M, Patisso, V, Bortolan, F, Foresti, C, Frigeni, B, Canella, S, Xhani, R, Crabbio, M, Clemenzi, A, Mauri, M, Beretta, S, La Spina, I, Bernasconi, S, De Santis, T, Cavallini, A, Ranieri, M, D'Adda, E, Fruguglietti, M, Peverelli, L, Agosti, E, Leoni, O, Rigamonti, A, Salmaggi, A, Martinelli-Boneschi F., Colombo A., Bresolin N., Sessa M., Bassi P., Grampa G., Magni E., Versino M., Ferrarese C., Zarcone D., Albanese A., Micieli G., Zanferrari C., Cagnana A., Ferrante C., Zilioli A., Locatelli D., Calloni M. V., Delodovici M. L., Pozzato M., Patisso V., Bortolan F., Foresti C., Frigeni B., Canella S., Xhani R., Crabbio M., Clemenzi A., Mauri M., Beretta S., La Spina I., Bernasconi S., De Santis T., Cavallini A., Ranieri M., D'Adda E., Fruguglietti M. E., Peverelli L., Agosti E., Leoni O., Rigamonti A., and Salmaggi A.

Abstract

The above article was published with error. The affiliation address of the authors Alberto Albanese and Tiziana De Santis has been modified to: “U.O. Neurologia, IRCCS Istituto Clinico Humanitas, Milan, Italy”.The Original article has been corrected.

Published
2023

6. SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy

Author

Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Diamanti, S, Santangelo, F, Xhani, R, Pozzi, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Diamanti S., Santangelo F., Xhani R., Pozzi F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., Padovani A., Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Diamanti, S, Santangelo, F, Xhani, R, Pozzi, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Diamanti S., Santangelo F., Xhani R., Pozzi F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., and Padovani A.

Abstract

Objective: To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients. Methods: In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19. Results: Among 1013 patients, 160 (15.8%) had SARS-CoV-2 infection. Male sex (OR 1.53; 95% CI 1.06–2.27) and atrial fibrillation (OR 1.60; 95% CI 1.05–2.43) were independently associated with COVID-19 status. Patients with COVID-19 had increased stroke severity at admission [median NIHSS score, 9 (25th to75th percentile, 13) vs 6 (25th to75th percentile, 9)] and increased risk of in-hospital death (38.1% deaths vs 7.2%; HR 3.30; 95% CI 2.17–5.02). The RF model based on six clinical and laboratory parameters exhibited high cross-validated classification accuracy (0.86) and precision (0.87), good recall (0.72) and F1-score (0.79) in predicting in-hospital death. Conclusions: Ischemic strokes in COVID-19 patients have distinctive risk factor profile and etiology, increased clinical severity and higher in-hospital mortality rate compared to non-COVID-19 patients. A simple model based on clinical and routine laboratory parameters may be useful in identifying ischemic stroke patients with SARS-CoV-2 infection who are unlikely to survive the acute phase.

Published
2022

7. New-onset myasthenia gravis after mRNA SARS-CoV-2 vaccination: a case series

Author

Fanella, G, Baiata, C, Candeloro, E, Toscano, G, Colnaghi, S, Mauri, M, Cariddi, L, Rebecchi, V, Solazzo, F, Banfi, P, Piatti, M, Ferrarese, C, Versino, M, Fanella G., Baiata C., Candeloro E., Toscano G., Colnaghi S., Mauri M., Cariddi L. P., Rebecchi V., Solazzo F., Banfi P., Piatti M., Ferrarese C., Versino M., Fanella, G, Baiata, C, Candeloro, E, Toscano, G, Colnaghi, S, Mauri, M, Cariddi, L, Rebecchi, V, Solazzo, F, Banfi, P, Piatti, M, Ferrarese, C, Versino, M, Fanella G., Baiata C., Candeloro E., Toscano G., Colnaghi S., Mauri M., Cariddi L. P., Rebecchi V., Solazzo F., Banfi P., Piatti M., Ferrarese C., and Versino M.

Abstract

Background: Myasthenia gravis (MG) is an autoimmune disease that targets acetylcholine receptor (AChR) of the neuromuscular junction. New-onset MG after SARS-CoV-2 vaccination has rarely been reported. Case presentation: We report about three patients who presented new-onset myasthenia gravis after receiving mRNA SARS-CoV-2 vaccination. The patients were all males and older than 55 years. All the patients presented with ocular and bulbar symptoms. The interval between vaccine administration and MG onset ranged from 3 days after the first dose to 10 days after the second dose. All the patients had elevated serum AChR antibodies and responded to pyridostigmine. Two out of three patients were successfully treated with IVIG or plasma exchange and with long-term immunosuppression. Conclusions: MG is a rare disease; clinicians should be aware of possible new-onset MG after SARS-CoV-2 vaccination, especially with the current recommendation of booster doses. The hyperstimulation of the innate immune system or the exacerbation of a subclinical pre-existing MG could be possible explanations.

Published
2022

8. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke

Author

Gentile, L, Pracucci, G, Saia, V, Falcou, A, Biraschi, F, Zini, A, Simonetti, L, Riva, L, Bigliardi, G, Vallone, S, Nencini, P, Limbucci, N, Diomedi, M, Da Ros, V, Longoni, M, Ruggiero, M, Tassinari, T, Allegretti, L, Cerrato, P, Rubino, E, Bergui, M, Cavallo, R, Naldi, A, Comelli, C, Cappellari, M, Zivelonghi, C, Plebani, M, De Vito, A, Merli, N, Saletti, A, Musolino, Rf, Ferraù, L, Vinci, Sl, Sacco, S, Orlandi, B, De Santis, F, Filauri, P, Ruiz, L, Sepe, Fn, Gallesio, I, Petruzzellis, M, Chiumarulo, L, Sangalli, D, Salmaggi, A, Filizzolo, M, Moller, J, Melis, M, Comelli, S, Magoni, M, Gilberti, N, Gasparotti, R, Invernizzi, P, Pavia, M, Pinto, V, Laspada, S, Marcheselli, S, Ajello, D, Viaro, F, Baracchini, C, Causin, F, Giannini, N, Caselli, Mc, Mancuso, M, Cosottini, M, Scoditti, U, Menozzi, R, Russo, M, Amistá, P, Napoletano, R, Romano, Dg, Tassi, R, Bracco, S, Carimati, F, Versino, M, Giorgianni, A, De Boni, A, Fasano, A, Barbarini, L, Paladini, A, Franchini, E, Dall'Ora, E, Comai, A, Giovanni, F, Pedicelli, A, Sallustio, F, Casetta, I, Fainardi, E, Mangiafico, S, and Toni, D

Subjects
Left ventricular ejection fraction, Acute ischemic stroke, Heart failure, Mechanical thrombectomy, Settore MED/37 - Neuroradiologia, Settore MED/26
Published
2023

11. Impact of SARS-CoV-2 infection on acute intracerebral haemorrhage in northern Italy

Author

Sangalli, D, Martinelli-Boneschi, F, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Altavilla, R, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Santalucia, P, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Salmaggi, A, Sangalli D., Martinelli-Boneschi F., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Altavilla R., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Santalucia P., Zanferrari C., Grampa G., D'Adda E., Peverelli L., Colombo A., Salmaggi A., Sangalli, D, Martinelli-Boneschi, F, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Altavilla, R, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Santalucia, P, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Salmaggi, A, Sangalli D., Martinelli-Boneschi F., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Altavilla R., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Santalucia P., Zanferrari C., Grampa G., D'Adda E., Peverelli L., Colombo A., and Salmaggi A.

Abstract

Introduction: Growing evidence has been published as to the impact of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) on cerebrovascular events over the last few months, with considerable attention paid to ischemic strokes. Conversely, little is known about the clinical course of intracerebral haemorrhage (ICH) and simultaneous SARS-CoV-2 infection. Method: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurological Departments in Northern Italy. Clinical data on patients with acute cerebrovascular diseases, admitted from March 1st to April 30th, 2020, were collected. A comparison was made of the demographical and clinical features of both SARS-CoV-2 positive and negative patients with ICH. Results: 949 patients were enrolled (average age 73.4 years; 52.7% males); 135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, both symptomatic and asymptomatic. SARS-CoV-2 related pneumonia or respiratory distress (OR 5.4), lobar location (OR 5.0) and previous antiplatelet or anticoagulant treatment (OR 2.9) were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a non-significantly increased risk of in-hospital death (37.5% vs 23.4%, p = 0.2). Discussion: ICH patients with COVID-19 did not experience an increase in mortality as striking as ischemic stroke. The inflammatory response and respiratory complications could justify the slight increase of death in ICH. Bleeding sites and previous antiplatelet or anticoagulant treatment were the only other predictors of a worse outcome.

Published
2021

12. Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy

Author

Colombo, A, Martinelli Boneschi, F, Beretta, S, Bresolin, N, Versino, M, Lorusso, L, Spagnoli, D, Nastasi, G, Vallauri, D, Rota, S, Repaci, M, Ferrarini, M, Pozzato, M, Princiotta Cariddi, L, Tabaee Damavandi, P, Carimati, F, Banfi, P, Clemenzi, A, Marelli, M, Giorgianni, A, Vinacci, G, Mauri, M, Melzi, P, Di Stefano, M, Tetto, A, Canesi, M, Salmaggi, A, Colombo A., Martinelli Boneschi F., Beretta S., Bresolin N., Versino M., Lorusso L., Spagnoli D., Nastasi G., Vallauri D., Rota S., Repaci M., Ferrarini M., Pozzato M., Princiotta Cariddi L., Tabaee Damavandi P., Carimati F., Banfi P., Clemenzi A., Marelli M., Giorgianni A., Vinacci G., Mauri M., Melzi P., Di Stefano M., Tetto A., Canesi M., Salmaggi A., Colombo, A, Martinelli Boneschi, F, Beretta, S, Bresolin, N, Versino, M, Lorusso, L, Spagnoli, D, Nastasi, G, Vallauri, D, Rota, S, Repaci, M, Ferrarini, M, Pozzato, M, Princiotta Cariddi, L, Tabaee Damavandi, P, Carimati, F, Banfi, P, Clemenzi, A, Marelli, M, Giorgianni, A, Vinacci, G, Mauri, M, Melzi, P, Di Stefano, M, Tetto, A, Canesi, M, Salmaggi, A, Colombo A., Martinelli Boneschi F., Beretta S., Bresolin N., Versino M., Lorusso L., Spagnoli D., Nastasi G., Vallauri D., Rota S., Repaci M., Ferrarini M., Pozzato M., Princiotta Cariddi L., Tabaee Damavandi P., Carimati F., Banfi P., Clemenzi A., Marelli M., Giorgianni A., Vinacci G., Mauri M., Melzi P., Di Stefano M., Tetto A., Canesi M., and Salmaggi A.

Abstract

Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment.

Published
2021

13. Vitamin D, Chronic Migraine, and Extracranial Pain: Is There a Link? Data From an Observational Study

Author

Rebecchi, V, Gallo, D, Princiotta Cariddi, L, Piantanida, E, Tabaee Damavandi, P, Carimati, F, Gallazzi, M, Clemenzi, A, Banfi, P, Candeloro, E, Tanda, M, Mauri, M, Versino, M, Rebecchi V., Gallo D., Princiotta Cariddi L., Piantanida E., Tabaee Damavandi P., Carimati F., Gallazzi M., Clemenzi A., Banfi P., Candeloro E., Tanda M. L., Mauri M., Versino M., Rebecchi, V, Gallo, D, Princiotta Cariddi, L, Piantanida, E, Tabaee Damavandi, P, Carimati, F, Gallazzi, M, Clemenzi, A, Banfi, P, Candeloro, E, Tanda, M, Mauri, M, Versino, M, Rebecchi V., Gallo D., Princiotta Cariddi L., Piantanida E., Tabaee Damavandi P., Carimati F., Gallazzi M., Clemenzi A., Banfi P., Candeloro E., Tanda M. L., Mauri M., and Versino M.

Abstract

Several studies focused on the role of vitamin D (vitD) in pain chronification. This study focused on vitD level and pain chronification and extension in headache disorders. Eighty patients with primary headache underwent neurological examination, laboratory exams, including serum calcifediol 25(OH)D, and headache features assessment along with three questionnaires investigating depression, anxiety, and allodynia. The 86.8% of the population had migraine (48% episodic and 52% chronic). The 44.1% of patients had extracranial pain, and 47.6% suffered from allodynia. A vitD deficit, namely a serum 25(OH)D level <20 ng/ml, was detectable in 46.1% of the patients, and it occurred more frequently (p = 0.009) in patients suffering from chronic migraine (CM)–medication overuse migraine (MOH) (62.9%) than in episodic migraine (EM, 25.7%) or tension-type headache (TTH, 11.4%). The occurrence of extracranial pain and allodynia was higher in the CM-MOH than in the EM and in the TTH groups but was not related to the co-occurrence of vitD deficiency (Fisher's exact test p = 0.11 and p = 0.32, respectively). Our findings show that 25(OH)D deficit is also related to chronic headache, probably because of vitD anti-inflammatory and tolerogenic properties, reinforcing the idea of a neuroinflammatory mechanism underpinning migraine chronification.

Published
2021

14. Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network

Author

Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Xhani, R, Pozzi, F, Diamanti, S, Santangelo, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Xhani R., Pozzi F., Diamanti S., Santangelo F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., Padovani A., Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Xhani, R, Pozzi, F, Diamanti, S, Santangelo, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Xhani R., Pozzi F., Diamanti S., Santangelo F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., and Padovani A.

Abstract

Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62–80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5–270) minutes vs. 190 (IQR 150–245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82–13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10–0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04–4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85–14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions.

Published
2021

15. An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era

Author

Candeloro, E, Carimati, F, Tabaee Damavandi, P, Princiotta Cariddi, L, Banfi, P, Clemenzi, A, Gallazzi, M, Mauri, M, Rebecchi, V, Baruzzi, F, Giorgianni, A, Tozzi, M, Bianchi, M, Ageno, W, Versino, M, Candeloro E., Carimati F., Tabaee Damavandi P., Princiotta Cariddi L., Banfi P., Clemenzi A., Gallazzi M., Mauri M., Rebecchi V., Baruzzi F., Giorgianni A., Tozzi M., Bianchi M., Ageno W., Versino M., Candeloro, E, Carimati, F, Tabaee Damavandi, P, Princiotta Cariddi, L, Banfi, P, Clemenzi, A, Gallazzi, M, Mauri, M, Rebecchi, V, Baruzzi, F, Giorgianni, A, Tozzi, M, Bianchi, M, Ageno, W, Versino, M, Candeloro E., Carimati F., Tabaee Damavandi P., Princiotta Cariddi L., Banfi P., Clemenzi A., Gallazzi M., Mauri M., Rebecchi V., Baruzzi F., Giorgianni A., Tozzi M., Bianchi M., Ageno W., and Versino M.

Abstract

During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.

Published
2020

16. Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient

Author

Princiotta Cariddi, L, Tabaee Damavandi, P, Carimati, F, Banfi, P, Clemenzi, A, Marelli, M, Giorgianni, A, Vinacci, G, Mauri, M, Versino, M, Princiotta Cariddi, L., Tabaee Damavandi, P., Carimati, F., Banfi, P., Clemenzi, A., Marelli, M., Giorgianni, A., Vinacci, G., Mauri, M., Versino, M., Princiotta Cariddi, L, Tabaee Damavandi, P, Carimati, F, Banfi, P, Clemenzi, A, Marelli, M, Giorgianni, A, Vinacci, G, Mauri, M, Versino, M, Princiotta Cariddi, L., Tabaee Damavandi, P., Carimati, F., Banfi, P., Clemenzi, A., Marelli, M., Giorgianni, A., Vinacci, G., Mauri, M., and Versino, M.

Abstract

Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2.

Published
2020

17. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke

Author

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.

Subjects
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.

Published
2022

21. Ocular motor myotonic phenomenon in myotonic dystrophy. (Paper)

Author

Versino, M., Rossi, B., Beltrami, G., Sandrini, G., and Cosi, V.

Subjects
Myotonic dystrophy -- Physiological aspects, Health, Psychology and mental health, Physiological aspects
Abstract

Objective: To detect disconjugate ocular motor abnormalities and a possible extraocular muscle myotonic phenomenon in patients with myotonic dystrophy (MyD). Methods: The magnetic scleral search coil technique was used to [...]

Published
2002

24. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study

Author

Gastaldi, M., primary, Mariotto, S., additional, Giannoccaro, M. P., additional, Iorio, R., additional, Zoccarato, M., additional, Nosadini, M., additional, Benedetti, L., additional, Casagrande, S., additional, Di Filippo, M., additional, Valeriani, M., additional, Ricci, S., additional, Bova, S., additional, Arbasino, C., additional, Mauri, M., additional, Versino, M., additional, Vigevano, F., additional, Papetti, L., additional, Romoli, M., additional, Lapucci, C., additional, Massa, F., additional, Sartori, S., additional, Zuliani, L., additional, Barilaro, A., additional, De Gaspari, P., additional, Spagni, G., additional, Evoli, A., additional, Liguori, R., additional, Ferrari, S., additional, Marchioni, E., additional, Giometto, B., additional, Massacesi, L., additional, and Franciotta, D., additional

Published
2020
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28. Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study: (TESI study: 'Trombolisi/Trombectomia e crisi Epilettiche precoci nello Stroke Ischemico')

Author

Belcastro, V., Brigo, F., Ferlazzo, E., Gasparini, S., Mastroianni, G., Cianci, V., Lattanzi, S., Silvestrini, M., Versino, M., Banfi, P., Carimati, F., Grampa, G., Lochner, P., Gigli, G. L., Bax, F., Merlino, G., Valente, M., Vidale, S., and Aguglia, U.

Subjects
Adult, Male, Alteplase, Endovascular thrombectomy, Recombinant tissue plasminogen activator, Stroke, Symptomatic seizures, Administration, Intravenous, Aged, Aged, 80 and over, Female, Fibrinolytic Agents, Humans, Incidence, Ischemic Stroke, Middle Aged, Prospective Studies, Reperfusion, Seizures, Thrombectomy, Tissue Plasminogen Activator, Treatment Outcome, Young Adult, 80 and over, Administration, Intravenous
Abstract

The aim of this study was to prospectively investigate the occurrence of early poststroke seizures (within 7 days of stroke) in patients undergoing reperfusion therapies (intravenous rtPA [recombinant tissue plasminogen activator] and/or endovascular thrombectomy) in comparison to those not undergoing these procedures.Patients aged ≥18 years with acute ischemic stroke admitted in five Italian centers were prospectively recruited. Clinical data, details on stroke type and etiology, stroke treatment, and radiological data were collected. The frequency of early poststroke seizures was assessed, and predictive factors for their occurrence were evaluated.Five hundred and sixteen patients (262 in the reperfusion therapies group) were included. Stroke severity on admission and at discharge was higher among patients undergoing reperfusion therapies. Ten patients (3.8%) undergoing reperfusion therapies and 6 (2.3%) of those not receiving these treatments experienced early poststroke seizures (p = 0.45). There were no differences in any of the baseline characteristics between patients experiencing and those not experiencing early seizures.The incidence of early poststroke seizures was overall rare, and no significant differences emerged between patients receiving and those not receiving reperfusion therapies. This article is part of the Special Issue "Seizures and Stroke".

Published
2019

29. The functional head impulse test: Comparing gain and percentage of correct answers

Author

Versino, M., Colnaghi, S., Corallo, G., Mandala, M., and Ramat, S.

Subjects
Adult, Male, Vestibulo-ocular reflex, Dizziness Handicap Inventory, Functional HIT, Head impulse test, Female, Follow-Up Studies, Head Impulse Test, Humans, Middle Aged, Reflex, Vestibulo-Ocular, Vertigo, Vestibular Neuronitis, Reflex, Vestibulo-Ocular
Abstract

The video head impulse test (vHIT) provides as output a gain value that summarizes the behavior of the vestibulo-ocular reflex as the ratio of a measure of eye movement to the corresponding measure of head movement and is not directly informative of the functional effectiveness of the motor response. The functional HIT (fHIT) is based on the ability to recognize the orientation of a Landolt C optotype that briefly appears on a computer screen during passive head impulses imposed by the examiner over a range of head accelerations; accordingly fHIT is a functional measurement of the vestibular-ocular reflex since it measures the capability to keep clear vision and to read during head movement.We compared the results of the fHIT with those of the vHIT and the results of the Dizziness Handicap Inventory (DHI) questionnaire in a group of 27 vestibular neuritis patients recorded acutely and at 3-months follow-up.Both the vHIT and fHIT exams correctly classified all patients as abnormal on the affected side when tested in the acute phase. After a 3-month follow-up, both were able to show that compensation phenomena had occurred. Otherwise the data from the two techniques were not correlated. More specifically, the fHIT detected more abnormalities than the vHIT, for head rotation toward the healthy side, both in the acute phase and after 3 months, and for head rotation toward the affected side after 3 months. The asymmetry indices, that compare the performance of the healthy to the affected side, also were larger for the fHIT than for the vHIT both at onset and after 3 months. There was no significant correlation between the different vHIT and fHIT parameters and indices, or with the DHI values after 3 months.The fHIT data are able to detect a difference between the healthy and the affected side in the acute phase, and they show an improvement after 3 months. fHIT detects more abnormalities than vHIT, but both these techniques lack a correlation with the DHI score.

Published
2019

30. Biallelic expansion of an intronic repeat in RFC1 is a common cause of late-onset ataxia (vol 51, pg 649, 2019)

Author

Cortese, A, Simone, R, Sullivan, R, Vandrovcova, J, Tariq, H, Yau, Wy, Humphrey, J, Jaunmuktane, Z, Sivakumar, P, Polke, J, Ilyas, M, Tribollet, E, Tomaselli, Pj, Devigili, G, Callegari, I, Versino, M, Salpietro, V, Efthymiou, S, Kaski, D, Wood, Nw, Andrade, Ns, Buglo, E, Rebelo, A, Rossor, Am, Bronstein, A, Fratta, P, Marques, Wj, Zuchner, S, Reilly, Mm, and Houlden, H

Published
2019

31. Author Correction: Biallelic expansion of an intronic repeat in RFC1 is a common cause of late-onset ataxia (Nature Genetics, (2019), 51, 4, (649-658), 10.1038/s41588-019-0372-4)

Author

Cortese, Alessandro, Simone, R., Sullivan, R., Vandrovcova, J., Tariq, H., Yau, W. Y., Humphrey, J., Jaunmuktane, Z., Sivakumar, P., Polke, J., Ilyas, M., Tribollet, E., Tomaselli, P. J., Devigili, G., Callegari, I., Versino, M., Salpietro, V., Efthymiou, S., Kaski, D., Wood, N. W., Andrade, N. S., Buglo, E., Rebelo, A., Rossor, A. M., Bronstein, A., Fratta, P., Marques, W. J., Zuchner, S., Reilly, M. M., and Houlden, H.

Published
2019

32. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study

Author

Gastaldi, M, Mariotto, S, Giannoccaro, M P, Iorio, R, Zoccarato, M, Nosadini, M, Benedetti, L, Casagrande, S, Di Filippo, M, Valeriani, M, Ricci, S, Bova, S, Arbasino, C, Mauri, M, Versino, M, Vigevano, F, Papetti, L, Romoli, M, Lapucci, C, Massa, F, Sartori, S, Zuliani, Danilo, Barilaro, Cynthia, De Gaspari, P, Spagni, Gregorio, Evoli Stampanoni-B, Amelia, Liguori, R, Ferrari, S, Marchioni, E, Giometto, B, Massacesi, L, Franciotta, D, Zuliani, L, Barilaro, A (ORCID:0000-0002-6576-8921), Spagni, G, Evoli, A (ORCID:0000-0003-0282-8787), Gastaldi, M, Mariotto, S, Giannoccaro, M P, Iorio, R, Zoccarato, M, Nosadini, M, Benedetti, L, Casagrande, S, Di Filippo, M, Valeriani, M, Ricci, S, Bova, S, Arbasino, C, Mauri, M, Versino, M, Vigevano, F, Papetti, L, Romoli, M, Lapucci, C, Massa, F, Sartori, S, Zuliani, Danilo, Barilaro, Cynthia, De Gaspari, P, Spagni, Gregorio, Evoli Stampanoni-B, Amelia, Liguori, R, Ferrari, S, Marchioni, E, Giometto, B, Massacesi, L, Franciotta, D, Zuliani, L, Barilaro, A (ORCID:0000-0002-6576-8921), Spagni, G, and Evoli, A (ORCID:0000-0003-0282-8787)

Abstract

BACKGROUND AND PURPOSE: Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS: This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS: Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS: In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgro

Published
2019

40. A new device to assess static ocular torsion

Author

Ramat, S., Nesti, A., Versino, M., Colnaghi , S., Magnaghi, C., Bianchi, A., and Beltrami, G.

Subjects
Ocular tilt reaction, Fovea Centralis, genetic structures, Rotation, Vision, Fundus Oculi, Ophthalmological, Optic Disk, Reproducibility of Results, Diagnostic Techniques, Ophthalmological, eye diseases, Diagnostic Techniques, Strabismus, Centro-coecal axis rotation, Ocular, Ocular torsion, Humans, Algorithms, Fluorescein Angiography, Vision, Ocular, sense organs
Abstract

In clinical settings, static ocular torsion is assessed by taking a fundus photograph and measuring the angle between a horizontal line and the line connecting the fovea to the head of the optic nerve (centro-cecal axis rotation; CCAR). We developed and tested a system specifically aimed at CCAR measurements, based on low-cost commercial hardware, and that implements an adaptive research algorithm that selects and presents bright dots on a monitor to outline the borders of the blind spot, locate its center, and measure CCAR. We examined 10 healthy subjects who underwent four CCAR measurements to evaluate the reliability of the system and compared our results with those of fundus photographic examination. Our data showed an excyclophoria, with mean ocular torsion of 6.4° in the right and 6.7° in the left eye. These values are in keeping with those in the literature. Moreover, the values of the intraclass correlation coefficients suggest excellent reliability of the technique.

Published
2011

47. Dizziness and migraine: a causal relationship?

Author

Versino, M., Sances, G., Elena Anghileri, Colnaghi, S., Albizzati, C., Bono, G., and Cosi, V.

Subjects
Adult, Male, Adolescent, Recurrence, Migraine Disorders, Vertigo, Humans, Female, Middle Aged, Child, Dizziness, Aged
Abstract

Both migraine and dizziness are very frequent complaints, but the comorbidity of the two disorders is higher than it might be expected to be on the basis of chance alone. This implies a possible causal relationship, but definite diagnostic criteria for migraine-related vertigo are still lacking. Very recent attempts in this direction have shown that migraine may be the third leading cause of vertigo and that migraine-related vertigo may be effectively treated. A review of the literature on this topic, which includes some preliminary data of our own, demonstrates the difficulty in pinpointing migraine-associated vertigo as a clearly-defined entity. However, there is a measure of agreement on a few points: the spells of vertigo occur in patients who habitually suffer from motion sickness, and who have a history of migraine, either without or with aura; the delay between migraine and vertigo onset may be several years; migraine-related vertigo may be described as rotatory and/or as a feeling of unsteadiness, and single spells can occur without any other accompanying symptoms, however, when spells do occur in association with headache, they usually precede it. The vertigo duration may be shorter or longer than that of the migraine aura since it ranges from a few seconds to a continuous condition of unsteadiness.

Published
2003

50. A device for the functional evaluation of the VOR in clinical settings

Author

Ramat, S, Colnaghi, S, Boehler, A, Astore, S, Falco, P, Mandala, M, Nuti, D, Colagiorgio, P, Versino, M, Ramat, S, Colnaghi, S, Boehler, A, Astore, S, Falco, P, Mandala, M, Nuti, D, Colagiorgio, P, and Versino, M

Abstract

We developed the head impulse testing device (HITD) based on an inertial sensing system allowing to investigate the functional performance of the rotational vestibulo-ocular reflex (VOR) by testing its gaze stabilization ability, independently from the subject’s visual acuity, in response to head impulses at different head angular accelerations ranging from 2000 to 7000 deg/s2. HITD was initially tested on 22 normal subjects, and a method to compare the results from a single subject (patient) with those from controls was set up. As a pilot study, we tested the HITD in 39 dizzy patients suffering, non-acutely, from different kinds of vestibular disorders. The results obtained with the HITD were comparable with those from the clinical head impulse test (HIT), but an higher number of abnormalities was detectable by HITD in the central vestibular disorders group. The HITD appears to be a promising tool for detecting abnormal VOR performance while providing information on the functional performance of the rotational VOR, and can provide a valuable assistance to the clinical evaluation of patients with vestibular disorders.

Published
2012

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