Background: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. Objectives: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death. Methods: We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale). Results: Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004–1.211], p = 0.042). Discussion: Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.
SUMMARYA 56-year-old man presented with weight loss, articular pain and minor neurological symptoms progressing over 1 month. Neurosonological evaluation suggested occlusion in intracranial segments of the left vertebral artery (VA) and of both internal carotid arteries (ICA) and hypoechoic halo sign in both superficial temporal arteries. The diagnosis of giant cell arteritis was supported by inflammatory markers and confirmed by biopsy. Despite early steroid initiation, he manifested fluctuant vascular deficits and became lethargic. Brain MRI indicated watershed infarcts and intracranial dissections of left VA and both ICA. The patient was stabilised with the association of prednisolone 2 mg/kg, methotrexate and oral anticoagulation. Since then he has been neurologically asymptomatic and control imaging showed only residual intracranial left VA stenosis, with no signs of temporal artery inflammation or new vascular lesions. This is to the best of our knowledge, the first reported clinical case with such an extensive intracranial involvement with multiple dissections. BACKGROUND
To characterize the most common peripheral and central neurological disorders during pregnancy. Original research and review of the literature on neurological complications during pregnancy. We searched for keywords related to the topic on different databases. Pregnancy involves physiological changes that can trigger peripheral neurological and/or central nervous system pathologies, which can sometimes be associated with hypertensive disorders. A definitive diagnosis of neurological disorders can be made according to the trimester of pregnancy and the clinical findings. Carpal tunnel syndrome and peripheral facial palsy are common peripheral neurological disorders, more frequent in the second half of pregnancy. Central nervous disorders are more complex and a precise diagnosis must be made in order to improve perinatal outcomes, provide correct management and treatment and to prevent acute and long-term complications. It is possible to achieve a precise diagnosis, management and treatment of neurological disorders during pregnancy, but these require a multidisciplinary approach, crucial to improve perinatal outcomes.
Juvenile myoclonic epilepsy is often regarded as a benign epileptic syndrome, but in this setting, half of the individuals with JME have refractory epilepsy with only about a quarter of those seizure-free in the previous year. Despite some advances in the understanding of this syndrome, there is still much to do before we can offer all the best outcomes.
RESUMOIntrodução: As baterias clássicas de caracterização de afasia são demasiado longas para serem utilizadas no contexto do acidente vascular cerebral agudo ou como ferramenta de monitorização. O Aphasia Rapid Test é uma escala de 26 pontos desenvolvida como teste de cabeceira para avaliar a gravidade da afasia num doente com acidente vascular cerebral em menos de três minutos. O objetivo do estudo é adaptar e validar a escala para o português europeu. ABSTRACT Introduction: Classical aphasia evaluation scales are too long to use in the context of acute stroke or as a monitoring tool. The Aphasia Rapid Test is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in less than 3 minutes. We aimed to adapt and validate this scale for European Portuguese. Material and Methods:We evaluated 56 acute stroke patients in the first and in the seventh days post-stroke. In the seventh day, patients were evaluated by two independent raters, to evaluate inter-rater agreement. To study concurrent validity, the Lisbon Aphasia Examination Battery was applied to a subset of 20 patients. The predictive ability of the Aphasia Rapid Test was assessed at six months, by the aphasia subscale of the National Institutes of Health Stroke Scale. Results: Translation to European Portuguese was based in the French and English versions, considering the words' utilization frequency. The Chronbach's alpha was 0.796. The concordance coefficient between the two raters was excellent (0.985). Correlation between Aphasia Rapid Test and the Lisbon Aphasia Examination Battery was strong (r = -0.958, p < 0.001). The study through BlandAltman graphs corroborated the good inter-rater agreement and concurrent validity of the test. The Aphasia Rapid Test score in the first day is an independent predictor of long-term outcome. Discussion: This study provides reliable results for European Portuguese, with adequate internal consistency, inter-rater agreement and concurrent validity. Conclusion:The Aphasia Rapid Test is a good tool for the evaluation and monitoring of aphasia in stroke patients.
Dyschromatopsia occurs frequently in MS patients. It may be associated with a worse disease status and possibly serve as a marker for the detection of subclinical disease progression since it was detected even in the absence of ON. It correlated with thinner peripapillary RNFL thickness and inferior cognitive performance.
Objectives The aim of this study was to evaluate postmarketing dimethyl fumarate (DMF) safety and effectiveness in a real-world population with relapsing-remitting multiple sclerosis (RRMS). Methods This was a retrospective, single-center study with RRMS patients treated with DMF. Demographic, clinical, and imagiological characteristics were analyzed, including annualized relapse rate (ARR), Expanded Disability Status Scale, “No Evidence of Disease Activity 3,” previous treatment, adverse events, treatment duration, and reason for discontinuation. We investigated which baseline variables were associated with clinical and radiological outcomes. Results We included 176 patients (70.4% females) with a median on-treatment follow-up time of 25.5 months. In total, 139 patients received prior disease-modifying therapies, and 37 were treatment-naive. Annualized relapse rate decreased by 77.1% in the total population (P < 0.001) and also decreased in the naive, tolerability switch, and efficacy switch groups by 95.8%, 56.7%, and 76.6% (P < 0.001). No Evidence of Disease Activity 3 status after 12 months of DMF treatment was maintained in 69.2% patients. Thirty patients (17%) discontinued treatment because of adverse drug reactions, and 21 (11.9%) because of lack of effectiveness. The occurrence of first relapse during follow-up was associated with higher ARR in the year before DMF start (hazard ratio, 4.833; P < 0.001) and prior exposure to multiple sclerosis treatments (tolerability and efficacy switchers). Conclusions In this real-world audit, DMF appeared to be effective and safe for RRMS. Additionally, the study suggested that naive patients strongly benefit from DMF, and DMF also improves ARR in patients who switched from injectable therapies due to tolerability and efficacy issues.
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