Introduction: Differentiating primary CNS vasculitis (PCNSV) from secondary CNS vasculitis (SCNSV) can be challenging based on brain imaging and cerebrospinal fluid (CSF) profile alone. Little is known about the diagnostic nuances of differentiating these 2 entities with CSF and vessel wall magnetic resonance imaging (VWMRI) as overlapping features may exist. We aimed to look at clinical features, serum & CSF biomarkers, and VWMRI differences between PCNSV & SCNSV. Methods: Patients presenting to our tertiary care center with a diagnosis of PCNSV or SCNSV between January 2015 and January 2021 were extracted from electronic medical record data. We included patients older than 18 years of age with active disease who had CSF studies and VWMRI data available. Demographic, clinical and diagnostic characteristics were reviewed and descriptive statistics were reported for comparison. Results: A total of 42 patients (24 with PCNSV and 18 with SCNSV) met study inclusion criteria. The SCNSV group was older (median age 43 years vs 41.5 years), had a higher proportion of male gender (78% vs 54%) and black race (22% vs 4%) compared to PCNSV. Patients with PCNSV more commonly had headache (63% vs 50%) and seizures (21% vs 11%) but less commonly had encephalopathy (42% vs 50%), focal neurological deficits (79% vs 83%) and constitutional symptoms (17% vs 33%). Patients with PCNSV more likely had positive antinuclear antigen levels (25% vs 11%) and elevated sedimentation rate (33% vs 25%) but less likely had elevated C-reactive protein (25% vs 33%) in blood. Comparison of CSF studies showed that the PSCNV group had a lower median CSF white blood cell count (10 cells/mm3 vs 43.5 cells/mm3 , both lymphocytic), lower median CSF protein count (62 mg/dl vs 82 mg/dl) and lower IgG index (33% vs 56%) in comparison to the SCNSV group. On VWMRI, PCNSV group had less diffuse (40 vs 54%) involvement and more anterior multifocal lesions (40 vs 15%) compared to SCNSV group with more large or medium-vessel involvement (70 vs 54%). Conclusion: Clinical and diagnostic differences with regards to CSF and VWMRI exist between PCNSV and SCNSV that can aid in differentiating these two entities. This can prove useful especially in undiagnosed systemic vasculitides presenting with CNS vasculitis.
Background: Post-acute transition of care (TOC) in stroke patients is a multifactorial process. Different TOC interventions have been tested, with inconsistent benefits. Objective: Our aim is to evaluate the effect of post-acute TOC interventions on various stroke patients’ outcomes. Methods: All published interventional studies evaluating the impacts of TOC models for stroke survivors, during their post-acute care disposition, were included. We excluded studies tackling only patients with intracerebral hemorrhage (ICH) or transient ischemic attacks, those with purely rehabilitative interventions, case reports and case studies, as well as systematic reviews and meta-analyses. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through July 2022. Results: We included 38 studies involving 82,416 patients. TOC services were heterogeneous, commonly including scheduled home visits, telephone calls and office visits, in the setting of a multidisciplinary approach. Outcome measurement time varied between 1 month and 5 years. Activities of daily living (ADLs)-related outcomes, functionality, quality of life (QOL)-related outcomes, readmission rates, mental health-related outcomes, and mortality were reported in 20, 11, 10, 10, 7, and 6 studies, respectively. Only 4 studies looked at rates of medication adherence and 2 studies at control of vascular risk factors. In 6 out of 10 studies, improvements in QOL measurements and patient-reported health surveys were reported, whereas no study reported improvement in mortality rates. Three studies showed improvement for each of the following outcomes: ADLs, functionality, and readmission rates. Only 2 studies noted decrease in mental health problems with the intervention, and 2 noted better control of vascular risk factors. Both studies with medication adherence outcomes showed that the intervention increases rates of compliance to prescribed drugs. Conclusion: Post-acute TOC interventions seem to have a positive effect on stroke survivors’ quality of life and self-perceived health, as well as on rates of medication adherence, but bear no effect on mortality.
ObjectivesAlzheimer disease (AD) imposes a burden on caregivers. However, less is known about its specific correlates in Lebanon. This study aimed to assess information provided by the physician upon announcing dementia diagnosis, caregiver burden and proactive care availability and application in Lebanon, compared to international studies. MethodsA prospective study of 24 caregivers of patients with mild AD, conducted over 18 months, assessed caregiver burden, depression and financial impact, using Zarit Burden Scale (ZBS), Patient Health Questionnaire 9 (PHQ9) and Financial Impact Scale (FIS), respectively. ResultsNone of the demographics characteristics correlated with burden for the exception of marital status, which increased CB. 30% had significant burden (ZBSN41), and half were depressed. ZBS and PHQ9 correlated positively (0.668, pb0.001), while ZBS and PHQ9 correlated negatively with FIS (-0.725, pb0.001 and -0.576, pb0.006). Proactive approaches, despite being explained at time of diagnosis, were overlooked by the caregiver and were found unavailable in the region. DiscussionDespite the dementia being in its mild form, a significant number of caregivers were struggling with burden and depression. Approaches to alleviate this burden were profoundly lacking. In developing countries like Lebanon, more attention should be drawn to help these caregivers and promote their well-being.
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is an inherited disorder caused by a mutation in the NOTCH 3 gene, characterized by early onset of subcortical lacunar infarcts in the absence of vascular risk factors and cerebral microbleeds. Homozygosity for the factor Methylenetetrahydrofolate Reductase (MTHFR) is also associated with lacunar stroke risk and cerebral small-vessel disease regardless of the homocysteine level. e coexistence of MTHFR C677T homozygosity and NOTCH 3 mutation has never been reported in the literature previously, and that brings up the challenge of antithrombotic treatment in the presence of cerebral microbleeds. DiscussionCADASIL is a rare, adult-onset inherited disorder, with a mean age at onset of 36.7 years. e earliest clinical
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