Established predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage are large amounts of extravasated blood and poor clinical condition on admission. The predictive value of ...other factors is uncertain.
We searched MEDLINE (1960-2012) for clinical, laboratory, and radiological predictors routinely available within 72 hours after subarachnoid hemorrhage. The studies were categorized according to methodological quality. Crude data and effect estimates (odds ratio OR, hazard ratios, and risk ratio) with 95% CI were extracted, (re-)calculated and pooled if possible. For every potential predictor we assessed all effect estimates on consistency (point estimates in equal direction) and clinical relevance (size and 95% CI).
Fifty-two studies on 33 potential predictors were included. There was strong evidence (≥3 high-quality studies) for a higher risk of delayed cerebral ischemia in smokers (pooled OR, 1.2; 95% CI, 1.1-1.4), and moderate evidence (2 high-quality studies) for an increased risk in patients with hyperglycemia (OR, 3.2; 1.8-5.8 and hazard ratios, 1.7; 1.1-2.5), hydrocephalus (OR, 1.3; 1.1-1.5 and OR, 2.6; 1.2-5.5), history of diabetes mellitus (pooled OR, 6.7; 1.7-26), and early systemic inflammatory response syndrome (pooled OR, 2.1; 1.4-3.3). Evidence was limited for increased risk in women (pooled OR, 1.3; 1.1-1.6) and in patients with history of hypertension (pooled OR, 1.5; 1.3-1.7). The evidence on initial loss of consciousness, history of migraine, previous use of selective serotonin reuptake inhibitors, hypomagnesemia, low hemoglobin, or high blood flow on early transcranial Doppler was also limited.
There is strong evidence that smoking is a predictor of delayed cerebral ischemia. For several other potential predictions the evidence is moderate, limited, or inconsistent.
Objectives
Several intracranial vessel wall sequences have been described in recent literature, with either 3-T or 7-T magnetic resonance imaging (MRI). In the current study, we compared 3-T and 7-T ...MRI in visualising both the intracranial arterial vessel wall and vessel wall lesions.
Methods
Twenty-one elderly asymptomatic volunteers were scanned by 3-T and 7-T MRI with an intracranial vessel wall sequence, both before and after contrast administration. Two raters scored image quality, and presence and characteristics of vessel wall lesions.
Results
Vessel wall visibility was equal or significantly better at 7 T for the studied arterial segments, even though there were more artefacts hampering assessment. The better visualisation of the vessel wall at 7 T was most prominent in the proximal anterior cerebral circulation and the posterior cerebral artery. In the studied elderly asymptomatic population, 48 vessel-wall lesions were identified at 3 T, of which 7 showed enhancement. At 7 T, 79 lesions were identified, of which 29 showed enhancement. Seventy-one percent of all 3-T lesions and 59 % of all 7-T lesions were also seen at the other field strength.
Conclusions
Despite the large variability in detected lesions at both field strengths, we believe 7-T MRI has the highest potential to identify the total burden of intracranial vessel wall lesions.
Key Points
•
Intracranial vessel wall visibility was equal or significantly better at 7-T MRI
•
Most vessel wall lesions in the cerebral arteries were found at 7-T MRI
•
Many intracranial vessel wall lesions showed enhancement after contrast administration
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Large variability in detected intracranial vessel wall lesions at both field strengths
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Seven-tesla MRI has the highest potential to identify total burden of intracranial atherosclerosis
To develop and validate a risk chart for prediction of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage based on admission characteristics.
For derivation of the risk chart, we ...studied data from 371 prospectively collected consecutive subarachnoid hemorrhage patients with a confirmed aneurysm admitted between 1999 and 2007. For its validation we similarly studied 255 patients admitted between 2007 and 2009. The predictive value of admission characteristics was tested in logistic regression models with delayed cerebral ischemia-related infarction as primary outcome. Procedure-related infarctions were not included. Performance of the models was tested by discrimination and calibration. On the basis of these models, a risk chart was developed for application in clinical practice.
The strongest predictors were clinical condition on admission, amount of blood on computed tomography (both cisternal and intraventricular) and age. A model that combined these 4 predictors had an area under the receiver operating characteristic curve of 0.63 (95% confidence interval, 0.57-0.69). This model improved little by including current smoking and hyperglycemia on admission (area under the receiver operating characteristic curve, 0.65; 95% confidence interval, 0.59-0.71). The risk chart predicted risks of delayed cerebral ischemia-related infarction varying from 12% to 61%. Both low risk (<20% risk) and high risk (>40% risk) were predicted in ≈20% of the patients. Validation confirmed that the discriminative ability was adequate (area under the receiver operating characteristic curve, 0.69; 95% confidence interval, 0.61-0.77).
Absolute risks of delayed cerebral ischemia-related infarction can be reliably estimated by a simple risk chart that includes clinical condition on admission, amount of blood on computed tomography (both cisternal and intraventricular), and age.
BACKGROUND AND PURPOSE—Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage worsens the prognosis and is difficult to diagnose. We investigated the diagnostic value of noncontrast ...CT (NCT), CT perfusion (CTP), and CT angiography (CTA) for DCI after clinical deterioration in patients with subarachnoid hemorrhage.
METHODS—We prospectively enrolled 42 patients with subarachnoid hemorrhage with clinical deterioration suspect for DCI (new focal deficit or Glasgow Coma Scale decrease ≥2 points) within 21 days after hemorrhage. All patients underwent NCT, CTP, and CTA scans on admission and directly after clinical deterioration. The gold standard was the clinical diagnosis DCI made retrospectively by 2 neurologists who interpreted all clinical data, except CTP and CTA, to rule out other causes for the deterioration. Radiologists interpreted NCT and CTP images for signs of ischemia (NCT) or hypoperfusion (CTP) not localized in the neurosurgical trajectory or around intracerebral hematomas, and CTA images for presence of vasospasm. Diagnostic values for DCI of NCT, CTP, and CTA were assessed by calculating sensitivities, specificities, positive predictive values, and negative predictive values with 95% CIs.
RESULTS—In 3 patients with clinical deterioration, imaging failed due to motion artifacts. Of the remaining 39 patients, 25 had DCI and 14 did not. NCT had a sensitivity of 0.56 (95% CI, 0.37 to 0.73), specificity=0.71 (0.57 to 0.77), positive predictive value=0.78 (0.55 to 0.91), negative predictive value=0.48 (0.28 to 0.68); CTPsensitivity=0.84 (0.65 to 0.94), specificity=0.79 (0.52 to 0.92), positive predictive value=0.88 (0.69 to 0.96), negative predictive value=0.73 (0.48 to 0.89); CTAsensitivity=0.64 (0.45 to 0.80), specificity=0.50 (0.27 to 0.73), positive predictive value=0.70 (0.49 to 0.84), negative predictive value=0.44 (0.23 to 0.67).
CONCLUSION—As a diagnostic tool for DCI, qualitative assessment of CTP is overall superior to NCT and CTA and could be useful for fast decision-making and guiding treatment.
Diagnostic criteria for Susac syndrome Kleffner, Ilka; Dörr, Jan; Ringelstein, Marius ...
Journal of neurology, neurosurgery and psychiatry,
12/2016, Letnik:
87, Številka:
12
Journal Article
Recenzirano
Susac syndrome is characterised by the triad of encephalopathy with or without focal neurological signs, branch retinal artery occlusions and hearing loss. Establishment of the diagnosis is often ...delayed because the triad is complete only in a minority of patients at disease onset. This leads to a critical delay in the initiation of appropriate treatment. Our objective was to establish criteria for diagnosis of either definite or probable Susac syndrome.
The establishment of diagnostic criteria was based on the following three steps: (1) Definition of a reference group of 32 patients with an unambiguous diagnosis of Susac syndrome as assessed by all interdisciplinary experts of the European Susac Consortium (EuSaC) team (EuSaC cohort); (2) selection of diagnostic criteria, based on common clinical and paraclinical findings in the EuSaC cohort and on a review of the literature; and (3) validation of the proposed criteria in the previously published cohort of all Susac cases reported until 2012.
Integrating the clinical presentation and paraclinical findings, we propose formal criteria and recommend a diagnostic workup to facilitate the diagnosis of Susac syndrome. More than 90% of the cases in the literature fulfilled the proposed criteria for probable or definite Susac syndrome. We surmise that more patients could have been diagnosed with the recommended diagnostic workup.
We propose diagnostic criteria for Susac syndrome that may help both experts and physicians not familiar with Susac syndrome to make a correct diagnosis and to prevent delayed treatment initiation.
Prospective memory is the ability to remember actions to be performed later in time or when a certain event occurs. Multiple cognitive processes are involved in prospective memory, and the degree to ...which automatic or effortful processes are involved may differ for different types of prospective memory tasks. This study aimed to investigate prospective memory (dys)functioning in stroke patients, and to get more insight in which cognitive processes are involved in time- versus event-based prospective memory.
We investigated 39 community-dwelling stroke survivors and 53 matched control participants. Assessment included naturalistic and experimental event- and time-based prospective memory tasks, as well as standard neuropsychological measures of (retrospective) memory, processing speed and attention/executive functioning.
41% of the stroke patients performed significantly worse than control participants on prospective memory tasks. Deficits in prospective memory occurred as frequently as impairments in retrospective memory (33%, χ2(1, N=39)=3.4, p=.066), and more often than impairments in attention/executive functioning (15%, χ2(1, N=39)=5.2, p=.022) and speed of processing (23%, χ2(1, N=39)=6.5, p=.011).
Regression analyses showed that event-based (‘focal’) prospective memory is supported by retrospective memory, indicating that it is a relatively simple and automatic process. Time-based (non-‘focal’) prospective memory proved to be a more complex process, requiring active monitoring of the environment. Performance was predicted by speed of processing, attention/executive functioning and retrospective memory. Thirteen percent of the patients suffered from selective prospective memory impairment, which was associated with damage to the superior temporal gyrus.
Impairment of prospective memory occurs frequently after stroke. Different cognitive operations are involved in distinct types of prospective memory. Results fit within the multi-process framework of prospective memory and help further specify its contents.
•We delineated the cognitive architecture underlying prospective memory (PM).•Different cognitive processes support event-based and time-based PM (EBPM & TBPM).•EBPM is a relatively automatic process, whereas TBPM requires effortful processing.•PM failure is common after stroke, and can occur without other cognitive deficits.•The superior temporal gyrus might serve as integration hub for PM performance.
Brain areas involved in spatial working memory van Asselen, Marieke; Kessels, Roy P.C.; Neggers, Sebastiaan F.W. ...
Neuropsychologia,
2006, 2006-00-00, 2006-1-00, 20060101, Letnik:
44, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time. To study the areas of the brain that are involved in spatial working ...memory, a group of stroke patients was tested with a spatial search task. Patients and healthy controls were asked to search through a number of boxes shown at different locations on a touch-sensitive computer screen in order to find a target object. In subsequent trials, new target objects were hidden in boxes that were previously empty. Within-search errors were made if a participant returned to an already searched box; between-search errors occurred if a participant returned to a box that was already known to contain a target item. The use of a strategy to remember the locations of the target objects was calculated as well. Damage to the right posterior parietal and right dorsolateral prefrontal cortex impaired the ability to keep spatial information ‘on-line’, as was indicated by performance on the Corsi Block-Tapping task and the within-search errors. Moreover, patients with damage to the right posterior parietal cortex, the right dorsolateral prefrontal cortex and the hippocampal formation bilaterally made more between-search errors, indicating the importance of these areas in maintaining spatial information in working memory over an extended time period.
OBJECTIVE:In this retrospective case series study, we used 7.0 tesla MRI to describe patterns of intracranial vessel wall abnormalities in relation to ischemic infarcts in 9 patients with different ...intracranial vessel wall pathologies.
METHODS:A patient-specific clinical imaging protocol was obtained after regular clinical workup, including a fluid-attenuated inversion recovery and an intracranial vessel wall sequence before and after contrast administration using 7.0 tesla MRI. An attempt was made to describe patterns by grouping the patients by intracranial vessel wall abnormalities (eccentric or concentric; enhancing or nonenhancing), then on the presence of macroinfarcts and cortical microinfarcts (CMIs), and lastly on type of macroinfarct (lacunar, small macroinfarct, or large macroinfarct).
RESULTS:Intracranial vessel wall abnormalities were identified in all patients, totaling 45 lesions, 12 of which enhanced after contrast administration. CMIs were found in 5 patients. Two patients had eccentric, enhancing wall thickening but differed based on presence or absence of CMIs. Four patients also had eccentric but nonenhancing wall thickening, 2 of whom showed CMIs. The 2 patients lacking CMIs could be subdivided based on the type of macroinfarct. Concentric, enhanced wall thickening was observed in 2 patients with CMIs who differed regarding macroinfarct types. One patient with previous vasculitis showed concentric, nonenhancing wall thickening.
CONCLUSION:Our results suggest that the combination of intracranial vessel wall abnormalities and infarct type is related to different stroke etiologies.
Spinal muscular atrophy (SMA) is a heterogeneous group of neuromuscular disorders caused by degeneration of lower motor neurons. Although functional loss of SMN1 is associated with ...autosomal-recessive childhood SMA, the genetic cause for most families affected by dominantly inherited SMA is unknown. Here, we identified pathogenic variants in bicaudal D homolog 2 (Drosophila) (BICD2) in three families afflicted with autosomal-dominant SMA. Affected individuals displayed congenital slowly progressive muscle weakness mainly of the lower limbs and congenital contractures. In a large Dutch family, linkage analysis identified a 9q22.3 locus in which exome sequencing uncovered c.320C>T (p.Ser107Leu) in BICD2. Sequencing of 23 additional families affected by dominant SMA led to the identification of pathogenic variants in one family from Canada (c.2108C>T p.Thr703Met) and one from the Netherlands (c.563A>C p.Asn188Thr). BICD2 is a golgin and motor-adaptor protein involved in Golgi dynamics and vesicular and mRNA transport. Transient transfection of HeLa cells with all three mutant BICD2 cDNAs caused massive Golgi fragmentation. This observation was even more prominent in primary fibroblasts from an individual harboring c.2108C>T (p.Thr703Met) (affecting the C-terminal coiled-coil domain) and slightly less evident in individuals with c.563A>C (p.Asn188Thr) (affecting the N-terminal coiled-coil domain). Furthermore, BICD2 levels were reduced in affected individuals and trapped within the fragmented Golgi. Previous studies have shown that Drosophila mutant BicD causes reduced larvae locomotion by impaired clathrin-mediated synaptic endocytosis in neuromuscular junctions. These data emphasize the relevance of BICD2 in synaptic-vesicle recycling and support the conclusion that BICD2 mutations cause congenital slowly progressive dominant SMA.
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