Monogenic cerebral small vessel diseases are a topic of growing interest, as several genes responsible have been recently described, and new sequencing techniques such as Next-generation sequencing ...are available. Brain imaging is significant for the detection of these diseases. Since it is often performed at an initial stage, an MRI is a key to selecting patients for genetic testing and for interpreting nextgeneration sequencing reports. In addition, neuroimaging can be helpful in describing the underlying pathological mechanisms involved in cerebral small vessel disease. In this review, we aim to provide neurologists and stroke physicians with an up-to-date overview of the current neuroimaging knowledge on monogenic small vessel diseases.
Objective
We describe a severe case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after the first dose of the ChAdOx1 nCoV-19 vaccine leading to massive ischemic stroke.
Methods
A ...42-year-old woman developed acute left hemiparesis (NIHSS 12) 9 days after the first vaccine dose.
Results
The blood tests revealed low platelets (70 10
3
/μL) and severe increment of D-dimer (70,745 ng/mL FEU). Brain non-contrast computed tomography and multiphasic CT angiography demonstrated a right middle cerebral artery occlusion. The patient was treated with primary thrombectomy, steroids, immunoglobulin, and fondaparinux. Despite the treatment, the neurological status deteriorated and underwent decompressive hemicraniectomy. She was transferred to the rehab’s unit 52 days after the onset.
Discussion
Healthcare providers should be aware of the possibility of ischemic stroke as a manifestation of VITT. Awareness on this very rare and possibly fatal complication should be reinforced on both the vaccine recipients and general practitioners.
Optimizing work shifts in healthcare is crucial for maintaining high standards of service delivery and fostering professional development. This study delves into the emerging field of skill-oriented ...work shift optimization, focusing specifically on radiographers within the healthcare sector. Through the development of Skills Retention Monitoring (SRH), this research aims to enhance skill monitoring, workload management, and organizational performance. In this study, several key highlights emerged: (a) Introduction of the SRH tool: The SRH tool represents a resource-efficient solution that harnesses existing software infrastructure. A preliminary version, focusing on the radiographers’ professional profile, was released, and after several months of use, it demonstrated effectiveness in optimizing work based on competency monitoring. (b) The SRH tool has thus demonstrated the capacity to generate actionable insights in the organizational context of radiographers. By generating weekly reports, the SRH tool streamlines activity management and optimizes resource allocation within healthcare settings. (c) Application of a Computer-Assisted Web Interviewing (CAWI) tool for pre-release feedback during a training event. (d) Strategic importance of a maintenance and monitoring plan: This plan, rooted in a continuous quality improvement approach and key performance indicators, ensures the sustained effectiveness of the SRH tool. (e) Strategic importance of a transfer plan: Involving professional associations and employing targeted questionnaires, this plan ensures the customization of the tool from the perspective of each profession involved. This is a crucial point, as it will enable the release of tool versions tailored to various professions operating within the hospital sector. As a side result, the tool could allow for a more tailored and personalized medicine both by connecting the insights gathered through the SRH tool with the right competencies for healthcare professionals and with individual patient data. This integration could lead to better-informed decision making, optimizing treatment strategies based on both patient needs and the specific expertise of the healthcare provider. Future directions include deploying the SRH tool within the Pisa hospital network and exploring integration with AI algorithms for further optimization. Overall, this research contributes to advancing work shift optimization strategies and promoting excellence in healthcare service delivery.
Abstract Background Mild cognitive impairment (MCI) prodromic of vascular dementia is expected to have a multidomain profile. Methods In a sample of cerebral small vessel disease (SVD) patients, we ...assessed MCI subtypes distributions according to different operationalization of Winblad criteria and compared the neuroimaging features of single versus multidomain MCI. We applied three MCI diagnostic scenarios in which the cutoffs for objective impairment and the number of considered neuropsychological tests varied. Results Passing from a liberal to more conservative diagnostic scenarios, of 153 patients, 5% were no longer classified as MCI, amnestic multidomain frequency decreased, and nonamnestic single domain increased. Considering neuroimaging features, severe medial temporal lobe atrophy was more frequent in multidomain compared with single domain. Conclusions Operationalizing MCI criteria changes the relative frequency of MCI subtypes. Nonamnestic single domain MCI may be a previously nonrecognized type of MCI associated with SVD.
Highlights • RayStation can reproduce measured couch attenuations within an uncertainty of 1.0%. • Using a couch CT scan can be sub-optimal compared to a geometrical-model. • Gamma pass-rates ...increase if the couch is considered in pre-treatment QA. • Ignoring the couch in the TPS leads to notably underdose for clinical targets. • The 3%/3 mm γ-criterion hardly detects the inaccuracy of ignoring the couch.
•MoCA trajectories seem to be sensitive to cognitive changes in MCI patients with SVD.•Baseline MoCA has some predictive utility on cognitive progression in VCI patients.•MoCA clinimetric properties ...need to be further explored in longitudinal VCI studies.
The Montreal Cognitive Assessment (MoCA) is a cognitive screening test largely employed in vascular cognitive impairment, but there are no data about MoCA longitudinal changes in patients with cerebral small vessel disease (SVD). We aimed to describe changes in MoCA performance in patients with mild cognitive impairment (MCI) and SVD during a 2-year follow-up, and to evaluate their association with transition to major neurocognitive disorder (NCD).
Within the prospective observational VMCI-Tuscany Study, patients with MCI and SVD underwent a comprehensive clinical, neuropsychological, and functional evaluation at baseline, and after 1 and 2 years.
Among the 138 patients (mean age 74.4 ± 6.9 years; males: 57%) who completed the study follow-up, 44 (32%) received a major NCD diagnosis. Baseline MoCA scores (mean±SD) were lower in major NCD patients (20.5 ± 5) than in reverter/stable MCI (22.2 ± 4.3), and the difference approached the statistical threshold of significance (p=.051). The total cohort presented a decrease in MoCA score (mean±SD) of -1.3 ± 4.2 points (-2.6 ± 4.7 in major NCD patients, -0.7 ± 3.9 in reverter/stable MCI). A multivariate logistic model on the predictors of transition from MCI to major NCD, showed MoCA approaching the statistical significance (OR=1.09, 95% CI=1.00–1.19, p=.049).
In our sample of MCI patients with SVD, longitudinal changes in MoCA performances were consistent with an expected more pronounced deterioration in patients who received a diagnosis of major NCD. MoCA sensitivity to change and predictive utility need to be further explored in VCI studies based on larger samples and longer follow-up periods.
Aims: The DSM-5 introduced the term “major neurocognitive disorders” (NCDs) to replace the previous term “dementia.” However, psychometric and functional definitions of NCDs are missing. We aimed to ...apply the DSM-5 criteria for diagnosing the transition to NCD to patients with mild cognitive impairment (MCI) and small vessel disease (SVD), and to define clinically significant thresholds for this transition. Methods: The functional and cognitive features of the NCD criteria were evaluated as change from baseline and operationalized according to hierarchically ordered psychometric rules. Results: According to the applied criteria, out of 138 patients, 44 were diagnosed with major NCD (21 with significant cognitive worsening in ≥1 additional cognitive domain), 84 remained stable, and 10 reverted to normal. Single-domain MCI patients were the most likely to revert to normal, and none progressed to major NCD. The amnestic multiple-domain MCI patients had the highest rate of progression to NCD. Conclusion: We provide rules for the DSM-5 criteria for major NCD based on cognitive and functional changes over time, and define psychometric thresholds for clinically significant worsening to be used in longitudinal studies. According to these operationalized criteria, one-third of the MCI patients with SVD progressed to major NCD after 2 years, but only within the multiple-domain subtypes.
Purpose. The long-term efficacy of carotid artery stenting is debated. Predictors of stent restenosis are not fully investigated. Our aim was to assess the incidence of long term restenosis after CAS ...and to identify some predictors of restenosis. Methods. We retrospectively selected 189 treated patients and we obtained the survival Kaplan-Meier curves for overall survival, for freedom from stroke or death and from restenosis. To correlate clinical, radiological, and procedural variables to stent restenosis, an univariate analysis was performed while to determine independent predictors of restenosis, a multivariate analysis was applied. Results. At 1, 3, and 5 years, the cumulative overall survival rate was 98%, 94%, and 92% with a cumulative primary patency rate of 87%, 82.5%, and 82.5%. The percentage residual stenosis after CAS and multiple stents deployment were independent predictors of restenosis, while diabetes and tumors are suggestive but not significant predictors of restenosis. Conclusions. In our CAS experience, encouraging long-term results seem to derive from both neurological event free rate and restenosis incidence. Adequate recanalization of the treated vessel is important to limit the development of stent restenosis. Multiple stents deployment, and with less evidence, diabetes, or neoplasms has to be considered to facilitate restenosis.
Background Basing on easily available clinical and instrumental data, we aimed to define an “atrial fibrillation profile” able to discriminate cases of stroke due to atrial fibrillation from cases ...due to atherothrombosis of large vessels or small-vessel disease. Methods A total of 1037 consecutive patients with ischemic stroke were enrolled. Cases with undetermined stroke, rare causes, and cardioembolic sources of emboli other than atrial fibrillation were excluded from further analysis. Thus, 653 patients were evaluated, dividing them into 2 groups for comparison (164 with stroke due to atrial fibrillation and 489 with atherothrombotic/lacunar stroke). Clinical, echocardiography, and neuroradiologic data were considered to characterize such groups. Results Atrial fibrillation and atherothrombotic–lacunar group presented a differential phenotypic profile. Binary multiple logistic regression identified age older than 75 years, female sex, left atrial dilation, cortical–subcortical cerebral index infarct, ischemic lesions in multiple vascular grounds, and spontaneous hemorrhagic transformation of brain infarction as significant predictors of cardioembolic stroke due to atrial fibrillation. Conclusions A simple profile, based on commonly available data, seems suitable to characterize patients with stroke due to atrial fibrillation. If further validated, it may be useful to identify patients with undetermined stroke (or other well-defined causes of stroke) at high risk of being affected by undetected subclinical paroxysmal atrial fibrillation, prompting further diagnostic work-up and with potential therapeutic implication.
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