Supracardiac atherosclerosis in embolic stroke of undetermined source: the underestimated source

2020 ◽  
Author(s):  
George Ntaios ◽  
Max Wintermark ◽  
Patrik Michel
Keyword(s):  
Stroke Risk ◽  
Embolic Stroke ◽  
Future Research ◽  
Atherosclerotic Plaques ◽  
Imaging Features ◽  
Advanced Imaging ◽  
Randomized Controlled ◽  
Intracranial Arteries ◽  
Embolic Risk

Abstract The term ‘embolic stroke of undetermined source’ (ESUS) is used to describe patients with a non-lacunar ischaemic stroke without any identified embolic source from the heart or the arteries supplying the ischaemic territory, or any other apparent cause. When the ESUS concept was introduced, covert atrial fibrillation was conceived to be the main underlying cause in the majority of ESUS patients. Another important embolic source in ESUS is the atherosclerotic plaque in the carotid, vertebrobasilar, and intracranial arteries, or the aortic arch—collectively described as supracardiac atherosclerosis. There is emerging evidence showing that the role of supracardiac atherosclerosis is larger than it was initially perceived. Advanced imaging methods are available to identify plaques which high embolic risk. The role of novel antithrombotic strategies in these patients needs to be assessed in randomized controlled trials. This review presents the evidence which points towards a major aetiological association between atherosclerotic plaques and ESUS, summarizes the imaging features which may aid to identify plaques more likely to be associated with ESUS, discusses strategies to reduce the associated stroke risk, and highlights the rationale for future research in this field.

Juvenile xanthogranuloma of the subdural spaces mimicking chronic hematoma with positive FDG uptake on PET: case report

2020 ◽  
Vol 26 (4) ◽  
pp. 449-453
Author(s):  
Jacob A. Kahn ◽  
Jeffrey T. Waltz ◽  
Ramin M. Eskandari ◽  
Cynthia T. Welsh ◽  
Michael U. Antonucci
Keyword(s):  
Potential Role ◽  
Response To Treatment ◽  
Juvenile Xanthogranuloma ◽  
Imaging Features ◽  
Limited Information ◽  
Advanced Imaging ◽  
Systemic Involvement ◽  
The Central Nervous System ◽  
Infancy And Early Childhood

The authors report an unusual presentation of juvenile xanthogranuloma (JXG), a non–Langerhans cell histiocytosis of infancy and early childhood. This entity typically presents as a cutaneous head or neck nodule but can manifest with more systemic involvement including in the central nervous system. However, currently there is limited information regarding specific imaging features differentiating JXG from other neuropathological entities, with diagnosis typically made only after tissue sampling. The authors reviewed the initial images of a young patient with shunt-treated hydrocephalus and enlarging, chronic, extraaxial processes presumed to reflect subdural collections from overshunting, and they examine the operative discovery of a mass lesion that was pathologically proven to be JXG. Their results incorporate the important associated histological and advanced imaging features, including previously unreported metabolic activity on FDG PET. Ultimately, the case underscores the need to consider JXG in differential diagnoses of pediatric intracranial masses and highlights the potential role of PET in the initial diagnosis and response to treatment.

Embolic stroke of undetermined source correlates to atrial fibrosis without atrial fibrillation

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. e381-e387 ◽  
Author(s):  
Karman Tandon ◽  
David Tirschwell ◽  
W.T. Longstreth ◽  
Bryn Smith ◽  
Nazem Akoum
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Embolic Stroke ◽  
Cardioembolic Stroke ◽  
Healthy Controls ◽  
Atrial Fibrosis ◽  
Stroke Risk Factors ◽  
Causal Pathway

ObjectiveTo examine the hypothesis that atrial fibrosis and associated atrial cardiopathy may be in the causal pathway of cardioembolic stroke independently of atrial fibrillation (AF) by comparing atrial fibrosis burden between patients with embolic stroke of undetermined source (ESUS), patients with AF, and healthy controls.MethodsWe used late-gadolinium-enhancement MRI to compare atrial fibrosis in 10 patients with ESUS against 10 controls (no stroke, no AF) and 10 patients with AF. Fibrosis was compared between groups, controlling for stroke risk factors.ResultsMean age was 51 ± 15 years, and 43% of participants were female. Patients with ESUS had more atrial fibrosis than controls (16.8 ± 5.7% vs 10.6 ± 5.7%, p = 0.019) and similar fibrosis compared to patients with AF (17.8 ± 4.8%, p = 0.65). Odds ratios of ESUS per quartile of fibrosis were 3.22 (95% CI [CI] 1.11–9.32, p = 0.031, unadjusted) and 3.17 (95% CI 1.05–9.52, p = 0.041, CHA2DVASc score adjusted). Patients with >12% fibrosis had a higher percentage of ESUS (77.8% vs 27.3%, p = 0.02), and patients with >20% fibrosis had the highest proportion of ESUS (4 of 5).ConclusionsPatients with ESUS exhibit similar atrial fibrosis compared to patients with AF and more fibrosis than healthy controls. Fibrosis is associated with ESUS after controlling for stroke risk factors, supporting the hypothesis that fibrosis is in the causal pathway of cardioembolic stroke independently of AF. Prospective studies are needed to assess the role of anticoagulation in primary and secondary stroke prevention in patients with high atrial fibrosis.

scholarly journals Carotid Plaque With High-Risk Features in Embolic Stroke of Undetermined Source

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 311-314 ◽  
Author(s):  
Joseph Kamtchum-Tatuene ◽  
Alan Wilman ◽  
Maher Saqqur ◽  
Ashfaq Shuaib ◽  
Glen C. Jickling
Keyword(s):  
High Risk ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Random Effect ◽  
Embolic Stroke ◽  
Imaging Features ◽  
Luminal Narrowing ◽  
Carotid Plaque Imaging

Background and Purpose— An ipsilateral mild carotid stenosis, defined as plaque with <50% luminal narrowing, is identified in nearly 40% of patients with embolic stroke of undetermined source and could represent an unrecognized source of atheroembolism. We aimed to summarize data about the frequency of mild carotid stenosis with high-risk features in embolic stroke of undetermined source. Methods— We searched Pubmed and Ovid-Embase for studies reporting carotid plaque imaging features in embolic stroke of undetermined source. The prevalence of ipsilateral and contralateral mild carotid stenosis with high-risk features was pooled using random-effect meta-analysis. Results— Eight studies enrolling 323 participants were included. The prevalence of mild carotid stenosis with high-risk features in the ipsilateral carotid was 32.5% (95% CI, 25.3–40.2) compared with 4.6% (95% CI, 0.1–13.1) in the contralateral carotid. The odds ratio of finding a plaque with high-risk features in the ipsilateral versus the contralateral carotid was 5.5 (95% CI, 2.5–12.0). Conclusions— Plaques with high-risk features are 5 times more prevalent in the ipsilateral compared with the contralateral carotid in embolic stroke of undetermined source, suggesting a relationship to stroke risk.

scholarly journals Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3156-3168 ◽  
Author(s):  
Mitchell S.V. Elkind ◽  
Amelia K. Boehme ◽  
Craig J. Smith ◽  
Andreas Meisel ◽  
Marion S. Buckwalter
Keyword(s):  
Stroke Risk ◽  
Respiratory Infections ◽  
Immune Dysregulation ◽  
Future Research ◽  
Cumulative Number ◽  
Stroke Risk Factor ◽  
Acute Infections ◽  
The Impact

Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.

scholarly journals The Promising Role of Probiotics in Managing the Altered Gut in Autism Spectrum Disorders

2020 ◽  
Vol 21 (11) ◽  
pp. 4159 ◽  
Author(s):  
Basma Abdellatif ◽  
Clare McVeigh ◽  
Ghizlane Bendriss ◽  
Ali Chaari
Keyword(s):  
Gastrointestinal Symptoms ◽  
Autism Spectrum ◽  
Future Research ◽  
Beneficial Bacteria ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Potential Benefits ◽  
Spectrum Disorders ◽  
Irritable Bowel

Gastrointestinal symptoms (GIS) have been reported repeatedly in people with autism spectrum disorder (ASD) and studies have reported interesting correlations between severity of behavioral and gastrointestinal symptoms. Growing evidence indicates that the gut microbiota in ASD is altered with various shifts described at different taxonomic levels, pointing to the importance of considering the gut–brain axis in treatment of these disorders. Probiotics are live beneficial bacteria that are ingested as food or customized pills. These beneficial bacteria, when added in sufficient amounts, can correct the dysbiosis. Because probiotics have shown success in treating irritable bowel syndrome (IBS), it is plausible to investigate whether they can induce alleviation of behavioral symptoms as well. Probiotics show, in some clinical studies, their potential benefits (1) in improving gastrointestinal dysfunction, (2) in correcting dysbiosis, (3) in consequently reducing the severity of ASD symptoms. This review compiles data from selected studies that investigate these benefits and the mechanisms that mediate these effects, which include the production of metabolites, hormones, and neurotransmitters and the regulation of pro-inflammatory and regulatory cytokines. Future research based on more randomized, controlled studies with a larger population size and standardized use of strains, concentration of probiotics, duration of treatments, and methods of DNA extraction is still needed in this area, which may lead to more robust results.

Coping Humor as a Mediator Between Emotional Intelligence and Job Satisfaction

2017 ◽  
Vol 16 (3) ◽  
pp. 155-159 ◽  
Author(s):  
Peizhen Sun ◽  
Jennifer J. Chen ◽  
Hongyan Jiang
Keyword(s):  
Job Satisfaction ◽  
Emotional Intelligence ◽  
Future Research ◽  
Satisfaction Scale ◽  
Primary School Teachers ◽  
Mediating Role ◽  
Regulation Of Emotion ◽  
The Relationship ◽  
Overall Job Satisfaction

Abstract. This study investigated the mediating role of coping humor in the relationship between emotional intelligence (EI) and job satisfaction. Participants were 398 primary school teachers in China, who completed the Wong Law Emotional Intelligence Scale, Coping Humor Scale, and Overall Job Satisfaction Scale. Results showed that coping humor was a significant mediator between EI and job satisfaction. A further examination revealed, however, that coping humor only mediated two sub-dimensions of EI (use of emotion and regulation of emotion) and job satisfaction. Implications for future research and limitations of the study are discussed.

Public Administration in the Islamic World: Considering the Importance of Religion, its Values and Culture

2019 ◽  
Vol 19 (2) ◽  
pp. 23-38
Author(s):  
Daniel Hummel
Keyword(s):  
Public Administration ◽  
Core Values ◽  
Comparative Perspective ◽  
Religious Values ◽  
Future Research ◽  
Islamic World ◽  
Salient Region ◽  
The People ◽  
Comparative Public Administration

A small but growing area of public administration scholarship appreciates the influence of religious values on various aspects of government. This appreciation parallels a growing interest in comparative public administration and indigenized forms of government which recognizes the role of culture in different approaches to government. This article is at the crossroads of these two trends while also considering a very salient region, the Islamic world. The Islamic world is uniquely religious, which makes this discussion even more relevant, as the nations that represent them strive towards legitimacy and stability. The history and core values of Islam need to be considered as they pertain to systems of government that are widely accepted by the people. In essence, this is being done in many countries across the Islamic world, providing fertile grounds for public administration research from a comparative perspective. This paper explores these possibilities for future research on this topic.

Moderating Role of Gender in the Relationship between Cognitive Errors and Anxiety among Adolescents

2020 ◽  
Vol 4 (1) ◽  
pp. 86-102
Author(s):  
Tasnim Rehna ◽  
Rubina Hanif ◽  
Muhammad Aqeel
Keyword(s):  
Mental Health Problems ◽  
Adolescent Psychopathology ◽  
Future Research ◽  
Cognitive Errors ◽  
Adolescent Anxiety ◽  
Study Results ◽  
The Status ◽  
Manifest Anxiety ◽  
The Relationship

Background: Widespread social paradigms on which the status variances are grounded in any society, gender plays pivotal role in manifestation of mental health problems (Rutter, 2007). A hefty volume of research has addressed the issue in adults nonetheless, little is vividly known about the role of gender in adolescent psychopathology. Sample: A sample of 240 adolescents (125 boys, 115 girls) aging 12-18 years was amassed from various secondary schools of Islamabad with the approval of the Federal Directorate of Education (FDE), relevant authorities of the schools and the adolescents themselves. Instruments: Taylor Manifest Anxiety Scale (Taylor & Spence, 1953) and Children’s Negative Cognitive Errors Questionnaire (CNCEQ) by Leitenberg et al., (1986) were applied in present study. Results: Multiple regression analysis revealed that cognitive errors jointly accounted for 78% of variance in predicting anxiety among adolescents. Findings also exhibited that gender significantly moderated the relationship between cognitive errors and adolescent anxiety. Implications of the findings are discoursed for future research and clinical practice.

Stroke Prophylaxis by Percutaneous Closure of Patent Foramen Ovale and Left Atrial Appendage

2011 ◽  
Vol 6 (1) ◽  
pp. 67
Author(s):  
Antonio L Bartorelli ◽  
Claudio Tondo ◽  
◽  
Keyword(s):  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Stroke Risk ◽  
Left Atrial Appendage ◽  
Cryptogenic Stroke ◽  
Atrial Appendage ◽  
Foramen Ovale ◽  
Percutaneous Procedures ◽  
Cerebrovascular Events

Innovative percutaneous procedures for stroke prevention have emerged in the last two decades. Transcatheter closure of the patent foramen ovale (PFO) is performed in patients who suffered a cryptogenic stroke or a transient ischaemic attach (TIA) in order to prevent recurrence of thromboembolic events. Percutaneous occlusion of the left atrial appendage (LAA) has been introduced to reduce stroke risk in patients with atrial fibrillation (AF). The role of PFO and LAA in the occurrence of cerebrovascular events and the interventional device-based therapies to occlude the PFO and LAA are discussed.

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