scholarly journals Acute Phase Neuronal Activity for the Prognosis of Stroke Recovery

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Filippo Zappasodi ◽  
Patrizio Pasqualetti ◽  
Paolo M. Rossini ◽  
Franca Tecchio
Keyword(s):  
Acute Phase ◽  
Brain Activity ◽  
Stroke Recovery ◽  
Clinical State ◽  
Middle Cerebral Artery Territory ◽  
Clinical Recovery ◽  
Wide Group ◽  
Promising Line ◽  
Bilateral Impairment

Strokes causing similar lesions and clinical states can be followed by diverse regains of neurological functions, indicating that the clinical recovery can depend on individual modulating factors. A promising line to disclose these factors, to finally open new therapeutic strategies, is to search for individual indices of recovery prognosis. Here, we pursued on strengthening the value of acute phase electrophysiological biomarkers for poststroke functional recovery in a wide group of patients. We enrolled 120 patients affected by a monohemispheric stroke within the middle cerebral artery territory (70 left and 50 right damages) and collected the NIH stroke scale (NIHSS) score in the acute phase (T0, median 4 days) and chronic follow-up (T1, median 6 months). At T0, we executed electrophysiological noninvasive assessment (19-channel electroencephalography (EEG) or 28 channels per side magnetoencephalography (MEG)) of brain activity at rest by means of band powers in the contra- and ipsilesional hemispheres (CLH, ILH) or the homologous area symmetry (HArS). Low-band (2-6 Hz) HArS entered the regression model for predicting the stabilized clinical state (p<0.001), with bilateral impairment correlated with a poor outcome. Present data strengthen the fact that low-band impairment of homologous ipsi- and contralesional hemispheric regions in the acute stroke indicate a negative prognosis of clinical recovery.

Changes in M.P.I. Scores in Neurotic Patients: A Three Year Follow-up

1966 ◽  
Vol 112 (490) ◽  
pp. 931-939 ◽  
Author(s):  
J. G. Ingham
Keyword(s):  
Acute Phase ◽  
Psychiatric Diagnosis ◽  
Practical Importance ◽  
Temporal Stability ◽  
Acute Illness ◽  
Reliable Information ◽  
Clinical State ◽  
Stable Characteristic

Do the relatively high N-scores observed in neurotic patients reflect a stable characteristic of the neurotic's personality, or are they temporary manifestations occurring only in the acute phase of the illness? Similarly, do the relatively low E-scores of dysthymic patients remain low through variations of clinical state or are they also temporary? The temporal stability of M.P.I. scores is of some practical importance. Criteria for psychiatric diagnosis often include assessments of personality before the illness. Fairly reliable information about this can often be obtained from relatives, but in other cases the clinician is faced with a problem that might appear insoluble. How is he to assess previous personality during an acute illness which may influence the behaviour on which personality is judged?

scholarly journals Primary Extra-Nodal DLBCL of Glands: Our Experiences outside Guidelines of Treatment

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 286
Author(s):  
Antonello Sica ◽  
Mario Santagata ◽  
Caterina Sagnelli ◽  
Piero Rambaldi ◽  
Renato Franco ◽  
...  
Keyword(s):  
Lymph Node ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Lymphoid Tissues ◽  
Clinical Recovery ◽  
Large B Cell Lymphoma ◽  
Thyroid Glands ◽  
Chemotherapy Protocol ◽  
Large B Cell

Lymphomas usually involve lymph nodes and other lymphoid tissues, but sometimes occur in non-lymphoid organs, called extra-nodal sites. Primary diffuse extra-lymph node large B-cell lymphoma (DLBCL) of the thyroid and parotid gland have been observed rarely. According to the most accredited guidelines, primary extra-nodal DLBCL of the parotid and thyroid glands should be treated with three cycles of R-CHOP followed by radiotherapy of the involved site (ISRT). Surgery alone is not enough to treat DLBCL. We describe two unusual cases of primary extra-nodal DLBCL in elderly patients treated exclusively with surgical resection, given the inability to apply chemotherapy. Both patients achieved clinical recovery, which was maintained after a follow-up of more than 18 months, despite not having performed the indicated chemotherapy protocol. The two cases presented here, and a few others reported in the literature, should be considered exceptions to the rule, and do not allow the conclusion that surgery alone might be sufficient for complete remission.

scholarly journals Physiological parameters deterioration in acute stage after stroke: Rehabilitation versus conventional care

2019 ◽  
Vol 10 (3) ◽  
pp. 79
Author(s):  
Reham AbdElhamed AbdElmawla Elsaid ◽  
Amina Mohamed AbdElfatah Sliman
Keyword(s):  
Acute Stroke ◽  
Acute Phase ◽  
Stroke Rehabilitation ◽  
Recovery Period ◽  
Acute Stage ◽  
Conventional Care ◽  
Physiological Parameters ◽  
Stroke Recovery ◽  
University Hospital ◽  
Control Group

Objective: Stroke is considered the main health problem and the second leading cause of death worldwide. Stroke resulting in varied and unpredictable complications if not managed correctly in the acute stage with intensive rehabilitation therapy which may affect stroke prognosis, and resulting functional decline. Therefore, the aim of the study was to explore the consequences of rehabilitation versus conventional care on physiological parameters during the acute stroke recovery period.Methods: The quasi-experimental research design was used in the neurology department at Mansoura University Hospital. A convenient sample of sixty-four adult patients of both sex with stroke, who corresponded to inclusion criteria was assigned into two equal groups, study group (rehabilitation group) and control group (conventional care).Results: The results indicates, acute phase rehabilitation limit physiological parameters deterioration during acute stroke recovery period comparing to conventional care only.Conclusions: Acute phase stroke rehabilitation has a significant positive impact on physiological parameters.

scholarly journals Recovery from Transient Global Amnesia Following Restoration of Hippocampal and Fronto–Cingulate Perfusion

2010 ◽  
Vol 22 (3-4) ◽  
pp. 131-139 ◽  
Author(s):  
Paolo Caffarra ◽  
Letizia Concari ◽  
Simona Gardini ◽  
Sabrina Spaggiari ◽  
Francesca Dieci ◽  
...  
Keyword(s):  
Acute Phase ◽  
Neuropsychological Testing ◽  
Transient Global Amnesia ◽  
Normal Limits ◽  
Global Amnesia ◽  
One Year ◽  
The Right ◽  
Rcbf Spect ◽  
Subject Comparison

A patient who suffered a transient global amnesia (TGA) attack underwent regional cerebral blood flow (rCBF) SPECT imaging and neuropsychological testing in the acute phase, after one month and after one year. Neuropsychological testing in the acute phase showed a pattern of anterograde and retrograde amnesia, whereas memory was within age normal limits at follow up. SPECT data were analysed with a within subject comparison and also compared with those of a group of healthy controls. Within subject comparison between the one month follow up and the acute phase detected increases in rCBF in the hippocampus bilaterally; further rCBF increases in the right hippocampus were detected after one year. Compared to controls, significant hypoperfusion was found in the right precentral, cingulate and medial frontal gyri in the acute phase; after one month significant hypoperfusion was detected in the right precentral and cingulate gyri and the left postcentral gyrus; after one year no significant hypoperfusion appeared. The restoration of memory was paralleled by rCBF increases in the hippocampus and fronto-limbic-parietal cortex; after one year neither significant rCBF differences nor cognitive deficits were detectable. In conclusion, these data indicate that TGA had no long lasting cognitive and neural alterations in this patient.

Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device

2015 ◽  
Vol 8 (10) ◽  
pp. 1030-1033 ◽  
Author(s):  
Edgar A Samaniego ◽  
German Abdo ◽  
Ricardo A Hanel ◽  
Andrey Lima ◽  
Santiago Ortega-Gutierrez ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Phase ◽  
Posterior Inferior Cerebellar Artery ◽  
Short Term ◽  
Small Series ◽  
Low Profile ◽  
Procedural Complications ◽  
Reconstructive Technique ◽  
Pica Aneurysms

ObjectiveTo describe the treatment of posterior inferior cerebellar artery (PICA) aneurysms with the Low-profile Visualized Intraluminal Support Device (LVIS Jr) stent.Materials and methodsThe databases of three institutions were retrospectively reviewed. Patients who underwent endovascular treatment of PICA aneurysms using a reconstructive technique where the LVIS Jr stent was totally or partially deployed into the PICA were included in the analysis. Clinical presentation, aneurysm and PICA sizes, procedural complications, and clinical and angiographic follow-up information was recorded and analyzed.ResultsSeven patients who underwent endovascular treatment of PICA aneurysms with an LVIS Jr stent were identified. Four aneurysms were treated in the acute phase of subarachnoid hemorrhage (SAH). There were no symptomatic complications. One patient had spasm distal to the stent as a result of mechanical straightening of the vessel. One patient was treated in the acute phase of SAH and required a gycoprotein IIb/IIIa inhibitor after the stent was implanted. This patient needed to be re-treated to complete embolization. All patients had good clinical outcomes (Glasgow Outcome Scale 5). No in-stent stenosis or occlusion was seen on short-term angiographic follow-up and the aneurysms were occluded.ConclusionsThis small series suggests that the use of a reconstructive technique with the LVIS Jr stent for the treatment of PICA aneurysms is feasible, safe and effective in the short term.

Association of Refractory Pain in the Acute Phase After Subarachnoid Hemorrhage with Continued Outpatient Opioid Use

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011906
Author(s):  
Matthew N. Jaffa ◽  
Jamie E. Podell ◽  
Madeleine C. Smith ◽  
Arshom Foroutan ◽  
Adam Kardon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ethnic Minority ◽  
Acute Phase ◽  
Acute Illness ◽  
Minority Status ◽  
Opioid Use ◽  
Opioid Dose ◽  
Refractory Pain ◽  
Racial Ethnic

ObjectiveLittle is known about the prevalence of continued opioid use following aneurysmal subarachnoid hemorrhage (aSAH) despite guidelines recommending their use during the acute phase of disease. We sought to determine prevalence of opioid use following aSAH and test the hypothesis that acute pain and higher inpatient opioid dose increased outpatient opioid use.MethodsWe reviewed consecutively admitted aSAH patients from November 2015 through September 2019. We retrospectively collected pain scores and daily doses of analgesics. Pain burden was calculated as area under the pain-time curve. Univariate and multivariable regression models determined risk factors for continued opioid use at discharge and outpatient follow-up.ResultsWe identified 234 aSAH patients with outpatient follow-up. Continued opioid use was common at discharge (55% of patients) and follow-up (47% of patients, median 63 (IQR 49–96) days from admission). Pain burden, craniotomy, and racial-ethnic minority status were associated with discharge opioid prescription in multivariable analysis. At outpatient follow-up, pain burden (OR 1.88, 95% CI 1.5–2.4), depression (OR 3.1, 95% CI 1.1–8.8), and racial-ethnic minority status (OR 2.1, 95% CI 1.1–4.0) were independently associated with continued opioid use while inpatient opioid dose was not.ConclusionContinued opioid use following aSAH is prevalent and related to refractory pain during acute illness, but not inpatient opioid dose. More efficacious analgesic strategies are needed to reduce continued opioid use in patients following aSAH.Classification of evidenceThis study provides Class II evidence that continued opioid use following aSAH is associated with refractory pain during acute illness but not hospital opioid exposure.

Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)

2018 ◽  
Vol 33 (4) ◽  
pp. 773-783 ◽  
Author(s):  
Carina M Samuelsson ◽  
Per-Olof Hansson ◽  
Carina U Persson
Keyword(s):  
Confidence Interval ◽  
Postural Control ◽  
Acute Phase ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Inpatient Rehabilitation ◽  
Stroke Onset ◽  
Multivariable Regression ◽  
Walking Aid

Objective: To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation. Design: Prospective follow-up study. Setting: Stroke unit and outpatient department. Subjects: A total of 490 individuals with acute stroke. Methods: Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses. Main measures: The endpoint was a self-reported fall. Results: Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07–7.45, P < 0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71–4.72, P < 0.0001) were predictors of falls after discharge within 12 months after stroke onset. The same variables were independent predictors of falls within six months. Conclusion: Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.

scholarly journals Psychedelics and hypnosis: Commonalities and therapeutic implications

2018 ◽  
Vol 32 (7) ◽  
pp. 732-740 ◽  
Author(s):  
Clément E Lemercier ◽  
Devin B Terhune
Keyword(s):  
Acute Phase ◽  
Therapeutic Efficacy ◽  
Therapeutic Action ◽  
Therapeutic Implications ◽  
Recent Advances ◽  
Therapeutic Outcomes ◽  
Potential Efficacy

Background: Recent research on psychedelics and hypnosis demonstrates the value of both methods in the treatment of a range of psychopathologies with overlapping applications and neurophenomenological features. The potential of harnessing the power of suggestion to influence the phenomenological response to psychedelics toward more therapeutic action has remained unexplored in recent research and thereby warrants empirical attention. Aims: Here we aim to elucidate the phenomenological and neurophysiological similarities and dissimilarities between psychedelic states and hypnosis in order to revisit how contemporary knowledge may inform their conjunct usage in psychotherapy. Methods: We review recent advances in phenomenological and neurophysiological research on psychedelics and hypnosis, and we summarize early investigations on the coupling of psychedelics and hypnosis in scientific and therapeutic contexts. Results/outcomes: We highlight commonalities and differences between psychedelics and hypnosis that point to the potential efficacy of combining the two in psychotherapy. We propose multiple research paths for coupling these two phenomena at different stages in the preparation, acute phase and follow-up of psychedelic-assisted psychotherapy in order to prepare, guide and integrate the psychedelic experience with the aim of enhancing therapeutic outcomes. Conclusions/interpretation: Harnessing the power of suggestion to modulate response to psychedelics could enhance their therapeutic efficacy by helping to increase the likelihood of positive responses, including mystical-type experiences.

Abstract TP170: Persistently Elevated Factor VIII In Acute Ischemic Stroke Is Associated With Higher CRP, Lower Baseline NIHSS, And Longer Length Of Hospital Stay

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Adrianne M Dorsey ◽  
Amelia K Boehme ◽  
Laurie Schluter ◽  
Karen C Albright ◽  
Tiffany R Chang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Factor Viii ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Clinical Course ◽  
Length Of Hospital Stay ◽  
Lower Baseline ◽  
Persistent Elevation

Objective: We sought to determine the proportion of patients with elevated factor VIII (FVIII) levels whose FVIII levels remain elevated after the acute phase of stroke, and the patient characteristics that predict sustained elevation of FVIII levels. Background: Factor VIII plays a major role in the fluid phase of blood coagulation. Elevated FVIII has been shown to increase risk of venous and arterial thrombosis. The importance of screening for elevated FVIII after a first thrombotic event especially acute ischemic stroke (AIS) has not been adequately investigated. Design/Methods: We reviewed FVIII levels taken at baseline and follow-up in patients with AIS treated at our stroke center from July 2008 to June 2012. Elevated FVIII was defined as >150%. Baseline demographics, laboratory data, clinical course, outcomes, and time to follow-up were collected in patients with elevated FVIII at baseline and data was compared in patients who had normalized FVIII with patients whose FVIII remained elevated at least 7 days later. Results: Repeat FVIII levels were available for 34/111 patients with elevated FVIII level with AIS. FVIII remained elevated in 68% after a median interval of 110 days. Factors associated with persistent elevation included higher baseline FVIII level (239 vs 185%, p=0.015), elevated CRP (73.3 vs 12.5%, p=0.008), lower baseline NIHSS (4 vs 8, p=0.046), and longer length of hospital stay (8 vs. 3, p=0.0063). Normalization of FVIII was associated with tPA use (54.5% vs 13%, p=0.016). No relationship was found between persistently elevated FVIII and baseline demographics, clinical course and outcomes. Conclusion: Persistently elevated FVIII after AIS may be predicted by higher baseline levels and elevations in CRP. Despite worse baseline stroke severity, patient with normalization of FVIII had similar outcomes as those with persistent elevation, which may be explained by the higher use of tPA in the normalized group. The relevance of elevated FVIII in stroke is not well understood. Our preliminary results suggest elevations persist in the majority and may not merely represent an acute phase reactant.

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