21 results on '"Scali I"'
Search Results
2. Asterixis resulting from neurosurgery.
- Author
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Palacino, F., Scali, I., Prandin, G., Perano, F., Cegalin, M., Baldo, S., La Russa, A., Badreddine, H., Fabbro, S., Catalan, M., Tacconi, L., and Manganotti, P.
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NEUROSURGERY - Published
- 2024
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3. Lung ultrasonography in COVID‐19: a game changer in the stroke unit?
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Lugnan, C., primary, Tommasini, V., additional, Furlanis, G., additional, Naccarato, M., additional, Caruso, P., additional, Scali, I., additional, Buoite Stella, A., additional, Ajčević, M., additional, Cillotto, T., additional, and Manganotti, P., additional
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- 2020
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4. La metafora nella clinica del trauma: un ponte verso la creazione di sensi mai nati
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Scali, I, Bonello, F, and Ferruzza, Emilia
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Adolescenza ,Traumatismo precoce ,Metafora ,Simbolo - Published
- 2007
5. CT perfusion in hyper-acute ischemic stroke: the acid test for COVID-19 fear
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Alex Buoite Stella, Miloš Ajčević, Roberta Pozzi Mucelli, Agostino Accardo, Sasha Olivo, Maria Assunta Cova, Carlo Lugnan, Giovanni Furlanis, Ilario Scali, Paola Caruso, Paolo Manganotti, Marcello Naccarato, Furlanis, G., Ajcevic, M., Scali, I., Buoite Stella, A., Olivo, S., Lugnan, C., Caruso, P., Pozzi Mucelli, R. A., Accardo, A., Cova, M. A., Naccarato, M., and Manganotti, P.
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medicine.medical_specialty ,Neurology ,Coronavirus disease 2019 (COVID-19) ,Perfusion Imaging ,Coronaviru ,Clinical Neurology ,Perfusion scanning ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Image processing ,Internal medicine ,medicine ,Coronavirus ,COVID ,CT perfusion ,Perfusion pattern ,Stroke ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Pandemics ,Neuroradiology ,Diagnostic Neuroradiology ,Ischemic Stroke ,business.industry ,SARS-CoV-2 ,COVID-19 ,Retrospective cohort study ,Fear ,medicine.disease ,Perfusion ,Radiology Nuclear Medicine and imaging ,Communicable Disease Control ,Cardiology ,Neurology (clinical) ,Neurosurgery ,business ,Cardiology and Cardiovascular Medicine ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery - Abstract
Purpose The fear of COVID-19 infection may discourage patients from going to the hospital even in case of sudden onset of disabling symptoms. There is growing evidence of the reduction of stroke admissions and higher prevalence of severe clinical presentation. Yet, no studies have investigated the perfusion pattern of acute strokes admitted during the lockdown. We aimed to evaluate the effects of the COVID-19 pandemic on hyper-acute stroke CT perfusion (CTP) pattern during the first months of the pandemic in Italy. Methods In this retrospective observational study, we analyzed CTP images and clinical data of ischemic stroke patients admitted between 9 March and 2 June 2020 that underwent CTP (n = 30), to compare ischemic volumes and clinical features with stroke patients admitted during the same period in 2019 (n = 51). In particular, CTP images were processed to calculate total hypoperfused volumes, core volumes, and mismatch. The final infarct volumes were calculated on follow-up CT. Results Significantly higher total CTP hypoperfused volume (83.3 vs 18.5 ml, p = 0.003), core volume (27.8 vs 1.0 ml, p < 0.001), and unfavorable mismatch (0.51 vs 0.91, p < 0.001) were found during the COVID-19 period compared to no-COVID-19 one. The more unfavorable perfusion pattern at admission resulted in higher infarct volume on follow-up CT during COVID-19 (35.5 vs 3.0 ml, p < 0.001). During lockdown, a reduction of stroke admissions (− 37%) and a higher prevalence of severe clinical presentation (NIHSS ≥ 10; 53% vs 36%, p = 0.029) were observed. Conclusion The results of CTP analysis provided a better insight in the higher prevalence of major severity stroke patients during the COVID-19 period.
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- 2021
6. A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper-acute ischaemic stroke patients
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Marcello Naccarato, Maria Assunta Cova, Alex Buoite Stella, Paolo Manganotti, Miloš Ajčević, Marina Gaio, Paola Caruso, Ilario Scali, Tommaso Cillotto, Carlo Lugnan, Giovanni Furlanis, Buoite Stella, A., Ajcevic, M., Furlanis, G., Lugnan, C., Gaio, M., Cillotto, T., Scali, I., Caruso, P., Cova, M. A., Naccarato, M., and Manganotti, P.
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medicine.medical_specialty ,Physiology ,Perfusion Imaging ,Perfusion scanning ,Neuroimaging ,030204 cardiovascular system & hematology ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Ischaemic stroke ,Medicine ,Humans ,Prospective Studies ,Stroke ,cerebrovascular diseases ,CT perfusion ,hydration ,image processing ,stroke unit ,Hydration status ,Ischemic Stroke ,Osmole ,business.industry ,Penumbra ,030229 sport sciences ,General Medicine ,medicine.disease ,cerebrovascular disease ,Cerebrovascular Circulation ,Cardiology ,Urine osmolality ,business ,Tomography, X-Ray Computed - Abstract
Hypohydration may be associated with vascular diseases, poor prognosis and worse outcomes in stroke. The underlying mechanisms have not yet been completely investigated, although some studies suggested potential associations with brain perfusion and collaterals status. Despite the potentially different mechanisms promoting serum or urine biomarkers of hypohydration, few studies have investigated both markers separately. A prospective descriptive study was conducted in stroke patients admitted to a stroke unit 15 and “underhydrated” (UND) if urine osmolality was >500 mOsm/kg. CTP images were processed to calculate core, penumbra, their mismatch and total hypoperfused volume. Forty-six patients were included and were grouped according to hydration status. Despite no different NIHSS at baseline, at CTP HYP was independently associated with core-penumbra mismatch (β: −0.157, 95% CI: −0.305 to −0.009; p =.04), while UND was independently associated with the total hypoperfused volume (β: 31.502, 95% CI: 8.522‒54.481; p =.01). Using CTP imaging, this study proposes a physiological insight of some possible mechanisms associated with the better outcomes observed in acute stroke patients when properly hydrated. These results suggest different associations between hydration status and CTP parameters depending on serum or urine biomarkers in the hyper-acute phase and encourage the association between hydration status and stroke characteristics.
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- 2021
7. Lung ultrasonography in COVID‐19: a game changer in the stroke unit?
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Valentina Tommasini, Carlo Lugnan, Giovanni Furlanis, Paola Caruso, A. Buoite Stella, Ilario Scali, Tommaso Cillotto, Paolo Manganotti, Miloš Ajčević, Marcello Naccarato, Lugnan, C., Tommasini, V., Furlanis, G., Naccarato, M., Caruso, P., Scali, I., Buoite Stella, A., Ajcevic, M., Cillotto, T., and Manganotti, P.
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Coronavirus disease 2019 (COVID-19) ,Lung ultrasonography ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Clinical Neurology ,Unit (housing) ,03 medical and health sciences ,0302 clinical medicine ,COVID‐19 ,Pandemic ,Medicine ,030212 general & internal medicine ,Letters to the Editor ,Stroke ,stroke unit ,business.industry ,COVID-19 ,Outbreak ,lung ultrasonography ,medicine.disease ,Friuli venezia giulia ,Neurology ,Neurology (clinical) ,Medical emergency ,business ,Stroke Unit ,030217 neurology & neurosurgery - Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) is rapidly spreading worldwide, and the WHO declared its pandemic nature on 11th March 20201. The outbreak has hit Europe and, as of April 19, 2020, Italy has the third largest number of confirmed cases, namely a total of 175,925 cases and 23,227 deaths according to the John Hopkins University 2. This is the largest health and economic emergency of our country since the post‐war period, and many hospitals are now dedicated exclusively to COVID‐19 assistance. Our University Hub Stroke Unit of Cattinara Hospital is in the northeaster Italian region of Friuli Venezia Giulia which enlisted 2,731 cases and 222 deaths at the time of writing3.
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- 2020
8. Novel quantitative approach for crossed cerebellar diaschisis detection in acute ischemic stroke using CT perfusion
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Maja Ukmar, Paola Caruso, Carlo Lugnan, Giovanni Furlanis, Ilario Scali, Marcello Naccarato, Paolo Manganotti, Alex Buoite Stella, Lara Stragapede, Miloš Ajčević, Naccarato, M., Ajcevic, M., Furlanis, G., Lugnan, C., Buoite Stella, A., Scali, I., Caruso, P., Stragapede, L., Ukmar, M., and Manganotti, P.
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medicine.medical_specialty ,Cerebellum ,Stroke severity ,Acute ischemic stroke ,Crossed cerebellar diaschisi ,Perfusion scanning ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Image processing ,Modified Rankin Scale ,Internal medicine ,Humans ,Medicine ,Functional neuroimaging ,030212 general & internal medicine ,Asymmetry Index ,Ischemic Stroke ,business.industry ,Crossed cerebellar diaschisis ,CT perfusion ,Perfusion ,Stroke ,medicine.anatomical_structure ,Neurology ,Cerebrovascular Circulation ,Cardiology ,Neurology (clinical) ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery - Abstract
Purpose Crossed cerebellar diaschisis (CCD) is a common finding in hyper-acute ischemic stroke, related to supratentorial dysfunction of the contralateral hemisphere. Several studies investigated a possible relationship between CCD and clinical outcomes but still no evidence emerged. We proposed a novel quantitative whole cerebellum analysis using CT perfusion (CTP) imaging to investigate the relationship between CCD and stroke severity, hypoperfused volume and outcome measures. Methods 55 patients with supratentorial ischemic stroke who underwent CTP evaluation within 4.5 h since symptom onset were enrolled. CCD was evaluated by CTP image-processing and by calculating the mean transit time (MTT)-map asymmetry index in the whole cerebellum. MTT asymmetry correlation with ischemic volume and clinical outcomes was investigated. Results MTT asymmetry was found in most of the included patients and significantly correlated with NIH Stroke Scale (NIHSS) score at baseline and CTP ischemic volume. MTT asymmetry was significantly correlated with hemorrhagic transformation, NIHSS and modified Rankin Scale (mRS) score on discharge in treated patients. Conclusions CCD was detectable by CTP in acute supratentorial ischemic stroke by processing the whole cerebellum volume. CCD perfusion asymmetry was significantly correlated with neurological and perfusion deficit on admission as well as with clinical outcomes in treated patients.
- Published
- 2020
9. e-Health vs COVID-19: home patient telemonitoring to maintain TIA continuum of care
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Paola Caruso, Carlo Lugnan, Alex Buoite Stella, Giovanni Furlanis, Marcello Naccarato, Paolo Manganotti, Miloš Ajčević, Ilario Scali, Furlanis, G., Ajcevic, M., Naccarato, M., Caruso, P., Scali, I., Lugnan, C., Buoite Stella, A., and Manganotti, P.
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Telemedicine ,medicine.medical_specialty ,Telemonitoring ,Coronavirus disease 2019 (COVID-19) ,COVID-19 ,e-Health ,TIA ,Betacoronavirus ,Humans ,Ischemic Attack, Transient ,Self-Management ,Continuity of Patient Care ,Coronavirus Infections ,Pandemics ,Pneumonia, Viral ,Quarantine ,Clinical Neurology ,Dermatology ,Pandemic ,medicine ,Viral ,Continuum of care ,Neuroradiology ,Betacoronaviru ,biology ,Ischemic Attack ,Transient ,Coronavirus Infection ,business.industry ,SARS-CoV-2 ,Pneumonia ,General Medicine ,biology.organism_classification ,Psychiatry and Mental health ,Emergency medicine ,Neurology (clinical) ,Neurosurgery ,business ,Human - Abstract
N/A
- Published
- 2020
10. Stroke heart injury: the effect of cerebral reperfusion treatment. A 3-year retrospective study.
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Prandin G, Furlanis G, Mancinelli L, Palacino F, Vincis E, Scali I, Caruso P, Naccarato M, and Manganotti P
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- Humans, Male, Retrospective Studies, Female, Aged, Middle Aged, Aged, 80 and over, Ischemic Stroke blood, Ischemic Stroke therapy, Reperfusion, Troponin I blood, Heart Injuries etiology, Natriuretic Peptide, Brain blood, Stroke therapy, Stroke complications, Stroke blood, Stroke etiology
- Abstract
Background: Cardiac involvement following an acute stroke (Stroke Heart Syndrome-SHS) is an established complication and it is linked to the involvement of sympathetic activation, inflammation, and neuro-endocrine response. Troponin "rise and fall pattern" > 30% is one marker of SHS. The aim of this study was to evaluate the role of reperfusion treatments in the prevention/pathogenesis of SHS with different stroke sizes and locations (OCSP classification)., Methods: We retrospectively analyzed data of 890 patients admitted to the Stroke Unit of Trieste (Italy) between 2018 and 2020. Out of them, 411 met the inclusion criteria (acute ischemic non-lacunar stroke). Clinical data were collected for each patient, imaging characteristics, and markers of cardiac injury [troponin I (TnI), NT-proBNP, "rise and fall pattern" > 30%]. We compared different stroke subtypes according to OCSP, while evaluating any differences in patients with and without SHS., Results: In treated total anterior circulation infarct (TACI) patients, the rate of SHS is lower than in non-treated TACI. Similar SHS rate was found in partial anterior (PACI) and posterior stroke (POCI), and between treated and non-treated patients. Focusing on TACI group, we compared SHS-TACI and non-SHS-TACI, we performed a univariate and multivariate analysis; treatment (OR 0.408 CI95% 0.185-0.900; p = 0.026) and diabetes (OR 2.618 CI95% 1.181-5.803; p = 0.018) were significantly associated to SHS. No clear insular effect was found in SHS development., Conclusions: In severe anterior stroke (TACI), reperfusion treatment may be effective in preventing SHS. Conversely, diabetes is an independent risk factor for SHS. PACI and POCI have similar troponin elevation rate., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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11. Sex differences in Wake-Up Stroke patients characteristics and outcomes.
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Vincis E, Prandin G, Furlanis G, Scali I, Buoite Stella A, Cillotto T, Lugnan C, Caruso P, Naccarato M, and Manganotti P
- Abstract
Objectives: Wake-up Stroke (WUS) accounts for about 25% of all ischemic strokes. Differences according to sex in the WUS subgroup has been poorly investigated so far, so we aimed to assess these differences by differentiating the enrolled population based on treatment administered., Materials & Methods: We retrospectively analysed clinical and imaging data of WUS patients admitted to our hospital between November 2013 and December 2018 dividing them in two groups: rTPA-treated and non-rTPA treated group. To point out outcome differences we evaluated: NIHSS at 7 days or at discharge, mRS at discharge and ΔNIHSS., Results: We enrolled 149 WUS patients, 74 rTPA treated and 75 non-rTPA treated. Among rTPA treated patients, time from last known well (LKW) to Emergency Department (ED) admission was longer in females than males (610 vs 454 min), while females had a higher ΔNIHSS than males (5 vs 3). Finally, among non-rTPA treated patients, females were older than males (85 vs 79 years), had a higher pre-admission mRS (although very low in both cases), had a longer length of stay (17 vs 13 days) and shown a higher NIHSS at discharge (4 vs 2) compared to males., Conclusions: Females not receiving thrombolytic treatment had worse functional outcome than males, showing a higher NIHSS at discharge but, in contrast, when treated with rTPA they showed better neurological recovery as measured by a greater ΔNIHSS. We emphasize the importance of a prompt recognition of WUS in females since they seem to benefit more from rTPA treatment., (© 2024. Fondazione Società Italiana di Neurologia.)
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- 2024
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12. Status Epilepticus after mechanical thrombectomy: The role of early EEG assessment in Stroke Unit, clinical and radiological prognostication.
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Prandin G, Furlanis G, Scali I, Palacino F, Mancinelli L, Vincis E, Caruso P, Mazzon G, Tomaselli M, Naccarato M, and Manganotti P
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- Humans, Male, Female, Aged, Retrospective Studies, Middle Aged, Prognosis, Ischemic Stroke surgery, Ischemic Stroke physiopathology, Ischemic Stroke diagnostic imaging, Stroke surgery, Stroke physiopathology, Aged, 80 and over, Risk Factors, Brain Ischemia physiopathology, Brain Ischemia surgery, Status Epilepticus physiopathology, Status Epilepticus diagnostic imaging, Electroencephalography methods, Thrombectomy methods
- Abstract
Background: Convulsive (CSE) and non-convulsive (NCSE) Status Epilepticus are a complication in 0.2-0.3% ischemic strokes. Large stroke and cortical involvement are the main risk factors for developing SE. This study evaluates the prevalence of SE in patients treated with endovascular thrombectomy (EVT) through EEG recording within 72- h from admission. Moreover, we compared clinical, radiological, and outcome measures in SE and no-SE patients., Materials and Methods: We collected retrospectively demographical and clinical characteristics of acute ischemic stroke patients who underwent EVT, admitted in the Stroke Unit (SU) of the University Hospital of Trieste between January 2018 and March 2020 who underwent EEG recording within 72- h from the symptoms' onset., Results: Out of 247 EVT patients, 138 met the inclusion criteria, of whom 9 (6.5%) showed SE with median onset time of 1 day (IQR 1-2). No difference was found between the two groups as for age, sex, risk factors, grade of recanalization, etiology of stroke, and closed vessel. The no-SE group presented higher NIHSS improvement rate (p=0.025) compared to the SE group. The sum of the lobes involved in the ischemic lesion was significantly higher in SE group (p=0.048)., Conclusion: SE after EVT in large strokes is a non-rare complication, with most being NCSE. Performing a rapid EEG assessment in a Stroke Unit setting may allow for a prompt recognition and treatment of SE in the acute/hyper-acute phase. SE may be correlated with worse clinical outcomes in patients with large vessel occlusion., Competing Interests: Declaration of Copmeting Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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13. Thrombolysis in Stroke-Heart Syndrome: a useful tool for neurocardiac wellness?
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Scali I, Naccarato M, Prandin G, Palacino F, Lugnan C, Mancinelli L, Vincis E, Furlanis G, Caruso P, and Manganotti P
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- Humans, Male, Female, Aged, Retrospective Studies, Middle Aged, Thrombectomy methods, Aged, 80 and over, Heart Diseases etiology, Heart Diseases complications, Fibrinolytic Agents administration & dosage, Syndrome, Thrombolytic Therapy methods, Ischemic Stroke complications, Ischemic Stroke blood
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Introduction: Stroke-heart syndrome is a physiopathological condition of cardiac suffering due to cerebral injury secondary to major vessel occlusion in anterior circulation. It can be detected by increase in cardiac blood biomarkers. Our aim was to investigate a possible ancillary effect of thrombolysis in mitigating Stroke-Heart Syndrome after acute ischaemic stroke., Patients and Methods: We retrospectively collected ischaemic stroke patients admitted to our Stroke Unit between August 1, 2017 and December 31, 2020 and acutely treated for an intracranial anterior circulation occlusion, without anamnestic ischaemic cardiopathy. We divided patients into Group B ("Bridge") including patients treated with both thrombolysis and thrombectomy and Group D ("Direct") including primary thrombectomies., Results: 120 patients were included in the study. Group B consisted of 92 patients, Group D of 28 patients, without significant differences in age, baseline and discharge NIHSS, cardiovascular risk factors or TOAST aetiology. Whilst admission, troponin levels were similar in both groups, significant differences in troponin peak (median 16 ng/L in Group B vs 45 ng/L in Group D, p = 0.022) and BNP values (median 455 pg/mL in Group B vs 784 pg/mL in Group D, p = 0.031) were found in the first 72 h since admission. Functional independence at discharge was significantly higher in Group B than Group D (mRS 0-2 36% vs 10%, p = 0.011)., Discussion and Conclusion: Significant differences in troponin peak and BNP values suggest a reduced stroke-related heart impairment in patients treated with bridge therapeutic approach: thrombolysis prior to thrombectomy could have a complementary effect on reducing Stroke-Heart Syndrome, improving overall neurological outcome., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
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- 2024
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14. Fibrinogen Depletion Coagulopathy Predicts Major Bleeding After Thrombolysis for Ischemic Stroke: A Multicenter Study.
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Romoli M, Vandelli L, Bigliardi G, Naccarato M, Moller J, Balestrino M, Giammello F, Gentile M, Dell'Acqua ML, Manganotti P, Forlivesi S, Melis M, Picchetto L, Rosafio F, Furlanis G, Testoni S, Piras V, Malfatto L, Musolino RF, Scali I, Maffei S, Migliaccio L, Trenti T, Mancini R, Marietta M, Randi V, Meletti S, and Zini A
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- Humans, Female, Aged, Male, Tissue Plasminogen Activator adverse effects, Thrombolytic Therapy adverse effects, Fibrinolytic Agents adverse effects, Fibrinogen, Prospective Studies, Cerebral Hemorrhage complications, Treatment Outcome, Ischemic Stroke, Stroke, Blood Coagulation Disorders complications, Hemostatics therapeutic use, Brain Ischemia complications, Brain Ischemia drug therapy
- Abstract
Background: Symptomatic intracerebral hemorrhage (sICH) and major bleeding can be fatal complications of intravenous thrombolysis (IVT) for acute ischemic stroke. We investigated the impact of early fibrinogen depletion after IVT on major bleeding events., Methods: This multicenter observational prospective cohort study enrolled 1678 consecutive patients receiving IVT for acute ischemic stroke at 6 Italian centers, undergoing fibrinogen concentration assessment at baseline, 2 hours and 6 hours after IVT. Fibrinogen depletion was defined as a reduction below 200 mg/dL after 2 hours from IVT, or as a reduction below 50% of baseline fibrinogen levels after 2 hours from IVT. Main outcomes were (1) sICH (National Institute of Neurological Disorders and Stroke criteria) and (2) major bleeding defined as fatal bleeding, decrease in the hemoglobin level>2 g/dL/>1 unit transfusion, or bleeding at critical site. Additional outcomes were (1) any ICH, (2) any bleeding, (3) fatal ICH, and (4) sICH according to ECASSII definition. Good functional recovery was defined as modified Rankin Scale score 0 to 2 at 3 months., Results: Overall, 1678 patients were included (mean age 72 years, 46% female). sICH (n=116) and major bleeding (n=297) were associated with lower rate of good functional recovery ( P <0.001). Despite similar fibrinogen levels at admission, fibrinogen depletion after 2 hours from IVT was more common in people with sICH, major bleeding and all additional bleeding outcomes. In the backward stepwise multivariable logistic regression model, fibrinogen depletion remained a significant predictor of sICH (OR, 1.55 [95% CI, 1.04-2.32]) and major bleeding (OR, 1.36 [95% CI, 1.03-1.8]). Thirty-one percent of sICH could be attributable to fibrinogen depletion. The association between fibrinogen depletion and worse clinical outcome at 3 months after stroke ( P =0.012) was attributable to the higher risk of major bleeding/sICH., Conclusions: Fibrinogen depletion significantly increases the risk of sICH and major bleeding after IVT for acute ischemic stroke. Fibrinogen depletion represents an independent risk factor for bleeding, and routine assessment could be considered to stratify the risk of ICH. Trials on early fibrinogen repletion are needed to investigate mitigation of bleeding risk.
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- 2022
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15. Paraneoplastic neurological syndromes associated with non-Hodgkin lymphoma: a case series.
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Dinoto A, Cheli M, Catalan M, Olivo S, Scali I, Bertolotti C, Sartori A, and Manganotti P
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- Aged, Antibodies, Female, Humans, Male, Retrospective Studies, Lymphoma, Non-Hodgkin complications, Lymphoma, Non-Hodgkin diagnosis, Neoplasms complications, Paraneoplastic Syndromes, Nervous System diagnosis
- Abstract
Background: Paraneoplastic neurological syndromes (PNS) associated with lymphoma are rare diseases that usually have different peculiar features when compared to PNS associated with solid neoplasms., Methods: We retrospectively identified patients with NHL-associated PNS. Clinical and demographic data are reported., Results: We report two cases of NHL-associated PNS: a 72-years old female that presented with rapidly progressive cerebellar syndrome (RCPS) and a 65-years old male that presented with encephalomyelitis (confusion, sensory neuropathy, lower motor neuron involvement). Both PNS were associated with a NHL, small lymphocytic lymphoma and nodal marginal zone lymphoma respectively, and onconeural antibodies tested negative. All patients received first-line immunotherapy with absent or minimal benefit and died of intercurrent infection before cancer or immunosuppressive treatment., Discussion: RCPS and encephalomyelitis rarely present in association with NHL. In our cases, those syndromes took place in the setting of non-aggressive advanced hematological disorders, had an unfavorable prognosis with minimal benefit from immunotherapy, and were seronegative for onconeural antibodies. Our patients fulfilled the criteria for "definite PNS" in the 2004 PNS criteria, but they would be classified as "probable", in the new 2021 PNS criteria. The newest criteria rely on onconeural antibodies testing and on the evidence of antigen expression in cancer cells, features that are usually absent in NHL-associated PNS. New antibodies are being discovered but are still not available to promptly test yet., Conclusion: NHL-associated PNS are rare and bear unfavorable prognosis. The diagnosis should not be overlooked even in seronegative patients., (© 2021. Fondazione Società Italiana di Neurologia.)
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- 2022
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16. Stroke management during the coronavirus disease 2019 (COVID-19) pandemic: experience from three regions of the north east of Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige).
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Manganotti P, Naccarato M, Scali I, Cappellari M, Bonetti B, Burlina A, Turinese E, Bogo S, Teatini F, Franchini E, Caneve G, Ruzza G, Gaudenzi A, Bombardi R, Bozzato G, Padoan R, Gentile C, Rana M, Turazzini M, Alessandra D, Brigo F, Nardone R, Quatrale R, Menegazzo E, Masato M, Novello S, Passadore P, Baldi A, Valentinis L, Baracchini C, Pieroni A, Basile AM, Semplicini C, Piffer S, Giometto B, Tonello S, Bonifatti DM, Lorenzut S, Merlino G, Valente MR, Paladin F, Tonon A, de Luca C, Perini F, Centonze S, and Bovi P
- Subjects
- Communicable Disease Control, Humans, Italy epidemiology, Pandemics, Retrospective Studies, SARS-CoV-2, COVID-19, Stroke epidemiology, Stroke therapy
- Abstract
Background: Efficiency of care chain response and hospital reactivity were and are challenged for stroke acute care management during the pandemic period of coronavirus disease 2019 (COVID-19) in North-Eastern Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige), counting 7,193,880 inhabitants (ISTAT), with consequences in acute treatment for patients with ischemic stroke., Methods: We conducted a retrospective data collection of patients admitted to stroke units eventually treated with thrombolysis and thrombectomy, ranging from January to May 2020 from the beginning to the end of the main first pandemic period of COVID-19 in Italy. The primary endpoint was the number of patients arriving to these stroke units, and secondary endpoints were the number of thrombolysis and/or thrombectomy. Chi-square analysis was used on all patients; furthermore, patients were divided into two cohorts (pre-lockdown and lockdown periods) and the Kruskal-Wallis test was used to test differences on admission and reperfusive therapies., Results: In total, 2536 patients were included in 22 centers. There was a significant decrease of admissions in April compared to January. Furthermore, we observed a significant decrease of thrombectomy during the lockdown period, while thrombolysis rate was unaffected in the same interval across all centers., Conclusions: Our study confirmed a decrease in admission rate of stroke patients in a large area of northern Italy during the lockdown period, especially during the first dramatic phase. Overall, there was no decrease in thrombolysis rate, confirming an effect of emergency care system for stroke patients. Instead, the significant decrease in thrombectomy rate during lockdown addresses some considerations of local and regional stroke networks during COVID-19 pandemic evolution., (© 2021. The Author(s).)
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- 2021
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17. CT perfusion in hyper-acute ischemic stroke: the acid test for COVID-19 fear.
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Furlanis G, Ajčević M, Scali I, Buoite Stella A, Olivo S, Lugnan C, Caruso P, Pozzi Mucelli RA, Accardo A, Cova MA, Naccarato M, and Manganotti P
- Subjects
- Communicable Disease Control, Fear, Humans, Pandemics, Perfusion, Perfusion Imaging, SARS-CoV-2, Tomography, X-Ray Computed, Brain Ischemia, COVID-19, Ischemic Stroke, Stroke diagnostic imaging
- Abstract
Purpose: The fear of COVID-19 infection may discourage patients from going to the hospital even in case of sudden onset of disabling symptoms. There is growing evidence of the reduction of stroke admissions and higher prevalence of severe clinical presentation. Yet, no studies have investigated the perfusion pattern of acute strokes admitted during the lockdown. We aimed to evaluate the effects of the COVID-19 pandemic on hyper-acute stroke CT perfusion (CTP) pattern during the first months of the pandemic in Italy., Methods: In this retrospective observational study, we analyzed CTP images and clinical data of ischemic stroke patients admitted between 9 March and 2 June 2020 that underwent CTP (n = 30), to compare ischemic volumes and clinical features with stroke patients admitted during the same period in 2019 (n = 51). In particular, CTP images were processed to calculate total hypoperfused volumes, core volumes, and mismatch. The final infarct volumes were calculated on follow-up CT., Results: Significantly higher total CTP hypoperfused volume (83.3 vs 18.5 ml, p = 0.003), core volume (27.8 vs 1.0 ml, p < 0.001), and unfavorable mismatch (0.51 vs 0.91, p < 0.001) were found during the COVID-19 period compared to no-COVID-19 one. The more unfavorable perfusion pattern at admission resulted in higher infarct volume on follow-up CT during COVID-19 (35.5 vs 3.0 ml, p < 0.001). During lockdown, a reduction of stroke admissions (- 37%) and a higher prevalence of severe clinical presentation (NIHSS ≥ 10; 53% vs 36%, p = 0.029) were observed., Conclusion: The results of CTP analysis provided a better insight in the higher prevalence of major severity stroke patients during the COVID-19 period., (© 2021. The Author(s).)
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- 2021
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18. A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper-acute ischaemic stroke patients.
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Buoite Stella A, Ajčević M, Furlanis G, Lugnan C, Gaio M, Cillotto T, Scali I, Caruso P, Cova MA, Naccarato M, and Manganotti P
- Subjects
- Cerebrovascular Circulation, Humans, Neuroimaging, Perfusion Imaging, Prospective Studies, Tomography, X-Ray Computed, Brain Ischemia diagnostic imaging, Ischemic Stroke, Stroke diagnostic imaging
- Abstract
Hypohydration may be associated with vascular diseases, poor prognosis and worse outcomes in stroke. The underlying mechanisms have not yet been completely investigated, although some studies suggested potential associations with brain perfusion and collaterals status. Despite the potentially different mechanisms promoting serum or urine biomarkers of hypohydration, few studies have investigated both markers separately. A prospective descriptive study was conducted in stroke patients admitted to a stroke unit <4.5 h from symptoms onset. All patients underwent neurological evaluation and whole-brain computed tomography perfusion (CTP) upon admission. Blood and urine samples were immediately collected at admission, and patients were defined as "hypohydrated" (HYP) if blood urea nitrogen-to-creatinine ratio was >15 and "underhydrated" (UND) if urine osmolality was >500 mOsm/kg. CTP images were processed to calculate core, penumbra, their mismatch and total hypoperfused volume. Forty-six patients were included and were grouped according to hydration status. Despite no different NIHSS at baseline, at CTP HYP was independently associated with core-penumbra mismatch (β: -0.157, 95% CI: -0.305 to -0.009; p = .04), while UND was independently associated with the total hypoperfused volume (β: 31.502, 95% CI: 8.522-54.481; p = .01). Using CTP imaging, this study proposes a physiological insight of some possible mechanisms associated with the better outcomes observed in acute stroke patients when properly hydrated. These results suggest different associations between hydration status and CTP parameters depending on serum or urine biomarkers in the hyper-acute phase and encourage the association between hydration status and stroke characteristics., (© 2021 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)
- Published
- 2021
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19. Novel quantitative approach for crossed cerebellar diaschisis detection in acute ischemic stroke using CT perfusion.
- Author
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Naccarato M, Ajčević M, Furlanis G, Lugnan C, Buoite Stella A, Scali I, Caruso P, Stragapede L, Ukmar M, and Manganotti P
- Subjects
- Cerebellum diagnostic imaging, Cerebrovascular Circulation, Humans, Perfusion, Tomography, X-Ray Computed, Brain Ischemia complications, Brain Ischemia diagnostic imaging, Ischemic Stroke, Stroke complications, Stroke diagnostic imaging
- Abstract
Purpose: Crossed cerebellar diaschisis (CCD) is a common finding in hyper-acute ischemic stroke, related to supratentorial dysfunction of the contralateral hemisphere. Several studies investigated a possible relationship between CCD and clinical outcomes but still no evidence emerged. We proposed a novel quantitative whole cerebellum analysis using CT perfusion (CTP) imaging to investigate the relationship between CCD and stroke severity, hypoperfused volume and outcome measures., Methods: 55 patients with supratentorial ischemic stroke who underwent CTP evaluation within 4.5 h since symptom onset were enrolled. CCD was evaluated by CTP image-processing and by calculating the mean transit time (MTT)-map asymmetry index in the whole cerebellum. MTT asymmetry correlation with ischemic volume and clinical outcomes was investigated., Results: MTT asymmetry was found in most of the included patients and significantly correlated with NIH Stroke Scale (NIHSS) score at baseline and CTP ischemic volume. MTT asymmetry was significantly correlated with hemorrhagic transformation, NIHSS and modified Rankin Scale (mRS) score on discharge in treated patients., Conclusions: CCD was detectable by CTP in acute supratentorial ischemic stroke by processing the whole cerebellum volume. CCD perfusion asymmetry was significantly correlated with neurological and perfusion deficit on admission as well as with clinical outcomes in treated patients., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2020
- Full Text
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20. e-Health vs COVID-19: home patient telemonitoring to maintain TIA continuum of care.
- Author
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Furlanis G, Ajčević M, Naccarato M, Caruso P, Scali I, Lugnan C, Buoite Stella A, and Manganotti P
- Subjects
- Betacoronavirus, COVID-19, Humans, SARS-CoV-2, Self-Management methods, Continuity of Patient Care, Coronavirus Infections, Ischemic Attack, Transient diagnosis, Ischemic Attack, Transient therapy, Pandemics, Pneumonia, Viral, Quarantine, Telemedicine methods
- Published
- 2020
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21. Has COVID-19 played an unexpected "stroke" on the chain of survival?
- Author
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Naccarato M, Scali I, Olivo S, Ajčević M, Buoite Stella A, Furlanis G, Lugnan C, Caruso P, Peratoner A, Cominotto F, and Manganotti P
- Subjects
- Aged, Aged, 80 and over, COVID-19, Clinical Protocols, Comorbidity, Delayed Diagnosis, Emergency Service, Hospital statistics & numerical data, Fear, Female, Hospital Units, Hospitalization statistics & numerical data, Hospitals, University organization & administration, Hospitals, University statistics & numerical data, Humans, Italy, Male, Middle Aged, Patient Admission statistics & numerical data, Quarantine, Retrospective Studies, Risk Factors, SARS-CoV-2, Stroke epidemiology, Stroke etiology, Stroke mortality, Time-to-Treatment statistics & numerical data, Betacoronavirus, Coronavirus Infections complications, Coronavirus Infections epidemiology, Delivery of Health Care statistics & numerical data, Disease Management, Health Services Accessibility statistics & numerical data, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral epidemiology, Stroke therapy
- Abstract
Background: The COVID-19 pandemics required several changes in stroke management and it may have influenced some clinical or functional characteristics. We aimed to evaluate the effects of the COVID-19 pandemics on stroke management during the first month of Italy lockdown. In addition, we described the emergency structured pathway adopted by an Italian University Hub Stroke Unit in the cross-border Italy-Slovenia area., Methods: We analyzed admitted patients' clinical features and outcomes between 9th March 2020 and 9th April 2020 (first month of lockdown), and compared them with patients admitted during the same period in 2019., Results: Total admissions experienced a reduction of 45% during the lockdown compared to the same period in 2019 (16 vs 29, respectively), as well as a higher prevalence of severe stroke (NIHSS>10) at admission (n = 8, 50% vs n = 8, 28%). A dramatic prevalence of stroke of unknown symptom onset was observed in 2020 (n = 8, 50% vs n = 3, 10%). During lockdown, worse functional and independence outcomes were found, despite the similar proportion of reperfused patients. Similar 'symptoms alert-to-admission' and 'door-to-treatment' times were observed. During lockdown hospitalization was shorter and fewer patients completed the stroke work-up., Conclusion: In conclusion, the adopted strategies for stroke management during the COVID-19 emergency have suggested being effective, while suffering a reduced and delayed reporting of symptoms. Therefore, we recommend raising awareness among the population against possible stroke symptoms onset. Thus, think F.A.S.T. and do not stay-at-home at all costs., Competing Interests: Declaration of Competing Interest The Authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2020
- Full Text
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