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1. Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes

Author

Maurizio Paciaroni, Fabio Bandini, Giancarlo Agnelli, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H. Abdul‐Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D'Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Riccardo Altavilla, Giacomo Volpi, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Manuel Cappellari, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Luca Masotti, Vieri Vannucchi, Sung‐Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrissoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Gino Gialdini, Tiziana Tassinari, Maria Luisa De Lodovici, Giorgio Bono, Christina Rueckert, Antonio Baldi, Sebastiano D'Anna, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars‐Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, and Valeria Caso

Subjects
atrial fibrillation, hemorrhagic transformation, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3–8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0–6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24–2.35). Conclusions In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.

Published
2018
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2. Anticoagulation After Stroke in Patients With Atrial Fibrillation

Author

Francesca Guideri, Martina Giuntini, Luca Masotti, Sung Il Sohn, László Csiba, Marta Bellesini, Ludovica Anna Cimini, Lars-Peder Pallesen, Michele Venti, Walter Ageno, Efstathia Karagkiozi, Davide Imberti, Leonardo Ulivi, Alessandro Padovani, Giancarlo Agnelli, Giovanni Orlandi, Danilo Toni, Gianni Lorenzini, Alfonso Ciccone, Dirk Deleu, Licia Denti, Federica Letteri, Giorgio Bono, Karen L. Furie, Vieri Vannucchi, Miriam Maccarrone, Cecilia Becattini, Theodore Karapanayiotides, Domenico Consoli, Monica Carletti, Jukka Putaala, Cataldo D'Amore, Nicola Mumoli, Maria Chondrogianni, Alberto Chiti, Peter Vanacker, Marialuisa Zedde, Michelangelo Mancuso, Boris Doronin, Giorgio Silvestrelli, Vanessa Gourbali, Simona Sacco, Manuel Cappellari, Giuseppe Martini, Christina Rueckert, Faisal Ibrahim, George Ntaios, Serena Monaco, Franco Galati, Antonio Carolei, Alessio Pieroni, Dorjan Zabzuni, Simona Marcheselli, Naveed Akhtar, Prasanna Tadi, Loris Poli, Mario Maimone Baronello, Antonio Baldi, Fabio Bandini, Vera Volodina, George Athanasakis, Yuriy Flomin, Chrysoula Liantinioti, Nicola Giannini, Umberto Scoditti, Elisa Giorli, Gayane Melikyan, Alessandro Pezzini, Alessia Lanari, Andrea Alberti, Konstantinos Makaritsis, Cindy Tiseo, Francesco Corea, Rossana Tassi, Georgios Tsivgoulis, Maria Luisa De Lodovici, Enrico Maria Lotti, Odysseas Kargiotis, Jessica Barlinn, Massimo Del Sette, Konstantinos Vadikolias, Paolo Bovi, Kennedy R. Lees, Riccardo Altavilla, Turgut Tatlisumak, Liisa Tomppo, Maurizio Paciaroni, Lilla Szabó, Alberto Rigatelli, Kristian Barlinn, Monica Acciarresi, Patrik Michel, Tiziana Tassinari, Maurizio Acampa, Maria Giulia Mosconi, Shadi Yaghi, Jessica Fusaro, Valeria Caso, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Gino Gialdini, HUS Neurocenter, Department of Neurosciences, and Neurologian yksikkö

Subjects
anticoagulants, medicine.medical_specialty, LEUKOARAIOSIS, ARTERIAL TERRITORIES, 030204 cardiovascular system & hematology, 3124 Neurology and psychiatry, 03 medical and health sciences, 0302 clinical medicine, atrial fibrillation, humans, incidence, secondary prevention, Internal medicine, medicine, In patient, ACUTE ISCHEMIC-STROKE, Stroke, METAANALYSIS, Cerebral Hemorrhage, RISK, Advanced and Specialized Nursing, Secondary prevention, OUTCOMES, Cardioembolic stroke, Heparin, business.industry, Incidence (epidemiology), Low-Molecular-Weight, 3112 Neurosciences, Atrial fibrillation, HUMAN BRAIN, medicine.disease, Anticoagulants, Atrial Fibrillation, Heparin, Low-Molecular-Weight, Humans, Secondary Prevention, 3. Good health, Heparin.low molecular weight, 3121 General medicine, internal medicine and other clinical medicine, Cardiology, Human medicine, HEMORRHAGIC TRANSFORMATION, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background and Purpose— Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods— We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results— Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients ( P =0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4–3.7; P P =0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2–4.9; P =0.01) end points separately. Conclusions— Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.

Published
2019
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3. Anticoagulation After Stroke in Patients With Atrial Fibrillation

Author

Riccardo, Altavilla, Valeria, Caso, Fabio, Bandini, Giancarlo, Agnelli, Georgios, Tsivgoulis, Shadi, Yaghi, Karen L, Furie, Prasanna, Tadi, Cecilia, Becattini, Marialuisa, Zedde, Azmil H, Abdul-Rahim, Kennedy R, Lees, Andrea, Alberti, Michele, Venti, Monica, Acciarresi, Cataldo, D'Amore, Maria Giulia, Mosconi, Ludovica, Anna Cimini, Jessica, Fusaro, Paolo, Bovi, Monica, Carletti, Alberto, Rigatelli, Manuel, Cappellari, Jukka, Putaala, Liisa, Tomppo, Turgut, Tatlisumak, Simona, Marcheselli, Alessandro, Pezzini, Loris, Poli, Alessandro, Padovani, Luca, Masotti, Vieri, Vannucchi, Sung-Il, Sohn, Gianni, Lorenzini, Rossana, Tassi, Francesca, Guideri, Maurizio, Acampa, Giuseppe, Martini, George, Ntaios, George, Athanasakis, Konstantinos, Makaritsis, Efstathia, Karagkiozi, Konstantinos, Vadikolias, Chrysoula, Liantinioti, Maria, Chondrogianni, Nicola, Mumoli, Domenico, Consoli, Franco, Galati, Simona, Sacco, Antonio, Carolei, Cindy, Tiseo, Francesco, Corea, Walter, Ageno, Marta, Bellesini, Giorgio, Silvestrelli, Alfonso, Ciccone, Alessia, Lanari, Umberto, Scoditti, Licia, Denti, Michelangelo, Mancuso, Miriam, Maccarrone, Leonardo, Ulivi, Giovanni, Orlandi, Nicola, Giannini, Gino, Gialdini, Tiziana, Tassinari, Maria Luisa, De Lodovici, Giorgio, Bono, Christina, Rueckert, Antonio, Baldi, Sebastiano, D'Anna, Danilo, Toni, Federica, Letteri, Martina, Giuntini, Enrico, Maria Lotti, Yuriy, Flomin, Alessio, Pieroni, Odysseas, Kargiotis, Theodore, Karapanayiotides, Serena, Monaco, Mario, Maimone Baronello, Laszló, Csiba, Lilla, Szabó, Alberto, Chiti, Elisa, Giorli, Massimo, Del Sette, Davide, Imberti, Dorjan, Zabzuni, Boris, Doronin, Vera, Volodina, Patrik, Michel, Peter, Vanacker, Kristian, Barlinn, Lars-Peder, Pallesen, Jessica, Barlinn, Dirk, Deleu, Gayane, Melikyan, Faisal, Ibrahim, Naveed, Akhtar, Vanessa, Gourbali, and Maurizio, Paciaroni

Subjects
Stroke, anticoagulants, atrial fibrillation, humans, incidence, secondary prevention, Heparin, Low-Molecular-Weight, Cerebral Hemorrhage
Abstract

Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2-4.9; P=0.01) end points separately. Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.

Published
2019

4. Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

Author

Umberto Scoditti, Suzette Remillard, Maria Giulia Mosconi, Serena Monaco, Giancarlo Agnelli, Maurizio Paciaroni, Dorjan Zabzuni, Boris Doronin, Giorgio Bono, Simona Sacco, Ulf Bodechtel, Simona Marcheselli, Maria Luisa De Lodovici, Kennedy R. Lees, Alessio Pieroni, Lilla Szabó, Gianni Lorenzini, Cecilia Becattini, Nicola Falocci, Tiziana Tassinari, Jukka Putaala, Peter Vanacker, László Csiba, Giovanni Orlandi, Maria Cordier, Giuseppe Martini, Danilo Toni, Domenico Consoli, Christina Rueckert, Davide Imberti, Chrissoula Liantinioti, Monica Acciarresi, Paolo Costa, Sung Il Sohn, Monica Carletti, Dirk Deleu, Johannes Gerber, Francesca Guideri, Paolo Bovi, Rossana Tassi, Luca Masotti, Alberto Chiti, Licia Denti, Valeria Caso, Georgios Tsivgoulis, Antonio Baldi, Naveed Akhtar, Massimo Del Sette, Alberto Rigatelli, Kristian Barlinn, Cindy Tiseo, Franco Galati, Antonio Carolei, Andrea Morotti, Alessandro Pezzini, Francesco Corea, Patrik Michel, Vera Volodina, Cataldo D'Amore, Lars-Peder Pallesen, Andrea Alberti, Faisal Ibrahim, Mario Maimone Baronello, Jessica Kepplinger, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Michele Venti, Walter Ageno, Gino Gialdini, Kostantinos Vadikolias, Gayane Melikyan, Turgut Tatlisumak, Alessandro Padovani, Neurologian yksikkö, Department of Neurosciences, Clinicum, University of Helsinki, and HUS Neurocenter

Subjects
Male, atrial fibrillation, CHA, 2, DS, VASc score, Ischemic stroke, outcome, scores, severity, Aged, Aged, 80 and over, Area Under Curve, Asia, Atrial Fibrillation, Chi-Square Distribution, Disability Evaluation, Europe, Female, Humans, Linear Models, Logistic Models, Magnetic Resonance Imaging, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Risk Factors, Severity of Illness Index, Stroke, Time Factors, Tomography, X-Ray Computed, Decision Support Techniques, CHA2DS2-VASc score, Surgery, Rehabilitation, Neurology (clinical), Cardiology and Cardiovascular Medicine, ARTERIAL TERRITORIES, 030204 cardiovascular system & hematology, Logistic regression, CHADS(2), 3124 Neurology and psychiatry, 0302 clinical medicine, Modified Rankin Scale, 80 and over, Medicine, Elméleti orvostudományok, ACUTE ISCHEMIC-STROKE, Prospective cohort study, Tomography, OUTCOMES, Area under the curve, Atrial fibrillation, Orvostudományok, HUMAN BRAIN, X-Ray Computed, CHA(2)DS(2)-VASc score, Cardiology, medicine.medical_specialty, education, macromolecular substances, 03 medical and health sciences, Internal medicine, cardiovascular diseases, ischemic stroke, surgery, rehabilitation, neurology (clinical), cardiology and cardiovascular medicine, Receiver operating characteristic, business.industry, 3112 Neurosciences, medicine.disease, 3121 General medicine, internal medicine and other clinical medicine, CHA2DS2–VASc score, Physical therapy, Human medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose: The aim of this study was to investigate for a possible association between both prestroke CHA(2)DS(2)-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). Methods: This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS >= 10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS = 3). Multiple logistic regression was used to correlate prestroke CHA(2)DS(2)-VASc and severity of stroke, as well as disability and mortality at 90 days. Results: Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS >= 3. A linear correlation was found between the prestroke CHA(2)DS(2)-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA(2)DS(2)-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS = 3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA(2)DS(2)-VASc score and lesion size. Conclusions: In patients with AF, in addition to the risk of stroke, a high CHA(2)DS(2)-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.

Published
2017

5. Serum Interleukin-10 Levels Correlate with Cerebrospinal Fluid Amyloid Beta Deposition in Alzheimer Disease Patients

Author

Lucio D'Anna, Nova Sanvilli, Mariarosaria Valente, Francesco Curcio, Samir Abu-Rumeileh, Cinzia Pistis, Martina Fabris, Sebastiano D'Anna, Gian Luigi Gigli, and Antonio Baldi

Subjects
0301 basic medicine, Male, Vascular Endothelial Growth Factor A, Pathology, medicine.medical_specialty, Amyloid beta, Statistics as Topic, Inflammation, tau Proteins, Disease, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Alzheimer Disease, medicine, Humans, Neuroinflammation, Aged, Retrospective Studies, Aged, 80 and over, Amyloid beta-Peptides, biology, business.industry, Middle Aged, medicine.disease, Peptide Fragments, Interleukin 10, 030104 developmental biology, Neurology, biology.protein, Cytokines, Female, Neurology (clinical), Independent Living, Alzheimer's disease, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Background and Objective: In Alzheimer disease (AD) inflammation becomes evident throughout the course of the disease. However, the association between inflammation, cognitive impairment, and cerebrospinal biomarkers (Aβ42, t-tau, p-tau181, and Aβ42/p-tau181 ratio) is poorly understood. Methods: A large panel of inflammatory cytokines (interleukin [IL]-1β, IL-1ra, IL-2, IL-4, IL-6, IL-10, IL-17, interferon-γ, tumor necrosis factor-α, and vascular endothelial growth factor) was analyzed using a multiplex immunoassay in 27 patients with a diagnosis of AD dementia and in 18 control subjects. In a subgroup with available cerebrospinal fluid (CSF) samples, cytokines in serum were correlated with the levels of neurodegenerative CSF biomarkers (Aβ42, t-tau, p-tau181, and Aβ42/p-tau181 ratio). Results: Compared to control subjects, AD patients showed a significant upregulation of IL-10, IL-1β, and IL-17 serum levels. Several cytokines appeared intercorrelated, and IL-10 in particular presented a significant inverse correlation with CFS levels of Aβ42 and the Aβ42/p-tau ratio. Conclusion: Our findings indicate that serum levels of IL-10 may represent a possible peripheral expression of amyloid beta deposition in AD patients.

Published
2016

6. Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

Author

Francesca Guideri, Martina Giuntini, Luca Masotti, Alessandro Padovani, Danilo Toni, Maria Chondrogianni, Monica Carletti, Cecilia Becattini, Dorjan Zabzuni, Loris Poli, Theodore Karapanayiotides, Monica Acciarresi, Antonio Procopio, Giuseppe Martini, Giovanni Orlandi, Maurizio Acampa, Nicola Falocci, Vieri Vannucchi, Valeria Caso, Cindy Tiseo, Enrico Maria Lotti, László Csiba, Giancarlo Agnelli, Michelangelo Mancuso, Giorgio Bono, Lilla Szabó, Antonio Baldi, Serena Monaco, Jukka Putaala, Faisal Ibrahim, Dirk Deleu, Prasanna Tadi, Yuriy Flomin, Miriam Maccarrone, Georgios Tsivgoulis, Kennedy R. Lees, George Ntaios, Massimo Del Sette, Alberto Rigatelli, Kristian Barlinn, Naveed Akhtar, Jessica Kepplinger, Simona Sacco, Fabio Bandini, Vera Volodina, Lars-Peder Pallesen, Rossana Tassi, Odysseas Kargiotis, Peter Vanacker, Tiziana Tassinari, Nicola Giannini, Christina Rueckert, Ulf Bodechtel, Elisa Giorli, Simona Marcheselli, Efstathia Karagkiozi, Davide Imberti, Michele Venti, Walter Ageno, Chrysoula Liantinioti, Kostantinos Vadikolias, Alfonso Ciccone, Federica Letteri, Domenico Consoli, Andrea Alberti, Turgut Tatlisumak, Marialuisa Zedde, Vanessa Gourbali, Alberto Chiti, Manuel Cappellari, Cataldo D'Amore, Alessandro Pezzini, Francesco Corea, Maurizio Paciaroni, Liisa Tomppo, Giorgio Silvestrelli, Gayane Melikyan, Gianni Lorenzini, K. Makaritsis, Paolo Bovi, Marta Bellesini, Patrik Michel, Ludovica Anna Cimini, Alessio Pieroni, Shadi Yaghi, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Gino Gialdini, Licia Denti, Nicola Mumoli, Mario Maimone Baronello, Maria Luisa De Lodovici, Sung Il Sohn, Johannes Gerber, Giovanna Colombo, Boris Doronin, Karen L. Furie, Franco Galati, Antonio Carolei, Maria Giulia Mosconi, George Athanasakis, and Umberto Scoditti

Subjects
Male, medicine.medical_specialty, atrial fibrillation, myocardial infarction, risk stratification, stroke, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Internal medicine, Thromboembolism, Atrial Fibrillation, 80 and over, Medicine, Humans, Myocardial infarction, Aged, Aged, 80 and over, Anticoagulants, Female, Ischemic Attack, Transient, Prospective Studies, Stroke, Warfarin, Prospective cohort study, Advanced and Specialized Nursing, business.industry, Ischemic Attack, Transient, Neurology (clinical), Cardiology and Cardiovascular Medicine, atrial fibrillation, myocardial infarction, risk stratification, stroke, Atrial fibrillation, medicine.disease, Cardiology, Observational study, Human medicine, business, Risk assessment, Complication, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background and Purposes— This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods— The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08–2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P =0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30–1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632–0.763; P =0.0001) for ischemic outcome events and 0.585 (0.493–0.678; P =0.10) for major bleedings. Results— The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529–0.763; P =0.009) for ischemic outcome events and 0.407 (0.275–0.540; P =0.14) for hemorrhagic outcome events. Conclusions— In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.

Published
2016

7. Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Author

Domenico Consoli, Alberto Chiti, Antonio Baldi, Massimo Del Sette, Alessandro Padovani, Cecilia Becattini, Kostantinos Vadikolias, Vera Volodina, Patrik Michel, Chrissoula Liantinioti, Davide Imberti, Naveed Akhtar, Cataldo D'Amore, Umberto Scoditti, Simona Sacco, Dirk Deleu, Michele Venti, Walter Ageno, Cindy Tiseo, Serena Monaco, Turgut Tatlisumak, Paolo Bovi, Valeria Caso, Francesca Guideri, Ulf Bodechtel, Luca Masotti, Faisal Ibrahim, Sebastiano D'Anna, Dorjan Zabzuni, Loris Poli, Azmil H. Abdul-Rahim, Kennedy R. Lees, Boris Doronin, Gino Gialdini, Lilla Szabó, Gayane Melikyan, Alberto Rigatelli, Kristian Barlinn, Giuseppe Martini, Alessio Pieroni, Tiziana Tassinari, Andrea Alberti, Nicola Falocci, Gianni Lorenzini, Jessica Kepplinger, Peter Vanacker, Maria Giulia Mosconi, Lars-Peder Pallesen, Christina Rueckert, Monica Acciarresi, Mario Maimone Baronello, Suzette Remillard, Danilo Toni, Rossana Tassi, Monica Carletti, Maurizio Paciaroni, Simona Marcheselli, Giancarlo Agnelli, László Csiba, Giorgio Bono, Jukka Putaala, Georgios Tsivgoulis, Johannes Gerber, Alessandro Pezzini, Francesco Corea, Giovanni Orlandi, Maria Cordier, Franco Galati, Antonio Carolei, Maria Luisa De Lodovici, Sung Il Sohn, and Licia Denti

Subjects
Male, medicine.medical_specialty, Neurology, Atrial enlargement, 030204 cardiovascular system & hematology, Klinikai orvostudományok, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, Internal medicine, medicine, Left atrial enlargement, Secondary Prevention, Humans, Acute stroke, cardiovascular diseases, Stroke, Neuroradiology, Aged, Acute stroke, Atrial fibrillation, Echocardiography, Outcome, Outcome, business.industry, Atrial fibrillation, Orvostudományok, medicine.disease, Prognosis, Thrombosis, Echocardiography, Atrial Fibrillation, Female, Neurology (clinical), Cardiology, Human medicine, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 +/- A 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06-4.29, p = 0.033) and CHA(2)DS(2)-VASc score (OR 1.22; 95 % CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

Published
2016

8. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Author

László Csiba, Francesca Guideri, Luca Masotti, Davide Imberti, Sokratis G. Papageorgiou, Dorjan Zabzuni, Giancarlo Agnelli, Loris Poli, Sebastiano D'Anna, Azmil H. Abdul-Rahim, Gino Gialdini, Umberto Scoditti, Giorgio Bono, Naveed Akhtar, Gianni Lorenzini, Alessandro Padovani, Dirk Deleu, Serena Monaco, Nicola Falocci, Cecilia Becattini, Jukka Putaala, Simona Sacco, Patrik Michel, Alberto Rigatelli, Kristian Barlinn, Maria Luisa De Lodovici, Gayane Melikyan, Ulf Bodechtel, Georgios Tsivgoulis, Boris Doronin, Cindy Tiseo, Monica Acciarresi, Alessandro Pezzini, Lilla Szabó, Rossana Tassi, Francesco Corea, Giovanni Orlandi, Maria Giulia Mosconi, Maria Cordier, Paolo Bovi, Licia Denti, Valeria Caso, Turgut Tatlisumak, Sung Il Sohn, Simona Marcheselli, Alessio Pieroni, Mario Maimone Baronello, Suzette Remillard, Maurizio Paciaroni, Danilo Toni, Cataldo D'Amore, Kateryna Antonenko, Monica Carletti, Antonio Baldi, Peter Vanacker, Christina Rueckert, Kennedy R. Lees, Michele Venti, Walter Ageno, Andrea Alberti, Lars-Peder Pallesen, Tiziana Tassinari, Johannes Gerber, Faisal Ibrahim, Domenico Consoli, Jessica Kepplinger, Kostantinos Vadikolias, Alberto Chiti, Massimo Del Sette, Vera Volodina, Franco Galati, Antonio Carolei, and Giuseppe Martini

Subjects
medicine.medical_specialty, anticoagulation therapy, atrial fibrillation, ischemic stroke, secondary prevention, Sex differences, stroke outcome, Early Recurrence, Internal medicine, Original Research Articles, Medicine, In patient, cardiovascular diseases, Risk factor, Acute ischemic stroke, Stroke, Fibrillation, business.industry, Atrial fibrillation, medicine.disease, Cardiology, Neurology (clinical), medicine.symptom, Cardiology and Cardiovascular Medicine, business, Cerebral Bleeding
Abstract

Introduction Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes. Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable outcome, 3–6 unfavorable outcome). Results Of the 1029 patients enrolled, 561 were women (54.5%) ( p Conclusions Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes.

Published
2016

9. Seizures With Prolonged EEG Abnormalities During an Attack of Migraine Without Aura

Author

Giovanni Merlino, Sebastiano D'Anna, Mariarosaria Valente, and Gian Luigi Gigli

Subjects
Male, Migraine without Aura, Adolescent, medicine.diagnostic_test, business.industry, Aura, Electroencephalography, Neurological disorder, medicine.disease, Magnetic Resonance Imaging, Migraine with aura, Central nervous system disease, Epilepsy, Neurology, Migraine, Anesthesia, Migralepsy, Humans, Medicine, Epilepsy, Generalized, Neurology (clinical), medicine.symptom, business
Abstract

The term "migralepsy" indicates a particular condition in which seizures occur during a migraine attack. Several cases of seizures associated with migraine with aura and characterized by transient MRI abnormalities have been published. We report the case of a patient who presented 2 generalized seizures during an attack of migraine without aura and with a transient, diffuse, irregular, high voltage slow activity without clear epileptiform abnormalities in subsequent EEG recordings.

Published
2007
Full Text
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10. Prestroke CHA

Author

Monica, Acciarresi, Maurizio, Paciaroni, Giancarlo, Agnelli, Nicola, Falocci, Valeria, Caso, Cecilia, Becattini, Simona, Marcheselli, Christina, Rueckert, Alessandro, Pezzini, Andrea, Morotti, Paolo, Costa, Alessandro, Padovani, Laszló, Csiba, Lilla, Szabó, Sung-Il, Sohn, Tiziana, Tassinari, Azmil H, Abdul-Rahim, Patrik, Michel, Maria, Cordier, Peter, Vanacker, Suzette, Remillard, Andrea, Alberti, Michele, Venti, Cataldo, D'Amore, Umberto, Scoditti, Licia, Denti, Giovanni, Orlandi, Alberto, Chiti, Gino, Gialdini, Paolo, Bovi, Monica, Carletti, Alberto, Rigatelli, Jukka, Putaala, Turgut, Tatlisumak, Luca, Masotti, Gianni, Lorenzini, Rossana, Tassi, Francesca, Guideri, Giuseppe, Martini, Georgios, Tsivgoulis, Kostantinos, Vadikolias, Chrissoula, Liantinioti, Francesco, Corea, Massimo, Del Sette, Walter, Ageno, Maria Luisa, De Lodovici, Giorgio, Bono, Antonio, Baldi, Sebastiano, D'Anna, Simona, Sacco, Antonio, Carolei, Cindy, Tiseo, Davide, Imberti, Dorjan, Zabzuni, Boris, Doronin, Vera, Volodina, Domenico, Consoli, Franco, Galati, Alessio, Pieroni, Danilo, Toni, Serena, Monaco, Mario Maimone, Baronello, Kristian, Barlinn, Lars-Peder, Pallesen, Jessica, Kepplinger, Ulf, Bodechtel, Johannes, Gerber, Dirk, Deleu, Gayane, Melikyan, Faisal, Ibrahim, Naveed, Akhtar, Maria Giulia, Mosconi, and Kennedy R, Lees

Subjects
Male, Asia, Time Factors, Risk Assessment, Severity of Illness Index, Decision Support Techniques, Disability Evaluation, Predictive Value of Tests, Risk Factors, Atrial Fibrillation, Odds Ratio, Humans, Prospective Studies, Aged, Aged, 80 and over, Chi-Square Distribution, Prognosis, Magnetic Resonance Imaging, Europe, Stroke, Logistic Models, ROC Curve, Area Under Curve, Multivariate Analysis, Linear Models, Female, Tomography, X-Ray Computed
Abstract

The aim of this study was to investigate for a possible association between both prestroke CHAThis prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHAOf the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHAIn patients with AF, in addition to the risk of stroke, a high CHA

Published
2015

11. Risk of Guillain-Barré syndrome after 2010–2011 influenza vaccination

Author

Galeotti F, Massari M, Beghi E, Chiò A, Logroscino G, Filippini G, Benedetti MD, Pugliatti M, Santuccio C, Raschetti R, The ITANG study Group [Clinical research assistants: Sara Marconi, Giorgia Giussani, Enrica Bersano, Umberto Manera, Stefano Zoccolella, Antonio Leo, Roberta Barki, Marco Turatti, Stefania Leoni, Steering committee of the study: Ettore Beghi, Maria Donata Benedetti, Andrea Calvo, Adriano Chiò, Roberto D’Alessandro, Fernanda Ferrazin, Graziella Filippini, Giancarlo Logroscino, Giampiero Mazzaglia, Maura Pugliatti, Roberto Raschetti, Carmela Santuccio, Loriana Tartaglia, Francesco Trotta, Clinical centers, co investigators: E. Romagna: Roberto MICHELUCCI, Patrizia RIGUZZI, Tommaso SACQUEGNA, Anna Maria BORGHI, Vittoria MUSSUTO, Patrizia DE MASSIS, Rita Rinaldi, Walter NERI, Carlo GUIDI, Maria Rosaria TOLA, Enrico GRANIERI, Valentina SIMIONI, Paolo NICHELLI, Jessica MANDRIOLI, Donata GUIDETTI, Emilio TERLIZZI, Mario Giovanni TERZANO, Giovanni PAVESI, Fabrizio RASI, Claudio CALLEGARINI, Norina MARCELLO, Massimo BONDAVALLI, Alessandro RAVASIO, Marco CURRÒ DOSSI, Annamaria MAURO, Chiara MINARDI, Gabriele GRECO, Stefano AMIDEI, Enrico MONTANARI, Doriana MEDICI, Lombardy: Tommaso RICCARDI, Elisabetta D’ADDA, Luigi BETTONI, Luciano ABRUZZI, Elio AGOSTONI, Francesco BASSO, Andrea MAGNONI, Vittorio CRESPI, Maria REPACI, Antonella CHELDI, Mariagrazia BELLOTTI, Carlo FERRARESE, Natale Augusto CURTÒ, Giovanni MEOLA, Giuseppe ROTONDO, Eduardo NOBILE ORAZIO, Fabrizia TERENGHI, Franco SASANELLI, Alessio GALBUSSERA, Marco MATTIOLI, Marco TIRITICCO, Caterina NASCIMBENE, Alessandra VANOTTI, Stefano JANN, Luisa DE TONI FRANCESCHINI, Vincenzo SILANI, Nicola TICOZZI, Giancarlo COMI, Raffaella FAZIO, Patrizia PERRONE, Andrea GIORGETTI, Alessandro ROMORINI, Pietro BASSI, Domenico SANTORO, Nereo BRESOLIN, Simone TONIETTI, Massimo SUARDELLI, Giacomo BEZZI, Daria BALDINI, Angelo Maurizio CLERICI, Giuseppina CAFASSO, Daniele PORAZZI, Isidoro LA SPINA, Giampiero GRAMPA, Davide ZARCONE, Michele PERINI, Marco POLONI, Emanuela AGAZZI, Massimiliano FILOSTO, Alessandro PADOVANI, Renato BESANA, Edoardo DONATI, Eugenio MAGNI, Marco ARNABOLDI, Vincenzo BELCASTRO, Mario GUIDOTTI, Raffaella CLERICI, Maurizio RIVA, Eugenio VITELLI, Paolo PREVIDI, Giuseppe MICIELI, Elisa CANDELORO, Carlo DALLOCCHIO, Carla ARBASINO, Piedmont: Andrea CALVO: Scdu Neurologia 4—AOU S. Giovanni Battista, Cristina MOGLIA: Scdu Neurologia 4—AOU S. Giovanni Battista, Marco VERCELLINO, Bruno FERRERO, Pietro PIGNATTA, Enrico ODDENINO, Daniele IMPERIALE, Daniela LEOTTA, Maurizio GIONCO, Carlo RAVETTI, Roberto CAVALLO, Nicoletta Di Vito, Claudio GEDA, Simona BORTOLOTTO, Emilio LUDA DI CORTEMIGLIA, Giovanna LIOTTA, Emilio URSINO, Mario PALERMO, Luca AMBROGIO, Piero MEINERI, Michele DOTTA, Paolo GHIGLIONE, Joseph MAISTRELLI, Susana ONORATO, Maurizio LEONE, Diego Maria PAPURELLO, Angelo VILLANI, Roberto CONTI, Franco COPPO, Fabiana TESSER, Lucia Testa, Silvia Isabella Cattaneo, Maria Teresa Penza, Graziano Gusmaroli, Katia Savio, Franco Perla, Fabrizio Pisano, Fabio Poglio, Luca Pradotto, Valle d’Aosta: Edo Fausto BOTTACCHI, Puglia: Paolo LIVREA, Francesco FEDERICO, Maria TROJANO, Vito COVELLI, Bruno MAGGIO, Vito SANTAMATO, Bruno PASSARELLA, Giovanni ZIMATORE, Giorgio TRIANNI, Gerardo CIARDO, Salvatore INTERNO’, Veneto: Corrado MARCHINI, Sandro ZAMBITO MARSALA, Giorgio MICHIELI, Carlo BORSATO, Giuseppe DIDONÈ, Emma FRASSON, Alberto POLO, Vincenza ARGENTIERO, Vincenzo ROMEO, Novenia PERLOTTO, Roberto L’ERARIO, Gianfranco MICAGLIO, Tiziana ROSSO, Sandro BRUNO, Bruno GIOMETTO, Mirco SERENA, Rocco QUATRALE, Ernesto GASTALDO, Francesco PERINI, Michele DILEONE, Alessandro CASANO, Lauretta SILVESTRI, Alessandro BURLINA, Virginia MUNERATI, Sebastiano D’Anna, Flavio SANSON, Valeria SARTORI, Giuseppe MORETTO, Giovanna SQUINTANI, Salvatore MONACO, Maria Donata BENEDETTI, Simone FUSINA, Claudio BIANCONI, Fabiana PIMAZZONI, Angela BONOMETTI, Giampietro ZANETTE, Marco TURATTI, Sardinia: Stefania LEONI, Giuseppe MURA, Anna TICCA, Piernicola MARCHI, Davide MANCA], D'ALESSANDRO, ROBERTO, CIRIGNOTTA, FABIO, Galeotti F, Massari M, D'Alessandro R, Beghi E, Chiò A, Logroscino G, Filippini G, Benedetti MD, Pugliatti M, Santuccio C, Raschetti R, The ITANG study Group [Clinical research assistants: Sara Marconi, Giorgia Giussani, Enrica Bersano and Umberto Manera, Stefano Zoccolella and Antonio Leo, Roberta Barki, Marco Turatti, Stefania Leoni, Steering committee of the study: Ettore Beghi, Maria Donata Benedetti, Andrea Calvo and Adriano Chiò, Roberto D’Alessandro, Fernanda Ferrazin, Graziella Filippini, Giancarlo Logroscino, Giampiero Mazzaglia, Maura Pugliatti, Roberto Raschetti, Carmela Santuccio, Loriana Tartaglia and Francesco Trotta, Clinical centers and co-investigators: E. Romagna: Roberto MICHELUCCI, Patrizia RIGUZZI, Tommaso SACQUEGNA, Anna Maria BORGHI, Vittoria MUSSUTO, Patrizia DE MASSIS, Fabio CIRIGNOTTA, Rita Rinaldi, Walter NERI, Carlo GUIDI, Maria Rosaria TOLA, Enrico GRANIERI, Valentina SIMIONI, Paolo NICHELLI, Jessica MANDRIOLI, Donata GUIDETTI, Emilio TERLIZZI, Mario Giovanni TERZANO, Giovanni PAVESI, Fabrizio RASI, Claudio CALLEGARINI, Norina MARCELLO, Massimo BONDAVALLI, Alessandro RAVASIO, Marco CURRÒ DOSSI, Annamaria MAURO, Chiara MINARDI, Gabriele GRECO, Stefano AMIDEI, Enrico MONTANARI, Doriana MEDICI, Lombardy: Tommaso RICCARDI, Elisabetta D’ADDA, Luigi BETTONI, Luciano ABRUZZI, Elio AGOSTONI, Francesco BASSO, Andrea MAGNONI, Vittorio CRESPI, Maria REPACI, Antonella CHELDI, Mariagrazia BELLOTTI, Carlo FERRARESE, Natale Augusto CURTÒ, Giovanni MEOLA, Giuseppe ROTONDO, Eduardo NOBILE-ORAZIO, Fabrizia TERENGHI, Franco SASANELLI, Alessio GALBUSSERA, Marco MATTIOLI, Marco TIRITICCO, Caterina NASCIMBENE, Alessandra VANOTTI, Stefano JANN, Luisa DE TONI FRANCESCHINI, Vincenzo SILANI, Nicola TICOZZI, Giancarlo COMI, Raffaella FAZIO, Patrizia PERRONE, Andrea GIORGETTI, Alessandro ROMORINI, Pietro BASSI, Domenico SANTORO, Nereo BRESOLIN, Simone TONIETTI, Massimo SUARDELLI, Giacomo BEZZI, Daria BALDINI, Angelo Maurizio CLERICI, Giuseppina CAFASSO, Daniele PORAZZI, Isidoro LA SPINA, Giampiero GRAMPA, Davide ZARCONE, Michele PERINI, Marco POLONI, Emanuela AGAZZI, Massimiliano FILOSTO, Alessandro PADOVANI, Renato BESANA, Edoardo DONATI, Eugenio MAGNI, Marco ARNABOLDI, Vincenzo BELCASTRO, Mario GUIDOTTI, Raffaella CLERICI, Maurizio RIVA, Eugenio VITELLI, Paolo PREVIDI, Giuseppe MICIELI, Elisa CANDELORO, Carlo DALLOCCHIO, Carla ARBASINO, Piedmont: Andrea CALVO: Scdu Neurologia 4—AOU S. Giovanni Battista, Cristina MOGLIA: Scdu Neurologia 4—AOU S. Giovanni Battista, Marco VERCELLINO, Bruno FERRERO, Pietro PIGNATTA, Enrico ODDENINO, Daniele IMPERIALE, Daniela LEOTTA, Maurizio GIONCO, Carlo RAVETTI, Roberto CAVALLO, Nicoletta Di Vito, Claudio GEDA, Simona BORTOLOTTO, Emilio LUDA DI CORTEMIGLIA, Giovanna LIOTTA, Emilio URSINO, Mario PALERMO, Luca AMBROGIO, Piero MEINERI, Michele DOTTA, Paolo GHIGLIONE, Joseph MAISTRELLI, Susana ONORATO, Maurizio LEONE, Diego Maria PAPURELLO, Angelo VILLANI, Roberto CONTI, Franco COPPO, Fabiana TESSER, Lucia Testa, Silvia Isabella Cattaneo, Maria Teresa Penza, Graziano Gusmaroli, Katia Savio, Franco Perla, Fabrizio Pisano, Fabio Poglio, Luca Pradotto, Valle d’Aosta: Edo Fausto BOTTACCHI, Puglia: Paolo LIVREA, Francesco FEDERICO, Maria TROJANO, Vito COVELLI, Bruno MAGGIO, Vito SANTAMATO, Bruno PASSARELLA, Giovanni ZIMATORE, Giorgio TRIANNI, Gerardo CIARDO, Salvatore INTERNO’, Veneto: Corrado MARCHINI, Sandro ZAMBITO MARSALA, Giorgio MICHIELI, Carlo BORSATO, Giuseppe DIDONÈ, Emma FRASSON, Alberto POLO, Vincenza ARGENTIERO, Vincenzo ROMEO, Novenia PERLOTTO, Roberto L’ERARIO, Gianfranco MICAGLIO, Tiziana ROSSO, Sandro BRUNO, Bruno GIOMETTO, Mirco SERENA, Rocco QUATRALE, Ernesto GASTALDO, Francesco PERINI, Michele DILEONE, Alessandro CASANO, Lauretta SILVESTRI, Alessandro BURLINA, Virginia MUNERATI, Sebastiano D’Anna, Flavio SANSON, Valeria SARTORI, Giuseppe MORETTO, Giovanna SQUINTANI, Salvatore MONACO, Maria Donata BENEDETTI, Simone FUSINA, Claudio BIANCONI, Fabiana PIMAZZONI, Angela BONOMETTI, Giampietro ZANETTE, Marco TURATTI, Sardinia: Stefania LEONI, Giuseppe MURA, Anna TICCA, Piernicola MARCHI, Davide MANCA], Galeotti, F, Massari, M, D'Alessandro, R, Beghi, E, Chiò, A, Logroscino, G, Filippini, G, Benedetti, M, Pugliatti, M, Santuccio, C, Raschetti, R, Ferrarese, C, Benedetti, Md, ITANG study, Group, and Giometto, B

Subjects
Male, Epidemiology, Pharmaco-Epidemiology, medicine.disease_cause, MED/26 Neurologia, Influenza A Virus, H1N1 Subtype, Risk Factors, Influenza A virus, Odds Ratio, influenza vaccination, Guillain-Barré Syndrome, Case–control study, self controlled case series, Prospective Studies, Case-control study, Guillain-Barrè Syndrome, Influenza vaccination, Self controlled case series, Aged, 80 and over, Guillain-Barre syndrome, Respiratory tract infections, Incidence (epidemiology), Incidence, Middle Aged, Vaccination, Guillain-Barrè, epidemic risk , gastrointestinal and respiratory infections, Italy, Influenza Vaccines, Population Surveillance, Regression Analysis, Female, Settore MED/26 - Neurologia, Adult, medicine.medical_specialty, Guillain-Barre Syndrome, Mass Vaccination, NO, Internal medicine, Influenza, Human, medicine, Humans, Pandemics, Aged, business.industry, Odds ratio, medicine.disease, Relative risk, Case-Control Studies, Immunology, Attributable risk, business
Abstract

Influenza vaccination has been implicated in Guillain Barre Syndrome (GBS) although the evidence for this link is controversial. A case–control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case–control analysis and a self-controlled case series analysis (SCCS). Case–control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.

Published
2013

12. Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study

Author

Kennedy R. Lees, Alessandro Pezzini, Francesco Corea, Tiziana Tassinari, Lars-Peder Pallesen, Suzette Remillard, Maria Cordier, Cecilia Becattini, Maria Luisa De Lodovici, Peter Vanacker, Alessandro Padovani, Simona Marcheselli, Maurizio Paciaroni, Christina Rueckert, Domenico Consoli, Serena Monaco, Sung Il Sohn, Cindy Tiseo, Cataldo D'Amore, Johannes Gerber, Alberto Chiti, Vera Volodina, Kostantinos Vadikolias, Paolo Bovi, Massimo Del Sette, Licia Denti, Dorjan Zabzuni, Loris Poli, Faisal Ibrahim, Nicola Falocci, Andrea Alberti, Michele Venti, Walter Ageno, Giancarlo Agnelli, Franco Galati, Antonio Carolei, Antonio Baldi, Mario Maimone Baronello, Valentina Bubba, Danilo Toni, Giorgio Bono, Jessica Kepplinger, Gianni Lorenzini, Gayane Melikyan, Monica Carletti, Jukka Putaala, Ilenia Silvestri, Chrissoula Liantinioti, Giovanni Orlandi, Dirk Deleu, Turgut Tatlisumak, Sebastiano D'Anna, Rossana Tassi, Alessio Pieroni, Davide Imberti, Azmil H. Abdul-Rahim, Gino Gialdini, Giuseppe Martini, Valeria Caso, Naveed Akhtar, Lilla Szabó, Francesca Guideri, Luca Masotti, Monica Acciarresi, Umberto Scoditti, Maria Giulia Mosconi, Boris Doronin, Patrik Michel, Simona Sacco, Ulf Bodechtel, Alberto Rigatelli, Kristian Barlinn, László Csiba, and Georgios Tsivgoulis

Subjects
Male, Time Factors, Brain Ischemia, Brain ischemia, Cohort Studies, Recurrence, Risk Factors, Atrial Fibrillation, 80 and over, hemorrhagic stroke, Prospective Studies, Prospective cohort study, Stroke, anticoagulant therapy, atrial fibrillation, ischemic stroke, secondary prevention, Aged, Aged, 80 and over, Anticoagulants, Cerebral Hemorrhage, Female, Follow-Up Studies, Humans, Middle Aged, Treatment Outcome, Medicine (all), Atrial fibrillation, Orvostudományok, 3. Good health, Cardiology, Anticoagulant therapy, Hemorrhagic stroke, Ischemic stroke, Secondary prevention, Neurology (clinical), Cardiology and Cardiovascular Medicine, Advanced and Specialized Nursing, Cohort study, medicine.medical_specialty, Klinikai orvostudományok, Anticoagulant therapy, Atrial fibrillation, Hemorrhagic stroke, Ischemic stroke, Secondary prevention, Internal medicine, medicine, business.industry, medicine.disease, Surgery, Human medicine, Cerebral Bleeding, business
Abstract

Background and Purpose— The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. Methods— The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Results— Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA 2 DS 2 -VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30–0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively ( P =0.003). Conclusions— Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA 2 DS 2 -VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants.

Published
2015

13. Brain metastases in colorectal cancer patients: less rare than before

Author

Sebastiano D’Anna, Daniele Bernardi, Micaela Stefani, Alessia Di Giacobbe, and Ottaviano Tomassi

Subjects
Oncology, medicine.medical_specialty, Neurology, business.industry, Colorectal cancer, Brain Neoplasms, Cancer, Dermatology, General Medicine, medicine.disease, Psychiatry and Mental health, Internal medicine, medicine, Humans, Neurology (clinical), Neurosurgery, business, Colorectal Neoplasms, Neuroradiology
Published
2013

14. Auditory dysfunction

Author

Antonio, Baldi, Serena, Tenaglia, and Sebastiano, D'Anna

Subjects
Auditory Pathways, Vertebrobasilar Insufficiency, Humans, Auditory Diseases, Central, Cochlea
Abstract

Hearing impairment, although uncommon, may occur in patients with a vertebrobasilar artery occlusion disease. The pathogenesis may be an ischemic lesion involving the auditory pathways in the pons and midbrain, the cochlear nucleus, cochlear nerve or the cochlea. The AICA and IAA are the main arteries that supply the peripheral audiovestibular structures of the inner ear and central audiovestibular pathways of the middle cerebellar peduncle and lateral pons.

Published
2012

15. Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study

Author

Federica Macellari, Simone Beretta, Mauro Silvestrini, Andrew M. Demchuk, Michele Venti, Danilo Toni, Charlotte Cordonnier, Mascia Nesi, Claudia Trentini, Giovanni Orlandi, Paolo Bovi, Renganayaki Pandurengan, Alessia Lanari, Andrea Alberti, Ioannis Heliopoulos, Rossana Tassi, Simona Marcheselli, Frédéric Dumont, Antonio Baldi, Alessandro Padovani, Serena Monaco, Charitomeni Piperidou, Giuseppe Martini, James C. Grotta, Didier Leys, Elisabetta Traverso, Carlo Ferrarese, Edoardo Donati, Maurizio Paciaroni, Alessandro Pezzini, Valeria Caso, Emilio Luda, Sung Il Sohn, Giorgio Silvestrelli, Francesco Corea, Clotilde Balucani, Simerpreet Bal, Patrizia Nencini, Jessica Kepplinger, Manuel Cappellari, Farhaan S Vahidy, Monica Acciarresi, Cataldo D'Amore, Stéphanie Debette, Andrei V. Alexandrov, Ulf Bodechtel, Nicole R. Gonzales, Melvin R Sline, Paolo Previdi, Sebastiano D'Anna, Domenico Consoli, Domenico Inzitari, Gino Gialdini, Maria Luisa DeLodovici, Alberto Chiti, Massimo Del Sette, Giampiero Galletti, Giancarlo Agnelli, Paolo Invernizzi, Giorgio Bono, Georgios Tsivgoulis, Kristian Barlinn, Raffaella Cerqua, Luisa Fofi, Paciaroni, M, Balucani, C, Agnelli, G, Caso, V, Silvestrelli, G, Grotta, J, Demchuk, A, Sohn, S, Orlandi, G, Leys, D, Pezzini, A, Alexandrov, A, Silvestrini, M, Fofi, L, Barlinn, K, Inzitari, D, Ferrarese, C, Tassi, R, Tsivgoulis, G, Consoli, D, Baldi, A, Bovi, P, Luda, E, Galletti, G, Invernizzi, P, Delodovici, M, Corea, F, Del Sette, M, Monaco, S, Marcheselli, S, Alberti, A, Venti, M, Acciarresi, M, D'Amore, C, Macellari, F, Lanari, A, Previdi, P, Gonzales, N, Pandurengan, R, Vahidy, F, Sline, M, Bal, S, Chiti, A, Gialdini, G, Dumont, F, Cordonnier, C, Debette, S, Padovani, A, Cerqua, R, Bodechtel, U, Kepplinger, J, Nesi, M, Nencini, P, Beretta, S, Trentini, C, Martini, G, Piperidou, C, Heliopoulos, I, D'Anna, S, Cappellari, M, Donati, E, Bono, G, Traverso, E, and Toni, D

Subjects
Male, medicine.medical_specialty, acute stroke, carotid occlusion, outcome, thrombolysis, Time Factors, medicine.medical_treatment, acute stroke carotid occlusion outcome thrombolysis, Tissue plasminogen activator, Brain Ischemia, Fibrinolytic Agents, Modified Rankin Scale, Internal medicine, medicine.artery, Occlusion, 80 and over, medicine, Humans, Carotid Stenosis, Thrombolytic Therapy, Stroke, Aged, Advanced and Specialized Nursing, Aged, 80 and over, Case-Control Studies, Female, Middle Aged, Tissue Plasminogen Activator, Treatment Outcome, Carotid Artery, Internal, Neurology (clinical), Cardiology and Cardiovascular Medicine, business.industry, Thrombolysis, medicine.disease, Internal, Surgery, acute stroke, carotid occlusion, outcome, thrombolysis, Cardiology, Carotid Artery, Internal carotid artery, business, Plasminogen activator, Fibrinolytic agent, medicine.drug
Abstract

Background and Purpose— The beneficial effect of intravenous thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. The aim of this study was to evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator in these patients. Methods— ICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke severity. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale, dichotomized as favorable (score of 0–2) or unfavorable (score of 3–6). Safety outcomes were death and any intracranial bleeding. Results— Included in the analysis were 253 cases and 253 controls. Seventy-three cases (28.9%) had a favorable outcome as compared with 52 controls (20.6%; adjusted odds ratio (OR), 1.80; 95% confidence interval [CI], 1.03–3.15; P =0.037). A total of 104 patients died, 65 cases (25.7%) and 39 controls (15.4%; adjusted OR, 2.28; 95% CI, 1.36–3.22; P =0.001). There were more fatal bleedings (2.8% versus 0.4%; OR, 7.17; 95% CI, 0.87–58.71; P =0.068) in the cases than in the controls. Conclusions— In patients with stroke attributable to ICA occlusion, thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.

Published
2012

17. Sensory involvement in X-linked spino-bulbar muscolar atrophy (Kennedy's syndrome): an electrophysiological study

Author

Alberto Polo, Paolo Manganotti, Bruno Dallapiccola, Alessandro Salviati, Sebastiano D'Anna, Nicolo' Rizzuto, Francesco Teatini, Giampietro Zanette, Polo, A., Teatini, F., D'Anna, S., Manganotti, Paolo, Salviati, A., Dalla Piccola, B., Zanette, G., and Rizzuto, N.

Subjects
Adult, Male, medicine.medical_specialty, Neurology, X Chromosome, Genetic Linkage, Motor nerve, Sensory system, Electromyography, Muscular Atrophy, Spinal, Atrophy, Evoked Potentials, Somatosensory, Evoked Potentials, Auditory, Brain Stem, Medicine, Humans, medicine.diagnostic_test, business.industry, Anatomy, Syndrome, Middle Aged, medicine.disease, Amyotrophy, Pedigree, Motor unit, Somatosensory evoked potential, Carrier State, Female, Neurology (clinical), business
Abstract

Electrophysiological findings were studied in a family with spino-bulbar muscular atrophy (SBMA): the subjects were three male patients aged 58, 38 and 34 years and two female carriers aged 63 and 28 years. Diagnosis was proven at the molecular genetic level. Electromyography in the males showed spontaneous activity and neurogenic reorganization of the motor unit; motor nerve conduction was normal. Sensory action potentials were variably reduced in amplitude, but some were completely normal. Somatosensory evoked potentials, from both the upper and lower limbs, were invariably abnormal because involvement of the central pathways was observed. These findings are in agreement with histological investigations documenting lesions in the posterior columns. Brain-stem acoustic evoked potentials showed an increase in wave I latency. The electrophysiological data provide further evidence of the extent of sensory damage either in the central or the peripheral nervous system in SBMA patients, who otherwise have a constant clinical presentation of progressive motor neuron disease.

Published
1996

18. Front & Back Matter

Author

Hana Stufkova, Jessica Mandrioli, Amelia Conte, Federica Violi, Elmar H. Pinkhardt, Takahiro Fukuda, Maria Carmela Tartaglia, Yosr Bouhlal, Hans-Jürgen Huppertz, Andrew B. Singleton, Daniela Vidinska, Marie Coutelier, Carla Sanchis-Segura, Ai-Ling Shen, David S. Howland, Margot Samson, María Sol Fittipaldi-Márquez, Alexis Brice, Jos Prinzen, Marco Vinceti, Francesco Curcio, Sean B. Chong, Mario Sabatelli, Chien-Yeh Hsu, Satz Mengensatzproduktion, Nuno Sousa, Giovanni Stevanin, Samir Abu-Rumeileh, Peter Grill, Che-Yi Chou, Ricardo Taipa, Valeria A. Sansone, Monika Macakova, Daniela Berg, Rob van Lummel, Rim Amouri, Antonio Baldi, Hsiu-Chen Lin, Hisashi Hashimoto, Olga Vintonyak, Jiri Klima, Perrine Charles, Nova Sanvilli, Jinhui Ding, Yuan-Fu Tseng, Daniel O. Claassen, Antonio Belenguer, Jana Krizova, Sampath K. Arepalli, Marie Rodinova, Manuel Melo Pires, Christian Lunetta, Cristina Forn, Alexandra Durr, Elisa Majounie, Markus A. Hobert, Gian Luigi Gigli, Silvia Del Din, Martina Fabris, Andrew C Robinson, Ghada Eleuch-Fayache, Jan Motlik, Steven J. Clipman, Inga Liepelt-Scarfone, Faycal Hentati, Dominik Blum, Zdenka Ellederova, Bernhard Cerff, Druckerei Stückle, J. Raphael Gibbs, Bernhard Michalke, Hana Hansikova, Hsiu-Li Lin, Sebastiano D'Anna, Cassandra Jessica Anor, Hans-Peter Müller, Dena G. Hernandez, Malte Kampmeyer, Tomonori Kawabe, César Ávila, Lucio D'Anna, Fanny Mochel, Houda Nehdi, Bozena Bohuslavova, Monia B. Hammer, Paulo Brochado, Mariarosaria Valente, David M. A. Mann, Nikolay Solovyev, Patrício Costa, Walter Maetzler, David F. Tang-Wai, Álvaro Javier Cruz-Gómez, Ron Keren, Cinzia Pistis, Albert C. Ludolph, Martin Gorges, Patricia Sulzer, Antonin Pavlok, Moriaki Kusakabe, Susanne Gräber, Sean O'Connor, Jiri Zeman, Amardeep Saund, Inês Reis, and Jan Kassubek

Subjects
Optics, Neurology, business.industry, Neurology (clinical), Dermatology, business, Geology, Front (military)
Published
2012
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