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9. Acute right insular ischaemic lesions and poststroke left ventricular dysfunction

Author

Winder, Klemens, primary, Villegas Millar, Carolina, additional, Siedler, Gabriela, additional, Knott, Michael, additional, Dörfler, Arnd, additional, Engel, Anna, additional, Achenbach, Stephan, additional, Hilz, Max J, additional, Kallmünzer, Bernd, additional, Schwab, Stefan, additional, Seifert, Frank, additional, and Fröhlich, Kilian, additional

Published
2023
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10. Atrial Fibrillation Detected before or after Stroke:Role of Anticoagulation

Author

Lyrer, Flurina, Zietz, Annaelle, Seiffge, David J., Koga, Masatoshi, Volbers, Bastian, Wilson, Duncan, Bonetti, Bruno, Schaedelin, Sabine, Gensicke, Henrik, Yoshimura, Sohei, Macha, Kosmas, Ambler, Gareth, Thilemann, Sebastian, Dittrich, Tolga, Inoue, Manabu, Miwa, Kaori, Wang, Ruihao, Siedler, Gabriela, Biburger, Luise, Brown, Martin M., Jäger, Rolf H., Muir, Keith, Traenka, Christopher, Tanaka, Kanta, Shiozawa, Masayuki, Bonati, Leo H., Peters, Nils, Lip, Gregory Y. H., Lyrer, Philippe A., Cappellari, Manuel, Toyoda, Kazunori, Kallmünzer, Bernd, Schwab, Stefan, Werring, David J., Engelter, Stefan T., De Marchis, Gian Marco, and Polymeris, Alexandros A.

Abstract

Background: Atrial fibrillation (AF) known before ischemic stroke (KAF) has been postulated to be an independent category with a recurrence risk higher than that of AF detected after stroke (AFDAS). However, it is unknown whether this risk difference is confounded by pre-existing anticoagulation, which is most common in KAF and also indicates a high ischemic stroke recurrence risk.Methods: Individual patient data analysis from 5 prospective cohorts of anticoagulated patients following AF-associated ischemic stroke. We compared the primary (ischemic stroke recurrence) and secondary outcome (all-cause death) among patients with AFDAS versus KAF and among anticoagulation-naïve versus previously anticoagulated patients using multivariable Cox, Fine-Gray models, and goodness-of-fit statistics to investigate the relative independent prognostic importance of AF-category and pre-existing anticoagulation.Results: Of 4,357 patients, 1,889 (43%) had AFDAS and 2,468 (57%) had KAF, while 3,105 (71%) were anticoagulation-naïve before stroke and 1,252 (29%) were previously anticoagulated. During 6,071 patient-years of follow-up, we observed 244 recurrent strokes and 661 deaths. Only pre-existing anticoagulation (but not KAF) was independently associated with a higher hazard for stroke recurrence in both Cox and Fine-Gray models. Models incorporating pre-existing anticoagulation showed better fit than those with AF category; adding AF-category did not result in better model fit. Neither pre-existing anticoagulation nor KAF were independently associated with death.Conclusion: Our findings challenge the notion that KAF and AFDAS are clinically relevant and distinct prognostic entities. Instead of attributing an independently high stroke recurrence risk to KAF, future research should focus on the causes of stroke despite anticoagulation to develop improved preventive treatments. ANN NEUROL 2023. Background: Atrial fibrillation (AF) known before ischemic stroke (KAF) has been postulated to be an independent category with a recurrence risk higher than that of AF detected after stroke (AFDAS). However, it is unknown whether this risk difference is confounded by pre-existing anticoagulation, which is most common in KAF and also indicates a high ischemic stroke recurrence risk.Methods: Individual patient data analysis from 5 prospective cohorts of anticoagulated patients following AF-associated ischemic stroke. We compared the primary (ischemic stroke recurrence) and secondary outcome (all-cause death) among patients with AFDAS versus KAF and among anticoagulation-naïve versus previously anticoagulated patients using multivariable Cox, Fine-Gray models, and goodness-of-fit statistics to investigate the relative independent prognostic importance of AF-category and pre-existing anticoagulation.Results: Of 4,357 patients, 1,889 (43%) had AFDAS and 2,468 (57%) had KAF, while 3,105 (71%) were anticoagulation-naïve before stroke and 1,252 (29%) were previously anticoagulated. During 6,071 patient-years of follow-up, we observed 244 recurrent strokes and 661 deaths. Only pre-existing anticoagulation (but not KAF) was independently associated with a higher hazard for stroke recurrence in both Cox and Fine-Gray models. Models incorporating pre-existing anticoagulation showed better fit than those with AF category; adding AF-category did not result in better model fit. Neither pre-existing anticoagulation nor KAF were independently associated with death.Conclusion: Our findings challenge the notion that KAF and AFDAS are clinically relevant and distinct prognostic entities. Instead of attributing an independently high stroke recurrence risk to KAF, future research should focus on the causes of stroke despite anticoagulation to develop improved preventive treatments. ANN NEUROL 2023.

Published
2023

12. Atrial Fibrillation Detected before or after Stroke: Role of Anticoagulation.

Author

Lyrer, Flurina, Zietz, Annaelle, Seiffge, David J., Koga, Masatoshi, Volbers, Bastian, Wilson, Duncan, Bonetti, Bruno, Schaedelin, Sabine, Gensicke, Henrik, Yoshimura, Sohei, Macha, Kosmas, Ambler, Gareth, Thilemann, Sebastian, Dittrich, Tolga, Inoue, Manabu, Miwa, Kaori, Wang, Ruihao, Siedler, Gabriela, Biburger, Luise, and Brown, Martin M.

Subjects
ATRIAL fibrillation, ISCHEMIC stroke, ANTICOAGULANTS, STROKE
Abstract

Background: Atrial fibrillation (AF) known before ischemic stroke (KAF) has been postulated to be an independent category with a recurrence risk higher than that of AF detected after stroke (AFDAS). However, it is unknown whether this risk difference is confounded by pre‐existing anticoagulation, which is most common in KAF and also indicates a high ischemic stroke recurrence risk. Methods: Individual patient data analysis from 5 prospective cohorts of anticoagulated patients following AF‐associated ischemic stroke. We compared the primary (ischemic stroke recurrence) and secondary outcome (all‐cause death) among patients with AFDAS versus KAF and among anticoagulation‐naïve versus previously anticoagulated patients using multivariable Cox, Fine‐Gray models, and goodness‐of‐fit statistics to investigate the relative independent prognostic importance of AF‐category and pre‐existing anticoagulation. Results: Of 4,357 patients, 1,889 (43%) had AFDAS and 2,468 (57%) had KAF, while 3,105 (71%) were anticoagulation‐naïve before stroke and 1,252 (29%) were previously anticoagulated. During 6,071 patient‐years of follow‐up, we observed 244 recurrent strokes and 661 deaths. Only pre‐existing anticoagulation (but not KAF) was independently associated with a higher hazard for stroke recurrence in both Cox and Fine‐Gray models. Models incorporating pre‐existing anticoagulation showed better fit than those with AF category; adding AF‐category did not result in better model fit. Neither pre‐existing anticoagulation nor KAF were independently associated with death. Conclusion: Our findings challenge the notion that KAF and AFDAS are clinically relevant and distinct prognostic entities. Instead of attributing an independently high stroke recurrence risk to KAF, future research should focus on the causes of stroke despite anticoagulation to develop improved preventive treatments. ANN NEUROL 2023;94:43–54 [ABSTRACT FROM AUTHOR]

Published
2023
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14. Prognostic Accuracy of CTP Summary Maps in Patients with Large Vessel Occlusive Stroke and Poor Revascularization after Mechanical Thrombectomy—Comparison of Three Automated Perfusion Software Applications

Author

Muehlen, Iris, primary, Borutta, Matthias, additional, Siedler, Gabriela, additional, Engelhorn, Tobias, additional, Hock, Stefan, additional, Knott, Michael, additional, Hoelter, Philip, additional, Volbers, Bastian, additional, Schwab, Stefan, additional, and Doerfler, Arnd, additional

Published
2022
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15. Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study

Author

Kimura, Shunsuke, primary, Toyoda, Kazunori, additional, Yoshimura, Sohei, additional, Minematsu, Kazuo, additional, Yasaka, Masahiro, additional, Paciaroni, Maurizio, additional, Werring, David J., additional, Yamagami, Hiroshi, additional, Nagao, Takehiko, additional, Yoshimura, Shinichi, additional, Polymeris, Alexandros, additional, Zietz, Annaelle, additional, Engelter, Stefan T., additional, Kallmünzer, Bernd, additional, Cappellari, Manuel, additional, Chiba, Tetsuya, additional, Yoshimoto, Takeshi, additional, Shiozawa, Masayuki, additional, Kitazono, Takanari, additional, Koga, Masatoshi, additional, Todo, Kenichi, additional, Kimura, Kazumi, additional, Yagita, Yoshiki, additional, Furui, Eisuke, additional, Itabashi, Ryo, additional, Terasaki, Tadashi, additional, Shiokawa, Yoshiaki, additional, Hirano, Teruyuki, additional, Kamiyama, Kenji, additional, Nakagawara, Jyoji, additional, Takizawa, Shunya, additional, Homma, Kazunari, additional, Okuda, Satoshi, additional, Okada, Yasushi, additional, Tokunaga, Keisuke, additional, Kameda, Tomoaki, additional, Kario, Kazuomi, additional, Nagakane, Yoshinari, additional, Hasegawa, Yasuhiro, additional, Akiyama, Hisanao, additional, Shibuya, Satoshi, additional, Mochizuki, Hiroshi, additional, Ito, Yasuhiro, additional, Nakashima, Takahiro, additional, Matsuoka, Hideki, additional, Takamatsu, Kazuhiro, additional, Nishiyama, Kazutoshi, additional, Sato, Shoichiro, additional, Arihiro, Shoji, additional, Inoue, Manabu, additional, Takagi, Masahito, additional, Tanaka, Kanta, additional, Nagatsuka, Kazuyuki, additional, Yamaguchi, Takenori, additional, Hashimoto, Yoichiro, additional, Houkin, Kiyohiro, additional, Kitagawa, Kazuo, additional, Matsumoto, Masayasu, additional, Tanahashi, Norio, additional, Terayama, Yasuo, additional, Uchiyama, Shinichiro, additional, Mori, Etsuro, additional, Furukawa, Yutaka, additional, Kimura, Takeshi, additional, Kumon, Yoshiaki, additional, Nagata, Ken, additional, Nogawa, Shigeru, additional, Sakamoto, Tomohiro, additional, Hirai, Toshinori, additional, Kudo, Kohsuke, additional, Sasaki, Makoto, additional, Kobayashi, Shotai, additional, Hamasaki, Toshimitsu, additional, Giustozzi, Michela, additional, Acciarresi, Monica, additional, Agnelli, Giancarlo, additional, Caso, Valeria, additional, Bandini, Fabio, additional, Tsivgoulis, Georgios, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Tadi, Prasanna, additional, Becattini, Cecilia, additional, Zedde, Marialuisa, additional, Abdul-Rahim, Azmil H, additional, Lees, Kennedy R, additional, Alberti, Andrea, additional, Venti, Michele, additional, D’Amore, Cataldo, additional, Giulia Mosconi, Maria, additional, Anna Cimini, Ludovica, additional, Bovi, Paolo, additional, Carletti, Monica, additional, Rigatelli, Alberto, additional, Putaala, Jukka, additional, Tomppo, Liisa, additional, Tatlisumak, Turgut, additional, Marcheselli, Simona, additional, Pezzini, Alessandro, additional, Poli, Loris, additional, Padovani, Alessandro, additional, Vannucchi, Vieri, additional, Sohn, Sung-Il, additional, Lorenzini, Gianni, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Martini, Giuseppe, additional, Ntaios, George, additional, Athanasakis, George, additional, Makaritsis, Konstantinos, additional, Karagkiozi, Efstathia, additional, Vadikolias, Konstantinos, additional, Liantinioti, Chrissoula, additional, Chondrogianni, Maria, additional, Mumoli, Nicola, additional, Galati, Franco, additional, Sacco, Simona, additional, Tiseo, Cindy, additional, Corea, Francesco, additional, Ageno, Walter, additional, Bellesini, Marta, additional, Colombo, Giovanna, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Lanari, Alessia, additional, Scoditti, Umberto, additional, Denti, Licia, additional, Mancuso, Michelangelo, additional, Maccarrone, Miriam, additional, Ulivi, Leonardo, additional, Orlandi, Giovanni, additional, Giannini, Nicola, additional, Tassinari, Tiziana, additional, De Lodovici, Maria Luisa, additional, Rueckert, Christina, additional, Baldi, Antonio, additional, Toni, Danilo, additional, Letteri, Federica, additional, Giuntini, Martina, additional, Lotti, Enrico Maria, additional, Flomin, Yuriy, additional, Pieroni, Alessio, additional, Kargiotis, Odysseas, additional, Karapanayiotides, Theodore, additional, Monaco, Serena, additional, Baronello, Mario Maimone, additional, Csiba, Laszló, additional, Szabó, Lilla, additional, Chiti, Alberto, additional, Giorli, Elisa, additional, Del Sette, Massimo, additional, Imberti, Davide, additional, Zabzuni, Dorjan, additional, Doronin, Boris, additional, Volodina, Vera, additional, Michel, Patrik, additional, Vanacker, Peter, additional, Barlinn, Kristian, additional, Pallesen, Lars-Peder, additional, Barlinn, Jessica, additional, Deleu, Dirk, additional, Melikyan, Gayane, additional, Ibrahim, Faisal, additional, Akhtar, Naveed, additional, Gourbali, Vanessa, additional, Masotti, Luca, additional, Parry-Jones, Adrian, additional, Patterson, Chris, additional, Price, Christopher, additional, Elmarimi, Abduelbaset, additional, Parry, Anthea, additional, Nallasivam, Arumug, additional, Mohd Nor, Azlisham, additional, Esis, Bernard, additional, Bruce, David, additional, Roffe, Christine, additional, Holmes, Clare, additional, Cohen, David, additional, Hargroves, David, additional, Mangion, David, additional, Chadha, Dinesh, additional, Vahidassr, Djamil, additional, Manawadu, Dulka, additional, Giallombardo, Elio, additional, Warburton, Elizabeth, additional, Flossman, Enrico, additional, Gunathilagan, Gunaratam, additional, Proschel, Harald, additional, Emsley, Hedley, additional, Anwar, Ijaz, additional, Okwera, James, additional, Putterill, Janet, additional, O’Connell, Janice, additional, Bamford, John, additional, Corrigan, John, additional, Scott, Jon, additional, Birns, Jonathan, additional, Kee, Karen, additional, Saastamoinen, Kari, additional, Pasco, Kath, additional, Dani, Krishna, additional, Sekaran, Lakshmanan, additional, Choy, Lillian, additional, Iveson, Liz, additional, Mamun, Maam, additional, Sajid, Mahmud, additional, Cooper, Martin, additional, Burn, Matthew, additional, Smith, Matthew, additional, Power, Michael, additional, Davis, Michelle, additional, Smyth, Nigel, additional, Veltkamp, Roland, additional, Sharma, Pankaj, additional, Guyler, Paul, additional, O’Mahony, Paul, additional, Wilkinson, Peter, additional, Datta, Prabel, additional, Aghoram, Prasanna, additional, Marsh, Rachel, additional, Luder, Robert, additional, Meenakishundaram, Sanjeevikumar, additional, Subramonian, Santhosh, additional, Leach, Simon, additional, Ispoglou, Sissi, additional, Andole, Sreeman, additional, England, Timothy, additional, Manoj, Aravindakshan, additional, Harrington, Frances, additional, Rehman, Habib, additional, Sword, Jane, additional, Staals, Julie, additional, Mahawish, Karim, additional, Harkness, Kirsty, additional, Shaw, Louise, additional, McCormich, Michael, additional, Sprigg, Nikola, additional, Mansoor, Syed, additional, Krishnamurthy, Vinodh, additional, Lyrer, Philippe A, additional, Bonati, Leo H, additional, Seiffge, David J, additional, Traenka, Christopher, additional, Peters, Nils, additional, De Marchis, Gian Marco, additional, Thilemann, Sebastian, additional, Avramiotis, Nikolaos S, additional, Gensicke, Henrik, additional, Hert, Lisa, additional, Wagner, Benjamin, additional, Schaub, Fabian, additional, Meya, Louisa, additional, Fladt, Joachim, additional, Dittrich, Tolga, additional, Fisch, Urs, additional, Bonetti, Bruno, additional, Tomelleri, Giampaolo, additional, Micheletti, Nicola, additional, Zivelonghi, Cecilia, additional, Emiliani, Andrea, additional, Macha, Kosmas, additional, Siedler, Gabriela, additional, Stoll, Svenja, additional, Wang, Ruihao, additional, Volbers, Bastian, additional, Schwab, Stefan, additional, Haupenthal, David, additional, and Gaßmann, Luise, additional

Published
2022
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20. Pain related evoked potentials in patients with small - and large fiber neuropathies

Author

Siedler, Gabriela Anja

Subjects
ddc:616, Evoziertes Potenzial, Fabry-Krankheit, Polyneuropathie
Abstract

In dieser Studie wurden 108 Patienten mit PNP, 60 Patienten mit M. Fabry und 58 gesunde Kontrollpersonen mittels PREP auf eine small fiber-Pathologie untersucht. Zudem erfolgte eine PREP-Untersuchung bei 5 gesunden Probanden und 3 Patienten nach Anwendung von lokalem Capsaicin. Zur Charakterisierung der small fibers erfolgten zudem Anamnese, klinische Untersuchung, die Fragebögen NPSI, GCPS und ADS, QST und eine Hautbiopsie. In der Gruppe der Patienten mit PNP waren sowohl Patienten mit LFN, MFN und SFN unterschiedlicher Ätiologie vertreten. Patienten mit einer MFN und Patienten mit einer zu einer Mitbeteiligung der small fibers passenden Anamnese (MFN und SFN) wiesen eine verlängerte N1-Latenz nach Stimulation am Fuß auf. Bei einer reduzierten IENFD in der proximalen Hautbiopsie zeigte sich die PPA nach Stimulation im Gesicht reduziert, beide Werte korrelierten positiv miteinander. Bei Patienten mit einer demyelinisierenden PNP war die N1-Latenz nach Stimulation an der Hand verlängert, zudem war bei Patienten mit CIDP die PPA nach Stimulation an Gesicht und Hand reduziert. M. Fabry ist eine X-chromosomal vererbte lysosomale Speicherkrankheit, welche mit einer SFN einhergehen kann. Weibliche Patienten mit M. Fabry und einer subjektiven Hypohidrose als klinische Präsentation einer small fiber Pathologie wiesen eine reduzierte PPA nach Stimulation an Gesicht, Hand und Fuß auf. Über die gesamte Patientengruppe hinweg zeigte sich eine negative Korrelation der PPA nach Stimulation am Fuß mit der klinischen Schmerzpräsentation im NPSI (Summenscore, Subscores evozierte Schmerzen und Schmerzattacken), sowie bei weiblichen Patienten mit der CDT, WDT und TSL in der QST als Marker für die small fiber Funktion. Patienten mit einer längenunabhängigen Reduktion der IENFD wiesen eine niedrigere PPA nach Stimulation am Fuß auf. Ein nicht-auswertbares PREP-Potential spricht nach Ausschluss messtechnischer Artefakte für eine fortgeschrittene Nervenfaserschädigung. Probanden und Patienten zeigten nach Applikation von topischem Capsaicin eine Reduktion der PPA. PREP ist eine einfache, komplikationslos durchzuführende und objektive Methode zur Untersuchung der small fibers. Sie stellt eine sinnvolle Ergänzung zu den bereits etablierten Methoden QST und Hautbiopsie dar und bietet insbesondere für die Evaluation von Medikamenteneffekten wie z.B. von topischem Capsaicin eine vielversprechende Untersuchungsmöglichkeit., In this study, 108 patients with polyneuropathy, 60 patients with M. Fabry and 58 healthy controls underwent PREP for diagnoses of small fiber pathology. Furthermore, PREP was performed on 5 healthy controls and 3 patients after treatment with local Capsaicin. For characterization of small fibers, anamnesis, clinical examination, NPSI, GCPS, ADS, QST and skin biopsy were performed. In patients with polyneuropathy, patients with LFN, MFN and SFN of different etiology were included. Patients with MFN and patients with clinical symptoms of small fiber pathology had prolonged N1-latency after stimulation at the foot. In case of a reduced IENFD in the proximal skin biopsy, PPA after stimulation at the face was reduced, both parameters correlated. In patients with demyelinating polyneuropathy, N1-latency after stimulation at the hand was prolonged, and in patients with CIDP PPA after stimulation at face and hand was reduced. M. Fabry is an x-chromosomal inherited lysosomal storage disorder, which can induce SFN. Female patients with M. Fabry and subjective hypohidrosis as clinical presentation of small fiber pathology had a reduced PPA after stimulation at face, hand, and foot. Regarding all patients, PPA after stimulation at the foot did show a correlation to clinical symptoms in NPSI (sumscore and subscores for evoked pain and pain attacks), and in female patients with CDT, WDT, and TSL in QST as parameters of small fiber function. Patients with a non-length-dependent reduction of IENFD did show a reduced amplitude after stimulation at the foot. A non-evaluable PREP-potential gives hint on advanced nerve fiber damage after exclusion of examination errors. Patients and controls show a reduction of PPA after application of topical Capsaicin. PREP is an easy, complicationfree and objective method for examination of small fibers. It is a useful additional method alongside established methods, like QST and skin biopsy, and does provide promising possibilities, especially for examination of medication effects, like topical capsaicin.

Published
2018

23. Left Ventricular Function Disturbances in Patients With Acute Ischemic Stroke : Prognostic and Therapeutic Implications

Author

Siedler, Gabriela

Abstract

Background and AimsDisturbances of systolic left ventricular function (DLV) in ischemic stroke constitute a source of detrimental pathophysiologic cascades, including prothrombotic and proinflammatory states, worsening of cerebral tissue oxygenation as well as hemodynamic impairment. In addition, DLV may affect the safety and efficacy of intravenous thrombolysis.MethodClinical cohort study among patients with ischemic stroke and acute recanalising therapies between 2006 and 2016 at a universitary stroke center.Results1418 patients were included. 25% had systolic DLV on echocardiography. In 67% this was established as an initial diagnosis. Neurologic deficits in patient with DLV were more sever on admission (NIHSS 11 versus 9.5) and discharge (4 versus 3, p

Published
2017

27. [Diagnostik Lumbar Puncture - Step by Step].

Author

Siedler G, Kallmünzer B, and Schwab S

Subjects
Clinical Competence, Humans, Spinal Puncture methods
Abstract

Performing a diagnostic lumbar puncture is an essential clinical skill for the clinician. The procedure is of high importance for both, the emergency care for patients with suspected infection of the cerebral nervous system or subarachnoidal hemorrhage, as well as the elective diagnostic work up of chronic disease including multiple sclerosis and dementia. Furthermore the technique's principles are applied for spinal anesthesia or the intrathecal administration of drugs. This article describes a Standard Operating Procedure for the lumbar puncture step by step. Based on the latest evidence, it particularly focusses on clinically relevant questions and practical aspects., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Published
2019
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