The effect of intravenous thrombolytic therapy on post stroke depression and cognitive dysfunction: A 3-months follow up study.

Several studies have demonstrated the efficacy of intravenous thrombolytic therapy with recombinant plasminogen activator (rt-PA) on functional recovery at 3-18 months following the treatment. The objectives of this study were to investigate differences between thrombolytic or no thrombolytic treatment and if could be a relationship between patients who have underwent the thrombolytic treatment in terms of depressive symptoms and cognitive impairment. In this retrospective study, we evaluated 92 patients affected by ischemic stroke recruited from our rehabilitation center, coming from a Stroke Unit. All the eligible subjects were assessed at admission (T0) and two months later, at discharge, upon concluded the rehabilitation program (T1). The patients were divided into two groups: Thrombolysis Group (n.40 subjects) and no Thrombolysis Group (n.52 subjects). Cognitive functions were evaluated with the Montreal Overall Cognitive Assessment. Functional status were evaluated with the Barthel Index and the Functional Independent Misure. We administered Beck Depression Inventory-II to verify the presence of a depressive state. We found that at three months after stroke, the prevalence of depressive symptoms and cognitive improvement, among patient who had undergone thrombolytic treatment, and who had not, was not different. Conversely, we found an improvement of depressive symptoms in each group.

Analgesic hypnotic treatment in a post-stroke patient.

In recent years, hypnotic suggestions have been used in several clinical conditions. This treatment is often used for anxiety treatment, somatization, and post-traumatic stress disorder. Hypnotic analgesia is one of the most clinically useful phenomena of hypnosis. The article describes the case of a patient who underwent hypnotic treatments for hypersensitivity and chronic pain. Results showed an improvement of pain control and a decrease of pain hypersensibility. In addition, during rehabilitative treatments, the patient reported a high level of compliance with the multidisciplinary team. These findings suggest that hypnosis could be a useful treatment for post-stroke pain management.

Role of visual P300 in cognitive assessment of subacute stroke patients: a longitudinal study.

Aim: The aim of this study was to assess if pre- and post- event related potentials (ERPs) components after visual stimulation training admitted differences exist in subacute stroke patients and to observe the outcome markers of cognitive functions recovery by using Neurowave system.Materials and Methods: Eighteen ischemic subacute stroke patients were enrolled and underwent to neuropsychological evaluation and ERPs recording at two time points, at baseline (T0) and after 3 months from (T1). All patients were stimulated with customized images for three days a week.Findings: Intra group analysis showed a significance difference in ERPs parameters and neuropsychological tests. Correlation analysis showed a significant relation between neuropsychological and ERP values.Conclusion: Our findings confirm that P300 ERPs' component could be a predictive marker for cognitive recovery of ischemic subacute stroke patients. Intensive programs of neurosensory stimulation could facilitate recovery of cognitive and attentive functions in subacute cerebrovascular disease.

New versus Old Oral Anticoagulants: How Can We Set the Scale Needle? Considerations on a Case Report.

Ischemic stroke is a complex multifactorial disorder. Anticoagulation is a growing research area, with the main goal of preventing systemic embolization and stroke. We report the case of a 41-year-old woman with antiphospholipid syndrome who was unsuccessfully treated with Dabigatran, a new oral anticoagulant, as she developed a major stroke involving the right carotid artery, due to deep venous thrombosis with pulmonary embolism. We therefore suggest a closer monitoring of the safety and efficacy of dabigatran. Moreover, in the presence of multifactorial causes of pro-coagulation, we believe that warfarin should remain the mainstay of oral anticoagulation.

Compressibility of High-Density EEG Signals in Stroke Patients.

Stroke is a critical event that causes the disruption of neural connections. There is increasing evidence that the brain tries to reorganize itself and to replace the damaged circuits, by establishing compensatory pathways. Intra- and extra-cellular currents are involved in the communication between neurons and the macroscopic effects of such currents can be detected at the scalp through electroencephalographic (EEG) sensors. EEG can be used to study the lesions in the brain indirectly, by studying their effects on the brain electrical activity. The primary goal of the present work was to investigate possible asymmetries in the activity of the two hemispheres, in the case one of them is affected by a lesion due to stroke. In particular, the compressibility of High-Density-EEG (HD-EEG) recorded at the two hemispheres was investigated since the presence of the lesion is expected to impact on the regularity of EEG signals. The secondary objective was to evaluate if standard low density EEG is able to provide such information. Eighteen patients with unilateral stroke were recruited and underwent HD-EEG recording. Each EEG signal was compressively sensed, using Block Sparse Bayesian Learning, at increasing compression rate. The two hemispheres showed significant differences in the compressibility of EEG. Signals acquired at the electrode locations of the affected hemisphere showed a better reconstruction quality, quantified by the Structural SIMilarity index (SSIM), than the EEG signals recorded at the healthy hemisphere (p < 0.05), for each compression rate value. The presence of the lesion seems to induce an increased regularity in the electrical activity of the brain, thus an increased compressibility.

Functional MRI and laser-evoked potentials evaluation in Charcot-Marie-Tooth syndrome.

Charcot-Marie-Tooth (CMT) disease is a genetically heterogeneous group of disorders. Pain is a less common symptom complained by CMT patients. We described a case of a 39-year-old male patient affect by Charcot-Marie-Tooth (CMT) disease compared to five healthy controls (HC), to assess the sensory and the nociceptive pathways by using LEPs recording associated to fMRI examination, to find an "objective" marker which could be used in the management of CMT patient. The nociceptive system was evaluated by laser-evoked potentials (LEPs). Moreover, fMRI (functional magnetic resonance imaging) examination, by using laser stimuli, was performed. LEPs' examination showed an increase of latency and an amplitude reduction respect to HC. The laser stimulation during fMRI showed a decreased cortical activations if compared to HC. The originality of this paper, although limited to a single case, resides in a detailed evaluation of CMT1 patient performed by using neurophysiologic and neuroimaging methods to investigate extensively the sensory nociceptive pathways.