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1.
Crit Care Med ; 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38836697

RESUMEN

OBJECTIVES: To standardize optic nerve sheath diameter (ONSD) point-of-care ultrasonography (POCUS) and improve its research and clinical utility by developing the ONSD POCUS Quality Criteria Checklist (ONSD POCUS QCC). DESIGN: Three rounds of modified Delphi consensus process and three rounds of asynchronous discussions. SETTING: Online surveys and anonymous asynchronous discussion. SUBJECTS: Expert panelists were identified according to their expertise in ONSD research, publication records, education, and clinical use. A total of 52 panelists participated in the Delphi process. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three Delphi rounds and three asynchronous discussion rounds generated consensus on quality criteria (QC). This started with 29 QC in addition to other QC proposed by expert panelists. The QC items were categorized into probe selection, safety, body position, imaging, measurement, and research considerations. At the conclusion of the study, 28 QC reached consensus to include in the final ONSD POCUS QCC. These QC were then reorganized, edited, and consolidated into 23 QC that were reviewed and approved by the panelists. CONCLUSIONS: ONSD POCUS QCC standardizes ONSD ultrasound imaging and measurement based on international consensus. This can establish ONSD ultrasound in clinical research and improve its utility in clinical practice.

3.
Medicina (Kaunas) ; 59(9)2023 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-37763631

RESUMEN

Background and Objectives: Carotid intima-media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity.


Asunto(s)
Aterosclerosis , Grosor Intima-Media Carotídeo , Humanos , Obesidad/complicaciones , Antropometría , Peso Corporal , Composición Corporal , Aterosclerosis/etiología
4.
Croat Med J ; 63(5): 431-437, 2022 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-36325667

RESUMEN

AIM: To investigate stroke characteristics in patients with concomitant coronavirus disease 2019 (COVID-19) infection in Croatia during the second wave of the COVID-19 pandemic. METHODS: This retrospective study investigated the characteristics of two groups of ischemic stroke patients: those who developed COVID-19 infection before stroke and those who developed the infection during the hospital stay after stroke onset. Stroke etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. RESULTS: We analyzed data from 255 stroke patients from 12 Croatian hospitals. The two groups of ischemic stroke patients differed in stroke etiology (P=0.038). Patients with COVID-19 infection before stroke had fewer cardioembolic strokes (46% vs 29.1%), more cryptogenic strokes (32.5% vs 14.3%), and more strokes in multiple vascular territories (12.4% vs 1.8%). The percentage of large-vessel occlusions was high in both groups (49.6% and 44.4%). Median modified Rankin Scale score on discharge was 4 in both groups. Mortality was 36.4% in the group with stroke after COVID-19 and 33.3% in the group with COVID-19 after stroke. CONCLUSION: Ischemic stroke after COVID-19 differs in etiology from ischemic stroke complicated by COVID-19 infection. Both patient groups are characterized by severe disability and high mortality. Raising the awareness of prehospital stroke and optimization of clinical workflow are important if we want to improve the stroke outcomes by acute recanalization techniques.


Asunto(s)
COVID-19 , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Pandemias , COVID-19/complicaciones , COVID-19/epidemiología , Croacia/epidemiología , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/etiología
6.
Psychiatr Danub ; 31(2): 162-171, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31291220

RESUMEN

In this project, we recruited a sample of 150 patients with first episode of psychosis with schizophrenia features (FEP) and 100 healthy controls. We assessed the differences between these two groups, as well as the changes between the acute phase of illness and subsequent remission among patients over 18-month longitudinal follow-up. The assessments were divided into four work packages (WP): WP1- psychopathological status, neurocognitive functioning and emotional recognition; WP2- stress response measured by saliva cortisol during a stress paradigm; cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT) and during activation paradigm (with Transcranial Ultrasonography Doppler (TCD); WP3-post mortem analysis in histologically prepared human cortical tissue of post mortem samples of subjects with schizophrenia in the region that synaptic alteration was suggested by WP1 and WP2; WP4- pharmacogenetic analysis (single gene polymorphisms and genome wide association study (GWAS). We expect that the analysis of these data will identify a set of markers that differentiate healthy controls from patients with FEP, and serve as an additional diagnostic tool in the first episode of psychosis, and prediction tool which can be then used to help tailoring individualized treatment options. In this paper, we describe the project protocol including aims and methods and provide a brief description of planned post mortem studies and pharmacogenetic analysis.


Asunto(s)
Biomarcadores/análisis , Trastornos Psicóticos/genética , Femenino , Estudios de Seguimiento , Estudio de Asociación del Genoma Completo , Humanos , Hidrocortisona/análisis , Masculino , Farmacogenética , Estudios Prospectivos , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/tratamiento farmacológico , Saliva/química , Esquizofrenia/complicaciones
7.
Psychiatr Danub ; 30(2): 172-182, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29930227

RESUMEN

BACKGROUND: Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity (BFV) during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. SUBJECTS AND METHODS: We recruited 46 patients with the first episode of psychosis (FEP), admitted to the University Hospital Centre Zagreb during 2016-2017 and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. RESULTS: After the adjustment for age, sex and education by quantile regression, patients with FEP had significantly lower BFV in middle cerebral arteries during the 3rd (Δ-15, Δ%-28% p=0.023) and 4th task (Δ-15, Δ%-28% p=0.031) of the Stroop test and the 1st task of Foot tapping test (Δ -16, Δ% -30% p=0.034). We observed significantly lower changes of right middle cerebral artery BFV in FEP between two consecutive tests in all four tasks of the Phonemic verbal fluency test, 1st and 2nd task of the Stroop test and Trail making test, and the1st task of Foot tapping test; and of the left artery between first three tasks of the Phonemic verbal fluency test, the last one of the Phonemic verbal fluency test and all first three tasks of the Stroop test. CONCLUSIONS: Decreased middle BFV during the execution of particular neurocognitive tasks in patients with FEP, compared to control subjects might indicate impaired hemodynamic function in the prefrontal/parietal brain areas, and possibly provide an explanation of some of the observed neurocognitive deficits in patients with the first episode of psychosis.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Circulación Cerebrovascular/fisiología , Pruebas de Estado Mental y Demencia , Arteria Cerebral Media/diagnóstico por imagen , Trastornos Psicóticos/diagnóstico por imagen , Trastornos Psicóticos/fisiopatología , Ultrasonografía Doppler Transcraneal , Adulto , Croacia , Estudios Transversales , Dominancia Cerebral/fisiología , Femenino , Humanos , Masculino , Arteria Cerebral Media/fisiología , Trastornos Neurocognitivos/diagnóstico por imagen , Trastornos Neurocognitivos/fisiopatología , Valores de Referencia , Adulto Joven
8.
Stroke ; 48(3): 720-725, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28174326

RESUMEN

BACKGROUND AND PURPOSE: Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. METHODS: Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014. Two groups were defined: (1) patients with UKO (n=502) and (2) patients treated within 4.5 hours of stroke onset (n=44 875). Outcome measures were symptomatic intracerebral hemorrhage per Safe Implementation of Treatment in Stroke on the 22 to 36 hours post-treatment neuroimaging and mortality and functional outcome assessed by the modified Rankin Scale at 3 months. RESULTS: Patients in UKO group were significantly older, had more severe stroke at baseline, and longer door-to-needle times than patients in the ≤4.5 hours group. Logistic regression showed similar risk of symptomatic intracerebral hemorrhage (adjusted odds ratio, 1.09; 95% confidence interval, 0.44-2.67) and no significant differences in functional independency (modified Rankin Scale score of 0-2; adjusted odds ratio, 0.79; 95% confidence interval, 0.56-1.10), but higher mortality (adjusted odds ratio, 1.58; 95% confidence interval, 1.04-2.41) in the UKO group compared with the ≤4.5 hours group. Patients treated within 4.5 hours showed reduced disability over the entire range of modified Rankin Scale compared with the UKO group (common adjusted odds ratio, 1.29; 95% confidence interval, 1.01-1.65). CONCLUSIONS: Our data suggest no excess risk of symptomatic intracerebral hemorrhage but increased mortality and reduced favorable outcome in patients with UKO stroke compared with patients treated within the approved time window.


Asunto(s)
Isquemia Encefálica/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/etiología , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Terapia Trombolítica/métodos , Factores de Tiempo , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del Tratamiento
9.
BMC Med ; 15(1): 27, 2017 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-28178960

RESUMEN

BACKGROUND: The vascular contributions to neurodegeneration and neuroinflammation may be assessed by magnetic resonance imaging (MRI) and ultrasonography (US). This review summarises the methodology for these widely available, safe and relatively low cost tools and analyses recent work highlighting their potential utility as biomarkers for differentiating subtypes of cognitive impairment and dementia, tracking disease progression and evaluating response to treatment in various neurocognitive disorders. METHODS: At the 9th International Congress on Vascular Dementia (Ljubljana, Slovenia, October 2015) a writing group of experts was formed to review the evidence on the utility of US and arterial spin labelling (ASL) as neurophysiological markers of normal ageing, vascular cognitive impairment (VCI) and Alzheimer's disease (AD). Original articles, systematic literature reviews, guidelines and expert opinions published until September 2016 were critically analysed to summarise existing evidence, indicate gaps in current knowledge and, when appropriate, suggest standards of use for the most widely used US and ASL applications. RESULTS: Cerebral hypoperfusion has been linked to cognitive decline either as a risk or an aggravating factor. Hypoperfusion as a consequence of microangiopathy, macroangiopathy or cardiac dysfunction can promote or accelerate neurodegeneration, blood-brain barrier disruption and neuroinflammation. US can evaluate the cerebrovascular tree for pathological structure and functional changes contributing to cerebral hypoperfusion. Microvascular pathology and hypoperfusion at the level of capillaries and small arterioles can also be assessed by ASL, an MRI signal. Despite increasing evidence supporting the utility of these methods in detection of microvascular pathology, cerebral hypoperfusion, neurovascular unit dysfunction and, most importantly, disease progression, incomplete standardisation and missing validated cut-off values limit their use in daily routine. CONCLUSIONS: US and ASL are promising tools with excellent temporal resolution, which will have a significant impact on our understanding of the vascular contributions to VCI and AD and may also be relevant for assessing future prevention and therapeutic strategies for these conditions. Our work provides recommendations regarding the use of non-invasive imaging techniques to investigate the functional consequences of vascular burden in dementia.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Enfermedad de Alzheimer/patología , Humanos
10.
Brain Cogn ; 84(1): 26-33, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24270848

RESUMEN

OBJECTIVE: Transcranial Doppler sonography (TCD) enables monitoring of blood flow velocities (BFVs) in basal cerebral arteries during different cognitive tasks performance with great temporal resolution. So far, BFVs changes during mental activity were monitored primarily in middle cerebral arteries (MCAs) and little is known about these changes in anterior cerebral arteries (ACAs). AIM: To determine the effect of different cognitive tasks performance on BFV changes and hemispheric dominance in ACAs and to assess the most suitable activation test for monitoring of BFV changes in ACAs. METHODS: Fourteen right-handed, healthy subjects aged 20-26 were included in the study. BFVs in both ACAs were recorded simultaneously during performance of cognitive tasks designed to activate frontal lobes: phonemic verbal fluency test (pVFT), Stroop tests and Trail Making Tests (TMTs). RESULTS: A statistically significant BFV increase was recorded in both ACAs during performance of all cognitive tasks. Statistically significant right ACA dominance was found during performance of pVFT and TMTB. The most significant BFV increase was obtained during performance of TMTB. CONCLUSION: Our result addressed cognitive tests with great activation potential for monitoring of ACAs that might be used in distinguishing of healthy individuals and patients with neurovascular or neurodegenerative diseases.


Asunto(s)
Arteria Cerebral Anterior/fisiología , Cognición/fisiología , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Lóbulo Frontal/fisiología , Humanos , Masculino , Ultrasonografía Doppler Transcraneal , Adulto Joven
11.
Psychiatry Clin Neurosci ; 68(11): 795-803, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24735174

RESUMEN

AIM: The aim of this study was to obtain temporal pattern and hemispheric dominance of blood flow velocity (BFV) changes and to assess suitability of different cognitive tasks for monitoring of BFV changes in the middle cerebral arteries (MCA). METHODS: BFV were recorded simultaneously in MCA during performance of phonemic verbal fluency test (pVFT), Trail Making Tests A and B (TMTA and TMTB) and Stroop tests in 14 healthy, right-handed volunteers aged 20-26 years. RESULTS: A significant increase of BFV in both MCA was obtained during performance of all cognitive tasks. Statistically significant lateralization was found during performance of Stroop test with incongruent stimuli, while TMTB was found to have the best activation potential for MCA. CONCLUSION: Our findings specify TMTB as the most suitable cognitive test for monitoring of BFV in MCA.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Cognición/fisiología , Arteria Cerebral Media/fisiología , Desempeño Psicomotor/fisiología , Femenino , Lateralidad Funcional/fisiología , Humanos , Masculino , Pruebas Neuropsicológicas , Adulto Joven
12.
Ultrasound Int Open ; 10: a22439625, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38463153

RESUMEN

Purpose To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. Materials and Methods National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data. Results Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation. Conclusion Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials.

13.
Eur Stroke J ; 9(2): 409-417, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38149620

RESUMEN

INTRODUCTION: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes. PATIENTS AND METHODS: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days. RESULTS: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73-83) and a median stroke severity score of 11 (interquartile range 4-18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4-18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels (p < 0.05). A worse mRS score of 3-6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15-39.4), p = 0.04. CONCLUSIONS: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).


Asunto(s)
Fibrilación Atrial , Accidente Cerebrovascular Isquémico , Ultrasonografía Doppler Transcraneal , Humanos , Anciano , Fibrilación Atrial/complicaciones , Femenino , Masculino , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/terapia , Anciano de 80 o más Años , Estudios Prospectivos , Ultrasonografía Doppler Transcraneal/métodos , Embolia Intracraneal/diagnóstico por imagen , Trombectomía
14.
Int J Stroke ; 19(3): 314-321, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37700397

RESUMEN

BACKGROUND: The transmission of amyloid ß (Aß) in humans leading to iatrogenic cerebral amyloid angiopathy (iCAA) is a novel concept with analogies to prion diseases. However, the number of published cases is low, and larger international studies are missing. AIMS: We aimed to build a large multinational collaboration on iCAA to better understand the clinical spectrum of affected patients. METHODS: We collected clinical data on patients with iCAA from Austria, Croatia, Italy, Slovenia, and Spain. Patients were included if they met the proposed Queen Square diagnostic criteria (QSC) for iCAA. In addition, we pooled data on disease onset, latency, and cerebrospinal fluid (CSF) biomarkers from previously published iCAA cases based on a systematic literature review. RESULTS: Twenty-seven patients (22% women) were included in this study. Of these, 19 (70%) met the criteria for probable and 8 (30%) for possible iCAA. Prior neurosurgical procedures were performed in all patients (93% brain surgery, 7% spinal surgery) at median age of 8 (interquartile range (IQR) = 4-18, range = 0-26 years) years. The median symptom latency was 39 years (IQR = 34-41, range = 28-49). The median age at symptom onset was 49 years (IQR = 43-55, range = 32-70). Twenty-one patients (78%) presented with intracranial hemorrhage and 3 (11%) with seizures. CONCLUSIONS: Our large international case series of patients with iCAA confirms a wide age boundary for the diagnosis of iCAA. Dissemination of awareness of this rare condition will help to identify more affected patients.


Asunto(s)
Angiopatía Amiloide Cerebral , Accidente Cerebrovascular , Humanos , Femenino , Preescolar , Niño , Adolescente , Persona de Mediana Edad , Masculino , Péptidos beta-Amiloides/líquido cefalorraquídeo , Angiopatía Amiloide Cerebral/diagnóstico , Hemorragias Intracraneales , Enfermedad Iatrogénica , Hemorragia Cerebral , Imagen por Resonancia Magnética
15.
Vasc Med ; 18(5): 275-81, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24029541

RESUMEN

Aortic manipulation releases embolic material, thereby enhancing the probability of adverse neurologic outcomes following coronary artery bypass grafting (CABG). We prospectively evaluated 59 patients undergoing CABG. Patients in the single (SC, n = 37) and multiple clamp (MC, n = 22) groups were comparable in relation to age and operative risk (p > 0.05). Neurocognitive evaluation consisted of the Auditory Verbal Learning Test (AVLT), Color Trails Test A, the Grooved Pegboard test and the Mini-Mental State Examination. Data acquisition was performed preoperatively, early postoperatively and at the 4-month follow-up. Intraoperative transcranial Doppler (TCD) monitoring was used to quantify the embolic load in relation to different aortic clamping strategies. Preoperative neurocognitive results were similar between the groups (p > 0.05). The incidence of postoperative delirium was greater in the MC group but this failed to reach statistical significance (23% vs 8%, p = 0.14). SC patients had fewer embolization signals (270 ± 181 vs 465 ± 160, p < 0.0001). Early postoperative neurocognitive results were depressed in comparison to preoperative values in both groups (p < 0.05 for multiple comparisons). The magnitude of this cognitive depression was greater in the MC group (p < 0.05 for multiple comparisons). Preoperative levels of neurocognition were restored at follow-up in the SC group in all tests except the AVLT. A trend towards improvements in neurocognitive performances at follow-up was also observed in the MC group. Residual attention, motor skill and memory deficits were, however, documented with multiple tests. In conclusion, the embolic burden was significantly lower in the SC group. This TCD imaging outcome translated into fewer early cognition deficits and superior late restoration of function.


Asunto(s)
Trastornos del Conocimiento/prevención & control , Puente de Arteria Coronaria/métodos , Embolia Intracraneal/prevención & control , Complicaciones Posoperatorias/prevención & control , Anciano , Aorta , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Constricción , Puente de Arteria Coronaria/efectos adversos , Femenino , Humanos , Embolia Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía Doppler Transcraneal
16.
J Clin Med ; 12(15)2023 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-37568287

RESUMEN

Background: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). Methods: In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery. Perioperative complications and cerebral autoregulatory capacity were secondary endpoints. Results: Systolic blood pressure (p < 0.001) and norepinephrine doses (89 (54-122) vs. 147 (116-242) µg; p < 0.001) during carotid cross-clamping were lower in the intervention group. No group differences in postoperative neurocognitive function were observed. The rate of perioperative complications was lower in the intervention group than in the control group (3.3 vs. 26.7%, p = 0.03). The breath-holding index did not differ between groups. Conclusions: Postoperative neurocognitive function was comparable between CEA patients undergoing general anesthesia in whom arterial blood pressure during carotid cross-clamping was guided using NIRS and subjects receiving standard care. NIRS-guided, individualized arterial blood pressure management resulted in less vasopressor exposition and a lower rate of perioperative complications.

17.
Neuroepidemiology ; 38(3): 164-71, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22473420

RESUMEN

BACKGROUND: In Central/Eastern European countries, cerebrovascular diseases are among the leading causes of mortality. We aimed to determine the incidence of first-ever stroke (FES) in the north-western part of Croatia. METHODS: A population-based prospective incidence study was conducted between July 1, 2007, and June 30, 2009. Cases were sought from multiple overlapping sources. Incidence rates by stroke type and gender were calculated. RESULTS: A total of 1,487 events were recorded, 1,017 of which were FESs. European age-adjusted incidence rates (per 100,000 population) were: total FESs 223.6 [women/men rate ratio (w/m RR) = 0.65 (95% CI 0.57-0.73)]; ischemic stroke 162.4 (w/m RR = 0.65, 0.56-0.76); intracerebral hemorrhage 28.4 (w/m RR = 0.44, 0.30-0.63); subarachnoid hemorrhage 7.2 (w/m RR = 1.18, 0.55-2.54); unknown etiology 25.5 (w/m RR = 0.78, 0.54-1.14). Adjusted incidence rates of ischemic strokes by subtype were: cardioembolic 52.9 (w/m RR = 0.77, 0.59-0.99); large-artery atherosclerosis 14.4 (w/m RR = 0.22, 0.13-0.38); small-artery occlusion 24.5 (w/m RR = 0.53, 0.37-0.77) and 'other or uncertain causes' 70.6 (w/m RR = 0.77, 0.62-0.97). Thirty-day case-fatality rate was 23.5% overall and 17.1% for ischemic stroke. CONCLUSIONS: The incidence of FES and 30-day mortality of patients with ischemic strokes in the studied population is higher than in Western European countries.


Asunto(s)
Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Hemorragia Cerebral/epidemiología , Trastornos Cerebrovasculares/epidemiología , Comorbilidad , Croacia/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Distribución por Sexo , Fumar/epidemiología , Accidente Cerebrovascular/mortalidad , Tasa de Supervivencia
18.
Dement Geriatr Cogn Disord ; 33(6): 385-92, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22814030

RESUMEN

AIM: The aim of this study was standardization and validation of the Mini-Mental State Examination (MMSE) in the general Croatian aging population. METHODS: Three-hundred and forty-four participants underwent the MMSE test, 217 cognitively healthy subjects without neurological and psychiatric disorders and 127 patients with mild cognitive impairment (MCI) or dementia. RESULTS: The optimal cutoff point for screening of the general Croatian population (cognitively healthy vs. MCI and dementia) is 26/27; in the Croatian population aged ≥65 years, the cutoff point is 24/25, whereas for screening of highly educated persons (≥14 years of education) aged ≥65 years a higher cutoff point should be used (26/27). CONCLUSIONS: MMSE results when standardized and validated in a certain population might better contribute to recognition of the individuals at risk that should be directed to dementia outpatient clinics.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Escala del Estado Mental/estadística & datos numéricos , Anciano , Enfermedad de Alzheimer/diagnóstico , Estudios de Casos y Controles , Croacia , Escolaridad , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Psicometría/instrumentación , Reproducibilidad de los Resultados
19.
J Geriatr Psychiatry Neurol ; 25(4): 201-7, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23172762

RESUMEN

AIM: The Frontal Assessment Battery (FAB) has been used in different clinical settings as a valuable quick bedside test for executive dysfunction. The aim of the study was to evaluate clinical utility of the FAB for differential diagnosis of Alzheimer disease (AD), subcortical vascular cognitive impairment (scVCI), and frontotemporal lobar degeneration (FTLD). METHODS: Scores of the total FAB test and subtests were compared between consecutive series of 37 patients with AD, 31 patients with scVCI, 13 patients with FTLD, and 29 cognitively healthy individuals. RESULTS: There was no statistically significant difference in the total FAB scores among the groups of patients with dementia. When comparing subtest scores, patients with FTLD had significantly lower scores on the lexical fluency subtest compared to the patients with AD (P<.001) or scVCI (P<.001); patients with scVCI had significantly lower scores on the motor series subtest compared to patients with FTLD (P=.02) and AD (P=.035) and on conflicting instructions subtest compared to patients with AD (P=.033). CONCLUSION: Some FAB subtests might enhance diagnostic accuracy taking into account clinical history and other tests of executive function.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Demencia Vascular/diagnóstico , Lóbulo Frontal/fisiopatología , Degeneración Lobar Frontotemporal/diagnóstico , Pruebas Neuropsicológicas , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/fisiopatología , Enfermedad de Alzheimer/psicología , Demencia Vascular/fisiopatología , Demencia Vascular/psicología , Diagnóstico Diferencial , Función Ejecutiva , Femenino , Degeneración Lobar Frontotemporal/fisiopatología , Degeneración Lobar Frontotemporal/psicología , Humanos , Masculino , Persona de Mediana Edad
20.
Acta Neurol Belg ; 121(2): 437-442, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31452093

RESUMEN

Although most often considered a consequence of traumatic event, post-traumatic stress disorder (PTSD) also occurs after illness. The aim of this study was to establish prevalence of PTSD in patients with ischaemic stroke (IS) and its correlation to lesion location, degree of disability, age, gender and marital status. The study included 85 patients with IS. PTSD was diagnosed using a modified version of the PTSD Checklist Specific for a stressor (PCL-S). Depression and anxiety were assessed using Hospital Anxiety and Depression Scale (HADS). We defined stroke localisation as right cerebral hemisphere, left cerebral hemisphere, brainstem and cerebellum. Stroke severity was measured using the modified Rankin scale (mRS). Demographic information including age, gender and marital status was collected from medical history. Of the 85 patients with IS, 11 (12.9%) fulfilled PCL-S criteria for PTSD. We found a positive correlation between PTSD and higher degree of disability, P < 0.001. Patients with PTSD had lesions more frequently localised in the right cerebral hemisphere and the brainstem. We found no statistically significant correlation of PTSD with age, gender and marital status. Our results show that a significant number of IS patients develop PTSD after IS. Determining correlates of post-stroke PTSD can help to identify those at higher risk for its development. If proven by additional large sample studies, more patients can benefit from screening for the PTSD symptoms.


Asunto(s)
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Anciano , Isquemia Encefálica/complicaciones , Femenino , Humanos , Accidente Cerebrovascular Isquémico/complicaciones , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos por Estrés Postraumático/etiología , Encuestas y Cuestionarios
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