Brain Magnetic Resonance Imaging in Wilson's Disease-Significance and Practical Aspects-A Narrative Review.

Wilson's disease (WD) is a genetic disorder of copper metabolism with pathological copper accumulation in many organs, resulting in clinical symptoms, mostly hepatic and neuropsychiatric. As copper accumulates in the brain during WD, and almost 50% of WD patients at diagnosis present with neurological symptoms, neuroimaging studies (especially brain magnetic resonance imaging (MRI)) are part of WD diagnosis. The classical sequences (T1, T2, and fluid-attenuated inversion recovery) were used to describe brain MRI; however, with the development of neuroradiology, several papers proposed the use of new MRI sequences and techniques like susceptibility-weighted images, T2*, diffusion MRI, tractography, volumetric assessment and post-processing brain MRI analysis of paramagnetic accumulation-quantitative susceptibility mapping. Based on these neuroradiological data in WD, currently, brain MRI semiquantitative scale and the pathognomonic neuroradiological brain MRI signs in WD were proposed. Further, the volumetric studies and brain iron accumulation MRI analysis suggested brain atrophy and iron accumulation as biomarkers of neurological WD disease severity. All these results highlight the significance of brain MRI examinations in WD. Due to the extreme progress of these studies, based on the available literature, the authors present the current state of knowledge about the significance, practical aspects, and future directions of brain MRI in WD.

Embolic strokes of undetermined source in a cohort of Polish stroke patients.

We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) population based on a long-term prospective stroke registry. We retrospectively analyzed data collected in a detailed registry regarding consecutive patients admitted for first-ever ischemic stroke (IS) between January 2001 and December 2015. We used Org 10172 in Acute Stroke Treatment classification supplemented with ESUS criteria proposed by the Cryptogenic Stroke/ESUS International Working Group. Within the ESUS group, we additionally compared patients ≤ 60 and > 60 years of age. During the study period, there was a total of 3008 (1615 females and 1393 males) admissions of first-ever strokes. The most frequent cause was undetermined (38.7%), followed by cardioembolic (27.7%), large artery atherosclerosis (18.2%), small vessel disease (11.9%), and other determined (3.6%). We identified 326 patients as ESUS, which accounted for 10.8% of all strokes and 28% of strokes of undetermined etiology. ESUS patients were the youngest. Compared to all types of stroke but for those with small vessel disease, ESUS patients were most often independent before stroke and had the least severe neurological deficit at admission and the best outcome at discharge. ESUS patients ≤ 60 years were more frequently independent at discharge than ESUS patients > 60 years. Approximately 11% of patients from our registry met ESUS criteria. ESUS patients were younger when compared to all other stroke etiologies, suffered less severe strokes, and had more favorable outcome at discharge than other groups except for those with small vessel disease strokes.

Measurement of Nutritional Status Using Body Mass Index, Waist-to-Hip Ratio, and Waist Circumference to Predict Treatment Outcome in Females and Males with Acute First-Ever Ischemic Stroke.

BACKGROUND: We aimed to investigate whether increased waist-to-hip ratio (WHR), waist circumference (WC), or improper body mass index (BMI) may differently predict short-term outcomes in females and males with first-ever acute ischemic stroke. METHODS: This was a retrospective study of consecutive patients (1109 females and 939 males) admitted for first-ever ischemic stroke between 2003 and 2015. Data were collected in a detailed hospital stroke registry. BMI of 18.5-24.9 kg/m2 and gender-specific normal values of WHC and WC were used as references for comparisons. Logistic regression was used to calculate the odds of in-hospital death or being dead or dependent at discharge, adjusted for patients' age and prestroke disability. RESULTS: In both sexes a high WHR increased the odds of death or dependency at discharge (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.05-3.08 for females and 1.43; 95% CI, 1.00-2.04 for males), but not in-hospital death alone. Increased WC was significantly associated with lower odds of either death or death and dependency at discharge in females only (OR, .36; 95% CI, .22-.58 and .69; 95% CI, .48-.97, respectively). BMI did not show any clear predictive value in either sex. CONCLUSIONS: Our findings suggest that being overweight measured with WC is a strong predictor of good outcome in women but not in men. The WHR less consistently predicts stroke outcome, as it is not associated with death at discharge alone; however, the WHR seems to be of similar clinical relevance in both genders. BMI seems to have the least clinical value in predicting stroke outcome in both genders.

Successful treatment with intravenous recombinant tissue plasminogen activator in an acute stroke patient presenting with hemiballism.

A 79-year-old woman with hypertension was evaluated 3 hours and 20 minutes after the sudden onset of left-sided weakness which lasted about 15 minutes and was followed by involuntary, coarse, flinging movements of the left extremities (hemiballistic), occurring every few minutes, and facial asymmetry. Brain computed tomography revealed no abnormalities. The patient received intravenous thrombolysis with 0.9 mg/kg of alteplase 4 hours after the symptom onset. Involuntary movements and central facial nerve paresis subsided within 48 hours of the thrombolysis. Magnetic resonance imaging at day 5 revealed restricted diffusion within the right globus pallidus, which was a new ischemic lesion. Thrombolysis should be considered in hemiballism as a presenting symptom of acute stroke.

A survey to establish current methods of venous thromboembolism prophylaxis in stroke patients practiced by Polish neurologists.

INTRODUCTION: Venous thromboembolism (VTE) is associated with considerable morbidity and mortality in stroke patients. The purpose of our survey was to establish the current methods of VTE prophylaxis practiced by Polish neurologists. We also aimed to determine whether there is enough variation in practice to justify the development of an evidence-based guideline for VTE prevention. MATERIAL AND METHODS: Postal self-administered questionnaires about VTE prophylactic methods practiced by Polish neurologists were sent to 218 neurological wards where stroke is treated. If no response was received, the questionnaire was faxed and finally we attempted to obtain information by telephone. RESULTS: One hundred and seventy-six (80.7%) stroke centers of 218 responded. The majority (137/176; 77.8%) of centers had a stroke unit. The median admission rate of surveyed wards was estimated to be 320 patients/year (range from 20 to 1000 patients/year). The most common method of VTE prophylaxis reported was low molecular weight heparin (LMWH) (98.9%), and the least common was intermittent pneumatic compression (IPC) (6.8%). Centers admitting ≥ 200 patients/year (70.7% vs. 45%; p = 0.039), and those with stroke units (95 vs. 20; p = 0.031) were more willing to join a randomized trial evaluating any of the methods. All the centers participating in the survey reported a need for a detailed VTE prophylaxis guidelines. CONCLUSIONS: The LMWH is the predominant VTE prophylaxis strategy for stroke patients practiced by Polish neurologists. Due to the variation of methods used in VTE prophylaxis it might be reasonable to further specify this section of stroke treatment guidelines.

Venous thromboembolism prophylactic methods in acute stroke patients - current state of knowledge.

Deep venous thrombosis (DVT) and its sequel, pulmo-nary em-bolism (PE), are serious complications of stroke. There are pharmacological and physical methods to prevent these complications. The authors review the lite-rature and present the current state of knowledge re-garding the effectiveness of each of the DVT and PE prevention methods in stroke patients and cite current Polish, European and American recommendations re-garding this issue. Heparins are the method of choice for the prevention of venous thromboembolism in both ischaemic and haemorrhagic stroke patients.

The prognostic value of motor-evoked potentials in motor recovery and functional outcome after stroke − a systematic review of the literature.

The aim of this study was to systematically review published data on the value of motor-evoked potentials (MEPs) in predicting motor recovery of the upper extremity and general functional outcome early after stroke. We searched PubMed for original prognostic studies. Only full-text original papers evaluating the prognostic value of MEPs elicited by transcranial magnetic stimulation (TMS) in motor function recovery of the upper extremity were included in this review. Data from the studies included in the review are presented in two tables: one shows the general characteristics of the studies and the other gives methodological details and results. Of 842 publications, only 15 met the criteria for inclusion in this review. Data from 14 trials provided evidence that TMS of the motor cortex, eliciting MEPs, is a reliable tool for predicting motor recovery as well as functional outcome. The interpretation of the results was complicated by methodological differences between the included studies.