Claudia-Gabriela Potcovaru, T. Salmen, Marius-Costin Chitu, Vlad Dima, Margareta Bianca Mihai, R. Bohîlțea, D. Cinteză, M. Berteanu
Stroke is the second leading cause of death worldwide. The global incidence of stroke has increased in recent years, although low and middle-income countries have been heavily affected. Because of the complicated and diversified physical and emotional disruption, stroke survivors are likely to face a variety of difficulties in daily life activities. Because of the wide impact of a stroke on all body structures and functions, there is no gold standard instrument to evaluate impairment and all elements of recovery after a stroke, and there is no single scale that can capture all the effects of a stroke. The International Classification of Impairments, Disability, and Handicaps (ICIDH) categorized the consequences of the diseases into three categories: impairment, disability, and handicap. Using the biopsychosocial model in 2001 WHO defines and classifies disability by using International Classification of Functioning Disability and Health (ICF). The ICF divides the impairment into three categories: body function and structure, activity, and participation. This article aims to review the most important tools that are reliable and valid in assessing the disability left after a stroke: The National Institute of Health Stroke Scale (NIHSS), Barthel index (BI), The modified Rankin scale (mRS), Instrumental activities of daily living (IADL), Glasgow outcome scale (GOS), The Functional Independence Measure (FIM), The World Health Organization Disability Assessment Schedule (WHODAS 2.0). The WHODAS 2.0 questionnaire is validated in several countries and it would be useful to be validated, also, in our country.
{"title":"Assessment tools of disability status after stroke","authors":"Claudia-Gabriela Potcovaru, T. Salmen, Marius-Costin Chitu, Vlad Dima, Margareta Bianca Mihai, R. Bohîlțea, D. Cinteză, M. Berteanu","doi":"10.37897/rjn.2022.3.2","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.2","url":null,"abstract":"Stroke is the second leading cause of death worldwide. The global incidence of stroke has increased in recent years, although low and middle-income countries have been heavily affected. Because of the complicated and diversified physical and emotional disruption, stroke survivors are likely to face a variety of difficulties in daily life activities. Because of the wide impact of a stroke on all body structures and functions, there is no gold standard instrument to evaluate impairment and all elements of recovery after a stroke, and there is no single scale that can capture all the effects of a stroke. The International Classification of Impairments, Disability, and Handicaps (ICIDH) categorized the consequences of the diseases into three categories: impairment, disability, and handicap. Using the biopsychosocial model in 2001 WHO defines and classifies disability by using International Classification of Functioning Disability and Health (ICF). The ICF divides the impairment into three categories: body function and structure, activity, and participation. This article aims to review the most important tools that are reliable and valid in assessing the disability left after a stroke: The National Institute of Health Stroke Scale (NIHSS), Barthel index (BI), The modified Rankin scale (mRS), Instrumental activities of daily living (IADL), Glasgow outcome scale (GOS), The Functional Independence Measure (FIM), The World Health Organization Disability Assessment Schedule (WHODAS 2.0). The WHODAS 2.0 questionnaire is validated in several countries and it would be useful to be validated, also, in our country.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":"59 26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70152357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of ischemic stroke based on the American Heart Association (AHA) data in 2019 reached 77.2 million people. As much as 72% of post ischemic stroke patients got cognitive impairment. Vitamin D deficiency is often found in post-stroke patients and causes functional decline. This study aims to assess the relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. This study is a cross-sectional study using secondary data from medical records at Bethesda Hospital Yogyakarta taken from January to March 2021. Cognitive impairment in 90 days post ischemic stroke patients were assessed using MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test). This study was analyzed through univariate tests and bivariate tests using Spearman correlation. This proves a correlation between vitamin D levels and cognitive impairment which is formulated by the value of MMSE (p=0.000) and CDT (p=0.031). The mean of vitamin D levels was 13.53±3.625. The proportion of hypovitaminosis D was divided into 5.7% of insufficiency patients and 94.3% patients stated as deficiency. The lower the vitamin D levels, the lower the MMSE and CDT values accordingly. In conclusion, there is a relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. Low levels of vitamin D result in more frequent and more severe cognitive impairments.
{"title":"Correlation between vitamin D levels and cognitive impairment on 90 days post ischemic stroke patients","authors":"Rizaldy Taslim Pinzon, Nindya Stephanie Christina, Oey Yedida Stephanie Sugianto, Tillandsia Filli Folia Primastuti","doi":"10.37897/rjn.2022.3.7","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.7","url":null,"abstract":"The prevalence of ischemic stroke based on the American Heart Association (AHA) data in 2019 reached 77.2 million people. As much as 72% of post ischemic stroke patients got cognitive impairment. Vitamin D deficiency is often found in post-stroke patients and causes functional decline. This study aims to assess the relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. This study is a cross-sectional study using secondary data from medical records at Bethesda Hospital Yogyakarta taken from January to March 2021. Cognitive impairment in 90 days post ischemic stroke patients were assessed using MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test). This study was analyzed through univariate tests and bivariate tests using Spearman correlation. This proves a correlation between vitamin D levels and cognitive impairment which is formulated by the value of MMSE (p=0.000) and CDT (p=0.031). The mean of vitamin D levels was 13.53±3.625. The proportion of hypovitaminosis D was divided into 5.7% of insufficiency patients and 94.3% patients stated as deficiency. The lower the vitamin D levels, the lower the MMSE and CDT values accordingly. In conclusion, there is a relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. Low levels of vitamin D result in more frequent and more severe cognitive impairments.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42355436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim. The aim of this study was to compare the MRS imaging tumor index among high-grade and low-grade intra axial brain tumor with histology. Patients and methods. This prospective observational study consisted of 30 patients who underwent surgery for intra-axial brain glioma in the Department of Neurosurgery, Government Medical College, Thiruvananthapuram in a 1 year duration. Inferences were drawn based on MRI scans of brain (plain + contrast) with MRS and a histological examination. Results. The normalized area values of 3 metabolite resonances, namely N-Acetyl Aspartate (NAA), Choline (Cho) and Creatinine (Cr), between low grade glioma and high-grade glioma were found to be statistically significant (p<0.05). Significant difference was also present among Cho/NAA and Cho/Cr in differentiating low-grade from high-grade glioma. Conclusion. This study has shown that Cho/NAA and Cho/Cr ratios are reliable determinants of the tumor grade with good sensitivity and specificity. Thus, Cho/NAA and Cho/Cr ratios of MRS maybe used as a diagnostic tool in differentiating low grade gliomas from high grade gliomas.
{"title":"Comparison of MRS imaging tumor index among high and low grade intra axial brain tumor with histology","authors":"Varun Singh Pendro, Jyothish Ls, Darpan Kaur, Saurabh Sharma","doi":"10.37897/rjn.2022.3.3","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.3","url":null,"abstract":"Aim. The aim of this study was to compare the MRS imaging tumor index among high-grade and low-grade intra axial brain tumor with histology. Patients and methods. This prospective observational study consisted of 30 patients who underwent surgery for intra-axial brain glioma in the Department of Neurosurgery, Government Medical College, Thiruvananthapuram in a 1 year duration. Inferences were drawn based on MRI scans of brain (plain + contrast) with MRS and a histological examination. Results. The normalized area values of 3 metabolite resonances, namely N-Acetyl Aspartate (NAA), Choline (Cho) and Creatinine (Cr), between low grade glioma and high-grade glioma were found to be statistically significant (p<0.05). Significant difference was also present among Cho/NAA and Cho/Cr in differentiating low-grade from high-grade glioma. Conclusion. This study has shown that Cho/NAA and Cho/Cr ratios are reliable determinants of the tumor grade with good sensitivity and specificity. Thus, Cho/NAA and Cho/Cr ratios of MRS maybe used as a diagnostic tool in differentiating low grade gliomas from high grade gliomas.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47734934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edward Javier Acero Mondragon, Eduardo Tuta Quintero
Background. Fluctuating facial asymmetry (FFA) is accentuated throughout life and has perceptual psychological implications; tissue diagnosis shows interindividual differences at first glance, for example, in the number of fixations, but no reports are available regarding the visual perceptual background in relation to individuals with less or more FFA during the tissue diagnostic task. Materials and methods. In medical students, including 13 men (SD = 19.4 years) and 8 women (SD = 18.1 years), FFA was determined as follows: n = 9 FFA. The entire population performed tissue diagnostic analysis of normal skin and skin with squamous cell carcinoma pathology from digital images to establish the duration and number of fixations and the total time taken for diagnosis. Results. Individuals with > FFA show significant differences in the visual perceptual background during diagnostic analysis of normal and pathological skin, which are magnified by the fixation duration and the number of fixations when the tissue diagnosis is pathological. Conclusion. Compared to those with lower FFA, medical students with greater FFA performing tissue diagnosis of pathological tissue have visual perceptual backgrounds characterized by less time spent in each fixation but with more fixations.
{"title":"Fluctuating facial asymmetry and visual perceptive background during a tissue diagnostic histopathological","authors":"Edward Javier Acero Mondragon, Eduardo Tuta Quintero","doi":"10.37897/rjn.2022.3.5","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.5","url":null,"abstract":"Background. Fluctuating facial asymmetry (FFA) is accentuated throughout life and has perceptual psychological implications; tissue diagnosis shows interindividual differences at first glance, for example, in the number of fixations, but no reports are available regarding the visual perceptual background in relation to individuals with less or more FFA during the tissue diagnostic task. Materials and methods. In medical students, including 13 men (SD = 19.4 years) and 8 women (SD = 18.1 years), FFA was determined as follows: n = 9 FFA. The entire population performed tissue diagnostic analysis of normal skin and skin with squamous cell carcinoma pathology from digital images to establish the duration and number of fixations and the total time taken for diagnosis. Results. Individuals with > FFA show significant differences in the visual perceptual background during diagnostic analysis of normal and pathological skin, which are magnified by the fixation duration and the number of fixations when the tissue diagnosis is pathological. Conclusion. Compared to those with lower FFA, medical students with greater FFA performing tissue diagnosis of pathological tissue have visual perceptual backgrounds characterized by less time spent in each fixation but with more fixations.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41767255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bouadel, M. Oudrhiri, M. El Hassani, M. Jiddane, A. El Ouahabi
Background. Until the advent of new exploration techniques: functional magnetic resonance imaging (fMRI) and surgical protocols such as exeresis in awake mode, the functional recovery potential of postoperative deficits was limited by conventional tumor surgery. The use of these methods simultaneously improves the quality of life and survival medians, mainly for removing low-grade gliomas massively infiltrating subcortical networks in eloquent regions where surgery is historically not associated with high functional recovery rates. Accordingly, the results from the awake brain surgery literature motivate us to establish a new baseline on the relationship between electrical stimulation mapping (ESM) threshold, the extent of resection (EOR), neuroplastic typology, and functional recovery after intraoperative crises or postoperative care deficits using induced neuroplasticity. Materials and patients. This is a retrospective analytical study of 35 brain tumor cases of gliomas, operated by common craniotomy in awake conditions from September 2016 to July 2022. Before entering awake resection mode, all patients underwent brain mapping (ESM) by direct electrical stimulation (DES) according to standard conditions and Helsinki ethical guidelines. Analysis according to ESM was done for two groups (group 1 and group 2) of different intensities of DES. Outcomes. The ESM by threshold intensity expressed in mean ± deviation standard was: 2,45 ± 0.125 mA for sensorimotor functions against 1.35 ± 0.175 mA for cognitive mapping. These stimulation currents were optimum thresholds which allowed us during control mapping to overcome all boundary conditions, mostly false negative results. The functional recovery time (FRT) following stimulation-induced seizures was varied from 2 s to 6.26 s, marking the intraoperative neuroplasticity operated mainly by synaptic remodeling during the functional reactivation. The EOR was better for group 1 with 82.35 % gross total resection (GTR) with only 8.75% of the occurrence of transient seizures against 45.7% for group 2 and only 2.86% suffered from neurological permanent deficits in group 1 against 11.42% in group 2. Conclusions. ESM in the range of [2.35 - 2.45 mA] improved DES sensitivity without false negatives. We had a compromise of improved results between these stimulation thresholds, the duration of the craniotomy, the functional recovery time, the EOR and overall the occurrence of neurological deficits, which explain the processes involved in the success of awake surgery.
{"title":"Preliminary experience in Awake Surgery:Functional recovery profile","authors":"A. Bouadel, M. Oudrhiri, M. El Hassani, M. Jiddane, A. El Ouahabi","doi":"10.37897/rjn.2022.3.6","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.6","url":null,"abstract":"Background. Until the advent of new exploration techniques: functional magnetic resonance imaging (fMRI) and surgical protocols such as exeresis in awake mode, the functional recovery potential of postoperative deficits was limited by conventional tumor surgery. The use of these methods simultaneously improves the quality of life and survival medians, mainly for removing low-grade gliomas massively infiltrating subcortical networks in eloquent regions where surgery is historically not associated with high functional recovery rates. Accordingly, the results from the awake brain surgery literature motivate us to establish a new baseline on the relationship between electrical stimulation mapping (ESM) threshold, the extent of resection (EOR), neuroplastic typology, and functional recovery after intraoperative crises or postoperative care deficits using induced neuroplasticity. Materials and patients. This is a retrospective analytical study of 35 brain tumor cases of gliomas, operated by common craniotomy in awake conditions from September 2016 to July 2022. Before entering awake resection mode, all patients underwent brain mapping (ESM) by direct electrical stimulation (DES) according to standard conditions and Helsinki ethical guidelines. Analysis according to ESM was done for two groups (group 1 and group 2) of different intensities of DES. Outcomes. The ESM by threshold intensity expressed in mean ± deviation standard was: 2,45 ± 0.125 mA for sensorimotor functions against 1.35 ± 0.175 mA for cognitive mapping. These stimulation currents were optimum thresholds which allowed us during control mapping to overcome all boundary conditions, mostly false negative results. The functional recovery time (FRT) following stimulation-induced seizures was varied from 2 s to 6.26 s, marking the intraoperative neuroplasticity operated mainly by synaptic remodeling during the functional reactivation. The EOR was better for group 1 with 82.35 % gross total resection (GTR) with only 8.75% of the occurrence of transient seizures against 45.7% for group 2 and only 2.86% suffered from neurological permanent deficits in group 1 against 11.42% in group 2. Conclusions. ESM in the range of [2.35 - 2.45 mA] improved DES sensitivity without false negatives. We had a compromise of improved results between these stimulation thresholds, the duration of the craniotomy, the functional recovery time, the EOR and overall the occurrence of neurological deficits, which explain the processes involved in the success of awake surgery.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48480903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dumitru, N. Gică, R. Botezatu, G. Peltecu, A. Panaitescu
Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and Methods. We performed a literature review searching relevant information on the subject in PubMed and Medscape databases. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.
{"title":"Migraine and pregnancy","authors":"A. Dumitru, N. Gică, R. Botezatu, G. Peltecu, A. Panaitescu","doi":"10.37897/rjn.2022.2.1","DOIUrl":"https://doi.org/10.37897/rjn.2022.2.1","url":null,"abstract":"Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and Methods. We performed a literature review searching relevant information on the subject in PubMed and Medscape databases. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42300870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. The mechanism underlying the relationship between carotid flow velocities and stroke events remains unclear. This study aimed to reveal the relationship of flow velocity measurements with risk factors in patients with acute ischemic stroke. Material and methods. A group of patients between the ages of 41-90 who applied to Mengücek Training and Research Hospital in the Eastern Anatolia Region of Turkey between 2014-2015 due to acute ischemic stroke were included. Groups with large artery atherosclerosis and small-vessel occlusion according to the Toast classification were included in the study. Brain tomography and magnetic resonance imaging, echocardiography, high-resolution color Doppler Ultrasonography examinations were performed. Internal carotid artery peak-systolic and end-diastolic flow velocity, common carotid artery peak-systolic and end-diastolic flow velocity, internal carotid artery peak systolic-common carotid artery peak-systolic velocity ratio and common carotid artery intima-media thickness were measured with Doppler Ultrasonography. The relationship between carotid flow velocities and brain infarction volume, comorbid factors, biochemical variables, left ventricular systolic-diastolic dysfunction was defined by using Statistical Package for Social Sciences version 21.0. Outcomes. In acute ischemic stroke groups, a significant negative correlation between common carotid artery end-diastolic flow velocity and brain infarction volume, a significant positive relationship between common carotid artery peak-systolic velocity and smoking, a significant positive correlation between common carotid artery intima-media thickness and blood glucose and hba1c, a significant negative correlation between common carotid artery end-diastolic flow velocity and hypertension, a significant relationship between common carotid artery end-diastolic flow velocity and ischemic heart disease, an increase in cerebral infarction in patients with left ventricular systolic dysfunction and a decrease in Internal carotid artery peak-systolic flow velocity in patients with left ventricular diastolic dysfunction were detected. Conclusions. In clinical practice, Doppler ultrasound is currently the main diagnostic tool for evaluating the diagnosis of carotid stenosis. In stenosis in the carotid artery system, it should be known as a basic rule that the flow velocity in the stenosis area increases, except for in severe stenosis and four basic measurements should be made to determine the degree of stenosis clearly. These measurements are peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), peak-systolic flow velocity ratio (ICA/CCA PSV). The purpose of sonographic evaluation of the extracranial cerebral arteries is to prevent bad sequelae and permanent deficits together with cerebral infarction.
{"title":"Evaluation of extracranial carotid flow velocities in patients presenting with acute ischemic stroke: A clinical study conducted in Turkey","authors":"A. Ertekin","doi":"10.37897/rjn.2022.2.9","DOIUrl":"https://doi.org/10.37897/rjn.2022.2.9","url":null,"abstract":"Objective. The mechanism underlying the relationship between carotid flow velocities and stroke events remains unclear. This study aimed to reveal the relationship of flow velocity measurements with risk factors in patients with acute ischemic stroke. Material and methods. A group of patients between the ages of 41-90 who applied to Mengücek Training and Research Hospital in the Eastern Anatolia Region of Turkey between 2014-2015 due to acute ischemic stroke were included. Groups with large artery atherosclerosis and small-vessel occlusion according to the Toast classification were included in the study. Brain tomography and magnetic resonance imaging, echocardiography, high-resolution color Doppler Ultrasonography examinations were performed. Internal carotid artery peak-systolic and end-diastolic flow velocity, common carotid artery peak-systolic and end-diastolic flow velocity, internal carotid artery peak systolic-common carotid artery peak-systolic velocity ratio and common carotid artery intima-media thickness were measured with Doppler Ultrasonography. The relationship between carotid flow velocities and brain infarction volume, comorbid factors, biochemical variables, left ventricular systolic-diastolic dysfunction was defined by using Statistical Package for Social Sciences version 21.0. Outcomes. In acute ischemic stroke groups, a significant negative correlation between common carotid artery end-diastolic flow velocity and brain infarction volume, a significant positive relationship between common carotid artery peak-systolic velocity and smoking, a significant positive correlation between common carotid artery intima-media thickness and blood glucose and hba1c, a significant negative correlation between common carotid artery end-diastolic flow velocity and hypertension, a significant relationship between common carotid artery end-diastolic flow velocity and ischemic heart disease, an increase in cerebral infarction in patients with left ventricular systolic dysfunction and a decrease in Internal carotid artery peak-systolic flow velocity in patients with left ventricular diastolic dysfunction were detected. Conclusions. In clinical practice, Doppler ultrasound is currently the main diagnostic tool for evaluating the diagnosis of carotid stenosis. In stenosis in the carotid artery system, it should be known as a basic rule that the flow velocity in the stenosis area increases, except for in severe stenosis and four basic measurements should be made to determine the degree of stenosis clearly. These measurements are peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), peak-systolic flow velocity ratio (ICA/CCA PSV). The purpose of sonographic evaluation of the extracranial cerebral arteries is to prevent bad sequelae and permanent deficits together with cerebral infarction.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47718864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Astari Arum Cendani Goller, Anak Agung Ayu Putri Laksmidewi, R. Sihanto
Background/aim. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Although the main symptoms of this virus are in the respiratory system, neurological clinical manifestations in the form of the central nervous system (CNS), peripheral nervous system (PNS) and musculoskeletal system are often found. This study aims for data on the characteristics of neurological manifestations in COVID-19 patients. Research methods. A retrospective cohort study with medical record from June 2020 to June 2021 which was analyzed descriptive, Chi-Square test and survival using SPSS program. Research result. There were 136 patients with PCR swab results (+), 80 (58.8%) male and 56 (41.2%) female, age > 50 years 92 (67.6%), 47 (34.6%) died. Neurological manifestations in the CNS that stroke 72 (52.9%) RR 4.8 (CI 95% 2.1-10.6; p<0.001), seizures 19 (14%) RR 14.7 (95% CI 4-54.3; p <0.001), headache 32 (23.5%) RR 5.7 (95% CI 2, 4-13.4; p<0.001), encephalopathy 35 (25.7%) RR 41.1 (95% CI 12.7-132.7; p<0.001), in the PNS myasthenic crisis 6 (4.4%) RR 10.4 (95% CI 1.2-92.5; p = 0.035) anosmia 73 (53.7%) RR 0.2 (95% CI 0.1-0.5; p<0.001) while musculoskeletal myalgia 25 (18.4%) and low back pain 18 (13.2%) was not significant. Conclusion. Most neurological clinical manifestations in the CNS (stroke, headache, seizures and encephalopathy) followed by the PNS (myasthenia crisis and anosmia). Neuroinvasive complications are thought to play a role as one of the causes of respiratory failure and death in patients with COVID-19.
{"title":"Characteristics of neurologic manifestations in COVID-19 patients at Sanglah Hospital, Denpasar, Indonesia","authors":"Astari Arum Cendani Goller, Anak Agung Ayu Putri Laksmidewi, R. Sihanto","doi":"10.37897/RJN.2022.2.12","DOIUrl":"https://doi.org/10.37897/RJN.2022.2.12","url":null,"abstract":"Background/aim. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Although the main symptoms of this virus are in the respiratory system, neurological clinical manifestations in the form of the central nervous system (CNS), peripheral nervous system (PNS) and musculoskeletal system are often found. This study aims for data on the characteristics of neurological manifestations in COVID-19 patients. Research methods. A retrospective cohort study with medical record from June 2020 to June 2021 which was analyzed descriptive, Chi-Square test and survival using SPSS program. Research result. There were 136 patients with PCR swab results (+), 80 (58.8%) male and 56 (41.2%) female, age > 50 years 92 (67.6%), 47 (34.6%) died. Neurological manifestations in the CNS that stroke 72 (52.9%) RR 4.8 (CI 95% 2.1-10.6; p<0.001), seizures 19 (14%) RR 14.7 (95% CI 4-54.3; p <0.001), headache 32 (23.5%) RR 5.7 (95% CI 2, 4-13.4; p<0.001), encephalopathy 35 (25.7%) RR 41.1 (95% CI 12.7-132.7; p<0.001), in the PNS myasthenic crisis 6 (4.4%) RR 10.4 (95% CI 1.2-92.5; p = 0.035) anosmia 73 (53.7%) RR 0.2 (95% CI 0.1-0.5; p<0.001) while musculoskeletal myalgia 25 (18.4%) and low back pain 18 (13.2%) was not significant. Conclusion. Most neurological clinical manifestations in the CNS (stroke, headache, seizures and encephalopathy) followed by the PNS (myasthenia crisis and anosmia). Neuroinvasive complications are thought to play a role as one of the causes of respiratory failure and death in patients with COVID-19.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43954059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ioana-Elena Tarabasanu-Mihaila, F. Paslaru, A. Paslaru, N. Gică, G. Peltecu, A. Panaitescu
Moyamoya disease (MMD) is a chronic vasculopathy characterized by progressive bilateral stenosis and occlusion of the terminal portion of the internal carotid artery (ICA) and the presence of an abnormal vascular network at the base of the brain, termed Moyamoya vessels (MMV). The main presentations of MMD are ischemia and hemorrhage, and diagnosis is done via angiography. Cerebral events were reported in 5.1% of pregnancies of MMD diagnosed mothers, in Japan. In the case of MMD diagnosis due to cerebrovascular events during gestation, 34.7% of patients presented with an ischemic event, while 69.5% suffered from hemorrhage. During gestation, hemorrhagic events were found to occur mostly antepartum, after 24 weeks of gestation, while cerebral infarction peaked 3-7 days after delivery. No treatment has been found to halt or reverse the progress of the disease. Interventions focus on reducing the risk of stroke and cognitive disfunction as a result of ischemia. In the case of pregnant women suffering hemorrhage due to MMD, conservative treatment, as well as ventricle puncture and drainage were to be efficient, and did not severely impact the child. When diagnosed before pregnancy occurs, MMD under treatment does not pose a significantly increased risk of complications, compared to pregnancies in unaffected women. No evidence suggests that MMD is a contraindication for pregnancy.
{"title":"Moyamoya disease during pregnancy and childbirth","authors":"Ioana-Elena Tarabasanu-Mihaila, F. Paslaru, A. Paslaru, N. Gică, G. Peltecu, A. Panaitescu","doi":"10.37897/rjn.2022.2.6","DOIUrl":"https://doi.org/10.37897/rjn.2022.2.6","url":null,"abstract":"Moyamoya disease (MMD) is a chronic vasculopathy characterized by progressive bilateral stenosis and occlusion of the terminal portion of the internal carotid artery (ICA) and the presence of an abnormal vascular network at the base of the brain, termed Moyamoya vessels (MMV). The main presentations of MMD are ischemia and hemorrhage, and diagnosis is done via angiography. Cerebral events were reported in 5.1% of pregnancies of MMD diagnosed mothers, in Japan. In the case of MMD diagnosis due to cerebrovascular events during gestation, 34.7% of patients presented with an ischemic event, while 69.5% suffered from hemorrhage. During gestation, hemorrhagic events were found to occur mostly antepartum, after 24 weeks of gestation, while cerebral infarction peaked 3-7 days after delivery. No treatment has been found to halt or reverse the progress of the disease. Interventions focus on reducing the risk of stroke and cognitive disfunction as a result of ischemia. In the case of pregnant women suffering hemorrhage due to MMD, conservative treatment, as well as ventricle puncture and drainage were to be efficient, and did not severely impact the child. When diagnosed before pregnancy occurs, MMD under treatment does not pose a significantly increased risk of complications, compared to pregnancies in unaffected women. No evidence suggests that MMD is a contraindication for pregnancy.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45520754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Cudalbă, N. Gică, G. Peltecu, R. Botezatu, A. Panaitescu
Background. Women are commonly diagnosed with multiple sclerosis during reproductive age. There is need for disease control management during pregnancy, taking into consideration potential maternal and fetal risks. This review article aims to summarize what is acknowledged so far regarding treatment options of multiple sclerosis and outcomes in pregnancy, providing up-to-date information. Methods. In order to write this review a comprehensive literature electronic search for journal articles and guidelines regarding multiple sclerosis during pregnancy was undertaken. Results and conclusion. Multiple sclerosis management in pregnancy is a challenging issue. The use of disease-modifying drugs has improved both the course of the disease and the attitude towards pregnancy in patients living with multiple sclerosis. Pregnancy appears to have a protective effect on disease activity, particularly during the third trimester.
{"title":"Multiple sclerosis in pregnancy. Treatment options and outcomes: a review","authors":"D. Cudalbă, N. Gică, G. Peltecu, R. Botezatu, A. Panaitescu","doi":"10.37897/rjn.2022.2.5","DOIUrl":"https://doi.org/10.37897/rjn.2022.2.5","url":null,"abstract":"Background. Women are commonly diagnosed with multiple sclerosis during reproductive age. There is need for disease control management during pregnancy, taking into consideration potential maternal and fetal risks. This review article aims to summarize what is acknowledged so far regarding treatment options of multiple sclerosis and outcomes in pregnancy, providing up-to-date information. Methods. In order to write this review a comprehensive literature electronic search for journal articles and guidelines regarding multiple sclerosis during pregnancy was undertaken. Results and conclusion. Multiple sclerosis management in pregnancy is a challenging issue. The use of disease-modifying drugs has improved both the course of the disease and the attitude towards pregnancy in patients living with multiple sclerosis. Pregnancy appears to have a protective effect on disease activity, particularly during the third trimester.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46068271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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