Acta neurologica Taiwanica最新文献

Stroke is a leading cause of disability worldwide. Neuroplasticity, a condition wherein the brain's dynamic response to injury is heightened and rehabilitation might be effective, is observed shortly after acute stroke. However, although several trials have demonstrated that initiating treatment within 24 hours after stroke is potentially harmful, some have shown that early rehabilitation of patients is beneficial. Administration of constraint-induced movement therapy within two weeks after stroke appears to be beneficial for the upper extremities. In addition, intensive early post-stroke therapy may be beneficial for patients with severe aphasia. Novel approaches to early treatment of post-stroke dysphagia appear promising; however, the high rate of spontaneous improvement makes it difficult to gauge their benefits. Overall, although increasing evidence indicates that initiating rehabilitative strategies within two weeks after stroke is beneficial for some deficits, the optimal time for initiating post-stroke rehabilitation remains undetermined. Keywords: stroke, early rehabilitation, neuroplasticity, early mobilization.

Objective: To evaluate the effect of using acetylsalicylic acid (aspirin) together with lansoprazole in the secondary prevention of ischemic stroke.

Materials and methods: 199 patients with a diagnosis of ischemic stroke and transient ischemic attack (TIA) using 100 mg aspirin regularly were included in the study. All patients were evaluated for the presence of aspirin resistance before starting the study. 57 patients with aspirin resistance were excluded from the study. The remaining 142 patients were divided into two groups: the 1st group consisted of those with stomach discomfort and the 2nd group consisted of those without stomach discomfort. Patients in group 1 were given 30 mg of lansoprazole taken before breakfast in addition to aspirin therapy. All patients were re-evaluated for the presence of aspirin resistance at a one-month follow-up. The antiaggregant activity was evaluated by the impedance aggregometry method in both groups.

Results: Of 142 patients, 75 were in group 1, and 67 were in group 2. There was no difference between the two groups in terms of age and gender distribution of vascular risk factors. There was no statistically significant difference between the two groups in terms of aspirin efficacy. The dose of aspirin was increased in patients with aspirin resistance (AR).

Conclusion: The combination of 30 mg lansoprazole and 100 mg aspirin does not cause a decrease in antiaggregant activity in the early period, but chronic use was not evaluated in this study. Patients with AR may benefit from an increase in the dose of aspirin.

Purpose: The causes of acute stroke in patients with SLE are multifactorial. Antiphospholipid-associated hypercoagulability and inflammation-induced platelet activation are major causes of ischemic stroke in SLE patients. As such patients underwent intravenous thrombolysis and endovascular thrombectomy, they may have higher risk of complications and less favorable outcome.

Case report: A 30-year-old woman with underline SLE and Takayasu arteritis who presented with right CCA and MCA occlusion status post rtPA and endovascular thrombectomy. Twelve hours after the procedure, head CT was ordered due to anisocoria with loss of pupillary light reflex. The head CT showed partial obliteration of suprasellar and quadrigeminal cistern due to extensive brain edema, leading to her decompressive craniectomy. Two days later, patient's both pupil became dilated with head CT showing occlusion of the left MCA. Her condition drastically went downhill when complications such as central DI and myocardial stunning occurred.

Conclusion: Although autoimmune vasculitis is not listed as an absolute contraindication to endovascular thrombectomy, given the antecedent reports, it is prudent to disclose possible complications to both the patient and family while making the decision.

Purpose: Intracranial vertebrobasilar artery dissection (iVBD) is a potentially lethal disease, and progression of the dissected vessels is not uncommon. Our report is aimed at providing further clinical experience of the timing of follow-up vascular imaging or endovascular intervention in iVBD patients.

Case report: We report a case of iVBD with silent rapid progression. The 48-year-old woman presented as transient right limbs weakness. Brain MRI showed a small acute infarct over the left cerebellum, and MRA revealed a short segment of dissection over the left distal vertebral artery extending to proximal basilar artery. With no new clinical symptoms and signs, follow-up of vascular imaging within 1 week showed progressive critical narrowing of the dissected vertebrobasilar arteries. The blood flow of the vertebrobasilar system was restored by endovascular stenting.

Conclusion: iVBD might progress without clinical manifestations. Early follow-up of vascular imaging should be considered in the patients with high risk for progression.

Purpose: The three-dimensional (3D) measurement of vessel wall volume (VWV) and plaque volume is sensitive for predicting cardiovascular risk. We established the normal norms of carotid VWV.

Methods: We retrospectively enrolled 352 patients with normal findings of the carotid ultrasound studies. Two-dimensional carotid intima-media thickness (IMT) was measured online. Grayscale 3D images of both sides of the carotid arteries were analyzed offline for measurement of IMT (QIMT) and VWV.

Results: The median age of the enrollees was 59 years. The median carotid IMT, QIMT, and VWV was 0.61 mm, 0.72 mm, and 90 mm3, respectively. No differences in IMT and VWV were observed between men and women or between the right and left side. We stratified participants into four groups, namely young adults (≤50 years), middle-aged adults (51-65 years), older adults (66-75 years), and senior adults (≥75 years). All the values of measured variables increased with advancing age. The median VWV of each group was 84, 90, 100, and 112 mm3, respectively. The increment percentage from young to senior adults was similar in terms of IMT and VWV. Nevertheless, the difference in the value of VWV (28 mm3) was much larger than that in IMT (0.18 mm). All three measured variables exhibited a positive linear correlation with age.

Conclusion: Both IMT and VWV have positive linear correlations with age. The application of QIMT measurements was limited by its inconsistent accuracy. VWV not only has a strong correlation with IMT but also enables observation of dynamic vessel wall changes, which is valuable for clinical observational studies.

Purpose: Minor injury to head and neck is usually neglected for potential neurological consequences. We report a woman who suffered left Eagle syndrome due to styloid process fracture two years after a minor motorcycle collision.

Case report: A 53-year-old woman complained pain at her left upper neck, lower face and periauricular area after minor motorcycle collision at 2 years ago. The pain usually occurred spontaneously but was occasionally triggered or exacerbated by specific postural changes, including looking up or turning head to right side. Moreover, a foreign body sensation occurred at throat during swallowing. Physical examination provoked pain at the left submandibular area. Carotid bruit was absent. Otherwise, other neurological function was preserved. Computerized tomography revealed linear fracture at the middle of left styloid process. After inform, patient preferred conservative treatments including abortive non- steroidal anti-inflammatory drugs and an avoidance of rapid head rotations. Since afterwards, the frequency and intensity of neck pain greatly decreased and she could tolerate and maintain a normal daily living.

Conclusions: Asymptomatic or paucisymptomatic styloid process fracture may be neglected in case of minor injury to head and neck. A careful evaluation of neck should be completed in traumatic individuals to reveal underlying damage and prevent further harmful consequence.

The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated Taiwan's guidelines for the acute and preventive treatment of cluster headaches on the basis of the principles of evidence-based medicine. The subcommittee assessed the quality of clinical trials and levels of evidence and referred to the treatment guidelines of other countries. Over the course of several panel discussions, the subcommittee members reached a consensus regarding the major roles of, recommended levels of, clinical efficacy of, adverse events in, and clinical precautions for the acute and preventive treatment of cluster headaches. Thus, the subcommittee updated the previous version of the guidelines published in 2011. Most cluster headaches occurring in Taiwan are episodic, and very few patients develop chronic cluster headaches. Cluster headaches cause extreme pain over a short period and are accompanied by ipsilateral autonomic symptoms; therefore, immediate treatment can provide considerable relief. Treatment options can be categorized into acute and preventive types. Among the treatment methods currently available in Taiwan for cluster headaches, high-flow pure oxygen inhalation has demonstrated the best evidence and effectiveness for acute attacks, followed by triptan nasal spray; therefore, these are recommended as first-line treatments. Oral steroids and suboccipital steroid injections can be used as transitional preventative treatments. Verapamil is recommended as a first-line treatment for maintenance prophylaxis. Drugs such as lithium, topiramate, and calcitonin gene-related peptide (CGRP) monoclonal antibodies are recommended as secondline treatments. Noninvasive vagus nerve stimulation is the recommended instrumental therapy. The effectiveness of surgical treatment, such as sphenopalatine ganglion stimulation, is supported by a high level of evidence; nevertheless, because few patients have chronic cluster headaches in Taiwan, no clinical records are available for use as a reference. Transitional prophylaxis and maintenance prophylaxis can be used simultaneously according to the individual condition of the patient, and the transitional prophylaxis can be gradually discontinued once the maintenance prophylaxis takes effect. Steroids should not be used for more than 2 weeks as transitional prophylaxis. Maintenance prophylaxis should be administered until the end of the bout period (no attacks for 2 weeks) and then gradually tapered off. Key words: cluster headaches, oxygen therapy, triptans, steroids, CGRP monoclonal antibodies, noninvasive vagus nerve stimulation.