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Close your eyes and see – stroke sequelae versus functional neurological disorder in a physician
The first author was a left-handed, 51-year-old nephrologist who experienced a neurologic event. She underwent neurosurgery complicated by hemorrhage. Post-operatively, she developed persistent vertigo and unilateral tongue pain which persisted for over five years. Early neuroimaging revealed expected encephalomalacia but no neuroanatomical basis for my symptoms. A functional neurological disorder was suspected, and she was seen by several psychiatrists and psychotherapists. However, she suspected a neuroanatomical lesion would better explain her unrelenting symptoms. After seeing many neurologists, a neuroanatomical diagn...
Source: European Neurology - April 20, 2023 Category: Neurology Source Type: research

Efficacy and safety of ticagrelor versus aspirin and clopidogrel for stroke prevention in patients with vascular disease: a systematic review and meta-analysis
Introduction: Currently, it is still controversial to treat stroke with ticagrelor alone. The purpose of our study was to systematically review and analyze the efficacy and safety of ticagrelor on cerebrovascular outcomes in patients with vascular risk factors. Methods: The PubMed, Cochrane Library, and EMBASE databases were systematically searched using the keywords stroke, ticagrelor, clopidogrel, and aspirin to identify randomized controlled trials (RCT). Primary outcomes included reported stroke, ischemic stroke and complex events; the secondary outcome was hemorrhagic stroke. The safety outcomes included major bleedi...
Source: European Neurology - April 17, 2023 Category: Neurology Source Type: research

Advances in Futile Reperfusion following Endovascular Treatment in Acute Ischemic Stroke due to Large Vessel Occlusion
Background: Futile reperfusion (FR) is becoming an urgent issue for acute ischemic stroke patients who underwent endovascular treatment (EVT). Although the recanalization rate has improved after EVT, it is far from translating to increased tissue reperfusion and functional independence.Summary: Many underlying mechanisms including the “no-reflow” phenomenon, poor collateral flow, venous dysfunction, and inflammation were proposed, but the pathophysiology of FR is still unclear. Clinically, reliable predictors are still yet to be identified, and ongoing trials on shortening the time delay and cytoprotection may provide ...
Source: European Neurology - February 8, 2023 Category: Neurology Source Type: research

Microcirculation No-Reflow Phenomenon after Acute Ischemic Stroke
Conclusion: Here, we review the occurrence of the no-reflow phenomenon after ischemic stroke and discuss its impact, detection method, and therapeutic strategies on the course of ischemic stroke, from basic science to clinical findings.Eur Neurol
Source: European Neurology - January 6, 2023 Category: Neurology Source Type: research

Early Initiation of Exoskeletal Robotic Gait Training Improves Functional Outcomes in the Patients with Stroke: A Retrospective Observational Study
Conclusions: In conclusion, early initiation of gait training using HAL might improve the motor function of the paralyzed lower limb and disability in patients with stroke.Eur Neurol
Source: European Neurology - December 14, 2022 Category: Neurology Source Type: research

The Friar with the Crutch: A Pictorial Hint of the Stroke Suffered by Bernardino da Fossa (1420 –1503)
Background: Works of art may serve as a source of evidence of diseases and help to better understand their natural history.Summary: Bernardino da Fossa was a 15th-century Italian Franciscan friar who wrote sermons and historical works. He described the events of the Observance Reformation movement since its dawn, but the last chapter is unexplainably interrupted. This has been considered suggestive for an acute and disabling illness. A painting dating back 12 years after his death depicts Bernardino holding a crutch with his left arm. This may represent an important clue to establish a gait disturbance, whereas the permane...
Source: European Neurology - December 13, 2022 Category: Neurology Source Type: research

Effects of Direct Oral Anticoagulants ’ Nonrecommended Dose in Atrial Fibrillation: A Meta-Analysis
Background: The efficacy and safety profiles of nonrecommended direct oral anticoagulant (DOAC) doses in patients with nonvalvular atrial fibrillation (NVAF) are still undefined.Summary: We searched for randomized controlled trials and observational studies that compared nonrecommended versus recommended doses of DOACs, published up to December 2021. Primary study outcomes were ischemic stroke/transient ischemic attack/systemic embolism (IS/TIA/SE) and major bleeding (MB). All-cause mortality was a secondary outcome. We determined pooled odds ratios (ORs) between groups of patients with a random-effect model. Twenty-three ...
Source: European Neurology - September 13, 2022 Category: Neurology Source Type: research

Aspiration versus Stent Retriever Thrombectomy in Posterior Circulation Stroke: A Systematic Review and Meta-Analysis
Conclusion: This study provides preliminary evidence for improved morbidity and mortality outcomes in posterior circulation stroke patients undergoing aspiration-based thrombectomies as compared to stent retriever-based thrombectomy. The study also provides evidence for improved endovascular outcomes for patients undergoing aspiration-based thrombectomies. The findings from this study can have implications in developing awareness among neurosurgeons for stratifying patients to manage posterior circulation stroke according to the risks associated with aspiration and stent retriever-based thrombectomies.Eur Neurol
Source: European Neurology - August 10, 2022 Category: Neurology Source Type: research

Treatments in Ischemic Stroke: Current and Future
Background and Aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of drugs with better safety-efficacy profiles as well as strategies able to improve ischemic stroke management from the pre-hospital setting is needed.Summary: The pathophysiology of ischemic stroke involves multiple pathways resulting in cerebral artery obstruction and brain tissue ischemia. To date, the only approved drug for acute ischemic stroke is intravenous thrombolytic alt...
Source: European Neurology - August 2, 2022 Category: Neurology Source Type: research

Prediction of Motor Outcome of Stroke Patients Using a Deep Learning Algorithm with Brain MRI as Input Data
Conclusion: We showed that a CNN model trained using whole-brain axial T2-weighted MR images of stroke patients would help predict upper and lower limb motor function at the chronic stage.Eur Neurol
Source: European Neurology - June 23, 2022 Category: Neurology Source Type: research

Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke When Multiple Passes Are Required and Associated Risk Factors
Conclusion: Needing more than 2 passes during mechanical thrombectomy is associated with poorer outcomes. Higher preprocedural NIHSS scores and internal carotid artery thrombi are associated with more than 2 passes.Eur Neurol
Source: European Neurology - May 3, 2022 Category: Neurology Source Type: research

Effectiveness of Intensively Applied Mirror Therapy in Older Patients with Post-Stroke Hemiplegia: A Preliminary Trial
Conclusion: Intensive MT appears to be more effective than a more spaced over time therapy; therefore, at least in the older adults, this treatment protocol should be recommended in the post-stroke recovery of these patients. Further studies will confirm with certainty whether this treatment is the most suitable guideline for to treat these patients.Eur Neurol
Source: European Neurology - April 4, 2022 Category: Neurology Source Type: research

Practical Machine Learning Model to Predict the Recovery of Motor Function in Patients with Stroke
Conclusion: Although we used simple and common data that can be obtained in clinical practice as variables, our DNN algorithm was useful for predicting motor recovery of the upper and lower extremities in stroke patients during the recovery phase.Eur Neurol
Source: European Neurology - March 29, 2022 Category: Neurology Source Type: research

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