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HINTS and stroke

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https://www.readbyqxmd.com/read/29515362/on-the-viability-of-diffusion-mri-based-microstructural-biomarkers-in-ischemic-stroke
#1
Ilaria Boscolo Galazzo, Lorenza Brusini, Silvia Obertino, Mauro Zucchelli, Cristina Granziera, Gloria Menegaz
Recent tract-based analyses provided evidence for the exploitability of 3D-SHORE microstructural descriptors derived from diffusion MRI (dMRI) in revealing white matter (WM) plasticity. In this work, we focused on the main open issues left: (1) the comparative analysis with respect to classical tensor-derived indices, i.e., Fractional Anisotropy (FA) and Mean Diffusivity (MD); and (2) the ability to detect plasticity processes in gray matter (GM). Although signal modeling in GM is still largely unexplored, we investigated their sensibility to stroke-induced microstructural modifications occurring in the contralateral hemisphere...
2018: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29508131/acute-vestibular-syndrome-clinical-head-impulse-test-versus-video-head-impulse-test
#2
Nese Celebisoy
HINTS battery involving head impulse test (HIT), nystagmus, and test of skew is the critical bedside examination to differentiate acute unilateral peripheral vestibulopathy from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). The highest sensitivity component of the battery has been reported to be the horizontal HIT, whereas skew deviation is defined as the most specific but non-sensitive sign for PCS. Video-oculography-based HIT (vHIT) may have an additional power in making the differentiation...
March 5, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29373810/long-term-t-cell-responses-in-the-brain-after-an-ischemic-stroke
#3
Uma Maheswari Selvaraj, Ann M Stowe
Stroke, which occurs during a loss of blood flow to the brain, is a global disease that accounts for 10% of yearly mortality. But stroke is also a leading cause of long-term adult disability, with recovery continuing for months to years after initial stroke onset. This long-term functional recovery from stroke encompasses changes in neuronal structure and function, and occurs throughout the post-stroke brain. Much less understood is whether the adaptive immune cells that infiltrated the brain during acute post-stroke neuroinflammation remain long-term, and if their presence supports or hinders functional recovery...
December 2017: Discovery Medicine
https://www.readbyqxmd.com/read/29218753/neuronal-responses-to-the-scratching-and-caressing-of-one-s-own-skin-in-patients-with-skin-picking-disorder
#4
Anne Schienle, Sonja Übel, Albert Wabnegger
Skin-picking disorder (SPD) is a common mental disorder. The predominant symptom involves the repeated scratching and picking of one's own skin. This behavior causes severe tissue damage (sores, scars, and infections), often leading to disfigurement. Besides physical injury, SPD is associated with clinically significant distress and impairment in important areas of functioning. The neurobiological mechanisms of SPD are still poorly understood. In this study, 30 SPD patients and 31 control participants (35 women, 26 men) with a mean age of 34 years were instructed to either scratch or gently stroke a small skin area on their arms during functional magnetic resonance imaging...
March 2018: Human Brain Mapping
https://www.readbyqxmd.com/read/29150739/cell-therapy-in-stroke-cautious-steps-towards-a-clinical-treatment
#5
REVIEW
Olivier Detante, Keith Muir, Jukka Jolkkonen
In the future, stroke patients may receive stem cell therapy as this has the potential to restore lost functions. However, the development of clinically deliverable therapy has been slower and more challenging than expected. Despite recommendations by STAIR and STEPS consortiums, there remain flaws in experimental studies such as lack of animals with comorbidities, inconsistent approaches to experimental design, and concurrent rehabilitation that might lead to a bias towards positive results. Clinical studies have typically been small, lacking control groups as well as often without clear biological hypotheses to guide patient selection...
November 17, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/29148963/clinical-stroke-research-in-resource-limited-settings-tips-and-hints
#6
Jeyaraj D Pandian, Hueiming Liu, Dorcas Bc Gandhi, Richard I Lindley
Background Most stroke research is conducted in high income countries, yet most stroke occurs in low- and middle-income countries. There is an urgent need to build stroke research capacity in low- and middle-income countries. Aims To review the global health literature on how to improve research capacity in low- and middle-income countries, provide additional data from the recently completed ATTEND Trial and provide examples from our own experience. Summary of review The main themes from our literature review were: manpower and workload, research training, research question and methodology and research funding...
February 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29084063/central-vertigo
#7
Jeong-Yoon Choi, Seung-Han Lee, Ji-Soo Kim
PURPOSE OF REVIEW: This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. RECENT FINDINGS: Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/28697681/a-particularly-complex-case-of-matricide-by-means-of-plastic-bag-suffocation-case-report
#8
Arnaldo Stanislao Migliorini, Michele Boracchi, Guendalina Gentile, Francesca Maciocco, Andrea Piccinini, Riccardo Zoja
A rare case of homicide with plastic bag suffocation is presented in which forensic genetic investigations were carried out on the inner surface of a plastic bag placed over the head of an elderly woman, bedridden after a stroke. The results obtained suggested that she had been murdered and hinted at the perpetrator of the crime. In fact, it emerged that biological traces left by the victim matched those of her principal caregiver, her psychotic daughter, who later confessed to the crime. The old woman also had a son affected by a serious illness, whose genetic profile was found on the same bag...
July 2017: Medicine, Science, and the Law
https://www.readbyqxmd.com/read/28696571/acute-evaluation-of-the-acute-vestibular-syndrome-differentiating-posterior-circulation-stroke-from-acute-peripheral-vestibulopathies
#9
REVIEW
Benjamin K T Tsang, Alex S K Chen, Mark Paine
This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke (PCS) presenting as an AVS has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/Nystagmus/Test-of-skew) examination battery, yields a higher sensitivity for the diagnosis of PCS than even standard magnetic resonance imaging with diffusion-weighted imaging...
December 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28248913/pitfalls-and-rewards-for-implementing-ocular-motor-testing-in-acute-vestibular-syndrome-a-pilot-project
#10
Oana M Dumitrascu, Sam Torbati, Mourad Tighiouart, David E Newman-Toker, Shlee S Song
OBJECTIVES: Isolated acute vestibular syndrome (iAVS) presentations to the emergency department (ED) pose management challenges, given the concerns for posterior circulation strokes. False-negative brain imaging may erroneously reassure clinicians, whereas HINTS-plus examination outperforms imaging to screen for strokes in iAVS. We studied the feasibility of implementing HINTS-plus testing in the ED, aiming to reduce neuroimaging in patients with iAVS. METHODS: We launched an institutional Quality Improvement initiative, using DMAIC methodology...
March 2017: Neurologist
https://www.readbyqxmd.com/read/28187305/improvement-of-upper-trunk-posture-during-walking-in-hemiplegic-patients-after-injections-of-botulinum-toxin-into-the-arm
#11
Harald Hefter, Dietmar Rosenthal
BACKGROUND: It has been hypothesized that altered trunk movements during gait in post-stroke patients or children with cerebral palsy are compensatory to lower limb impairment. Improvement of trunk movements and posture after injections of botulinum toxin into the affected arm would be at variance with this hypothesis and hint towards a multifactorial trunk control deficit. PATIENTS AND METHODS: Clinical gait analysis was performed in 11 consecutively recruited hemiplegic patients immediately before and 4weeks after a botulinum toxin type A-injection into the affected arm...
March 2017: Clinical Biomechanics
https://www.readbyqxmd.com/read/28161193/preventive-treatment-of-astaxanthin-provides-neuroprotection-through-suppression-of-reactive-oxygen-species-and-activation-of-antioxidant-defense-pathway-after-stroke-in-rats
#12
Lei Pan, Ying Zhou, Xiu-Fang Li, Qing-Jia Wan, Le-Hua Yu
Astaxanthin, a natural antioxidant carotenoid, has been shown to reduce cerebral ischemic injury in rodents. However, there have not been any studies specifically addressing whether preventive administration of astaxanthin can protect against cerebral ischemia. The purpose of this study was to examine whether pretreatment of astaxanthin can protect against ischemic injuries in the adult rats. The rats were pre-administered intragastrically with astaxanthin for seven days (once a day), and middle cerebral artery occlusion was performed at 1h after the final administration...
April 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28100765/acute-transient-vestibular-syndrome-prevalence-of-stroke-and-efficacy-of-bedside-evaluation
#13
Jae-Hwan Choi, Min-Gyu Park, Seo Young Choi, Kyung-Pil Park, Seung Kug Baik, Ji-Soo Kim, Kwang-Dong Choi
BACKGROUND AND PURPOSE: The aim of this study was to determine the prevalence of stroke and efficacy of bedside evaluation in diagnosing stroke in acute transient vestibular syndrome (ATVS). METHODS: We performed a prospective, single-center, observational study that had consecutively recruited 86 patients presenting with ATVS to the emergency department of Pusan National University Yangsan Hospital from January to December 2014. All patients received a constructed evaluation, including HINTS plus (head impulse, nystagmus patterns, test of skew, and finger rubbing) and brain magnetic resonance imagings...
March 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27551274/the-diagnostic-accuracy-of-truncal-ataxia-and-hints-as-cardinal-signs-for-acute-vestibular-syndrome
#14
Sergio Carmona, Carlos Martínez, Guillermo Zalazar, Marcela Moro, Angel Batuecas-Caletrio, Leonel Luis, Carlos Gordon
The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI)...
2016: Frontiers in Neurology
https://www.readbyqxmd.com/read/27545414/vestibular-neuritis-involvement-and-long-term-recovery-of-individual-semicircular-canals
#15
Bela Büki, Manuela Hanschek, Heinz Jünger
OBJECTIVE: In this retrospective study, the aim of the authors was to examine the frequency of involvement of the individual semicircular canals (SCCs) in vestibular neuritis (VN) and to assess the degree of long-term recovery. A secondary aim was to retrospectively determine the usefulness of a three-step bedside oculomotor test (the HINTS-test) for the differential diagnosis of peripheral VN. METHODS: 44 cases were evaluated during the acute phase and approximately two months later...
June 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/27439368/propensity-score-matched-comparison-of-transcatheter-aortic-valve-implantation-versus-conventional-surgery-in-intermediate-and-low-risk-aortic-stenosis-patients-a-hint-of-real-world
#16
Javier Castrodeza, Ignacio J Amat-Santos, Myriam Blanco, Carlos Cortes, Javier Tobar, Irene Martin-Morquecho, Javier López, Salvatore Di Stefano, Paol Rojas, Luis H Varela-Falcon, Itziar Gomez, Jose A San Roman
BACKGROUND: Recently, the use of transcatheter aortic valve implantation (TAVI) in inter-mediate-low risk patients has been evaluated in the PARTNER II randomized trial. However, in the last years, this therapy has been employed in this scenario with underreported results, as compared to surgical aortic valve replacement (SAVR). METHODS: We enrolled 362 consecutive patients with severe symptomatic aortic stenosis and intermediate-low surgical risk (logEuroSCORE < 20%), treated in our center with TAVI (103 patients) or single SAVR (259 patients) between 2009 and 2014...
2016: Cardiology Journal
https://www.readbyqxmd.com/read/27190618/a-review-of-the-role-of-anticoagulation-for-patients-with-infective-endocarditis-and-embolic-stroke
#17
Arfah Hazel Preston, Stefan Williams, Judy Archer
Stroke is a common embolic complication of infective endocarditis. The most important treatment to prevent stroke in endocarditis is the initiation of antibiotic therapy. It is unclear whether the initiation of de novo anticoagulation (i.e, warfarin) in patients with infective endocarditis is beneficial, since there are no large or randomized controlled trials in this area. However, this case report suggests, despite the limited evidence, that anticoagulation in this patient caused no harm and could suggest a hint of possible benefit...
May 2016: Clinical Case Reports
https://www.readbyqxmd.com/read/27121592/impact-of-therapeutic-plasma-exchange-on-hemodynamic-parameters-in-medical-intensive-care-unit-patients-an-observational-study
#18
Tobias Lahmer, Marlena Messer, Christopher Schnappauf, Sebastian Rasch, Lisa Fekecs, Analena Beitz, Stefan Eser, Roland M Schmid, Wolfgang Huber
Therapeutic plasma exchange (TPE) is an extracorporeal treatment with reported beneficial as well as detrimental effects on circulation. However, there is a lack of data using advanced hemodynamic monitoring during TPE. Therefore, we investigated the effects of TPE on hemodynamic parameters derived from transpulmonary thermodilution (TPTD) as well as the risk for transfusion-related acute lung injury (TRALI). We compared hemodynamic parameters obtained before and after a total of 30 sessions of TPE treatment in 10 intensive care unit patients...
February 2017: Artificial Organs
https://www.readbyqxmd.com/read/26860124/vorapaxar-monotherapy-for-secondary-stroke-prevention-a-call-for-randomized-trial
#19
REVIEW
Victor L Serebruany, Moo H Kim, Daniel F Hanley
BACKGROUND AND PURPOSE: Vorapaxar, a novel platelet thrombin protease-activated receptor 1 blocker, is currently approved for post-myocardial infarction and peripheral artery disease indications on top of clopidogrel or/and aspirin. We sought to summarize the conflicting stroke data after vorapaxar for justifying a secondary stroke prevention trial. METHODS: Analyses of the stroke data after vorapaxar yielded from thrombin-receptor antagonist vorapaxar in acute coronary syndromes (TRACER) and TRA2P clinical trials, and affiliated Food and Drug Administration (FDA) reviews...
August 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/26835597/the-effect-of-sleep-on-motor-learning-in-the-aging-and-stroke-population-a-systematic-review
#20
REVIEW
W Backhaus, S Kempe, F C Hummel
There is extensive evidence for positive effects of sleep on motor learning in young individuals; however, the effects of sleep on motor learning in people with stroke and in healthy older individuals are not well understood. The aim of this systematic review was to quantify the association between sleep and procedural memory performance - a marker for motor learning - in healthy older people and people with stroke. After searches in PubMed, Medline and Embase fourteen studies, including 44 subjects after stroke and 339 healthy older participants were included...
2015: Restorative Neurology and Neuroscience
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