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HINTS and stroke

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
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...
August 18, 2016: Auris, Nasus, Larynx
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 intermediate-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...
July 21, 2016: Cardiology Journal
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
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...
April 28, 2016: Artificial Organs
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
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
Mamata V Kene, Dustin W Ballard, David R Vinson, Adina S Rauchwerger, Hilary R Iskin, Anthony S Kim
INTRODUCTION: We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. METHODS: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness...
September 2015: Western Journal of Emergency Medicine
Ti-Fei Yuan, Wei Chen, Chunlei Shan, Nuno Rocha, Oscar Arias-Carrión, Flávia Paes, Alberto Souza de Sá, Sergio Machado
The activity dependent brain repair mechanism has been widely adopted in many types of neurorehabilitation. The activity leads to target specific and non-specific beneficial effects in different brain regions, such as the releasing of neurotrophic factors, modulation of the cytokines and generation of new neurons in adult hood. However physical exercise program clinically are limited to some of the patients with preserved motor functions; while many patients suffered from paralysis cannot make such efforts...
2015: CNS & Neurological Disorders Drug Targets
David E Newman-Toker, Ian S Curthoys, G Michael Halmagyi
Patients who present to the emergency department with symptoms of acute vertigo or dizziness are frequently misdiagnosed. Missed opportunities to promptly treat dangerous strokes can result in poor clinical outcomes. Inappropriate testing and incorrect treatments for those with benign peripheral vestibular disorders leads to patient harm and unnecessary costs. Over the past decade, novel bedside approaches to diagnose patients with the acute vestibular syndrome have been developed and refined. A battery of three bedside tests of ocular motor physiology known as "HINTS" (head impulse, nystagmus, test of skew) has been shown to identify acute strokes more accurately than even magnetic resonance imaging with diffusion-weighted imaging (MRI-DWI) when applied in the early acute period by eye-movement specialists...
October 2015: Seminars in Neurology
Inke Thiele, Jakob Linseisen, Christa Meisinger, Sigrid Schwab, Cornelia Huth, Annette Peters, Siegfried Perz, Thomas Meitinger, Florian Kronenberg, Claudia Lamina, Joachim Thiery, Wolfgang Koenig, Wolfgang Rathmann, Stefan Kääb, Cornelia Then, Jochen Seissler, Barbara Thorand
BACKGROUND: Supplementation of calcium (Ca) and vitamin D for the prevention of osteoporosis is frequently found in Western countries. Recent re-analyses of clinical trials observed a higher risk of myocardial infarction and stroke in subjects taking Ca (+vitamin D) supplements, although the underlying mechanisms are not clear. OBJECTIVE: Thus, we analyzed the associations between Ca and vitamin D supplementation as well as serum concentrations of Ca and 25-hydroxyvitamin D (25(OH)D) and subclinical cardiovascular disease (CVD) phenotypes, namely intima-media thickness, ankle-brachial-index (ABI), intermittent claudication, and atrial fibrillation (AF)...
August 2015: Atherosclerosis
R-J Koivunen, H Harno, T Tatlisumak, J Putaala
BACKGROUND AND PURPOSE: Post-stroke depression (PSD) is an important complication of stroke. We studied long-term PSD after intracerebral hemorrhage (ICH) at young age, as well as anxiety, and cognitive functioning of the survivors. METHODS: We gathered clinical and imaging data of 336 young ICH patients between age 16 and 49 treated in the Helsinki University Central Hospital. After a median follow-up of 9.7 (7.0-12.0) years, we interviewed 130 survivors with structural questionnaires including Beck Depression Inventory II (BDI-II), Hospital Anxiety and Depression Scale (HADS), Pain Anxiety Symptoms Scale (PASS), Brief Pain Inventory (BPI), and Montreal Cognitive Assessment (MoCA)...
September 2015: Acta Neurologica Scandinavica
Julien Francisco Zaldivar-Jolissaint, Mahmoud Messerer, David Bervini, Pascal J Mosimann, Marc Levivier, Roy Thomas Daniel
BACKGROUND: Management of ischemic stroke in the presence of aneurysmal brain disease is controversial. Recent retrospective evidence suggests that in selected patients, intravenous thrombolysis (IVT) remains a safe approach for reperfusion. METHODS: We document a case of post-thrombolysis aneurysmal rupture. Supported by additional scientific literature we postulate that acute aneurysmal thrombosis leading to stroke in the culprit artery may be an ominous sign of rupture and should be considered separately from fortuitously discovered distant aneurysmal disease...
March 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Kyra Becker, Ruth Kohen, Richard Lee, Patricia Tanzi, Dannielle Zierath, Kevin Cain, Pamela Mitchell, Jonathan Weinstein
BACKGROUND: Poststroke fatigue (PSF) is common, but the biological basis of this fatigue is unknown. We explored the possibility that PSF is related to systemic inflammation by investigating polymorphisms in 2 genes that affect the immune response. METHODS: In a substudy of a larger trial that evaluated the role of the immune response on stroke outcome, fatigue was assessed at 30, 90, 180, and 365 days after ischemic stroke using the Fatigue Assessment Scale. Subjects were genotyped for 3 single nucleotide polymorphisms, one in the interleukin-1 receptor antagonist gene (IL1RN; rs4251961, a T/C substitution) and two in the in toll-like receptor-4 (TLR4) gene (1063 A/G [Asp299Gly] rs4986790 and 1363 C/T [Thr399Ile] rs4986791)...
March 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Pallab Bhattacharya, Anand Kumar Pandey, Sudip Paul, Ranjana Patnaik
Neurotransmitter imbalance is an inevitable outcome in cerebral ischemia that leads to neuronal death. In the present study, we evaluated the effects of piroxicam, a nonsteroidal anti-inflammatory drug (NSAID), on extracellular brain glutamate and γ-aminobutyric acid (GABA) release, survival time, and neuronal cell death. Transient focal cerebral ischemia in male Charles Foster rat led to neuronal infarction and compromised intrinsic antioxidant status. Thirty-minute preadministration of piroxicam (10 mg/kg b...
December 2014: Journal of Physiology and Biochemistry
Dronacharya Lamichhane
Stroke is becoming a major cause of morbidity and mortality in the developing world while the trend is actually downward in the developed nations. This is mostly because of the better recognition, treatment options and secondary prevention in addition to changes in lifestyles. There have been significant developments in the secondary prevention of ischaemic stroke in the last decade alone. Newer medications like direct thrombin inhibitors and factor Xa inhibitors have come into common practice. These medications are either equally effective or even better than age-old warfarin...
July 2014: JPMA. the Journal of the Pakistan Medical Association
James A Reiffel
The authors of this Mini-Hot-Topic collection of review manuscripts have provided an outstanding review of the development and current status of several of our most recently developed agents in the fight against atrial fibrillation (AF). They have also given the readers a glimpse into the difficulty of drug development and the contrasts that can exist with the same product in different geographies. For their efforts they have my deepest appreciation. It is my hope that these articles will assist those of you who are clinicians in your care of patients and those of you who are investigators in your appreciation of the drug development process and its hurdles...
November 2014: Current Cardiology Reviews
Ali S Saber Tehrani, Jorge C Kattah, Georgios Mantokoudis, John H Pula, Deepak Nair, Ari Blitz, Sarah Ying, Daniel F Hanley, David S Zee, David E Newman-Toker
OBJECTIVE: Describe characteristics of small strokes causing acute vestibular syndrome (AVS). METHODS: Ambispective cross-sectional study of patients with AVS (acute vertigo or dizziness, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with at least one stroke risk factor from 1999 to 2011 at a single stroke referral center. Patients underwent nonquantitative HINTS "plus" examination (head impulse, nystagmus, test-of-skew plus hearing), neuroimaging to confirm diagnoses (97% by MRI), and repeat MRI in those with initially normal imaging but clinical signs of a central lesion...
July 8, 2014: Neurology
Mirta Fiorio, Caterina Mariotti, Marta Panzeri, Emanuele Antonello, Joseph Classen, Michele Tinazzi
The sense of the body is deeply rooted in humans, and it can be experimentally manipulated by inducing illusions in at least two aspects: a subjective feeling of ownership and a proprioceptive sense of limb position. Previous studies mapped these different aspects onto anatomically distinct neuronal regions, with the ventral premotor cortex processing subjective experience of ownership and the inferior parietal lobule processing proprioceptive calibration. Lines of evidence suggest an involvement also of the cerebellum, but its precise role is not clear yet...
April 2014: Journal of Cognitive Neuroscience
David E Newman-Toker, Kevin A Kerber, Yu-Hsiang Hsieh, John H Pula, Rodney Omron, Ali S Saber Tehrani, Georgios Mantokoudis, Daniel F Hanley, David S Zee, Jorge C Kattah
OBJECTIVES: Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2])...
October 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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