INTRODUCTION: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes. PATIENTS AND METHODS: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days. RESULTS: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73-83) and a median stroke severity score of 11 (interquartile range 4-18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4-18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels (p < 0.05). A worse mRS score of 3-6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15-39.4), p = 0.04. CONCLUSIONS: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).

• MeSH
• fibrilace síní * komplikace   MeSH
• intrakraniální embolie diagnostické zobrazování   MeSH
• ischemická cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombektomie MeSH
• ultrasonografie dopplerovská transkraniální * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Cíl: Automaticky předpovídat stabilitu aterosklerotického plátu v karotidě ze standardních transverzálních ultrazvukových obrazů v B-modu za použití hlubokého učení. Spolehlivý prediktor by snížil potřebu klinických kontrol i farmakologické či chirurgické léčby. Metody: Automaticky byla lokalizována oblast zájmu obsahující karotidu. Adversariální metoda segmentace byla natrénována na kombinaci malého kompletně anotovaného datasetu a většího slabě anotovaného datasetu. Multikriteriální regrese s automatickou adaptací vah byla použita k predikci série klinicky relevantních atributů, vč. nárůstu tloušťky plátu během 3 let. Výsledky: Současnou šíři plátu bylo možno odhadnout s vysokou korelací (ρ = 0,32) a velmi vysokou statistickou signifikancí. Odhadovaný budoucí nárůst šíře plátu byl korelován méně (ρ = 0,22), ale stále statisticky významně (p < 0,01). Korelace mezi automatickým a expertním hodnocením echogenicity, hladkosti a kalcifikací byla ještě nižší. Závěr: Potvrdili jsme závislost mezi vzhledem plátu v ultrazvukovém obraze a pravděpodobností jeho budoucího růstu, ale je příliš slabá, než aby byla využitelná v klinické praxi jako jediný prediktor stability plátu.

Aim: To automatically predict the stability of carotid artery plaque from standard B-mode transversal ultrasound images using deep learning. A reliable predictor would reduce the need for follow-up examination and pharmacological and surgical treatment. Methods: A region of interest containing the carotid artery was automatically localized. An adversarial segmentation method was trained on a combination of a small pixelwise annotated dataset and a larger weakly annotated dataset. A multicriterion regression with automatic weight adaptation was applied to predict a series of clinically relevant attributes, including the plaque width increase over 3 years. Results: The current plaque width could be estimated with a high correlation (ρ = 0.32) and a very high statistical significance. The estimated future increase of the plaque width was correlated less (ρ = 0.22) but statistically significantly (P < 0.01). The correlation between automatic and expert assessments of echogenicity, smoothness and calcification was even smaller. Conclusion: We confirmed a relationship between the plaque appearance in ultrasound and the probability of its future growth, but it is too weak to be used in clinical practice as the sole predictor of the plaque stability.

• MeSH
• algoritmy MeSH
• aterosklerotický plát * diagnostické zobrazování   patologie   MeSH
• deep learning MeSH
• lidé MeSH
• počítačové metodologie MeSH
• prognóza MeSH
• regresní analýza MeSH
• statistika jako téma MeSH
• ultrasonografie karotid * statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• klinická studie MeSH
• práce podpořená grantem MeSH

AIMS: There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. METHODS AND RESULTS: Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82-95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76-92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75-84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). CONCLUSION: CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. REGISTRATION: PROSPERO ID CRD42022329690.

• MeSH
• aterosklerotický plát * diagnostické zobrazování   MeSH
• hodnocení rizik MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• nemoci arterie carotis diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie metody   MeSH
• stenóza arteria carotis diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

Úvod: Addenbrookský kognitivní test (The Addenbrooke‘s Cognitive Examination; ACE-III) je komplexní nástroj hodnotící pět kognitivních oblastí (pozornost, paměť, slovní produkce, jazyk, zrakově-prostorové schopnosti). Je citlivý na mírnou kognitivní poruchu i časná stádia demence a nahrazuje dřívější verzi (ACE-R). Cíl: Kulturní adaptace a validace české verze (ACE-III-CZ). Soubor a metodika: Do studie byli zařazeni zdraví jedinci a pacienti v počátečním stadiu demence ve věku 60 a více let z neurologických a geriatrických ambulancí čtyř fakultních nemocnic. Ověřovali jsme reliabilitu (Cronbachův koeficient alfa, McDonaldův koeficient omega), souběžnou validitu ACE-III-CZ a Mini-Mental State Examination (MMSE) (Paersonův korelační koeficient) a pomocí analýzy křivky ROC hodnoty AUC, senzitivitu a specifitu testu. Výsledky: Soubor tvořilo 250 respondentů (122 s diagnózou demence [průměrný věk 76,5 ± 7,1 let; 67,2 % žen] a 128 kognitivně zdravých [průměrný věk 71,1 ± 5,2 let; 77,3 % žen]). Vnitřní konzistence ACE-III-CZ byla velmi dobrá (Cronbachova alfa = 0,906; McDonaldovo omega = 0,937). Věk a stupeň vzdělání významně korelovaly s celkovým skórem a všemi doménovými skóry ACE-III-CZ (p < 0,001). Vysoké AUC (0,996; 95% CI 0,990–1,000) potvrdilo dobrou schopnost testu rozlišit osoby s demencí a bez demence. Optimální hraniční hodnota byla 89,5 bodu se senzitivitou 98 % a specificitou 100 %. Závěr: Výsledky naznačují vysokou diagnostickou schopnost ACE-III-CZ a její využitelnost v české klinické praxi.

Introduction: The Addenbrooke‘s Cognitive Examination (ACE-III) is a comprehensive tool assessing five cognitive domains (attention, memory, verbal production, language, and visuospatial ability). It is sensitive to both mild cognitive impairment and early stages of dementia and replaces an earlier version (ACE-R). Aim: Cultural adaptation and validation of the Czech version (ACE-III-CZ). Materials and methods: Healthy individuals and patients with early-stage dementia aged 60 years and older from neurological and geriatric outpatient clinics of four university hospitals were included in the study. We assessed reliability (Cronbach‘s alpha coefficient, McDonald‘s omega coefficient), concurrent validity of ACE-III-CZ and Mini-Mental State Examination (MMSE) (Pearson’s correlation coefficient), AUC values, sensitivity and specificity of the test using an ROC curve analysis. Results: The sample consisted of 250 subjects (122 with dementia [mean age 76.5 ± 7.1 years; 67.2% females] and 128 cognitively healthy [mean age 71.1 ± 5.2 years; 77.3% females]). The reliability of the ACE-III-CZ was very good (Cronbach‘s alpha = 0.906; McDonald‘s omega = 0.937). Age and level of education had significant correlation with the total score and all ACE-III-CZ domain scores (P < 0.001). A high AUC (0.996; 95% CI 0.990–1.000) confirmed a good ability of the test to differentiate between those with and without dementia. The optimal cut-off point was 89.5 with a sensitivity of 98% and a specificity of 100%. Conclusion: Results suggest a high diagnostic ability of ACE-III-CZ and its applicability in Czech clinical practice.

• MeSH
• demence * diagnóza   MeSH
• lidé MeSH
• neuropsychologické testy * MeSH
• psychometrie metody   MeSH
• senioři MeSH
• validační studie jako téma MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: This study investigates changes in cognitive function in patients with severe carotid stenosis who underwent carotid endarterectomy (CEA) and carotid stenting (CAS) over two decades. METHODS: We compared cognitive function within 30 days after the procedure in 267 patients (first 100 each for CEA and CAS in two periods: 2008-2012 and 2018-2022) in a single institution. Assessments used Adenbrooke's Cognitive Examination-Revised (ACE-R), the Mini-Mental State Examination (MMSE), Speech Fluency Test (SFT), and Clock Drawing Test (CDT), conducted before and 30 ± 2 days after surgery. RESULTS: Patients (mean age 67.2 years, 70%+ carotid stenosis) exhibited different cognitive changes over periods. In 2008-2012, significant declines in MMSE (CEA, p = 0.049) and CDT (CAS, p = 0.015) were observed among asymptomatic patients. On the contrary, in 2018-2022, improvements were observed in ACE-R and MMSE for symptomatic and asymptomatic patients undergoing CEA and CAS. CONCLUSION: Over a decade, advances in interventional techniques and patient management have reduced risks of cognitive decline in patients with asymptomatic carotid stenosis and also have improved cognitive functions in both symptomatic and asymptomatic individuals.

• Publikační typ
• časopisecké články MeSH

• MeSH
• diagnostické techniky neurologické MeSH
• lidé MeSH
• ultrasonografie dopplerovská transkraniální * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodní články MeSH

Ultrazvukové vyšetření se stalo díky své neinvazivitě a relativně nízké ceně nedílnou součástí lékařské praxe. V posledním desetiletí se díky tlaku na rychlejší a přesnější diagnostiku, především u akutních onemocnění, rozvíjí nový koncept ultrazvukového vyšetření přímo v místě péče o pacienta, a to pomocí mobilních ultrazvukových přístrojů. Tento nový koncept dostal název point-of­‐care ultrasound neboli POCUS a v posledních letech se rozšiřuje i do neurologie pod názvem Neuro­‐POCUS.

Due to its non-invasiveness and relatively low cost, ultrasound examination has become an integral part of medical practice. Thanks to the pressure for faster and more accurate diagnosis in the last decade, especially for acute diseases, a new concept of ultrasound examination is being developed directly at the point of care of the patient using mobile ultrasound devices. This new concept was named point-of-care ultrasound or POCUS, and it has also been extended to neurology in recent years under the name Neuro-POCUS. Neuro POCUS is defined as a targeted ultrasound examination of the head, neck, orbit, or musculoskeletal system performed at the patient's bedside to obtain a rapid answer to a specific clinical question related to neurological symptoms in real time. Currently, Neuro POCUS examination appears to be a very promising alternative to a complex neurosonological examination, especially for patients in the emergency room, ICU, infectious or unstable patients, or when perioperative patient monitoring is required. Detailed examination protocols are still lacking, but working groups are beginning to create lists of clinical questions and indications.

• MeSH
• akutní nemoc MeSH
• lidé MeSH
• ultrasonografie dopplerovská transkraniální * MeSH
• vyšetření u lůžka MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Transkraniální sonografie je jednou z modalit transkraniálního sonografického vyšetření, které umožňuje zobrazení nitrolebních struktur v ultrazvukovém B­‐obraze. Pomocí tohoto vyšetření je možno hodnotit změny echogenity, popř. rozměrů vybraných mozkových struktur, např. substantia nigra, ncl. raphe, ncl. lentiformis, ncl. caudatus, inzuly, mediotemporálního laloku či komorového systému. Díky tomu lze transkraniální sonografii využít jako pomocné vyšetření v diagnostice a diferenciální diagnostice neurodegenerativních a dalších neurologických a psychiatrických onemocnění centrální nervové soustavy. Typickým nálezem u Parkinsonovy nemoci je hyperechogenní substantia nigra s asymetrickým stranovým nálezem. Jelikož lze tento znak detekovat i mnoho desetiletí před samotným rozvojem motorických příznaků Parkinsonovy nemoci, lze toto vyšetření využít i při stanovení rizika rozvoje nemoci, a to především v kombinaci s dalšími testy.

Transcranial sonography is one of the modalities of transcranial sonographic examination, which enables to visualize intracranial structures in ultrasound B Mode. Using this examination, it is possible to evaluate changes in echogenicity or dimensions of selected brain structures, e.g. substantia nigra, ncl. raphe, ncl. lentiformis, ncl. caudate, insula, mediotemporal lobe or ventricular system. Thanks to this, transcranial sonography can be used as an auxiliary examination in the diagnosis and differential diagnosis of neurodegenerative and other neurological and psychiatric diseases of the central nervous system. A typical finding in Parkinson's disease is a asymmetric hyperechogenic substantia nigra. Since this sign can be detected many decades before the development of motor symptoms of Parkinson's disease itself, this examination can also be used to determine the risk of developing the disease, especially in combination with other tests.

• MeSH
• lidé MeSH
• neurodegenerativní nemoci diagnostické zobrazování   MeSH
• Parkinsonova nemoc * diagnostické zobrazování   MeSH
• ultrasonografie dopplerovská transkraniální * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND AND OBJECTIVES: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION: The study was registered under ClinicalTrials.gov identifier NCT04895462.

• MeSH
• cerebrální krvácení komplikace   MeSH
• cévní mozková příhoda * epidemiologie   terapie   diagnóza   MeSH
• COVID-19 * komplikace   MeSH
• endovaskulární výkony * škodlivé účinky   MeSH
• fibrinolytika terapeutické užití   MeSH
• intrakraniální krvácení etiologie   MeSH
• ischemická cévní mozková příhoda * epidemiologie   chirurgie   MeSH
• ischemie mozku * komplikace   epidemiologie   chirurgie   MeSH
• kohortové studie MeSH
• lidé MeSH
• registrace MeSH
• trombolytická terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

BACKGROUND: Accurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSVICA/ICA ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA. METHODS: Consecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman's correlation and Kendall's rank correlation were used to evaluate the results. RESULTS: A total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSVICA/ICA ratio showed the highest correlation [Spearman's correlation r = 0.576) with CTA, followed by PSV (r = 0.526), B-mode measurement (r = 0.482), and EDV (r = 0.441; p < 0.001 in all cases]. The worst correlation was found for PSV when the plaque was calcified (r = 0.238), whereas EDV showed a higher correlation (r = 0.523). Correlations of B-mode measurement were superior for plaques with smooth surface (r = 0.677), while the PSVICA/ICA ratio showed the highest correlation in stenoses with irregular (r = 0.373) or ulcerated (r = 0.382) surfaces, as well as lipid (r = 0.406), fibrous (r = 0.461), and mixed (r = 0.403; p < 0.01 in all cases) plaques. Nevertheless, differences between the mentioned correlations were not statistically significant (p > 0.05 in all cases). CONCLUSION: PSV, PSVICA/ICA ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy.

• Publikační typ
• časopisecké články MeSH