Kognitívna porucha (KP) po ischemickej cievnej mozgovej príhode (CMP) je častým fenoménom. U niektorých pacientov môže KP pretrvávať aj dlhý čas po prekonanej CMP, čo sa v anglickej literatúre označuje ako PCSI - post stroke cognitive impairment. Ide o osobitnú nozologickú jednotku, ktorú je potrebné začať diagnostikovať už počas hospitalizácie, no definitívnu diagnózu je možné vykonať až následne kontrolným vyšetrením kognitívnych funkcií s odstupom šesť mesiacov od CMP. Článok prináša aktuálny prehľad o diagnostike, predikcii a terapii PSCI ako osobitnej nozologickej jednotky.
Cognitive impairment (CI) after stroke is a frequent phenomenon. In some patients, CI can persist for a long time after overcoming stroke, which is referred to in the English literature as PCSI - post stroke cognitive impairment. It is a special nosological entity that needs to be diagnosed already during hospitalization, but a definitive diagnosis can only be made subsequently by a control examination of cognitive functions six months after stroke. The following article provides an up-to-date overview of the diagnosis, prediction and therapy of PSCI as a special nosological unit.
- MeSH
- cévní mozková příhoda * diagnóza komplikace patofyziologie MeSH
- demence diagnóza etiologie MeSH
- diferenciální diagnóza MeSH
- kognitivní dysfunkce * diagnóza etiologie farmakoterapie patofyziologie MeSH
- lidé MeSH
- management nemoci MeSH
- neurozobrazování klasifikace metody MeSH
- testy pro posouzení mentálních funkcí a demence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Endovascular treatment (EVT) of tandem lesion (TL) in the anterior circulation acute ischemic stroke (IS) usually requires periprocedural antithrombotic treatment and early initiation of dual antiplatelet therapy (DAPT) after carotid stenting. However, it may contribute to an occurrence of symptomatic intracerebral hemorrhage (SICH) in some cases. We investigated factors influencing the SICH occurrence and assessed the possible predictors of SICH after EVT. METHODS: IS patients with TL in the anterior circulation treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS) and recanalization using the TICI scale. SICH was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of SICH with adjustment for potential confounders. RESULTS: In total, 300 (68.7 % males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7 %) patients and 176 (58.7 %) had mRS 0-2. SICH occurred in 25 (8.3 %) patients. Patients with SICH did not differ from those without SICH in the rate of periprocedural antithrombotic treatment (64 vs. 57.5 %, p = 0.526) and in the rate of DAPT started within the first 12 h after EVT (20 vs. 42.2 %, p = 0.087). After adjustment, admission NIHSS and admission glycemia were found as the only predictors of SICH after EVT. CONCLUSION: Admission NIHSS and glycemia were found as the only predictors of SICH after EVT for TL. No associations between periprocedural antithrombotic treatment, early start of DAPT after EVT and SICH occurrence were found.
- MeSH
- časové faktory MeSH
- cerebrální krvácení * diagnostické zobrazování etiologie terapie MeSH
- duální protidestičková léčba škodlivé účinky MeSH
- endovaskulární výkony * škodlivé účinky přístrojové vybavení MeSH
- fibrinolytika * aplikace a dávkování škodlivé účinky MeSH
- hodnocení rizik MeSH
- inhibitory agregace trombocytů * škodlivé účinky aplikace a dávkování MeSH
- ischemická cévní mozková příhoda * etiologie terapie diagnóza diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- posuzování pracovní neschopnosti * MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Japonsko MeSH
PURPOSE: Endovascular treatment (EVT) of tandem lesion (TL) in anterior circulation (AC) acute ischemic stroke (AIS) represents still a clinical challenge. We aimed to evaluate selected factors related to EVT and assess other possible predictors of good clinical outcome besides the generally known ones. METHODS: AIS patients with TL in AC treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS) and achieved recanalization using the TICI scale. Symptomatic intracerebral hemorrhage (SICH) was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of mRS 0-2 with adjustment for potential confounders. RESULTS: In total, 300 (68.7% males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7%) patients and 176 (58.7%) had mRS 0-2. Besides the age, admission NIHSS and SICH, admission glycemia (p = 0.005, OR: 0.884) the stent patency within the first 30 days after EVT (p = 0.0003, OR: 0.219), dual antiplatelet therapy (DAPT) started within 12 h after EVT (p < 0.0001, OR: 5.006) and statin therapy started within 24 h after stenting (p < 0.0001, OR: 5.558) were found as other predictors. CONCLUSION: Admission glycemia, start of DAPT within 12 h and statin therapy within 24 h after EVT, and stent patency within the first 30 days after EVT were found as other predictors of good three-month clinical outcome in AIS patients treated with EVT for TL.
- MeSH
- cévní mozková příhoda * diagnostické zobrazování terapie etiologie MeSH
- endovaskulární výkony * metody MeSH
- ischemická cévní mozková příhoda * diagnostické zobrazování chirurgie MeSH
- ischemie mozku * diagnostické zobrazování terapie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři MeSH
- statiny * MeSH
- trombektomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Steroid responzívna encefalopatia asociovaná s autoimunitnou tyreoiditídou (SREAT) označovaná ako aj Hashimotova encefalopatia (HE) predstavuje heterogénne ochorenie s neurologickými a neuropsychiatrickými príznakmi, pri laboratórnom náleze protilátok proti štítnej žľaze a absencii inej príčiny encefalopatie. V klinickom náleze sa najčastejšie stretávame s akútnym vznikom encefalopatie pod obrazom porúch pamäti a správania, prítomnosťou epileptických záchvatov ako aj cerebelárnej alebo extrapyramídovej symptomatológie. U väčšiny pacientov pozorujeme dobrý efekt kortikoidov (metylprednisolon, prednison) s rýchlou úpravou stavu, a len malá časť pacientov vyžaduje inú imunosupresívnu terapiu (plazmaferéza, intravenózne imunoglobulíny). V práci prezentujeme prípady dvoch pacientok s akútnym rozvojom encefalopatie, status epilepticus na poklade SREAT, s úpravou stavu po kortikoidnej terapii.
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), known as Hashimoto's encephalopathy (HE), represents a heterogeneous group of neurological and neuropsychiatric symptoms associated with a presence of antithyroid antibodies in case of other causes of encephalopathy were excluded. Clinical symptoms most commonly includes acute onset of encephalopathy, behaviour changes and cognitive dysfunction, epileptic seizures as well as cerebellar and extrapyramidal symptoms. Corticoids provides rapid and sustained therapeutic benefit in most patients and only a few patients require other immunosuppressive therapy such as plasmapheresis, intravenous immunoglobulins, or others. We present the cases of two patients with acute onset of encephalopathy, status epilepticus based on SREAT, with rapid improvement after steroid treatment.
- Klíčová slova
- steroid responzivní encefalopatie asociovaná s autoimunitní tyreoitidou,
- MeSH
- autoimunitní tyreoiditida diagnóza farmakoterapie MeSH
- diferenciální diagnóza MeSH
- glukokortikoidy aplikace a dávkování terapeutické užití MeSH
- Hashimotova nemoc * diagnostické zobrazování farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozek diagnostické zobrazování patologie MeSH
- mozkomíšní mok chemie MeSH
- status epilepticus diagnóza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION: Sixteen subjects with biallelic WARS2 variants encoding the tryptophanyl mitochondrial aminoacyl-tRNA synthetase, presenting with a neonatal- or infantile-onset mitochondrial disease, have been reported to date. Here we present six novel cases with WARS2-related diseases and expand the spectrum to later onset phenotypes including dopa-responsive early-onset parkinsonism and progressive myoclonus-ataxia. METHODS: Six individuals from four families underwent whole-exome sequencing within research and diagnostic settings. Following the identification of a genetic defect, in-depth phenotyping and protein expression studies were performed. RESULTS: A relatively common (gnomAD MAF = 0.0033) pathogenic p.(Trp13Gly) missense variant in WARS2 was detected in trans in all six affected individuals in combination with different pathogenic alleles (exon 2 deletion in family 1; p.(Leu100del) in family 2; p.(Gly50Asp) in family 3; and p.(Glu208*) in family 4). Two subjects presented with action tremor around age 10-12 years and developed tremor-dominant parkinsonism with prominent neuropsychiatric features later in their 20s. Two subjects presented with a progressive myoclonus-ataxia dominant phenotype. One subject presented with spasticity, choreo-dystonia, myoclonus, and speech problems. One subject presented with speech problems, ataxia, and tremor. Western blotting analyses in patient-derived fibroblasts showed a markedly decreased expression of the full-length WARS2 protein in both subjects carrying p.(Trp13Gly) and an exon-2 deletion in compound heterozygosity. CONCLUSIONS: This study expands the spectrum of the disease to later onset phenotypes of early-onset tremor-dominant parkinsonism and progressive myoclonus-ataxia phenotypes.
- MeSH
- ataxie MeSH
- dihydroxyfenylalanin MeSH
- fenotyp MeSH
- lidé MeSH
- mutace MeSH
- myoklonus * MeSH
- parkinsonské poruchy * farmakoterapie genetika MeSH
- spinocerebelární degenerace * MeSH
- tremor MeSH
- tryptofan-tRNA-ligasa * genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
