Diagnostic value of non-invasive imaging techniques in the detection of carotid artery stenosis: a systematic review

The purpose of the study was to evaluate the diagnostic performance of non- invasive imaging methods of detecting carotid artery stenosis in comparison to digital subtraction angiography (DSA) by undertaking a systematic review of the literature. The non-invasive methods reviewed include multislice computed tomography (MSCT) angiography, duplex ultrasound (US) and magnetic resonance (MR) angiography.A search of medical databases (PubMed, Medline, ScienceDirect, Proquest) of the English literature was performed and 22 studies with 68 comparisons were found to meet the selection criteria and included in our study. 5 studies were performed with MSCT angiography, 11 with duplex US and 13 with MR angiography. Both duplex US and MR angiography were studied in 7 out of 24 US and MR studies. The diagnostic value of each imaging modality was reviewed in terms of the sensitivity and specificity compared to DSA, which is regarded as the standard method.The mean sensitivity and specificity for MSCT angiography, duplex US and MR angiography were 88% (95% CI: 83%, 92%) and 90% (95% CI: 85%, 94%), 88% (95% CI: 81%, 94%) and 89% (95% CI: 85%, 94%), 94% (95% CI: 90%, 97%) and 89% (95% CI: 85%, 92%), respectively based on overall assessment. The evaluation showed that contrast-enhanced MR angiography has high diagnostic value for detection of more than 50% stenosis of carotid artery stenosis with mean sensitivity and specificity being 95% (95% CI: 92%, 98%) and 91% (95% CI: 86% 95%). When assessment was based on a combination of MR angiography and duplex US, the sensitivity reached the highest value of 98% (95% CI: 96%, 100%). This analysis indicates that MR angiography, especially contrast-enhanced MR angiography could be used as a reliable alternative modality to DSA in the detection of carotid artery stenosis

RECTROSPECTIVE STUDY OF FEBRILE SEIZURES IN A POPULATION BASED COHORT OF CHILDREN

THIS STUDY SHOWED THAT THE PREVALENCE, THE AGE AT THE ONSET OF FBS, THE TYPE OF SEIZURES, THE RATE OF ADMISSION TO HOSPITAL, THE RISK OF RECURRENCE, THE AGEFOR MAJOR RISK FOR RECURRENCE, THE PERCENTAGE OF POSITIVE FAMILY HISTORY FORFEBRILE SEIZURES AND THE RISK FOR SUBSEQUENT EPILEPSY OR UNROVOKED SEIZURES WERE IN ACCORDANCE WITH THE PREVIOUS REPORTS FROM OTHER COUNTRIES. DIFFERENCES WERE NOTED IN THE HIGH PROPORTION OF PROPHYLAXIS THERAPY AND THE HIGH PERCENTAGE OF TWO OR MORE RECURENCIES. NO ASSOCIATION WAS FOUND WITH ANY NEUROLOGICAL (INCLUDED E.E.G. ABNORMALITIES) AND PSYCHOLOGICAL DISFUNCTION OR SCHOOL PERFORMANCE.ΜΕ ΤΗΝ ΑΝΑΛΥΣΗ ΤΩΝ ΔΕΔΟΜΕΝΩΝ ΑΥΤΗΣ ΤΗΣ ΕΡΓΑΣΙΑΣ ΑΠΟΔΕΙΚΝΥΕΤΑΙ ΟΤΙ: Ο ΕΠΙΠΟΛΑΣΜΟΣ, Η ΗΛΙΚΙΑ ΚΑΤΑ ΤΟ ΠΡΩΤΟ ΕΠΕΙΣΟΔΙΟ, Ο ΤΥΠΟΣ ΤΩΝ ΣΠΑΣΜΩΝ, ΤΟ ΠΟΣΟΣΤΟ ΕΙΣΑΓΩΓΗΣ ΣΤΟ ΝΟΣΟΚΟΜΕΙΟ, Ο ΚΙΝΔΥΝΟΣ ΥΠΟΤΡΟΠΗΣ, Η ΗΛΙΚΙΑ ΓΙΑ ΤΟ ΜΕΓΑΛΥΤΕΡΟ ΚΙΝΔΥΝΟ ΥΠΟΤΡΟΠΗΣ, ΤΟ ΠΟΣΟΣΤΟ ΤΟΥ ΘΕΤΙΚΟΥ ΟΙΚΟΓΕΝΕΙΑΚΟΥ ΙΣΤΟΡΙΚΟΥ ΚΑΙ Ο ΚΙΝΔΥΝΟΣ ΓΙΑ ΜΕΤΕΠΕΙΤΑ ΑΝΑΠΤΥΞΗ ΕΠΙΛΗΨΙΑΣ ~ ΑΠΡΟΚΛΗΤΩΝ ΣΠΑΣΜΩΝ ΕΙΝΑΙ ΣΕ ΣΥΜΦΩΝΙΑ ΜΕ ΤΙΣ ΜΕΧΡΙ ΤΩΡΑ ΜΕΛΕΤΕΣ. ΔΙΑΦΟΡΕΣ ΕΝΤΟΠΙΣΘΗΚΑΝ ΣΤΟ ΠΟΣΟΣΤΟ ΠΟΥ ΕΛΑΒΕ ΠΡΟΦΥΛΑΚΤΙΚΗ ΑΓΩΓΗ ΚΑΙ ΒΡΕΘΗΚΕ ΥΨΗΛΟΤΕΡΟ ΑΥΤΟΥ ΤΗΣ ΒΙΒΛΙΟΓΡΑΦΙΑΣ ΟΠΩΣ ΚΑΙ ΣΤΟ ΥΨΗΛΟ ΠΟΣΟΣΤΟ ΓΙΑ ΔΥΟ Η ΠΕΡΙΣΣΟΤΕΡΕΣ ΥΠΟΤΡΟΠΕΣ ΤΟΥ ΠΥΡΕΤΙΚΟΥ ΣΠΑΣΜΟΥ. ΔΕΝ ΒΡΕΘΗΚΕ ΚΑΠΟΙΑ ΣΥΣΧΕΤΙΣΗ ΜΕ ΚΑΠΟΙΑ ΝΕΥΡΟΛΟΓΙΚΗ ΕΠΙΠΛΟΚΗ ΟΠΩΣ ΚΑΙ ΣΤΙΣ ΠΕΡΙΣΣΟΤΕΡΕΣ ΕΡΓΑΣΙΕΣ

Factors defining occurrence of ischemic and hemorrhagic strokes during continuous flow left ventricular assist device support

OBJECTIVE: LVAD-related strokes occur at a much higher rate compared to traditional open heart surgery. The pathophysiology of ischemic and hemorrhagic strokes after LVAD implantation is not well defined. The aim of this study was to better describe the etiopathogenesis of strokes during continuous flow LVAD support based on our institutional experience. METHODS: We performed a retrospective analysis of 200 patients, with and without stroke that underwent implantation of a continuous flow LVAD from 2011 to 2016. RESULTS: The incidences of stroke in our patient population were 13% (26/200), of which 50% (13/26) were ischemic and 50% hemorrhagic (13/26). Only 8% of strokes occurred within the first 48 h from LVAD implantation, all of which were ischemic. The median duration of support was 148 days for ischemic and 351 days (p = 0.012) for hemorrhagic strokes. The average mean arterial pressure measurements at the time of hospital discharge were 89 mmHg for patients who subsequently developed stroke and 72 mmHg (p = 0.03) for stroke-free patients. The average outpatient pressure measurements were 96 mmHg and 76 mmHg (p = 0.02) for the stroke and stroke-free patients, respectively. The mean velocity index showed the potential impairment of cerebral autoregulation. Multivariate analysis demonstrated that INR, COPD, aortic cross clamping, previous stroke, and device infections were statistically significant risk factors for stroke occurrence after LVAD implantation. CONCLUSIONS: In addition to LVAD-related thrombogenicity, the subsequent need for anticoagulation, and an acquired von Willebrand syndrome, several clinical factors, such as deviation from the anticoagulation regimen, hypertension, COPD, device infections, and aortic cross clamping, appear to have an influence on the extremely high rate of postoperative ischemic and hemorrhagic strokes

Stroke after implantation of continuous flow left ventricular assist devices

OBJECTIVE: Stroke remains a frequent and devastating complication after left ventricular assist device (LVAD) implantation, despite recent advances in device technology. The aim of this study was to analyze risk factors and outcomes of stroke following implantation of 200 continuous-flow LVADs at our institution. METHODS: We retrospectively analyzed patients who underwent LVAD implantation from 2011-2016. Data were available for a total of 200 patients. RESULTS: Post-LVAD stroke occurred in 13% of patients (26 of 200). Ischemic stroke occurred in 50% of patients (13 of 26), and hemorrhagic stroke in 50% (13 of 26). The median duration of LVAD support at the time of stroke was 257.4 days. Baseline characteristics did not differ significantly between the stroke and stroke-free cohorts. The mean international normalized ratio (INR) at the time of embolic stroke was 1.86 (range, 1.23-3.25) and 4.62 (range, 1.4-21.4) in patients with hemorrhagic stroke (P = .014). Mortality within 30 days of stroke was 31% (8 of 26). Mortality for hemorrhagic stroke was 63% (5 of 8) and 37% (3 of 8) for ischemic stroke ( P = .03). Among the 18 patients that survived stroke, 28% (5 of 18) received a heart transplant, 39% (7 of 18) are receiving ongoing LVAD support, and 33% (6 of 18) have died from unrelated causes. Multivariate analysis showed that INR level, aortic cross-clamping, a history of previous stroke, and postoperative infection were significant predictors for post-LVAD stroke. CONCLUSION: The occurrence of stroke significantly increases morbidity and mortality after LVAD implantation. Despite an adverse impact on survival and quality of life, several patients who suffered stroke still received a heart transplant. Furthermore, none of our patients had recurrence of a neurological event. Strict implementation of anticoagulation protocols is likely the mainstay of preventing this devastating complication

Paraneoplastic autoimmunity and small‐cell lung cancer: Neurological and serological accompaniments

Paraneoplastic neurological autoimmunity is often associated with small‐cell lung cancer (SCLC), a highly malignant neuroendocrine tumor. Paraneoplastic autoimmunity often correlates with longer survival. We describe the paraneoplastic neurological manifestations of patients with SCLC with and without SCLC‐predictive autoantibodies and the correlation between autoimmunity and survival. We reviewed the records of 116 patients (51% male) from the Mayo Clinic with histopathologically confirmed SCLC for whom stored serum was available for neural autoantibody testing. Cancer was limited stage in 41%; the median age at diagnosis was 64 years. Paraneoplastic neurological manifestations were recorded in 61% (decreasing frequency: peripheral neuropathy, dysautonomia, cognitive decline, cerebellar ataxia, neuromuscular junction disorder, seizures, cranial neuropathy, movement disorder, brainstem disorder, or myelopathy). Neural autoantibodies, some with pathogenic potential, were detected in the sera of SCLC patients with and without neurological autoimmunity. The most frequent among patients with neurological manifestations were: anti‐neuronal nuclear antibody‐type 1, voltage‐gated calcium channel (VGCC)‐N‐type, VGCC‐P/Q‐type, glutamic acid decarboxylase 65 (GAD65), SOX1, and muscle acetylcholine receptor (AChR); while the most common in patients without neurological manifestations were: GAD65, muscle‐AChR, and VGCC‐P/Q‐type. Neither cancer stage at diagnosis nor survival correlated with neurological manifestations or autoantibody‐positivity, except for shorter survival in patients with myelopathy. The only predictor of longer survival was limited‐stage disease at diagnosis