The evolution of disability after ischemic stroke depending on the circadian variation of stroke onset

Introduction. The circadian variation of ischemic stroke onset is known, but its impact on recovery prognosis has been less studied. Materials and method. The study included 32 patients with ischemic stroke, admitted to Neurology Departments I and II of the Rehabilitation Hospital in Cluj-Napoca between 1 June 2008 and 31 December 2009 and followed up for 2 years, during 5 successive admissions. The diagnosis of ischemic stroke was defined according to updated World Health Organization criteria. The onset time of ischemic stroke was assigned to one of the following six-hour intervals: 00.01-06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). For each patient we recorded demographic data and the values of ADL and IADL scales on the occasion of each assessment. Statistical analysis was performed using Excel Microsoft, descriptive and one-way ANOVA test. Results and conclusions. Our study confirms the incidence pattern of ischemic stroke, with a morning peak, which is more obvious in the case of the male sex and patients aged less than 65 years. Patients with nocturnal stroke onset have a less favorable functional evolution during the second year after ischemic stroke

The influence of circadian variation in ischemic stroke onset on the evolution of the severity of the clinical picture and disability

Introduction. The chronobiology of ischemic stroke describes an occurrence pattern with the highest incidence in the morning according to most literature reports, but its influence on the evolution of the severity of the neurological picture and functional status is little studied. Materials and method. This cohort study included 63 patients with ischemic stroke admitted to the Neurology Departments I and II of the Rehabilitation Hospital in Cluj-Napoca between 1 June 2008 and 1 June 2009, who were followed up for 2 years by 5 successive evaluations. The onset time of ischemic stroke was assigned to one of the six hours intervals: 00.01- 06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). For each patient, the National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores were recorded on the occasion of each evaluation. Statistical analysis was performed using Excel Microsoft, descriptive and ANOVA test. Results and conclusions. Our study confirms the incidence pattern of ischemic stroke with a morning peak, which is more obvious in the case of patients aged less than 65 years. Patients with stroke onset in the nocturnal interval have a less favorable neurological and functional evolution during the second year after ischemic stroke

Evaluation of the combined therapeutic effect of methylprednisolone and cerebrolysin in traumatic medullar lesion

Objectives: The pharmacological effects of Methylprednisolone and Cerebrolysin have been extensively debated, but from our knowledge there are no studies to evaluate the association of these two drugs in spinal cord injury (SCI).Methods: Twenty-four Wistar rats underwent traumatic spinal cord injury by using clip-compression model. The animals were divided into four groups: group I received Methylprednisolone (MP); group II was injected with Cerebrolysin (C); group III received Methylprednisolone together with Cerebrolysin (MP+C); in the control group we have performed only decompression. The motor recovery of the animals was evaluated using the Ferguson et al. modification of the BBB scale. After ten days the rats were sacrificed. Results: The study demonstrated that the MP + C group presented the most notable recovery of the motor function, but no statistically significant (p>0,05). The first and the second group also presented better results than the fourth group, but the enhanced recovery of those group relative to control group was not statistically significant (p>0,05) Conclusion: The combination of MP and Cerebrolysin in experimental conditions seems to have promising results, but more experimental and clinical studies are necessary to evaluate the real benefit for SCI patients

Seasonal variation of stroke occurrence: a hospital based-study

Introduction. Cerebrovascular events are not randomly distributed over time. In addition to the better known circadian variation, a seasonal variation in stroke occurrence is described in different reports. The aim of our study was to investigate whether stroke with its types follows a seasonal occurrence pattern in the Cluj-Napoca area. Materials and method. The stroke event data were collected from the patient records of a consecutive series of 1083 patients admitted through the Emergency Room to the Neurology Departments I and II of the County Hospital Cluj-Napoca, between 1 January 2012 and 31 December 2012. The diagnosis of ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage was confirmed by neurologic examination and neuroimaging, according to updated World Health Organization criteria. The onset time was assigned to one of the four seasons: spring (March to May), summer (June to August), autumn (September to November) and winter (December to February). Statistical analysis was performed using Excel Microsoft. Results. All three types of stroke (ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage) showed a seasonal variation in their occurrence, with two peaks in the winter and in the summer. Conclusion. The knowledge of the seasonal variation pattern of stroke occurrence could provide a basis for preventive and therapeutic strategies in cerebrovascular patholog

Implications of Circadian Rhythm in Stroke Occurrence: Certainties and Possibilities

Stroke occurrence is not randomly distributed over time but has circadian rhythmicity with the highest frequency of onset in the morning hours. This specific temporal pattern is valid for all subtypes of cerebral infarction and intracerebral hemorrhage. It also correlates with the circadian variation of some exogenous factors such as orthostatic changes, physical activity, sleep-awake cycle, as well as with endogenous factors including dipping patterns of blood pressure, or morning prothrombotic and hypofibrinolytic states with underlying cyclic changes in the autonomous system and humoral activity. Since the internal clock is responsible for these circadian biological changes, its disruption may increase the risk of stroke occurrence and influence neuronal susceptibility to injury and neurorehabilitation. This review aims to summarize the literature data on the circadian variation of cerebrovascular events according to physiological, cellular, and molecular circadian changes, to survey the available information on the chronotherapy and chronoprophylaxis of stroke and its risk factors, as well as to discuss the less reviewed impact of the circadian rhythm in stroke onset on patient outcome and functional status after stroke

Circumpapillary Retinal Nerve Fiber Layer OCT Imaging in a Parkinson’s Disease Cohort—A Multidisciplinary Approach in a Clinical Research Hospital

(1) Background: The purpose of this paper is to report the data of the first study in a Clinical Research Hospital, in the Transylvania region, focusing on the Spectral Domain Optical Coherence Tomography (SD-OCT) measurements in the early stages of Parkinson’s disease (PD), and to compare the results with age-matched healthy controls. (2) Methods: This study assessed the circumpapillary retinal nerve fiber layer (cpRNFL) SD-OCT measurements (Heidelberg Spectralis, Heidelberg Engineering, Germany) of two study groups: patients suffering from PD (Hoehn−Yahr stages 1–3) and healthy controls. Secondary objectives were to investigate the reported visual symptoms by evaluating the color vision, contrast sensitivity, and the central visual defects for macular disease using standardized charts. Subjects with prior history of ophthalmologic diseases, advanced stages of PD (Hoehn−Yahr stages 4–5), or with psychiatric conditions were not included in this study. The same team of neurologists and ophthalmologists evaluated all individuals in order to have comparable data and to eliminate inter-examiner differences. All subjects were recruited from the same Clinical Research Hospital in the Transylvania region, Romania. (3) Results: 72% of the PD patients (n = 17) in this study reported visual symptoms. In respect to the ophthalmologic chart evaluation for PD patients, the most frequent disturbances were identified in the Ishihara color perception testing (33%). The regression analysis showed significant results for the Ishihara testing in relation to the cpRNFL thinning in the temporal retinal sectors for both eyes. cpRNFL thinning was predominantly contralateral to the parkinsonism (p = 0.001). The temporal and global values of the cpRNFL were significantly lower in all PD patients < 70 years old, compared to the age-matched healthy controls. (4) Conclusions: Specific patterns of cpRNFL thinning were found in the PD subjects younger than 70 years. A multidisciplinary approach is essential for a complete evaluation of PD patients

Proof of Concept in Artificial-Intelligence-Based Wearable Gait Monitoring for Parkinson’s Disease Management Optimization

Parkinson’s disease (PD) is the second most common progressive neurodegenerative disorder, affecting 6.2 million patients and causing disability and decreased quality of life. The research is oriented nowadays toward artificial intelligence (AI)-based wearables for early diagnosis and long-term PD monitoring. Our primary objective is the monitoring and assessment of gait in PD patients. We propose a wearable physiograph for qualitative and quantitative gait assessment, which performs bilateral tracking of the foot biomechanics and unilateral tracking of arm balance. Gait patterns are assessed by means of correlation. The surface plot of a correlation coefficient matrix, generated from the recorded signals, is classified using convolutional neural networks into physiological or PD-specific gait. The novelty is given by the proposed AI-based decisional support procedure for gait assessment. A proof of concept of the proposed physiograph is validated in a clinical environment on five patients and five healthy controls, proving to be a feasible solution for ubiquitous gait monitoring and assessment in PD. PD management demonstrates the complexity of the human body. A platform empowering multidisciplinary, AI-evidence-based decision support assessments for optimal dosing between drug and non-drug therapy could lay the foundation for affordable precision medicine

The Effect of Cerebrolysin on Anxiety, Depression, and Cognition in Moderate and Severe Traumatic Brain Injury Patients: A CAPTAIN II Retrospective Trial Analysis

Background and Objectives: Traumatic brain injuries represent an important source of disease burden requiring emergency inpatient care and continuous outpatient tailored rehabilitation. Although most TBIs are mild, patients are still developing post-TBI depression, anxiety, and cognitive impairments. Our secondary retrospective trial analysis aimed to (1) analyze correlations between HADS-Anxiety/HADS-Depression and scales that measure cognitive and motor processes in patients treated with Cerebrolysin compared to the placebo group and (2) compare anxiety and depression scores among the two treatment groups. Materials and Methods: Our secondary retrospective analysis focused on TBI patients with moderate and severe disability divided into two groups: Cerebrolysin (treatment) and saline solution (procedural placebo). We analyzed data from 125 patients. We computed descriptive statistics for nominal and continuous variables. We used Spearman’s correlation to find associations between HADS and other neuropsychological scales and the Mann–Whitney U test to compare HADS-Anxiety and HADS-Depression scores among the two study arms. Results: Our sample consisted of patients with a mean age of 45.3, primarily men, and with a 24 h GCS (Glasgow Coma Scale) mean of 12.67. We obtained statistically significant differences for HADS-Anxiety during the second and third visits for patients treated with Cerebrolysin. Our results show that Cerebrolysin has a large effect size (0.73) on anxiety levels. In addition, there are positive and negative correlations between HADS-Anxiety and Depression subscales and other neuropsychological scales. Conclusions: Our secondary database analysis supports the existing body of evidence on the positive effect of Cerebrolysin on post-TBI mental health status. Future confirmatory trials are necessary to clarify the link between the intervention and measured outcomes