Anxiety disorder, depression and chronic daily headache: a case-control study.

Chronic headache cause high disability in sufferers and high social cost. Data regarding possible comorbid diseases, manly depression and anxiety, are still few and conflicting.The aim of this case-control, hospital-based study was: to evaluate the prevalence of depression and anxiety in subjects with chronic migraine (CM) and chronic tension-type headache (CTTH); and to compare the results with those found in a control group without headache. Materials and methods We studied 79 patients, 46 with CM and 33 with CTTH, consecutively referred to the Adult Headache Centre of the University of Palermo (A.H. Study) between 2007 and 2009, and 316 controls without headache (each patient was matched by sex and age to four controls).The headache diagnosis was established according to the ICHD-II criteria. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HAD). Results Mean age was 47.6 years (±17.8 yrs) for the 79 patients with chronic headache (66 F, 13 M) and 47.6 years (±17.8 yrs) for the 316 controls (264 F, 52 M). The mean HAD-D score was 8.6±4.3 in the chronic headache group and 7.0±3.5 in the control group; ( p=0.00). The mean HAD-A score was 11.2±4.5 in the chronic headache group versus 9.0 ± 3.7 in the control group. Following multiple logistic regression analysis, the presence of depression and anxiety was associated with chronic headache (depression: OR=2.2, 95% CI 1.2-4.1; anxiety: OR=2.4, 95% CI 1.3-4.3). Conclusion. According to our data, anxiety and depressive symptoms are more prevalent in chronic headache, and correlate to an increased risk of chronic headache

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes

European Multicenter Study of ET-COVID-19

International audienceBackground and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090