Further evidence for a non-cortical origin of mirror movements after stroke.

Ejaz et al. (2018) are to be commended for showing no evidence for a cortical origin of post-stroke mirror movements. Using functional MRI during affected-finger presses in recovering adult-onset stroke patients, they found no consistent relationship between contralesional sensorimotor cortex (cSM1) activation and quantitative indices of mirror movements; specifically, mirror movements were not linked to the presence of cSM1 overactivation, arguing against the classic ‘transcallosal’ mechanism heretofore widely believed to cause mirror movements (Di Pino et al., 2014). We wish to report findings—previously published in abstract form (Calautti, 2008)—that further support the idea that mirror movements are not cortically mediated. We also present data that confirm that mirror movements can involve the affected (i.e. paretic) hand during movement of the unaffected (i.e. non-paretic) hand, also arguing in favour of disruption of a bilaterally-organized system

Early Recovery of Aphasia through Thrombolysis: The Significance of Spontaneous Speech

Aphasia in one of the most devastating stroke-related consequences for social interaction and daily activities. Aphasia recovery in acute stroke depends on the degree of reperfusion after thrombolysis or thrombectomy. As aphasia assessment tests are often time-consuming for patients with acute troke, physicians have been developing rapid and simple tests. The aim of our study is to evaluate the improvement of language functions in the earliest stage in patients treated with thrombolysis and in nontreated patients using our rapid screening tes

The impact of COVID-19 on myocardial infarctions, strokes and out-of-hospital cardiopulmonary arrests: an observational retrospective study on time-sensitive disorders in the Friuli Venezia Giulia region (Italy)

The COVID-19 global pandemic has changed considerably the way time-sensitive disorders are treated. Home isolation, people's fear of contracting the virus and hospital reorganisation have led to a significant decrease in contacts between citizens and the healthcare system, with an expected decrease in calls to the Emergency Medical Services (EMS) of the Friuli-Venezia Giulia (FVG) region. However, mortality in clinical emergencies like acute ST-elevation myocardial infarction (STEMI), stroke and out-of-hospital cardiopulmonary arrest (OHCA) remained high. An observational retrospective cross-sectional study was carried out in FVG, taking into account the period between March 1, 2020, and May 31, 2020, the first wave of the COVID-19 pandemic, and comparing it with the same period in 2019. The flow of calls to the EMS was analysed and COVID-19 impact on time-sensitive disorders (STEMIs, ischemic strokes and OHCPAs) was measured in terms of hospitalisation, treatment and mortality. Despite a -8.01% decrease (p value ˂0.001) in emergency response, a 10.89% increase in calls to the EMS was observed. A lower number of advanced cardiopulmonary resuscitations (CPR) (75.8 vs 45.2%, p=0.000021 in April) and ROSC (39.1 vs 11.6%, p=0.0001 in April) was remarked, and survival rate dropped from 8.5 to 5%. There were less strokes (-27.5%, p value=0.002) despite a more severe onset of symptoms at hospitalisation with NHISS˃10 in 38.47% of cases. Acute myocardial infarctions decreased as well (-20%, p value=0.05), but statistical significances were not determined in the variables considered and in mortality. Despite a lower number of emergency responses, the number of calls to the EMS was considerably higher. The number of cardiac arrests treated with advanced CPR (ALS) was lower, but mortality was higher. The number of strokes decreased as well, but at the time of hospitalisation the clinical picture of the patient was more severe, thus affecting the outcome when the patient was discharged. Finally, STEMI patients decreased; however, no critical issues were observed in the variables taken into account, neither in terms of response times nor in terms of treatment times

Endocannabinoidi e stroke: uno studio nell'uomo

Background: Endocannabinoids have shown neuroprotective properties in murine and neuronal coltural models of stroke, acting on NMDA-mediated excitotoxicity and probably modulating the subsequent neuroinflammatory response. Methods: 10 patients with a first ischemic stroke in the MCA territory with at least hand movement impairment and 8 age-matched control subjects were included. Groups were matched for body mass index (BMI) and plasmatic fasting glucose, cholesterol and triglyceride levels. All control subjects underwent a blood sample collection for anandamide (AEA), 2-arachidonoylglycerol (2-AG) and palmitoylethanolamide (PEA) measurement; patients admitted within 6 hours since stroke onset underwent the same procedure on admittance (T0), after 12 (T1) and after 24 (T2) hours since symptom onset. Patient’s neurological impairment was assessed using NIHSS and Fugl-Meyer Scale arm subitem (FMS); stroke volume was determined on 48-hours follow-up brain CT scans. Blood samples were analyzed by liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry. Statistical analysis was performed with SPSS 12.0, using Mann-Whitney U test and Spearman correlation analysis. Results: 1)The T0 levels of AEA, but not 2-AG and PEA, were significantly higher in stroke patients compared to control subjects. 2) There was a correlation between BMI, cholesterol, glucose and triglyceride plasmatic levels and 2-AG, but not AEA, levels. 3) Stroke patients showed a significant inverse correlation between T0 AEA levels and FMS score: the higher the AEA levels, the worse the neurological arm impairment. PEA T0 levels showed a significant direct correlation with NIHSS score. Finally, a positive correlation trend was found between T0 AEA levels and stroke volume at 48-hours follow-up brain CT scans. Conclusions: This is the first demonstration of elevated peripheral AEA levels in stroke patients; moreover, like in previous murine studies, there seems to be a significant relationship between AEA levels and neurological impairment at 6 hours since stroke onset

Effect of a Passive Intervention on Carers of Stroke Survivors During the Early Poststroke Period

BACKGROUND: Care partners of stroke survivors are often characterized by high burden levels and depression. Passive and active interventions have been proposed to help reduce burden and depression. The aim of this quality improvement report was to evaluate the effects of a single passive intervention on reported burden and depression in carers of stroke survivors. METHODS: A quality improvement report was conducted on carers who participated in a short passive intervention (n = 56) and a control group (n = 44). The Family Strain Questionnaire-Short Form (FSQ-SF) and the Beck Depression Inventory II were administered in both groups at patients' admission and before discharge, with the intervention taking place between the 2 data collection periods. RESULTS: No significant difference between groups was observed in FSQ-SF score and prevalence of depression at admission and in FSQ-SF at discharge. However, compared with admission, FSQ-SF at discharge was significantly reduced only in the intervention group (pre: 14, and interquartile range, 12-15; post: 9, and interquartile range, 9-13; P < .01). Moreover, a smaller proportion of carers classified as "depression" was found at discharge in the intervention group compared with controls (4% vs 28%, respectively; P < .01). CONCLUSION: Results encourage the development and use of short passive intervention to reduce burden and depression in care partners of stroke survivors

Fluid and energy intake in stroke patients during acute hospitalization in a stroke unit

Proper hydration and nutrition have been found to be contributing factors to a better recovery in patients after stroke. A better knowledge of factors influencing fluid and energy intake may contribute to a better care of the acute stroke patient. Aim of this study was to describe hydration status, fluid intake, and energy intake of stroke patients during acute hospitalization in a stroke unit. A retrospective descriptive study was conducted in stroke patients admitted to a stroke unit. All patients received neurological evaluation and urinary osmolality (uOsm) measure at admission and discharge. During stroke unit stay patients received a day-by-day diary to record data about beverages, food, and therapy. Water and energy content were then reported based on a national nutritional database. Ninety-five patients were included in the analysis. uOsm did not differ between patients with or without dysphagia, with uOsm\u202f>\u202f500\u202fmosm/kg in 58.1% at admission and 57.8% at discharge. Inadequate fluid intake was found in 41.2% of the sample with no difference between groups. Insufficient energy intake was found in 95.6% of the sample, with no patients with dysphagia reaching the minimum suggested amount. Our results suggest that a relevant proportion of stroke patients with and without dysphagia may not improve their hydration status during the first days after admission. Diet and therapy were insufficient to achieve recommended fluid intake and energy intake in a large proportion of patients, suggesting a more careful monitoring of hydration and nutrition needs

Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit

Backgrounds: Wake-Up Stroke (WUS) patients are generally excluded from thrombolytic therapy (rTPA) due to the unknown time of stroke onset. This study aimed to investigate the effects of rTPA in WUS patients during every day clinical scenarios, by measuring ischemic lesion volume and functional outcomes compared to non-treated WUS patients. Methods: We retrospectively analyzed clinical and imaging data of 149 (75 rTPA; 74 non-rTPA) patients with acute ischemic WUS. Ischemic volume was calculated on follow-up CT and functional outcomes were the NIHSS and mRS comparing rTPA and non-rTPA WUS. Patients were selected using ASPECTS > 6 on CT and/or ischemic penumbra > 50% of hypoperfused tissue on CTP. Results: A reduced volume was measured on the follow-up CT for rTPA (1 mL, 0-8) compared to the non-rTPA patients (10 mL, 0-40; p = 0.000). NIHSS at 7 days from admission was significantly lower in the rTPA (1, 0-4) compared to non-rTPA group (3, 1-9; p = 0.015), as was the percentage of improvement (\u394NIHSS) (70% vs 50%; p = 0.002). A higher prevalence of mRS 0-2 was observed in the rTPA compared to the non-rTPA (54% vs 39%; p = 0.060). Multivariate analysis showed that NIHSS at baseline and rTPA treatment are significant predictors of good outcome both in terms of NIHSS at 7 days and ischemic lesion volume on follow-up CT (p < 0.05). Conclusions: rTPA in WUS patients selected with CT and/or CTP resulted in reduced ischemic infarct volume on follow-up CT and better functional outcome without increment of intracranial hemorrhages and in-hospital mortality

Hyper-acute EEG alterations predict functional and morphological outcomes in thrombolysis-treated ischemic stroke: a wireless EEG study

Owing to the large inter-subject variability, early post-stroke prognosis is challenging, and objective biomarkers that can provide further prognostic information are still needed. The relation between quantitative EEG parameters in pre-thrombolysis hyper-acute phase and outcomes has still to be investigated. Hence, possible correlations between early EEG biomarkers, measured on bedside wireless EEG, and short-term/long-term functional and morphological outcomes were investigated in thrombolysis-treated strokes. EEG with a wireless device was performed in 20 patients with hyper-acute (< 4.5 h from onset) anterior ischemic stroke before reperfusion treatment. The correlations between outcome parameters (i.e., 7-day/12-month National Institutes of Health Stroke Scale NIHSS, 12-month modified Rankin Scale mRS, final infarct volume) and the pre-treatment EEG parameters were studied. Relative delta power and alpha power, delta/alpha (DAR), and (delta+theta)/(alpha+beta) (DTABR) ratios significantly correlated with NIHSS 7-day (rho = 0.80, - 0.81, 0.76, 0.75, respectively) and NIHSS 12-month (0.73, - 0.78, 0.74, 0.73, respectively), as well as with final infarct volume (0.75, - 0.70, 0.78, 0.62, respectively). A good outcome in terms of mRS 64 2 at 12 months was associated with DAR parameter (p = 0.008). The neurophysiological biomarkers obtained by non-invasive and portable technique as wireless EEG in the early pre-treatment phase may contribute as objective parameters to the short/long-term outcome prediction pivotal to better establish the treatment strategies.Graphical abstract Block diagram of study protocol and main findings. Assessment at admission including wireless EEG acquisition in emergency setting (< 4.5 from stroke onset), extracted EEG features before reperfusion thrombolytic treatment. The main findings in our study sample are summarized in two different exemplificative stroke patients with different pre-thrombolysis alterations of EEG parameters resulting in different final infarct volume extensions and short/long-term clinical outcomes (NIHSS, mRS)

A Novel Non-Invasive Thermometer for Continuous Core Body Temperature: Comparison with Tympanic Temperature in an Acute Stroke Clinical Setting

There is a growing research interest in wireless non-invasive solutions for core temperature estimation and their application in clinical settings. This study aimed to investigate the use of a novel wireless non-invasive heat flux-based thermometer in acute stroke patients admitted to a stroke unit and compare the measurements with the currently used infrared (IR) tympanic temperature readings. The study encompassed 30 acute ischemic stroke patients who underwent continuous measurement (Tcore) with the novel wearable non-invasive CORE device. Paired measurements of Tcore and tympanic temperature (Ttym) by using a standard IR-device were performed 3&ndash;5 times/day, yielding a total of 305 measurements. The predicted core temperatures (Tcore) were significantly correlated with Ttym (r = 0.89, p &lt; 0.001). The comparison of the Tcore and Ttym measurements by Bland&ndash;Altman analysis showed a good agreement between them, with a low mean difference of 0.11 &plusmn; 0.34 &deg;C, and no proportional bias was observed (B = &minus;0.003, p = 0.923). The Tcore measurements correctly predicted the presence or absence of Ttym hyperthermia or fever in 94.1% and 97.4% of cases, respectively. Temperature monitoring with a novel wireless non-invasive heat flux-based thermometer could be a reliable alternative to the Ttym method for assessing core temperature in acute ischemic stroke patients

Effects of therapy with the acetylcholinesterase inhibitor rivastigmine on spatial and verbal working memory in Alzheimer's disease: A H2150PET study

Objective: Impairments of spatial and verbal memory are early and common symptoms in Alzheimer\u2019s disease (AD). Cognitive impairment may result from cholinergic dysfunctions and can be improved by cholinergic therapies. The current study was designed to determine how a cholinergic therapy affects neural responses during different working memory tasks. Methods: In eight patients with mild AD (NINCDS-ADRDA criteria), regional cerebral blood flow (rCBF) was measured using H215O and PET prior to and three months after therapy with the acetylcholinesterase inhibitor rivastigmine (6\u20139 mg p.o., daily) in two consecutive series of four scans each. rCBF was measured in a rest condition and while patients were performing a verbal, a spatial or a more demanding verbalspatial working memory task. Results: Rivastigmine therapy speeded up reaction times across conditions but altered rCBF responses in a task-specific manner. Rivastigmine therapy enhanced rCBF activation in a left temporal area and rCBF deactivation in left parietal areas during verbal working memory. Furthermore, rivastigmine increased rCBF activation in the cerebellum and rCBF deactivation of the left temporal area during spatial working memory. Finally, rivastigmine enhanced rCBF activation in the right frontal and occipital areas and rCBF deactivation in posterior frontal, temporal and occipital areas during verbal/ spatial working memory. Conclusions: The results indicate that rivastigmine modulates neural responses in brain areas that are differentially activated by different working memory tasks. The results further suggest that rivastigmine may improve cognition in Alzheimer\u2019s disease by facilitating the attentional allocation of neural resources during effortful cognitive tasks