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Article ; Online: Employing a mobile health decision aid to improve decision-making for patients with advanced prostate cancer and their decision partners/proxies: the CHAMPION randomized controlled trial study design.

Carhuapoma, Lourdes R / Thayer, Winter M / Elmore, Catherine E / Gildersleeve, Jane / Singh, Tanmay / Shaukat, Farah / Uveges, Melissa K / Gray, Tamryn / Chu, Crystal / Song, Daniel / Hollen, Patricia J / Wenzel, Jennifer / Jones, Randy A

Trials

2021 Volume 22, Issue 1, Page(s) 631

Abstract: Background: Metastatic prostate cancer remains a lethal malignancy that warrants novel supportive interventions for patients and their decision partners and proxies. Decision aids have been applied primarily to patients with localized disease, with ... ...

Abstract	Background: Metastatic prostate cancer remains a lethal malignancy that warrants novel supportive interventions for patients and their decision partners and proxies. Decision aids have been applied primarily to patients with localized disease, with minimal inclusion of patients with advanced prostate cancer and their decision partners. The use of a community patient navigator (CPN) has been shown to have a positive supportive role in health care, particularly with individuals from minority populations. Research is needed to evaluate decision support interventions tailored to the needs of advanced prostate cancer patients and their decision partners in diverse populations. Methods: Guided by Janis and Mann's Conflict Model of Decision Making, the Cancer Health Aid to Manage Preferences and Improve Outcomes through Navigation (CHAMPION) is a randomized controlled trial to assess the feasibility and acceptability of a mobile health (mHealth), CPN-administered decision support intervention designed to facilitate communication between patients, their decision partners, and the healthcare team. Adult prostate cancer patients and their decision partners at three mid-Atlantic hospitals in the USA were randomized to receive enhanced usual care or the decision intervention. The CHAMPION intervention includes a theory-based decision-making process tutorial, immediate and health-related quality of life graphical summaries over time (using mHealth), values clarification via a balance sheet procedure with the CPN support during difficult decisions, and facilitated discussions with providers to enhance informed, shared decision-making. Discussion: The CHAMPION intervention is designed to leverage dynamic resources, such as CPN teams, mHealth technology, and theory-based information, to support decision-making for advanced prostate cancer patients and their decision partners. This intervention is intended to engage decision partners in addition to patients and represents a novel, sustainable, and scalable way to build on individual and community strengths. Patients from minority populations, in particular, may face unique challenges during clinical communication. CHAMPION emphasizes the inclusion of decision partners and CPNs as facilitators to help address these barriers to care. Thus, the CHAMPION intervention has the potential to positively impact patient and decision partner well-being by reducing decisional conflict and decision regret related to complex, treatment-based decisions, and to reduce cancer health disparities. Trial registration ClinicalTrials.gov NCT03327103 . Registered on 31 October 2017-retrospectively registered. World Health Organization Trial Registration Data Set included in Supplementary Materials.
MeSH term(s)	Adult ; Decision Making ; Decision Support Techniques ; Humans ; Male ; Patient Participation ; Prostatic Neoplasms/therapy ; Quality of Life ; Telemedicine
Language	English
Publishing date	2021-09-16
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-021-05602-0
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Article: Controversies in neurosciences critical care.

Chang, Tiffany R / Naval, Neeraj S / Carhuapoma, J Ricardo

Anesthesiology clinics

2012 Volume 30, Issue 2, Page(s) 369–383

Abstract: Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and ... ...

Abstract	Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and reversal of coagulopathy; (2) indications for seizure prophylaxis and choice of antiepileptic agent; and (3) the role of specialized neurocritical care units and specialists in the care of critically ill neurology and neurosurgery patients.
MeSH term(s)	Anemia/therapy ; Anticonvulsants/therapeutic use ; Blood Coagulation Disorders/drug therapy ; Blood Platelet Disorders/complications ; Blood Platelet Disorders/therapy ; Blood Transfusion ; Critical Care/methods ; Erythrocyte Transfusion ; Humans ; Intensive Care Units/organization & administration ; Intracranial Hemorrhages/therapy ; Nervous System Diseases/therapy ; Neurosciences ; Seizures/prevention & control
Chemical Substances	Anticonvulsants
Language	English
Publishing date	2012-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2228899-5
ISSN	2210-3538 ; 1932-2275 ; 0889-8537
ISSN (online)	2210-3538
ISSN	1932-2275 ; 0889-8537
DOI	10.1016/j.anclin.2012.05.006
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Article: Safety Trial of Low-Intensity Monitoring After Thrombolysis: Optimal Post Tpa-Iv Monitoring in Ischemic STroke (OPTIMIST).

Faigle, Roland / Butler, Jaime / Carhuapoma, Juan R / Johnson, Brenda / Zink, Elizabeth K / Shakes, Tenise / Rosenblum, Melissa / Saheed, Mustapha / Urrutia, Victor C

The Neurohospitalist

2019 Volume 10, Issue 1, Page(s) 11–15

Abstract: Background and purpose: At present, stroke patients receiving intravenous thrombolysis (IVT) undergo monitoring of their neurological status and vital signs every 15 minutes for the first 2 hours, every 30 minutes for the next 6 hours, and every hour ... ...

Abstract	Background and purpose: At present, stroke patients receiving intravenous thrombolysis (IVT) undergo monitoring of their neurological status and vital signs every 15 minutes for the first 2 hours, every 30 minutes for the next 6 hours, and every hour thereafter up to 24 hours post-IVT. The present study sought to prospectively evaluate whether post-IVT stroke patients with low risk for complications may safely be cared for utilizing a novel low-intensity monitoring protocol. Methods: In this pragmatic, prospective, single-center, open-label, single-arm safety study, we enrolled 35 post-IVT stroke patients. Adult patients were eligible if their NIH Stroke Scale (NIHSS) was less than 10 at the time of presentation, and if they had no critical care needs by the end of the IVT infusion. Patients underwent a low-intensity monitoring protocol during the first 24 hours after IVT. The primary outcome was need for a critical care intervention in the first 24 hours after IVT. Results: The median age was 54 years (range: 32-79), and the median pre-IVT NIHSS was 3 (interquartile range [IQR]: 1-6). None of the 35 patients required transfer to the intensive care unit or a critical care intervention in the first 24 hours after IVT. The median NIHSS at 24 hours after IVT was 1 (IQR: 0-3). Four (11.4%) patients were stroke mimics, and the vast majority was discharged to home (82.9%). At 90 days, the median NIHSS was 0 (IQR: 0-1), and the median modified Rankin Scale was 0 (range: 0-6). Conclusion: Post-IVT stroke patients may be safely monitored in the setting of a low-intensity protocol.
Language	English
Publishing date	2019-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2629083-2
ISSN	1941-8752 ; 1941-8744
ISSN (online)	1941-8752
ISSN	1941-8744
DOI	10.1177/1941874419845229
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Article ; Online: Cocaine use as an independent predictor of seizures after aneurysmal subarachnoid hemorrhage.

Chang, Tiffany R / Kowalski, Robert G / Carhuapoma, J Ricardo / Tamargo, Rafael J / Naval, Neeraj S

Journal of neurosurgery

2016 Volume 124, Issue 3, Page(s) 730–735

Abstract: Objective: Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), ...

Abstract	Objective: Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), poor neurological grade, increased clot thickness, and cerebral infarction are considered highest risk for seizures. The purpose of this study was to evaluate the impact of recent cocaine use on seizure incidence following aSAH. Methods: Prospectively collected data from aSAH patients admitted to 2 institutional neuroscience critical care units between 1991 and 2009 were reviewed. The authors analyzed factors that potentially affected the incidence of seizures, including patient demographic characteristics, poor clinical grade (Hunt and Hess Grade IV or V), medical comorbidities, associated ICH, intraventricular hemorrhage (IVH), hydrocephalus, aneurysm location, surgical clipping and cocaine use. They further studied the impact of these factors on "early" and "late" seizures (defined, respectively, as occurring before and after clipping/coiling). Results: Of 1134 aSAH patients studied, 182 (16%) had seizures; 81 patients (7.1%) had early and 127 (11.2%) late seizures, with 26 having both. The seizure rate was significantly higher in cocaine users (37 [26%] of 142 patients) than in non-cocaine users (151 [15.2%] of 992 patients, p = 0.001). Eighteen cocaine-positive patients (12.7%) had early seizures compared with 6.6% of cocaine-negative patients (p = 0.003); 27 cocaine users (19%) had late seizures compared with 10.5% non-cocaine users (p = 0.001). Factors that showed a significant association with increased risk for seizure (early or late) on univariate analysis included younger age (< 40 years) (p = 0.009), poor clinical grade (p = 0.029), associated ICH (p = 0.007), and MCA aneurysm location (p < 0.001); surgical clipping was associated with late seizures (p = 0.004). Following multivariate analysis, age < 40 years (OR 2.04, 95% CI 1.355-3.058, p = 0.001), poor clinical grade (OR 1.62, 95% CI 1.124-2.336, p = 0.01), ICH (OR 1.95, 95% CI 1.164-3.273, p = 0.011), MCA aneurysm location (OR 3.3, 95% CI 2.237-4.854, p < 0.001), and cocaine use (OR 2.06, 95% CI 1.330-3.175, p = 0.001) independently predicted seizures. Conclusions: Cocaine use confers a higher seizure risk following aSAH and should be considered during risk stratification for seizure prophylaxis and close neuromonitoring.
MeSH term(s)	Adult ; Cocaine-Related Disorders/complications ; Female ; Humans ; Incidence ; Intracranial Aneurysm/diagnosis ; Intracranial Aneurysm/etiology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Seizures/diagnosis ; Seizures/epidemiology ; Subarachnoid Hemorrhage/diagnosis ; Subarachnoid Hemorrhage/etiology
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2015.2.JNS142856
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Article ; Online: Early Quantification of Hematoma Hounsfield Units on Noncontrast CT in Acute Intraventricular Hemorrhage Predicts Ventricular Clearance after Intraventricular Thrombolysis.

Kornbluth, J / Nekoovaght-Tak, S / Ullman, N / Carhuapoma, J R / Hanley, D F / Ziai, W

AJNR. American journal of neuroradiology

2015 Volume 36, Issue 9, Page(s) 1609–1615

Abstract: Background and purpose: Thrombolytic efficacy of intraventricular rtPA for acute intraventricular hemorrhage may depend on hematoma composition. We assessed whether hematoma Hounsfield unit quantification informs intraventricular hemorrhage clearance ... ...

Abstract	Background and purpose: Thrombolytic efficacy of intraventricular rtPA for acute intraventricular hemorrhage may depend on hematoma composition. We assessed whether hematoma Hounsfield unit quantification informs intraventricular hemorrhage clearance after intraventricular rtPA. Materials and methods: Serial NCCT was performed on 52 patients who received intraventricular rtPA as part of the Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage trial and 12 controls with intraventricular hemorrhage, but no rtPA treatment. A blinded investigator calculated Hounsfield unit values for intraventricular hemorrhage volumes on admission (t0), days 3-4 (t1), and days 6-9 (t2). Controls were matched uniquely to 12 rtPA-treated patients for comparison. Results: Median intraventricular hemorrhage volume on admission for patients treated with intraventricular rtPA was 31.9 mL (interquartile range, 34.1 mL), and it decreased to 4.9 mL (interquartile range, 14.5 mL) (t2). Mean (±standard error of the mean) Hounsfield unit for intraventricular hemorrhage was 52.1 (0.59) at t0 and decreased significantly to 50.1 (0.63) (t1), and to 45.1 (0.71) (t2). Total intraventricular hemorrhage Hounsfield unit count was significantly correlated with intraventricular hemorrhage volume at all time points (t0: P = .002; t1: P < .001; t2: P < .001). On serologic and CSF analysis at t0, only higher CSF protein was positively correlated with intraventricular hemorrhage Hounsfield units (P = .03). In 24 matched patients treated with rtPA and controls, total intraventricular hemorrhage Hounsfield units were significantly lower in patients treated with rtPA at t2 (P = .02). Higher Hounsfield unit quantification of fourth ventricle hematomas independently predicted slower clearance of this ventricle (95% CI, 0.02-0.14; P = .02), along with higher intraventricular hemorrhage volume (95% CI, 0.02-0.41; P = .03) and lower CSF protein levels (95% CI, -0.003 to -0.002; P < .001). Conclusions: Intraventricular hemorrhage Hounsfield unit counts decrease significantly in the acute phase and to a greater extent with intraventricular rtPA treatment. Intraventricular hemorrhage Hounsfield units are correlated significantly with CSF protein and not with serum erythrocyte or platelet concentrations. Hounsfield unit counts may reflect intraventricular hemorrhage clot composition and rtPA sensitivity.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cerebral Hemorrhage/complications ; Cerebral Hemorrhage/diagnostic imaging ; Cerebral Hemorrhage/drug therapy ; Female ; Fibrinolytic Agents/therapeutic use ; Hematoma/diagnostic imaging ; Hematoma/drug therapy ; Hematoma/etiology ; Humans ; Male ; Middle Aged ; Thrombolytic Therapy ; Tissue Plasminogen Activator/therapeutic use ; Tomography, X-Ray Computed
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2015-07-30
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
DOI	10.3174/ajnr.A4393
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Article ; Online: Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes.

Chang, Tiffany R / Kowalski, Robert G / Carhuapoma, J Ricardo / Tamargo, Rafael J / Naval, Neeraj S

Journal of critical care

2015 Volume 30, Issue 3, Page(s) 469–472

Abstract: Purpose: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners.!## ...

Abstract	Purpose: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. Materials and methods: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents. Results: A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 ± 14.1 years, B: 53.1 ± 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%). Conclusions: The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
MeSH term(s)	Adult ; Aged ; Clinical Competence ; Comorbidity ; Female ; Hospital Mortality ; Hospitals, High-Volume ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Retrospective Studies ; Subarachnoid Hemorrhage/mortality ; Treatment Outcome
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2015.01.007
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Article ; Online: Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care: A Statewide Analysis.

Balucani, Clotilde / Carhuapoma, J Ricardo / Canner, Joseph K / Faigle, Roland / Johnson, Brenda / Aycock, Anna / Phipps, Michael S / Schrier, Chad / Yarbrough, Karen / Toral, Linda / Groman, Susan / Lawrence, Erin / Aldrich, Eric / Goldszmidt, Adrian / Marsh, Elizabeth / Urrutia, Victor C

Stroke

2021 Volume 52, Issue 5, Page(s) 1822–1825

Abstract: Figure: see text]. ...

Abstract	[Figure: see text].
MeSH term(s)	Acute Disease ; COVID-19/epidemiology ; Cerebral Hemorrhage/epidemiology ; Cerebral Hemorrhage/therapy ; Humans ; Ischemic Stroke/epidemiology ; Ischemic Stroke/therapy ; Maryland/epidemiology ; Patient Admission ; Quality Improvement ; Retrospective Studies ; Stroke/epidemiology ; Stroke/therapy ; Subarachnoid Hemorrhage/epidemiology ; Subarachnoid Hemorrhage/therapy ; Thrombectomy ; Thrombolytic Therapy/methods
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.121.034150
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Article ; Online: Anti-aging factor, serum alpha-Klotho, as a marker of acute physiological stress, and a predictor of ICU mortality, in patients with septic shock.

Abdelmalik, Peter A / Stevens, Robert D / Singh, Sarabdeep / Skinner, John / Carhuapoma, J Ricardo / Noel, Sanjeev / Johns, Roger / Fuchs, Ralph J

Journal of critical care

2017 Volume 44, Page(s) 323–330

Abstract: Purpose: Genetic deletions decreasing serum alpha-Klotho (alpha-KL) have been associated with rapid aging, multi-organ failure and increased mortality in experimental sepsis. We hypothesized that lower alpha-KL obtained at the onset of septic shock ... ...

Abstract	Purpose: Genetic deletions decreasing serum alpha-Klotho (alpha-KL) have been associated with rapid aging, multi-organ failure and increased mortality in experimental sepsis. We hypothesized that lower alpha-KL obtained at the onset of septic shock correlates with higher mortality. Materials and methods: Prospective cohort of 104 adult patients with septic shock. Alpha-KL was measured via ELISA on serum collected on the day of enrollment (within 72h from the onset of shock). Relationship between alpha-KL and clinical outcome measures was evaluated in uni- and multi-variable models. Results: Median (IQR) alpha-KL was 816 (1020.4) pg/mL and demonstrated a bimodal distribution with two distinct populations, Cohort A [n=97, median alpha-KL 789.3 (767.1)] and Cohort B [n=7, median alpha-KL 4365.1(1374.4), >1.5 IQR greater than Cohort A]. Within Cohort A, ICU non-survivors had significantly higher serum alpha-KL compared to survivors as well as significantly higher APACHE II and SOFA scores, rates of mechanical ventilation, and serum BUN, creatinine, calcium, phosphorus and lactate (all p≤0.05). Serum alpha-KL≥1005, the highest tertile, was an independent predictor of ICU mortality when controlling for co-variates (p=0.028, 95% CI 1.143-11.136). Conclusions: Elevated serum alpha-KL in patients with septic shock is independently associated with higher mortality. Further studies are needed to corroborate these findings.
MeSH term(s)	Aged ; Biomarkers/blood ; Female ; Glucuronidase/blood ; Hospital Mortality ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Shock, Septic/blood ; Shock, Septic/mortality ; Stress, Physiological/physiology
Chemical Substances	Biomarkers ; Glucuronidase (EC 3.2.1.31) ; klotho protein (EC 3.2.1.31)
Language	English
Publishing date	2017-11-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2017.11.023
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Article ; Online: Withdrawal of technological life support following subarachnoid hemorrhage.

Kowalski, Robert G / Chang, Tiffany R / Carhuapoma, J Ricardo / Tamargo, Rafael J / Naval, Neeraj S

Neurocritical care

2013 Volume 19, Issue 3, Page(s) 269–275

Abstract: Background: Prognostication of mortality or severe disability often prompts withdrawal of technological life support in patients following aneurysmal subarachnoid hemorrhage (aSAH). We assessed admission factors impacting decisions to withdraw treatment ...

Abstract	Background: Prognostication of mortality or severe disability often prompts withdrawal of technological life support in patients following aneurysmal subarachnoid hemorrhage (aSAH). We assessed admission factors impacting decisions to withdraw treatment after aSAH. Methods: Prospectively collected data of aSAH patients admitted to our institution between 1991 and 2009 were reviewed. Patients given comfort care measures were identified, including early withdrawal of treatment (<72 h after admission). Independent predictors of treatment withdrawal were assessed with multivariable analysis. Results: The study included 1,134 patients, of whom 72 % were female, 58 % white, and 38 % black or African-American. Mean age was 52.5 ± 14.0 years. In-hospital mortality was 18.3 %. Of the 207 patients who died, treatment was withdrawn in 72 (35 %) and comfort measures instituted early in 31 (15 %). Among patients who died, WOLST was associated with older age (63.6 ± 14.2 years, WOLST vs. 55.6 ± 13.7 years, no WOLST, p < 0.001); GCS score <8 (62 % of WOLST vs. 44 % with no WOLST, p = 0.010); HH >3 (72 % of WOLST vs. 53 % with no WOLST, p = 0.008); and hydrocephalus (81 % of WOLST vs. 63 % with no WOLST, p = 0.009). Independent predictors of WOLST were poorer Hunt and Hess grade (AOR 1.520, 95 % CI 1.160-1.992, p = 0.002) and older age (AOR 1.045, 95 % CI 1.022-1.068, p < 0.001) with the latter also impacting early WOLST decisions. Conclusions: Older age and poor clinical grade on presentation predicted WOLST, and age predicted decisions to withdraw treatment earlier following aSAH. While based on prognosis, and in some cases patient wishes, this may also constitute a self-fulfilling prophecy in others.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Glasgow Coma Scale ; Hospital Mortality ; Humans ; Intracranial Aneurysm/mortality ; Intracranial Aneurysm/therapy ; Life Support Care/standards ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Patient Admission/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Prognosis ; Prospective Studies ; Severity of Illness Index ; Subarachnoid Hemorrhage/mortality ; Subarachnoid Hemorrhage/therapy ; Time Factors
Language	English
Publishing date	2013-10-29
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2381896-7
ISSN	1556-0961 ; 1541-6933
ISSN (online)	1556-0961
ISSN	1541-6933
DOI	10.1007/s12028-013-9929-8
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Article: Moyamoya syndrome associated with Sneddon's syndrome and antiphospholipid-protein antibodies.

Carhuapoma, J R / D'Olhaberriague, L / Levine, S R

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2007 Volume 8, Issue 2, Page(s) 51–56

Abstract: Background: There are anecdotal reports of the rare combination of Sneddon's syndrome, lupus anticoagulant, and Moyamoya. To our knowledge, we now report the first case of anticardiolipin antibodies, Sneddon's syndrome, and Moyamoya.: Methods: Case- ... ...

Abstract	Background: There are anecdotal reports of the rare combination of Sneddon's syndrome, lupus anticoagulant, and Moyamoya. To our knowledge, we now report the first case of anticardiolipin antibodies, Sneddon's syndrome, and Moyamoya. Methods: Case-report and systematic literature review. Results: A 37-year-old woman had 31/2 years of recurrent left-sided sensory-motor symptoms. More recently, she had experienced vertigo, diplopia, and imbalance. Medical history included headaches, labile hypertension, left arm venous thrombosis requiring anticoagulation, and cigarette smoking. On examination she had livedo reticularis, limited left eye abduction, and left hemiparesis. Magnetic resonance imaging (MRI) showed right frontal, left parieto-occipital and pontine high intensity lesions on T(2)-weighted images consistent with ischemia and abnormally increased flow-void in the basal ganglionic regions. Conventional cerebral angiography showed a Moyamoya pattern. Transesophageal echocardiography and electroencephalogram were normal. Serologic studies were remarkable for anticardiolipin antibodies immunoglobulin G isotype only. She responded favorably to carbamazepine as treatment of presumptive focal seizures, and long-term anticoagulation. Seven other cases reported in the literature were found and reviewed, with different combinations of Moyamoya, Sneddon's syndrome, and antiphospholipid-protein antibodies. The mean age was 37 (range 18-59, SD+/-16) years, male/female ratio 3/5; clinical features included cognitive changes (4 pts), ischemic stroke (6pts), seizures (1pt), and intracranial hemorrhage (2pts). Anticoagulation/steroids/anti-platelet agents were empirically associated with a favorable survival and functional outcome in 6 cases. Conclusion: This case expands the spectrum of associations with Moyamoya, and in conjunction with a review of the literature, suggests that evaluation for antiphospholipid-protein antibodies is recommended in cases of Moyamoya syndrome.
Language	English
Publishing date	2007-09-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1052-3057
ISSN	1052-3057
DOI	10.1016/s1052-3057(99)80054-8
Database	MEDical Literature Analysis and Retrieval System OnLINE

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