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Article ; Online: Thrombolysis in Stroke-Heart Syndrome: a useful tool for neurocardiac wellness?

Scali, Ilario / Naccarato, Marcello / Prandin, Gabriele / Palacino, Federica / Lugnan, Carlo / Mancinelli, Laura / Vincis, Emanuele / Furlanis, Giovanni / Caruso, Paola / Manganotti, Paolo

Journal of neurology

2024

Abstract: Introduction: Stroke-heart syndrome is a physiopathological condition of cardiac suffering due to cerebral injury secondary to major vessel occlusion in anterior circulation. It can be detected by increase in cardiac blood biomarkers. Our aim was to ... ...

Abstract	Introduction: Stroke-heart syndrome is a physiopathological condition of cardiac suffering due to cerebral injury secondary to major vessel occlusion in anterior circulation. It can be detected by increase in cardiac blood biomarkers. Our aim was to investigate a possible ancillary effect of thrombolysis in mitigating Stroke-Heart Syndrome after acute ischaemic stroke. Patients and methods: We retrospectively collected ischaemic stroke patients admitted to our Stroke Unit between August 1, 2017 and December 31, 2020 and acutely treated for an intracranial anterior circulation occlusion, without anamnestic ischaemic cardiopathy. We divided patients into Group B ("Bridge") including patients treated with both thrombolysis and thrombectomy and Group D ("Direct") including primary thrombectomies. Results: 120 patients were included in the study. Group B consisted of 92 patients, Group D of 28 patients, without significant differences in age, baseline and discharge NIHSS, cardiovascular risk factors or TOAST aetiology. Whilst admission, troponin levels were similar in both groups, significant differences in troponin peak (median 16 ng/L in Group B vs 45 ng/L in Group D, p = 0.022) and BNP values (median 455 pg/mL in Group B vs 784 pg/mL in Group D, p = 0.031) were found in the first 72 h since admission. Functional independence at discharge was significantly higher in Group B than Group D (mRS 0-2 36% vs 10%, p = 0.011). Discussion and conclusion: Significant differences in troponin peak and BNP values suggest a reduced stroke-related heart impairment in patients treated with bridge therapeutic approach: thrombolysis prior to thrombectomy could have a complementary effect on reducing Stroke-Heart Syndrome, improving overall neurological outcome.
Language	English
Publishing date	2024-01-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	187050-6
ISSN	1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
ISSN (online)	1432-1459
ISSN	0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
DOI	10.1007/s00415-023-12167-2
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Article ; Online: Correction to: Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five‑year retrospective study.

Caruso, Paola / Prandin, Gabriele / Rossi, Lucrezia / Cegalin, Matteo / Lugnan, Carlo / Pasquin, Fulvio / Sisto, Ugo Giulio / Furlanis, Giovanni / Naccarato, Marcello / Cominotto, Franco / Manganotti, Paolo

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

2024

Language	English
Publishing date	2024-03-23
Publishing country	Italy
Document type	Published Erratum
ZDB-ID	2016546-8
ISSN	1590-3478 ; 1590-1874
ISSN (online)	1590-3478
ISSN	1590-1874
DOI	10.1007/s10072-024-07482-z
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Article ; Online: Improving acute stroke assessment in non-enhanced computed tomography: automated tool for early ischemic lesion volume detection.

Bernardi, Mara Sabina / Rodriguez, Alex / Caruso, Paola / Furlanis, Giovanni / Ridolfi, Mariana / Prandin, Gabriele / Naccarato, Marcello / Laio, Alessandro / Amati, Daniele / Manganotti, Paolo

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

2024

Abstract: Background and objectives: ASPECTs is a widely used marker to identify early stroke signs on non-enhanced computed tomography (NECT), yet it presents interindividual variability and it may be hard to use for non-experts. We introduce an algorithm ... ...

Abstract	Background and objectives: ASPECTs is a widely used marker to identify early stroke signs on non-enhanced computed tomography (NECT), yet it presents interindividual variability and it may be hard to use for non-experts. We introduce an algorithm capable of automatically estimating the NECT volumetric extension of early acute ischemic changes in the 3D space. We compared the power of this marker with ASPECTs evaluated by experienced practitioner in predicting the clinical outcome. Methods: We analyzed and processed neuroimaging data of 153 patients admitted with acute ischemic stroke. All patients underwent a NECT at admission and on follow-up. The developed algorithm identifies the early ischemic hypodense region based on an automatic comparison of the gray level in the images of the two hemispheres, assumed to be an approximate mirror image of each other in healthy patients. Results: In the two standard axial slices used to estimate the ASPECTs, the regions identified by the algorithm overlap significantly with those identified by experienced practitioners. However, in many patients, the regions identified automatically extend significantly to other slices. In these cases, the volume marker provides supplementary and independent information. Indeed, the clinical outcome of patients with volume marker = 0 can be distinguished with higher statistical confidence than the outcome of patients with ASPECTs = 10. Conclusion: The volumetric extension and the location of acute ischemic region in the 3D-space, automatically identified by our algorithm, provide data that are mostly in agreement with the ASPECTs value estimated by expert practitioners, and in some cases complementary and independent.
Language	English
Publishing date	2024-01-29
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2016546-8
ISSN	1590-3478 ; 1590-1874
ISSN (online)	1590-3478
ISSN	1590-1874
DOI	10.1007/s10072-024-07339-5
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Article ; Online: Status Epilepticus after mechanical thrombectomy: The role of early EEG assessment in Stroke Unit, clinical and radiological prognostication.

Prandin, Gabriele / Furlanis, Giovanni / Scali, Ilario / Palacino, Federica / Mancinelli, Laura / Vincis, Emanuele / Caruso, Paola / Mazzon, Giulia / Tomaselli, Marinella / Naccarato, Marcello / Manganotti, Paolo

Epilepsy research

2024 Volume 202, Page(s) 107343

Abstract: Background: Convulsive (CSE) and non-convulsive (NCSE) Status Epilepticus are a complication in 0.2-0.3% ischemic strokes. Large stroke and cortical involvement are the main risk factors for developing SE. This study evaluates the prevalence of SE in ... ...

Abstract	Background: Convulsive (CSE) and non-convulsive (NCSE) Status Epilepticus are a complication in 0.2-0.3% ischemic strokes. Large stroke and cortical involvement are the main risk factors for developing SE. This study evaluates the prevalence of SE in patients treated with endovascular thrombectomy (EVT) through EEG recording within 72- h from admission. Moreover, we compared clinical, radiological, and outcome measures in SE and no-SE patients. Materials and methods: We collected retrospectively demographical and clinical characteristics of acute ischemic stroke patients who underwent EVT, admitted in the Stroke Unit (SU) of the University Hospital of Trieste between January 2018 and March 2020 who underwent EEG recording within 72- h from the symptoms' onset. Results: Out of 247 EVT patients, 138 met the inclusion criteria, of whom 9 (6.5%) showed SE with median onset time of 1 day (IQR 1-2). No difference was found between the two groups as for age, sex, risk factors, grade of recanalization, etiology of stroke, and closed vessel. The no-SE group presented higher NIHSS improvement rate (p=0.025) compared to the SE group. The sum of the lobes involved in the ischemic lesion was significantly higher in SE group (p=0.048). Conclusion: SE after EVT in large strokes is a non-rare complication, with most being NCSE. Performing a rapid EEG assessment in a Stroke Unit setting may allow for a prompt recognition and treatment of SE in the acute/hyper-acute phase. SE may be correlated with worse clinical outcomes in patients with large vessel occlusion.
Language	English
Publishing date	2024-03-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632939-1
ISSN	1872-6844 ; 0920-1211
ISSN (online)	1872-6844
ISSN	0920-1211
DOI	10.1016/j.eplepsyres.2024.107343
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Article ; Online: Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

2024

Abstract: Background: Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24 h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in ... ...

Abstract	Background: Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24 h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED). Methods: This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90 days, and we evaluate the possible association between different types of management. Results: TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021). Conclusions: Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.
Language	English
Publishing date	2024-03-11
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2016546-8
ISSN	1590-3478 ; 1590-1874
ISSN (online)	1590-3478
ISSN	1590-1874
DOI	10.1007/s10072-024-07443-6
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Article ; Online: A Novel Non-Invasive Thermometer for Continuous Core Body Temperature: Comparison with Tympanic Temperature in an Acute Stroke Clinical Setting.

Ajčević, Miloš / Buoite Stella, Alex / Furlanis, Giovanni / Caruso, Paola / Naccarato, Marcello / Accardo, Agostino / Manganotti, Paolo

Sensors (Basel, Switzerland)

2022 Volume 22, Issue 13

Abstract: 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 ... ...

Abstract	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 3−5 times/day, yielding a total of 305 measurements. The predicted core temperatures (Tcore) were significantly correlated with Ttym (r = 0.89, p < 0.001). The comparison of the Tcore and Ttym measurements by Bland−Altman analysis showed a good agreement between them, with a low mean difference of 0.11 ± 0.34 °C, and no proportional bias was observed (B = −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.
MeSH term(s)	Body Temperature ; Fever/diagnosis ; Humans ; Ischemic Stroke ; Temperature ; Thermometers ; Tympanic Membrane
Language	English
Publishing date	2022-06-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2052857-7
ISSN	1424-8220 ; 1424-8220
ISSN (online)	1424-8220
ISSN	1424-8220
DOI	10.3390/s22134760
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Article ; Online: Application of Ultrasonography in Neurogenic Dysphagia: A Systematic Review.

Potente, Paola / Buoite Stella, Alex / Vidotto, Monica / Passerini, Michelle / Furlanis, Giovanni / Naccarato, Marcello / Manganotti, Paolo

Dysphagia

2022 Volume 38, Issue 1, Page(s) 65–75

Abstract: Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary ...

Abstract	Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson's disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.
MeSH term(s)	Humans ; Deglutition Disorders/diagnostic imaging ; Deglutition Disorders/etiology ; Quality of Life ; Deglutition/physiology ; Nervous System Diseases/complications ; Ultrasonography
Language	English
Publishing date	2022-05-13
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	632764-3
ISSN	1432-0460 ; 0179-051X
ISSN (online)	1432-0460
ISSN	0179-051X
DOI	10.1007/s00455-022-10459-9
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Article ; Online: Isolated aphasic status epilepticus: CT perfusion, SPECT and EEG reveal neurovascular coupling and support the differential diagnosis.

Manganotti, Paolo / Furlanis, Giovanni / Cova, Maria Assunta / Olivo, Sasha / Dore, Franca / Sartori, Arianna / Naccarato, Marcello

Epileptic disorders : international epilepsy journal with videotape

2022 Volume 24, Issue 3, Page(s) 549–554

Abstract: Objective Among the clinical manifestations of stroke mimics, isolated aphasia is one of the most challenging due to its aetiopathogenic diagnosis. This short communication describes a specific perfusion and brain oscillatory pattern in a challenging ... ...

Title translation	Isolated aphasic status epilepticus: CT perfusion, SPECT and EEG reveal neurovascular coupling and support the differential diagnosis.
Abstract	Objective Among the clinical manifestations of stroke mimics, isolated aphasia is one of the most challenging due to its aetiopathogenic diagnosis. This short communication describes a specific perfusion and brain oscillatory pattern in a challenging case of prolonged isolated aphasia caused by status epilepticus, jointly investigated by computed tomography (CT) perfusion, single-photon emission computerized tomography (SPECT)/CT and EEG qualitative and quantitative analysis. Methods We discuss the different patterns of perfusion neuroimaging and EEG between SE and ischaemic stroke or postictal (Todd's)-related isolated aphasia, and propose these differences as a basis to support the differential diagnosis. Results The pattern associated with SE was characterized by focal hyperperfusion on CT perfusion maps (the left mean transit time was shorter with >10% asymmetry, and left cerebral blood volume and cerebral blood flow increased or slightly altered, relative to the contralateral side) and SPECT (focal left temporal hyperperfusion), without any early ischaemic signs on non-enhanced CT, while the EEG showed a predominant left hemispheric slow delta power. The aforementioned perfusion pattern contrasts with postictal epileptic Todd's phenomenon, which is characterized by hypoperfusion on CT perfusion (the mean transit time is prolonged and cerebral blood volume and cerebral blood flow are reduced, compared to the contralateral hemisphere) and SPECT (focal hypoperfusion), not restricted to the specific vascular territories. Significance CT perfusion patterns may add valuable information to support the differential diagnosis of status epilepticus, rather than acute ischaemic stroke or postictal Todd's phenomenon, in cases with challenging symptoms of prolonged isolated aphasia.
MeSH term(s)	Aphasia/diagnostic imaging ; Aphasia/etiology ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Diagnosis, Differential ; Electroencephalography ; Humans ; Neurovascular Coupling ; Perfusion/adverse effects ; Status Epilepticus/complications ; Status Epilepticus/diagnostic imaging ; Stroke/diagnosis ; Stroke/diagnostic imaging ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed/adverse effects ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2022-06-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2086797-9
ISSN	1950-6945 ; 1294-9361
ISSN (online)	1950-6945
ISSN	1294-9361
DOI	10.1684/epd.2022.1421
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Zs.A 5740: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Functional neurological disorders miming a stroke: management in the acute phase.

Caruso, Paola / Bellavita, Giulia / Furlanis, Giovanni / Ridolfi, Mariana / Naccarato, Marcello / Manganotti, Paolo

Clinical neurology and neurosurgery

2020 Volume 196, Page(s) 105840

MeSH term(s)	Brain/diagnostic imaging ; Diagnosis, Differential ; Disease Management ; Humans ; Nervous System Diseases/diagnosis ; Nervous System Diseases/diagnostic imaging ; Stroke/diagnosis ; Stroke/diagnostic imaging
Language	English
Publishing date	2020-05-21
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2020.105840
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Article: Focusing on Single CT Perfusion Quantitative Maps: Percheron's Artery Stroke Detection.

Cillotto, Tommaso / Furlanis, Giovanni / Buoite Stella, Alex / Lugnan, Carlo / Caruso, Paola / Pozzi Mucelli, Roberta / Naccarato, Marcello / Manganotti, Paolo

The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

2021 Volume 49, Issue 4, Page(s) 600–602

MeSH term(s)	Arteries ; Brain Ischemia ; Cerebrovascular Circulation ; Humans ; Perfusion ; Stroke/diagnostic imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-07-14
Publishing country	England
Document type	Letter
ZDB-ID	197622-9
ISSN	0317-1671
ISSN	0317-1671
DOI	10.1017/cjn.2021.173
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