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Article ; Online: Factors influencing real-life use of direct oral anticoagulants in patients with cerebral sinus and venous thrombosis.

Simaan, Naaem / Molad, Jeremy / Honig, Asaf / Filioglo, Andrei / Peretz, Shlomi / Shbat, Fadi / Mansor, Tarek / Abu-Shaheen, Waleed / Leker, Ronen R

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

2023 Volume 32, Issue 9, Page(s) 107223

Abstract: Background: Direct oral anticoagulants (DOAC) are advocated as equally effective to vitamin K antagonists (VKA) for the treatment of patients with cerebral sinus and venous thrombosis (CSVT). However, data concerning the real-life management practices ... ...

Abstract	Background: Direct oral anticoagulants (DOAC) are advocated as equally effective to vitamin K antagonists (VKA) for the treatment of patients with cerebral sinus and venous thrombosis (CSVT). However, data concerning the real-life management practices in CSVT patients are is lacking. Methods: Prospective CSVT databases from four large academic medical centers were retrospectively studied. Demographics, clinical presentations, risk factors, radiological and outcome parameters were compared between CSVT patients treated with DOAC and VKA. Results: Out of 504 CSVT patients, 43 (8.5%) were treated with DOAC, and the remaining 461 (91.5%) were treated with VKA. All patients with antiphospholipid syndrome (APLA) were treated with VKA (61 vs. 0, p=0.013). Patients with a history or presence of malignancy were also more often treated with VKA (16% vs. 5%, p=0.046). Other risk factors for thrombosis did not differ between the groups. There were no differences in clot extent or location and no differences in the percentage of favorable outcomes or mortality were observed. Conclusion: Our data suggests that only malignancy and antiphospholipid antibodies significantly influenced physician's decisions towards choosing VKA rather than DOAC. DOAC appear to be as effective and safe as VKA in patients with CSVT.
MeSH term(s)	Humans ; Prospective Studies ; Retrospective Studies ; Vitamin K ; Anticoagulants/adverse effects ; Fibrinolytic Agents/therapeutic use ; Venous Thrombosis/drug therapy ; Administration, Oral
Chemical Substances	Vitamin K (12001-79-5) ; Anticoagulants ; Fibrinolytic Agents
Language	English
Publishing date	2023-07-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2023.107223
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Article ; Online: Clinical score for early diagnosis and treatment of stroke-like episodes in MELAS syndrome.

Naftali, Jonathan / Mermelstein, Maor / Landau, Yuval E / Barnea, Rani / Shelly, Shahar / Auriel, Eitan / Peretz, Shlomi

Acta neurologica Belgica

2023 Volume 123, Issue 3, Page(s) 1019–1028

Abstract: Background and objectives: Stroke-like episodes (SLEs) in patients with MELAS syndrome are often initially misdiagnosed as acute ischemic stroke (AIS), resulting in treatment delay. We aimed to determine clinical features that may distinguish SLEs from ... ...

Abstract	Background and objectives: Stroke-like episodes (SLEs) in patients with MELAS syndrome are often initially misdiagnosed as acute ischemic stroke (AIS), resulting in treatment delay. We aimed to determine clinical features that may distinguish SLEs from AISs and explore the benefit of early L-arginine treatment on patient outcomes. Methods: We looked retrospectively for MELAS patients admitted between January 2005 and January 2022 and compared them to an AIS cohort with similar lesion topography. MELAS patients who received L-arginine within 40 days of their first SLE were defined as the early treatment group and the remaining as late or no treatment group. Results: Twenty-three SLEs in 10 MELAS patients and 21 AISs were included. SLE patients had significantly different features: they were younger, more commonly reported hearing loss, lower body mass index, had more commonly a combination of headache and/or seizures at presentation, serum lactate was higher, and hemiparesis was less common. An SLE Early Clinical Score (SLEECS) was constructed by designating one point to each above features. SLEECS ≥ 4 had 80% sensitivity and 100% specificity for SLE diagnosis. Compared to late or no treatment, early treatment group patients (n = 5) had less recurrent SLEs (total 2 vs. 11), less seizures (14% vs. 25%, p = 0.048), lower degree of disability at first and last follow-up (modified ranking scale, mRS 2 ± 0.7 vs. 4.2 ± 1, p = 0.005; 2 ± 0.7 vs. 5.8 ± 0.5, p < 0.001, respectively), and a lower mortality (0% vs. 80% p = 0.048). Conclusions: The SLEECS model may aid in the early diagnosis and treatment of SLEs and lead to improved clinical outcomes.
MeSH term(s)	Humans ; Arginine ; Early Diagnosis ; Ischemic Stroke/drug therapy ; MELAS Syndrome/complications ; MELAS Syndrome/diagnosis ; Retrospective Studies ; Seizures/drug therapy ; Stroke/diagnosis ; Stroke/etiology ; Stroke/drug therapy
Chemical Substances	Arginine (94ZLA3W45F)
Language	English
Publishing date	2023-02-15
Publishing country	Italy
Document type	Journal Article
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-023-02196-z
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Article: Janus Kinase-2 V617F Mutation and Antiphospholipid Syndrome in Cerebral Sinus Venous Thrombosis: Natural History and Retrospective Bicenter Analysis.

Orion, David / Itsekson-Hayosh, Ze'ev / Peretz, Shlomi / Mendel, Rom / Yaniv, Gal / Attia, Moshe / Grizim-Merkel, Drorit

Frontiers in neurology

2022 Volume 13, Page(s) 783795

Abstract: Background: Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular entity, usually associated with acquired or genetic hypercoagulable states. In up to 30% of the cases it remains idiopathic. Bone marrow proliferation disorders that are ... ...

Abstract	Background: Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular entity, usually associated with acquired or genetic hypercoagulable states. In up to 30% of the cases it remains idiopathic. Bone marrow proliferation disorders that are associated with Janus Kinase 2 V617F mutation (JAK-2) are known causes of the systemic and cerebral thrombosis-at times despite normal blood counts-for which hematologic treatment exists. However, JAK-2 prevalence in the CSVT cases is not clear. Methods: In this retrospective analysis, data of 236 patients with CSVT admitted to two tertiary centers between 2010 and 2020 were analyzed, with emphasis on laboratory and imaging data and clinical and interventional outcomes. Results: A total of 236 patients were included in the analysis. The patients' median age was 42 years and the average age was 44 years (±19 years), with 59% female patients. JAK-2 positivity rate was 18% (among 77 patients tested for the mutation). Patients with normal blood counts on presentation comprised 36% of the JAK-2 positive cases. Other hypercoagulability states were also investigated, with the antiphospholipid syndrome (APLA) showing the highest prevalence (11%) followed by other etiologies including oral contraceptive use, Factor V Leiden, prothrombin mutation, and malignancy. Selected JAK-2, APLA, and prothrombin mutation cases showed a more severe clinical course. Conclusion: JAK-2 mutation is underdiagnosed and its screening may be warranted in the cases of idiopathic CSVT, even despite normal blood counts, to allow disease-modifying treatment and blood cell count monitoring. JAK-2, APLA, and prothrombin mutation may be associated with a more complicated clinical course.
Language	English
Publishing date	2022-04-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2022.783795
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Article: Clinicoradiologic Criteria for the Diagnosis of Stroke-like Episodes in MELAS.

Khasminsky, Vadim / Auriel, Eitan / Luckman, Judith / Eliahou, Ruth / Inbar, Edna / Pardo, Keshet / Landau, Yuval / Barnea, Rani / Mermelstein, Maor / Shelly, Shahar / Naftali, Jonathan / Peretz, Shlomi

Neurology. Genetics

2023 Volume 9, Issue 4, Page(s) e200082

Abstract: Background and objectives: Stroke-like episodes (SLEs) in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome are often misdiagnosed as acute ischemic stroke (AIS). We aimed to determine unique ... ...

Abstract	Background and objectives: Stroke-like episodes (SLEs) in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome are often misdiagnosed as acute ischemic stroke (AIS). We aimed to determine unique clinical and neuroimaging features for SLEs and formulate diagnostic criteria. Methods: We retrospectively identified patients with MELAS admitted for SLEs between January 2012 and December 2021. Clinical features and imaging findings were compared with a cohort of patients who presented with AIS and similar lesion topography. A set of criteria was formulated and then tested by a blinded rater to evaluate diagnostic performance. Results: Eleven MELAS patients with 17 SLE and 21 AISs were included. Patients with SLEs were younger (median 45 [37-60] vs 77 [68-82] years, Discussion: Clinicoradiologic criteria based on simple anamnesis and a CT scan at presentation can accurately diagnose SLE and lead to early administration of appropriate therapy. Classification of evidence: This study provides Class III evidence that an algorithm using clinical and imaging features can differentiate stroke-like episodes due to MELAS from acute ischemic strokes.
Language	English
Publishing date	2023-07-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2818607-2
ISSN	2376-7839
ISSN	2376-7839
DOI	10.1212/NXG.0000000000200082
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Article: Characteristics of Cerebral Sinus Venous Thrombosis Patients Presenting with Intracerebral Hemorrhage.

Simaan, Naaem / Molad, Jeremy / Peretz, Shlomi / Filioglo, Andrei / Auriel, Eitan / Hallevi, Hen / Seyman, Estelle / Barnea, Rani / Cohen, José E / Leker, Ronen R / Honig, Asaf

Journal of clinical medicine

2022 Volume 11, Issue 4

Abstract: Patients with cerebral venous sinus thrombosis (CVST) occasionally present with intracerebral hemorrhage (ICH). In this study, we aimed to identify predictors for ICH in CVST patients. Prospective CVST databases from three academic centers were ... ...

Abstract	Patients with cerebral venous sinus thrombosis (CVST) occasionally present with intracerebral hemorrhage (ICH). In this study, we aimed to identify predictors for ICH in CVST patients. Prospective CVST databases from three academic centers were retrospectively analyzed. CVST patients with and without ICH upon presentation were compared. Among the 404 included patients (mean age 41.8 years, 33% male), 74 (18.3%) had an ICH. The patients with ICH were older (45 ± 20.6 vs. 41.1 ± 18 years,
Language	English
Publishing date	2022-02-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11041040
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Article ; Online: Cardiac CT for intra-cardiac thrombus detection in embolic stroke of undetermined source (ESUS).

Barnea, Rani / Agmon, Inbar Nardi / Shafir, Gideon / Peretz, Shlomi / Mendel, Rom / Naftali, Jonathan / Shiyovich, Arthur / Kornowski, Ran / Auriel, Eitan / Hamdan, Ashraf

European stroke journal

2022 Volume 7, Issue 3, Page(s) 212–220

Abstract: Introduction: Embolic stroke of undetermined source (ESUS) is a common medical challenge regarding secondary prevention strategy. Cardiac imaging is the cornerstone of embolic stroke workup, in an effort to diagnose high risk cardio-embolic sources. ... ...

Abstract	Introduction: Embolic stroke of undetermined source (ESUS) is a common medical challenge regarding secondary prevention strategy. Cardiac imaging is the cornerstone of embolic stroke workup, in an effort to diagnose high risk cardio-embolic sources. Cardiac computed tomography angiography (CCTA) is an emerging imaging modality with high diagnostic performance for intra-cardiac thrombus detection. The yield of CCTA implementation in addition to standard care in ESUS workup is unknown. Thus, the aim of this study was to assess the utility of CCTA in detecting intra-cardiac thrombi in the routine ESUS workup. Patients and methods: This is a retrospective observational analysis of ESUS cases managed in vascular neurology unit between 2019 and 2021. Within this ESUS registry, consecutive patients undergoing CCTA were included and carefully analyzed. Results: During the study period 1066 Ischemic stroke (IS) cases were treated and evaluated. 266/1066 (25%) met ESUS criteria and 129/266 (48%) underwent CCTA. Intra-cardiac thrombus was detected by CCTA in 22/129 (17%; 95% CI, 11.5%-23.5%) patients: left ventricular thrombus (LVT) in 13 (10.1%) patients, left atrial appendage (LAA) thrombus in 8 (6.2%) patients, and left atrial (LA) thrombus in 1 (0.8%) patient. Only 5/22 (23%) of these thrombi were suspected, but could not be confirmed, in trans-thoracic echocardiogram (TTE). Among CCTA-undergoing patients, 27/129 (21%; 95% CI, 14%-28%) were found to have an indication (including pulmonary embolism) for commencing anticoagulation (AC) treatment, rather than anti-platelets. In favor of CCTA implementation, 22/266 (8.2%; 95% CI, 4.9%-11.5%) patients within the entire ESUS cohort were diagnosed with intra-cardiac thrombus, otherwise missed. Conclusion: CCTA improves the detection of intra-cardiac thrombi in addition to standard care in ESUS patients. The implementation of CCTA in routine ESUS workup can change secondary prevention strategy in a considerable proportion of patients.
Language	English
Publishing date	2022-05-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2851287-X
ISSN	2396-9881 ; 2396-9873
ISSN (online)	2396-9881
ISSN	2396-9873
DOI	10.1177/23969873221099692
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Article ; Online: Clinical improvement of a toddler with COVID-19 focal cerebral arteriopathy possibly due to intra-arterial nimodipine.

Avital, Dekel / Peretz, Shlomi / Perlow, Eliauh / Konen, Osnat / Inbar, Edna / Bulkowstein, Yarden / Nahum, Elhanan / Aharoni, Sharon / Vig, Lital Cohen / Nevo, Yoram / Auriel, Eitan / Straussberg, Rachel

European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society

2022 Volume 40, Page(s) 40–43

Abstract: Pediatric stroke is considered an infrequent complication of COVID-19. Focal cerebral arteriopathy (FCA) is one of the most common causes of arterial ischemic stroke in a previously healthy child. The present report describes a toddler with FCA most ... ...

Abstract	Pediatric stroke is considered an infrequent complication of COVID-19. Focal cerebral arteriopathy (FCA) is one of the most common causes of arterial ischemic stroke in a previously healthy child. The present report describes a toddler with FCA most likely induced by SARS-CoV-2 infection who showed significant clinical improvement that may be related to injection of intra-arterial nimodipine. To our knowledge, this is the first reported use of nimodipine in this setting.
MeSH term(s)	COVID-19/complications ; Cerebral Arterial Diseases/complications ; Cerebral Arterial Diseases/diagnostic imaging ; Cerebral Arterial Diseases/drug therapy ; Child ; Child, Preschool ; Humans ; Nimodipine/therapeutic use ; SARS-CoV-2 ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Stroke/etiology
Chemical Substances	Nimodipine (57WA9QZ5WH)
Language	English
Publishing date	2022-07-31
Publishing country	England
Document type	Journal Article
ZDB-ID	1397146-3
ISSN	1532-2130 ; 1090-3798
ISSN (online)	1532-2130
ISSN	1090-3798
DOI	10.1016/j.ejpn.2022.07.007
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Zs.A 4867: 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: Diagnosing Hyperperfusion Syndrome: CT Perfusion or Transcranial Doppler?

Orion, David / Yavne, Yarden / Peretz, Shlomi / Givaty, Gili

The Israel Medical Association journal : IMAJ

2015 Volume 17, Issue 10, Page(s) 656–658

MeSH term(s)	Aged ; Cerebrovascular Circulation ; Cerebrovascular Disorders/diagnosis ; Female ; Humans ; Syndrome ; Tomography, X-Ray Computed/methods ; Ultrasonography, Doppler, Transcranial/methods
Language	English
Publishing date	2015-10
Publishing country	Israel
Document type	Case Reports ; Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Characteristics of patients with cerebral sinus venous thrombosis and JAK2 V617F mutation.

Simaan, Naaem / Molad, Jeremy / Honig, Asaf / Filioglo, Andrei / Shbat, Fadi / Auriel, Eitan / Barnea, Rani / Hallevi, Hen / Seyman, Estelle / Mendel, Rom / Leker, Ronen R / Peretz, Shlomi

Acta neurologica Belgica

2022 Volume 123, Issue 5, Page(s) 1855–1859

Abstract: Objectives: Janus kinase 2 (JAK2-V617F) mutations can cause thrombocytosis, polycythemia and hyper viscosity leading to cerebral sinus venous thrombosis (CSVT). However, data regarding the characteristics and prevalence of JAK2-V617F mutation in ... ...

Abstract	Objectives: Janus kinase 2 (JAK2-V617F) mutations can cause thrombocytosis, polycythemia and hyper viscosity leading to cerebral sinus venous thrombosis (CSVT). However, data regarding the characteristics and prevalence of JAK2-V617F mutation in patients with CSVT are currently lacking. We aimed to evaluate the characteristics of CSVT patients that carry the JAK2 mutation. Materials and methods: Data of consecutive patients with CSVT, admitted to three large academic medical centers between 2010 and 2020, were retrospectively studied. Demographics, clinical presentations, radiological and clinical outcome parameters were compared between carriers of the JAK2-V617F mutation and controls. Results: Out of 404 patients diagnosed with CSVT, 26 patients (6.5%) were carriers of the mutation. JAK2 mutation carriers more often had thrombocytosis (54% vs. 1%, p < 0.001). Furthermore, carriers of the JAK2 mutation less often had involvement of the transverse sinus (50% vs. 68%, p = 0.021). Finally, patients with the JAK2 mutation were more prone to have intracerebral hemorrhage (ICH, 31% vs. 17%, p = 0.044), but there was no significant difference between groups in terms of mortality nor functional outcome. Conclusions: JAK2 mutation is not uncommon in patients with CSVT and should be routinely screened for in this population. CSVT in JAK2 mutation carriers may have a tendency toward involving specific venous sinuses and is associated with a higher rate of ICH but similar overall prognosis.
MeSH term(s)	Humans ; Venous Thrombosis ; Retrospective Studies ; Genetic Predisposition to Disease ; Mutation/genetics ; Thrombocytosis ; Janus Kinase 2/genetics
Chemical Substances	JAK2 protein, human (EC 2.7.10.2) ; Janus Kinase 2 (EC 2.7.10.2)
Language	English
Publishing date	2022-09-22
Publishing country	Italy
Document type	Journal Article
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-022-02077-x
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Article ; Online: Reduction in Acute Stroke Admissions during the COVID-19 Pandemic: Data from a National Stroke Registry.

Libruder, Carmit / Ram, Amit / Hershkovitz, Yael / Tanne, David / Bornstein, Natan M / Leker, Ronen R / Horev, Anat / Hallevi, Hen / Peretz, Shlomi / Orion, David / Zucker, Inbar

Neuroepidemiology

2021 Volume 55, Issue 5, Page(s) 354–360

Abstract: Introduction: The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for ... ...

Abstract	Introduction: The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for acute stroke and transient ischemic attack (TIA) in Israel, shortly after the start of the pandemic. Methods: We conducted a retrospective observational study, based on data reported to the Israeli National Stroke Registry from 7 tertiary hospitals. All hospital admissions for acute stroke or TIA that occurred between January 1 and April 30, 2020 were included. Data were stratified into 2 periods according to the timing of COVID-19 restrictions as follows: (1) "pre-pandemic" - January 1 to March 7, 2020 and (2) "pandemic" - March 8 to April 30, 2020. We compared the weekly counts of hospitalizations between the 2 periods. We further investigated changes in demographic characteristics and in some key parameters of stroke care, including the percentage of reperfusion therapies performed, time from hospital arrival to brain imaging and to thrombolysis, length of hospital stay, and in-hospital mortality. Results: 2,260 cases were included: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period. Hospital admissions significantly declined between the 2 periods, by 48% for TIA (rate ratio [RR] = 0.52; 95% CI 0.43-0.64) and by 29% for stroke (RR = 0.71; 95% CI 0.64-0.78). No significant changes were detected in demographic characteristics and in most parameters of stroke management. While the percentage of reperfusion therapies performed remained unchanged, the absolute number of patients treated with reperfusion therapies seemed to decrease. Higher in-hospital mortality was observed only for hemorrhagic stroke. Conclusion: The marked decrease in admissions for acute stroke and TIA, occurring at a time of a relatively low burden of COVID-19, is of great concern. Public awareness campaigns are needed as patients reluctant to seek urgent stroke care are deprived of lifesaving procedures and secondary prevention treatments.
MeSH term(s)	Aged ; Aged, 80 and over ; COVID-19 ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Pandemics ; Registries ; Retrospective Studies ; Stroke/therapy
Language	English
Publishing date	2021-07-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	603189-4
ISSN	1423-0208 ; 0251-5350
ISSN (online)	1423-0208
ISSN	0251-5350
DOI	10.1159/000516753
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