Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Amyloid-beta: a crucial factor in Alzheimer's disease

Alzheimer's disease [AD] is the most prevalent form of dementia which affects people older than 60 years of age. In AD, the dysregulation of the amyloid-beta [Abeta] level leads to the appearance of senile plaques which contain Abeta depositions. Abeta is a complex biological molecule which interacts with many types of receptors and/or forms insoluble assemblies and, eventually, its nonphysiological depositions alternate with the normal neuronal conditions. In this situation, AD signs appear and the patients experience marked cognitional disabilities. In general, intellect, social skills, personality, and memory are influenced by this disease and, in the long run, it leads to a reduction in quality of life and life expectancy. Due to the pivotal role of Abeta in the pathobiology of AD, a great deal of effort has been made to reveal its exact role in neuronal dysfunctions and to finding efficacious therapeutic strategies against its adverse neuronal outcomes. Hence, the determination of its different molecular assemblies and the mechanisms underlying its pathological effects are of interest. In the present paper, some of the well-established structural forms of Abeta, its interactions with various receptors and possible molecular and cellular mechanisms underlying its neurotoxicity are discussed. In addition, several Abeta-based rodent models of AD are reviewed

Early and intermediate prognosis of intravenous thrombolytic therapy in acute ischemic stroke subtypes according to the causative classification of stroke system

Intravenous thrombolytic therapy has established acceptable results in treating ischemic stroke. However, there is little information on treatment outcome especially in different subtypes. The aim of current study was to evaluate early and intermediate prognosis in intravenous thrombolytic therapy for acute ischemic stroke subtypes. Forty eligible patients [57.5% male with mean age of 63.18 +/- 13.49 years] with definite ischemic stroke who were admitted to emergency department of Imam Reza University Hospital, in the first 180 minutes after occurrence received recombinant tissue plasminogen activator. All investigation findings were recorded and stroke subtypes were determined according to the Causative Classification of Stroke System. Stroke severity forms including modified Rankin Scale [mRS] and National Institutes of Health Stroke Scale [NIHSS] scores were recorded for all patients in first, seven and 90 days after stroke and disease outcome was evaluated. The etiology of stroke was large artery atherosclerosis in 20%, cardio-aortic embolism in 45%, small artery occlusion in 17.5% and undetermined causes in 17.5%. NIHSS and mRS scores were significantly improved during time [P < 0.001 in both cases]. Three months mortality rate was 25%. Among the etiologies, patients with small artery occlusion and then cardio-aortic embolism had lower NIHSS score at arrival [P = 0.04]. Caplan-meier analysis showed that age, sex and symptom to needle time could predict disease outcome. Intravenous thrombolytic therapy is accompanied by good early and intermediate outcome in most patients with ischemic stroke. Small artery occlusion subtype had less disease severity and higher improvement

Correlation between transcranial doppler findings, neuroimaging and functional status in the first days of acute intracerebral hemorrhage

To have an appropriate and accessible modality for monitoring of patients with intracerebral hemorrhage [ICH] that have a correlation with Computed tomography [CT] scan data, we conducted a study to compare Transcranial Doppler finding with CT data in the first and 5th day after ICH and clear their relations with functional status [FS] of patients. We prospectively studied 50 patients with supratentorial ICH evaluated in less than 24 hours of its onset. All selected patients underwent emergent CT scan and TCD on admission. Doppler parameters of middle cerebral arteries [including systolic, diastolic and mean velocities, Pulsatility index [PI], Diastolic flow velocity [DFV]] were recorded in first and fifth days of admission by TCD. FS of patients was measured using National Institutes of Health Stroke Scale [NIHSS] score in these days. Twenty six female patients and 24 male entered the study with NIHSS score average of 14 +/- 6.5 in first and 13.7 +/- 7.3 in 5th days. Their hematoma volume was 13.5 +/- 1.7 millimeter in average. There was a significant reverse relation between DFV of 1st day and NIHSS score in unaffected hemisphere in first and 5th days [First day: P= 0.03 and 5th day: P < 0.001]. Also there was a positive relation between PI and NIHSS score in unaffected hemisphere in 5th day [P=0.03]. PI had no difference in the patients with intraventricular hemorrhage [IVH] and patients without the IVH, even though PI cannot predict the site of hematoma but DFV in 5th day, in unaffected hemisphere can be a predictive factor for intraventricular hemorrhage. Most of TCD parameters were correlated with functional status and some of them [DFV, PI] had prediction value for intraventricular hemorrhage in acute phase of ICH. Also they had a high correlation with CT scan findings.

Does low dose contraceptive pills increase stroke rate? A cross sectional study in North-West Iran

Several reports concern the relationship between low dose oral contraceptive pills [OCP] and the occurrence of strokes. The present study investigates this relationship in childbearing stroke women admitted to university referral hospitals in North-West Iran. One hundred seventy eight female patients between 15 and 44 years of age who were admitted to two referral University Hospitals in a six years period were evaluated in this descriptive-analytical study. Data concerning the use of OCP and other risk factors were recorded. The OCP usage data were compared between the patients and the matched normal population. The average age of the patients was 35.5 +/- 7.4 years. Seventy three patients were admitted with arterial stroke, 15 patients had cardioembolic origin, 39 patients with venous stroke and 46 patients with hemorrhagic stroke, 45.2%, 20%, 59% and 30.4% of them used OCP respectively. Approximately 26.3% of the matched female population of childbearing age used OCP and there was a significant correlation between venous stroke [P < 0.0001] and atherothrombotic stroke [P < 0.0001] with OCP usage. Migraine was the only risk factor that significantly correlated with OCP consumption and stroke. In addition, the data concerning OCP use in the stroke patients, without any other risk factors [32/71: 45%], demonstrated a significant difference comparing the matched population [P < 0.0001]. OCP usage increases the risk of venous and atherothrombotic stroke in North-West of Iran, particularly in those individuals who suffer concurrent migraine

Multiple sclerosis in East Azerbaijan, North West Iran

Background and Objective: Multiple sclerosis (MS) is variable in its prevalence and manifestations in different regions of the world. Iran is one of the most populous countries in Middle East, it is important to have a better understanding of the epidemiology and clinical pattern of MS in different parts of Iran. Although Iran is said to be located in the low-risk area, recent studies have shown that the prevalence of MS in Iran may be much higher than what was previously thought. This study determines the current prevalence and clinical features of MS in East Azerbaijan province, North West Iran. Methods: All patients for this study were MS cases listed in the Committee for Diagnosis and Treatment of MS (CDTMS) registry. The study patients were all residents of East Azerbaijan Province who were diagnosed with MS by neurologists. Results: Out of one thousand cases, 269 were males (26.9%) and 731 females (73.1%).The female/male ratio was 2.7. The crude prevalence of MS in East Azerbaijan was 27.7/100,000 population. The mean age (SD) of patients was 33.4 (8.9) years. The relapse-remitting form of disease was seen in 67.7% of patients; primary-progressive disease in 2.8%; and secondary progressive disease in 11.2%. Conclusion: Our study suggests that MS prevalence in North West Iran lies in the medium frequency range.

Effects of nimodipine on cerebral hemodynamics, and prognosis of diffuse axonal injury patients

To evaluate the effects of nimodipine on hemodynamic state, vasospasm, and short time prognosis of diffuse axonal injury [DAI] patients. In a prospective, clinical trial double blind study, 40 DAI patients with Glasgow coma scale of 5-8 were selected and randomly divided into 2 equal groups. The first group was treated with 60 mg of nimodipine every 4 hours immediately after admission, and the control group did not receive this treatment. Mean blood flow velocity [MFV] and pulsatility index of both middle cerebral arteries were measured using transcranial Doppler on the 1st, 3rd, and 10th days of admission. Glasgow outcome scale was evaluated one month after admission. This study was performed from June 2003 to June 2004 at Imam Medical Center, Tabriz, Iran. There were significant differences in MFV among the 3 transcranial Doppler, which demonstrated hemodynamic changes in these patients. Nimodipine did not have any significant difference on MFV between the treatment and control groups. In the nimodipine group, 45% had good prognosis [30% in the control group] and nobody had vasospasm on the 10th day Doppler study [15% in the control group], although it did not show any statistical significant difference between them. Nimodipine improved the prognosis and decreased vasospasm, however, there was no statistical difference. Therefore, we suggest further studies in a larger number of DAI patients

Preoperative transcranial and carotid Doppler study in coronary artery bypass graft patients

To assess the correlation of postoperative neurologic complications with preoperative transcranial and carotid Doppler study findings of coronary artery bypass graft [CABG] patients. In a descriptive, analytic, follow up study we prospectively studied 201 patients undergoing elective and isolated CABG surgery during a 12 month period from October 2003 to September 2004 at Madani Hospital of Tabriz Medical Sciences University, Iran. Neurologic examination, intracranial cerebral arterial study using transcranial Doppler [TCD] and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up for one month. Two hundred and one patients [158 male, 43 female] with a mean age of 57.29 +/- 9.67 were studied. Out of these, 131 patients had 3 coronary vessels disease, 64 had 2 vessels, 5 had one vessel, and one patient had diffuse coronary disease. A TCD was performed in 183 patients and disclosed abnormalities in 22 patients and was normal in 161 cases. The total number of involved arteries was 34. Among 154 carotid duplex studied patients, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in one, and 75-90% stenosis in 2 cases. Postoperative neurologic complication occurred as follows: 4 stroke, 7 delirium, and 3 amnesia. One of the operated patients died. Nine of 161 patients with normal TCD [5.6%] and 5 of 22 [22.7%] with intracranial cerebral arterial disease [ICAD] showed central nervous system [CNS] complications [p=0.015]. There were significant correlations between number of involved cerebral arteries and post CABG CNS complications [p=0.0001], including stroke [p=0.007], and between diabetes mellitus history with these complications [p=0.012]. Our results suggest that lCAD is an independent risk factor for CNS complications after CABG surgery. Hence, we recommend pre-CABG evaluation of the cerebral arteries by TCD, for the risk assessment of CABG surgery

Transcranial and carotid doppler study in coronary artery bypass graft patients

Atherosclerosis is a pathogenesis which is common in both coronary and intracranial arterial diseases. Therefore, we designed a group of coronary artery bypass graft [CABG] surgery patients for transcranial Doppler [TCD] to assess intracranial artery diseases and carotid duplex studies to assess carotid artery diseases. In a prospective randomized study, 129 elective CABG patients with proven coronary artery disease by angiography, were examined by TCD and 45 patients by carotid duplex preoperatively. Neurologic examination was carried out pre- and post- operatively. This study was carried out from April 2001 to August 2002 at Imam Hospital of Tabriz Medical Science University, Iran. Out of the 129 CABG patients, there were 105 males and 24 females, with an average age of 57'9.9 years. Risk factors were as follows: smoking in 44.8%, hypertension in 38%, hypercholesterolemia in 29%, and diabetes mellitus in 18.6%. The TCD findings of 30 patients [23.2%, 11 female and 19 male] revealed the following abnormalities: stenosis of basilar artery in 7 patients [5.4%], carotid siphon in 3 [2.3%], intracranial internal carotid in 5 [3.9%], middle cerebral artery in 3 [2.3%] and vertebral artery in one patient [0.8%]. Multiple vessel abnormality was detected in 11 patients [8.5%]. There was a significant correlation between severity of coronary artery disease in angiography and abnormality in TCD [p=0.008]. The TCD abnormality was detected more in females [p=0.008] or hypertensive patients [p=0.004]. In the carotid duplex study of the randomized 45 patients, 23 [51.1%] had abnormal results as follows: stenosis <50% in 17 [38%] cases, stenosis between 50-70% in 5 [11%], and hemodynamically significant stenosis [>70%] only in one [2%] patient. There was also significant correlation between severity of coronary involvement and carotid involvement [p<0.01]. No stroke occurred in the first postoperative week following CABG surgery. Stenosis of intracranial and carotid arteries was more common in CABG patients with more than 2-coronary vessel involvement or hypertensive or female patients. We recommend TCD and carotid duplex studies in these patients for prevention of probable cerebrovascular accidents