ABSTRACT
Patients with intracranial hemorrhage and indications of antithrombotic therapy are common in clinical practice. However, whether and when to start anticoagulant or antiplatelet therapy after intracranial hemorrhage are still debatable. Clinicians are posed with huge challenges without available guidelines. Through reviewing relevant literature, this article analyzed the risks of thromboembolism and hemorrhage recurrence after initiation of anticoagulant or antiplatelet therapy in patients with intracranial hemorrhage due to various etiologies. This article also presented the initiation time and specific antithrombotic plan in current clinical practice, aiming to propose references for clinicians.
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Anemia and hyperhemoglobin are not common stroke risk factors, and the association between hemoglobin concentration and stroke remains inconclusive. Through searching the literature, the impact of hypo- and hyper-hemoglobin on the risks of incident stroke, mortality, and poor functional prognosis was analyzed. The review revealed a U-shaped relationship between hemoglobin and the risks of incidental ischemic stroke, and mortality of ischemic stroke and intracranial hemorrhage, separately. However, the optimal hemoglobin concentration was undetermined.
ABSTRACT
Objective To describe the clinical spectrum,especially sleep disorder in three patients diagnosed with Morvan syndrome.Methods Three consecutive patients were identified with Morvan syndrome in the Department of Neurology, Peking Union Medical College Hospital between December 2014 and March 2016.The character in three cases has been studied from several aspects such as clinical presentation, imaging, polysomnography (PSG), cerebrospinal fluid and serum.Results Serum test showed serum contactin-associated protein 2 (CASPR2)antibodies strongly positive (+++) and leucine-rich glioma inactivated protein 1 antibodies positive (+) in three patients.Neuropsychiatric features, neuromyotonia, neuropathic pain, dysautonomia, agrypnia excitata presented in all three patients.The agrypnia excitata was characterized by severe insomnia, excessive motor activity during the night.Agrypnia excitata was diagnosed in three patients according to their history.PSG was finished in case 2 and case 3.PSG in one patient (case 2) documented severe insomnia (sleep efficiency was 59%), lack of cyclic sleep organization with a predominance of stage 1 non-rapid eye movement sleep episodes intermixed with brief rapid eye movement, and a marked reduction of spindles and delta sleep;PSG in another patient (case 3) revealed complete absence of recognizable sleep.Sleep disorders and other symptoms resolved completely or almost completely in two patients (case 1,case 2) who received immunotherapy.Case 3 died from sudden cardiac death before immunotherapy.Conclusions Morvan syndrome usually is associated with high-titer CASPR2 antibodies in serum.Agrypnia excitata is cardinal manifestation of Morvan syndrome in association with a spectrum of neurologic presentations.Early immunotherapy could provide a favorable outcome.