Association between cholesterol levels and infections after ischemic stroke.

BACKGROUND AND PURPOSE: Multiple studies have suggested an immunomodulatory role of cholesterol. We investigated whether cholesterol levels are associated with the risk of infectious complications (ICs) in acute ischemic stroke patients. METHODS: A single-center prospective cohort was analyzed. Total (TOTc), low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels were measured within 24 h from admission. The outcome of interest was the occurrence of any IC (pneumonia, urinary tract infection, sepsis, other infection) during hospitalization. Predictors of ICs were investigated with multivariable logistic regression. RESULTS: A total of 603 patients were included (median age 78 years, 49.3% males), of whom 134 (22.2%) developed an IC. Subjects with ICs had lower TOTc compared with patients without ICs (median 157 vs. 173 mg/dL; P < 0.001). When TOTc was stratified in quartiles, we observed a linear decrease in the prevalence of ICs with higher TOTc levels (Q1, <144 mg/dL, 32.7%; Q2, 145-168 mg/dL, 24.7%; Q3, 169-197 mg/dL, 17.8%; Q4, >197 mg/dL, 13.3% P < 0.001). The inverse relationship between TOTc and ICs remained significant after adjustment for confounders in logistic regression [odds ratio (OR) for 10 mg/dL increase, 0.92; 95% confidence intervals (CI), 0.87-0.97; P = 0.001]. This association was also confirmed for low-density lipoprotein cholesterol (OR, 0.93; 95% CI, 0.88-0.99; P = 0.013) and high-density lipoprotein cholesterol (OR, 0.85; 95% CI, 0.73-0.98; P = 0.026) and was not mediated by statin treatment. CONCLUSION: Higher cholesterol levels are independently associated with lower risk of ICs in ischemic stroke patients. Further studies are needed to confirm our findings and characterize the biological mechanisms underlying this association.

Prevalence and Time Course of Post-Stroke Pain: A Multicenter Prospective Hospital-Based Study.

OBJECTIVE: Pain prevalence data for patients at various stages after stroke. DESIGN: Repeated cross-sectional, observational epidemiological study. SETTING: Hospital-based multicenter study. SUBJECTS: Four hundred forty-three prospectively enrolled stroke survivors. METHODS: All patients underwent bedside clinical examination. The different types of post-stroke pain (central post-stroke pain, musculoskeletal pains, shoulder pain, spasticity-related pain, and headache) were diagnosed with widely accepted criteria during the acute, subacute, and chronic stroke stages. Differences among the three stages were analyzed with χ(2)-tests. RESULTS: The mean overall prevalence of pain was 29.56% (14.06% in the acute, 42.73% in the subacute, and 31.90% in the chronic post-stroke stage). Time course differed significantly according to the various pain types (P < 0.001). The prevalence of musculoskeletal and shoulder pain was higher in the subacute and chronic than in the acute stages after stroke; the prevalence of spasticity-related pain peaked in the chronic stage. Conversely, headache manifested in the acute post-stroke stage. The prevalence of central post-stroke pain was higher in the subacute and chronic than in the acute post-stroke stage. Fewer than 25% of the patients with central post-stroke pain received drug treatment. CONCLUSIONS: Pain after stroke is more frequent in the subacute and chronic phase than in the acute phase, but it is still largely undertreated.

Bayesian mapping of multiple sclerosis prevalence in the province of Pavia, northern Italy.

The geographical analysis of a disease risk is particularly difficult when the disease is non-frequent and the area units are small. The practical use of the Bayesian modelling, instead of the classical frequentist one, is applied to study the geographical variation of multiple sclerosis (MS) across the province of Pavia, Northern Italy. 464 MS-affected individuals resident in the province of Pavia were identified on December 31st 2000. The overall prevalence was 94 per 100,000 inhabitants. This estimate indicates an increasing MS prevalence in the province, in accordance with the vast majority of the Italian areas where prevalence studies have been repeated. We mapped the geographical variation of MS prevalence across the 190 communes of the province both with a classical approach and a Bayesian approach. The frequentist approach produced an extremely dishomogeneous map, while the Bayesian map was much smoother and more interpretable. Our study underlines the usefulness of Bayesian methods to obtain reliable maps of disease prevalence and to identify possible clusters of disease where to carry out further epidemiological investigations.

Single high-dose steroid treatment in episodic cluster headache.

Corticosteroids appear to be the most rapid-acting of the prophylactic drugs used in the treatment of cluster headache (CH). These agents are frequently employed as a short-term regimen to induce clinical remission. In this study, we assessed in an open fashion the effect of high dose methylprednisolone (MPD) in a group of 13 patients with episodic CH (3 females and 10 males). On the 8th day of the active period, MPD was administered intravenously at the dose of 30 mg/kg body weight, as a 3-h infusion in saline. The attack frequency was followed for 7 days. The mean daily attack frequency before MPD administration was statistically different from that reported after treatment (respectively: 1.38 +/- 0.42 and 0.83 +/- 0.78; P = 0.05 Student's t-test). The mean interval between MPD administration and the occurrence of the first subsequent attack was 3.8 +/- 2.2 days (range: 2-7 days). Only 3 (23%) of 13 patients experienced a complete headache remission. No significant side-effects were noted after MPD administration. These data further demonstrate that in most patients with episodic CH, high-dose systemic steroid administration may invariably interrupt attack recurrence for a few days, but is ineffective in maintaining complete clinical remission. This study also suggests that MPD administered as a solitary dose does not provide any advantage above prednisone in CH treatment.

Oligoclonal bands in Devic's neuromyelitis optica and multiple sclerosis: differences in repeated cerebrospinal fluid examinations.

We studied repeated cerebrospinal fluids of patients with Devic's neuromyelitis optica (NMO) and multiple sclerosis (MS). Variations of oligoclonal bands (OBs) had opposite trends in the two groups. In MS, OBs were detected in 399 of 411 patients (97%) and never disappeared. In NMO, OBs were detected in three of 11 patients (27%) and always disappeared. The hypothesis that NMO and MS follow distinct pathogenetic pathways is supported by our findings, which can be useful for the differentiation of NMO from MS.

Proximal nerve conduction by high-voltage electrical stimulation in S1 radiculopathies and acquired demyelinating neuropathies.

OBJECTIVE: To evaluate the reliability and sensitivity of the high-voltage electrical stimulation for studying proximal conduction of peripheral motor axons in normal subjects, S(1) radiculopathies and acquired demyelinating neuropathies. METHODS: Twelve patients with compressive S(1) radiculopathy, 22 patients with acquired demyelinating neuropathy and 29 healthy volunteers were examined. The conduction of peripheral motor axons between lumbosacral roots and the sciatic nerve at the gluteal fold was investigated by high-voltage electrical stimulation delivered percutaneously. RESULTS: The main electrophysiological finding in S(1) radiculopathy was an abnormal side to side difference in the amplitude of the compound motor action potential by proximal stimulation. Overall, the frequency of abnormalities detected by using high-voltage electrical stimulation was similar to that found with conventional EMG studies, and the two methods showed electrophysiological alterations in the same patients. In all patients with acquired demyelinating neuropathy, the proximal motor nerve conduction velocity from lumbosacral roots to the sciatic nerve at the gluteal fold was reduced; proximal stimulation of the motor axons revealed electrophysiological abnormalities more often than when using other electrophysiological techniques (F wave and H reflex). CONCLUSIONS: High-voltage electrical stimulation of peripheral motor axons shows high sensitivity in detecting proximal neuropathies; it can also define the site and relevance of proximal lesions in the peripheral nervous system better than other conventional techniques.

Quantitative measures of spasticity in post-stroke patients.

OBJECTIVE: Quantitative evaluation of muscle tone in post-stroke patients; correlation of biomechanical indices with conventional clinical scales and neurophysiological measures; characterization of passive and neural components of muscle tone. METHODS: Mechanical stretches of the wrist flexor muscles of 53 post-stroke patients were imposed by means of a torque motor at constant speed. Patients were clinically studied using the Ashworth scale for spasticity and the Medical Research Council score for residual muscle strength. The neurophysiological measures were Hoffmann reflex latency, Hmax/Mmax ratio, stretch reflex threshold speed (SRTS), stretch reflex (SR) latency and area, passive (ISI) and total (TSI) stiffness indices. RESULTS: Hmax/Mmax ratio, SR area, ISI and TSI values were significantly higher in patients, while SRTS was significantly lower. TSI, SRTS and SR area were highly correlated to the Ashworth score. CONCLUSIONS: This EMG-biomechanical technique allows an objective evaluation of changes in muscle tone in post-stroke patients, providing easily measurable, quantitative indices of muscle stiffness. The linear distribution of these measures is particularly indicated for monitoring changes induced by treatment. The apparatus seems suitable to characterize neural stiffness, while difficulties were found in isolating the passive components, because of the occurrence of tonic EMG activity in most spastic patients.

The effects of flumazenil on focal, electroinduced after-discharge in rabbits.

1. The anticonvulsive efficacy of flumazenil 10 mg/kg i.v., a BDZ antagonist, was studied in two models of experimental epilepsy electrically induced. 2. The EEG after-discharge, which was induced by the electrical stimulation of selected brain regions [(notably the dorsal hippocampus (Hip) and the amygdala (CAm)] was evaluated in rabbits pre- and post-drug administration. 3. In the animals submitted to electrical stimulation of the amygdala, flumazenil exerted a protective action, thereby inducing an increase in the after-discharge threshold and/or a decrease in after-discharge duration. 4. In the animals submitted to electrical stimulation of the hippocampus, flumazenil did not induced changes statistically significant. 5. Finally, the paper discusses the two possible mechanisms of action of flumazenil (a "per se" partial BDZ activity and/or a BDZ agonistic activity, which displaces the inverse agonist-like ligand) and the differencies in GABA distribution in the hippocampus and the amygdala.

Hereditary motor and sensory neuropathy type II (HMSN-II) and neurogenic muscle hypertrophy: a case report and literature review.

We present two siblings affected by hereditary motor and sensory type II neuropathy (HMSN-II) with neuromyotonia, and associated with muscle hypertrophy of the thighs and calves in one. We review the literature about the association between HMSN-II, neuromyotonia and muscle hypertrophy. Muscle enlargement in HMSN-II is rare and may be sporadic or under genetic control. In our patient, muscle hypertrophy was sporadic and probably due to neuromyotonia. The relationship between muscle hypertrophy and neuromyotonia can be deduced by the fact that both conditions were reduced after diphenylhydantoin treatment (200 mg/day).

Role of dopamine D-1 and D-2 antagonists in a model of focal epilepsy induced by electrical stimulation of hippocampus and amygdala in the rabbit.

1. The differential role played by blockade of D-1 or D-2 dopamine receptors in mechanisms underlying seizures was studied in a model of EEG after-discharge induced by electrical stimulation of selective brain regions (dorsal hippocampus and amygdala) in the rabbit. 2. The D-2 antagonist haloperidol (1 mg/Kg) increased significantly after-discharge duration after stimulation of either hippocampus or amygdala and lowered after-discharge threshold in few animals. 3. The D-1 antagonist SCH 23390 (0.3 mg/Kg) caused no changes following stimulation of amygdala and reduced after-discharge duration when hippocampus was stimulated. 4. Haloperidol exerted a proconvulsant action in this experimental model, having a clearer influence on D-2 receptors. SCH 23390 had no effect on amygdala whereas it exerted protection on the hippocampus. 5. The present data suggest that D-1 and D-2 receptors have different roles in generating and spreading the epileptic activity.