C-reactive protein in ischemic stroke: an independent prognostic factor.

BACKGROUND AND PURPOSE: There is growing evidence of the prognostic importance of C-reactive protein (CRP) in ischemic stroke. However, the independent value of CRP at different stages after stroke has not been established. Therefore, we assessed the prognostic values of CRP in ischemic stroke. We also compared the relation of CRP at admission and discharge with 1-year outcome. METHODS: One hundred ninety-three patients were included in a derivation set (n=128) and a validation set (n=65). Serum CRP was measured, within 24 hours after index ischemic stroke, within 48 to 72 hours, and at hospital discharge. We examined the association between the level of CRP at different stages after stroke and outcome. We adjusted for the possible confounding effect using a multivariate Cox proportional hazard model. RESULTS: A cutoff point of 1.5 mg/dL for CRP at discharge provided optimum sensitivity and specificity for adverse outcome, based on the receiver operator curves. CRP at admission (hazard ratio [HR] 2.78, 95% CI 1.45 to 5.33; P=0.0021) and discharge (HR 9.42, 95% CI 4.27 to 19.05; P<0.0001) were predictors of the combined end point of new vascular events or death at 1 year. CRP at hospital discharge was the strongest independent marker of adverse outcome (HR 7.42, 95% CI 2.75 to 20.03; P=0.0001). These results were confirmed in the validation set (HR 15.66, 95% CI 3.36 to 72.97; P=0.0005). CONCLUSIONS: CRP is a marker of increased 1-year risk in ischemic stroke. CRP at discharge is better related to later outcome and could be of greater utility for risk stratification. These findings are consistent with the hypothesis that elevated CRP may predict future cardiovascular events or death.

Prognostic influence of increased C-reactive protein and fibrinogen levels in ischemic stroke.

BACKGROUND AND PURPOSE: The prognostic influences of fibrinogen and C-reactive protein (CRP) levels and their relations in ischemic stroke have not been well described. The aim of this study was to investigate and compare the 1-year prognostic influences of fibrinogen and CRP levels on outcome in ischemic stroke. METHODS: Fibrinogen and CRP were determined within 24 hours after stroke and related to 1-year outcome in 128 patients with first-ever ischemic stroke. The Kaplan-Meier technique was applied in survival analysis. Multiple logistic regression analysis was used to evaluate the associations between risk factors and outcome. RESULTS: The probabilities of death or new vascular event were 21.1%, 27.9%, and 51.7% (P:=0.0172, chi(2) for trend), respectively, in patients stratified by tertiles of fibrinogen (<3.78, 3.78 to 6.17, and >6.17 g/L). The probabilities of a primary end point were 12.1%, 29.7%, and 54.8% (P:=0.0004), respectively, after stratification of patient data by tertiles of CRP level (<5, 5 to 33, and >33 mg/L). In multiple logistic regression analysis, higher CRP levels (odds ratio, 2.39; 95% CI, 1.28 to 4.49; P:=0.0066) and stroke severity on the Canadian Neurological Stroke Scale (odds ratio, 2.37; 95% CI, 1.01 to 5.58; P:=0.0472) were independently associated with death or new vascular event. CONCLUSIONS: Increased levels of CRP are associated with a worse outcome in patients with ischemic stroke. The increased risk associated with elevated CRP levels is independent of the prognostic influence of fibrinogen.

Antipanic effect of fluoxetine measured by CO2 challenge test.

BACKGROUND: Respiratory symptoms are important in panic disorder for frequency and intensity. Patients with this disorder are often chronic hyperventilators, and inhalation of carbon dioxide is a strong panicogenic stimulus. We tested the hypothesis of whether respiratory parameters may be used as indicators of the course of panic disorder during its treatment with fluoxetine. METHODS: Nine patients with panic disorders, previously shown to panic in response to intravenously administered lactate, and 10 control subjects underwent the Read rebreathing test by a 5-min inhalation of a 7% CO2/93% O2 mixture before and after 1 month of fluoxetine treatment. RESULTS: At baseline, patients differed from controls for higher percent value of expiratory reserve volume/vital capacity ratio and ventilatory response. Eight of the 9 patients had panic in response to the CO2 challenge. After fluoxetine, respiratory parameters decreased significatively, and only 3 patients remained hypercarbic challenge responders. CONCLUSIONS: The carbon dioxide challenge may represent a useful tool to evaluate the individual respiratory set, which may be a marker of the vulnerability to panic attack. Assessment of respiratory parameters may represent a biological marker to measure the efficacy of antipanic treatment.

Neuroleptic induced parkinsonism: MRI findings in relation to clinical course after withdrawal of neuroleptic drugs.

Parkinsonism is a common complication of neuroleptic drug use; however, the pathophysiology of the persistence of parkinsonian symptoms after withdrawal of neuroleptic drugs is poorly understood. Twenty patients with neuroleptic induced parkinsonism were studied by high field MRI. Persistence of symptoms was associated with different findings depending on the age of the patients--namely, putaminal hypointensity in young patients and striatal hyperintensities in old patients. High field MRI may be useful in identifying patients at higher risk for neuroleptic induced parkinsonism.

Diabetes mellitus in schizophrenic patients.

Studies conducted in the United States and Japan indicate that diabetes mellitus is more common among schizophrenic patients than among the general population. The prevalence of known diabetes was examined in 95 schizophrenic patients aged 45 to 74 years admitted to a long-term care facility in Italy. The overall prevalence of diabetes was 15.8% (95% confidence interval, 12.1% to 19.5%), and increased from 0% in those younger than 50 years, through 12.9% in the 50- to 59-year age group, and to 18.9% in the 60- to 69-year age group, and then decreased to 16.7% in those aged 70 to 74 years. These rates are considerably higher than those reported from population surveys in Italy, and indicate that a higher prevalence of diabetes in schizophrenic patients may be a universal phenomenon. The clinical picture indicated that in all cases this was the common variant of type II (non-insulin-dependent) diabetes mellitus. Diabetes was more common in patients not receiving neuroleptics than in those who were receiving such treatment. There was no association between diabetes and the use of anticholinergic drugs.

Adjunctive trazodone in the treatment of negative symptoms of schizophrenia.

OBJECTIVE: The study examined whether adjunctive treatment with trazodone would reduce negative symptomatology in patients with chronic, residual schizophrenia. METHODS: Patients selected for the study had an established clinical diagnosis of chronic schizophrenia with stable symptomatology, an absence of florid psychotic symptons, a stable regimen of neuroleptic medication, and an absence of depressive disorder. Active psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) score on the thinking disturbance factor. Negative symptoms were assessed using the BPRS withdrawal retardation factor as well as the affective flattening and alogia subscales from the Scale for Assessment of Negative Symptoms. Forty-nine patients were randomly assigned to either trazodone or placebo in a six-week double-blind trial. RESULTS: Forty-seven patients, 23 men and 24 women with an average age of 60 years, completed the six-week trial. Twenty-six of the patients received trazodone. Adjunctive treatment with trazodone significantly reduced the severity ratings on two of three measures of negative symptoms and did not significantly increase the severity of positive symptoms; however, the magnitude of the therapeutic effect was modest. The scores for negative symptoms were reduced by approximately 10 to 15 percent, and only three of the 26 actively treated patients showed moderate clinical improvement. CONCLUSIONS: Trazodone, used in conjunction with neuroleptics, mildly reduces the severity of negative symptoms in residual schizophrenia and does not exacerbate florid psychosis. The potential benefits of adjunctive trazodone therapy may outweigh the risk of worsening psychosis.

[The torcular Herophili: the diagnostic pitfalls in TOF 3D magnetic resonance angiography]. / Torcolare di Erofilo: trappola diagnostica nell'angiografia con risonanza magnetica TOF 3D.

The authors report on a diagnostic pitfall which is often observed in magnetic resonance angiography (MRA) of intracranial vessels (time-of-flight 3D)--i.e., the absence of one of the two transverse sinuses. Fifty patients underwent MRA of the intracranial vessels with the TOF 3D (FISP) and the TOF 2D (FISP) techniques. Five patients were affected with sinus stenosis. MRA was performed with a 1.5-T superconductive magnet and a circular head coil. All patients underwent Magnetic Resonance Angiography with FISP 2D sequences (FA 40 degrees, TR 40 ms, TE 12 ms) acquired on coronal plane as well as FISP 3D (FA 15 degrees, TR 30 ms, TE 7 ms) acquired on axial plane. In the patients in whom FISP 2D sequences correctly demonstrated the whole confluence of sinuses, FISP 3D sequences always depicted the upper sagittal sinus, while the right transverse sinus was seen in 84.4% (38/45) of cases and the left transverse sinus in 24.2% (11/45) of cases. In the patients with a stenosis in the confluence of sinuses, FISP 3D sequences demonstrated two false-positive cases with respect to FISP 2D. The statistical analysis (McNemar test) of the results demonstrated the difference between 2D and 3D sequences in the detection of the two transverse sinuses to be statistically significant: p < 0.01 for the right transverse sinus and p < 0.001 for the left transverse sinus. In the study of the intracranial vessels (TOF 3D technique) the absence of one of the two transverse sinuses is suggestive of a diagnostic pitfall; the combination of 3D and 2D sequences answers this diagnostic question.

MRI alterations as an early finding in Creutzfeld-Jakob disease.

Two cases of Creutzfeldt-Jakob Disease (CJD) are reported. In both cases, pathologically confirmed, magnetic resonance imaging (MRI) showed bilateral altered signal areas in the basal ganglia, early in the course of the disease. The CT scan, although performed later than MRI, confirmed these findings. Only in one patient did electroencephalography (EEG) show typical triphasic sharp-waves, but this support to clinical diagnosis was obtained 1 month after the appearance of MRI alterations.

Idebenone in senile dementia of Alzheimer type: a multicentre study.

Idebenone is a new cerebro-active drug, effective in dementia disorders, particularly indicated in primary degenerative dementias, i.e. Alzheimer's disease. This new molecule acts as an electron trapper and a free radical scavenger protecting mitochondrial membranes from lipid peroxidation. A multicentric, double-blind trial of idebenone (45 mg twice daily orally) vs. placebo was carried out on 102 elderly patients affected by Alzheimer-type dementia of mild or moderate severity. Idebenone was administered for 4 consecutive months, 45 mg twice daily. Clinical evaluations were performed at the time of enrollment (t0) and monthly thereafter (t30, t60, t90 and t120) and at follow-up (t150 ). Tolerability to idebenone treatment was good and was associated with a statistically significant improvement of memory, attention and behaviour. It is worthwhile noting that these cognitive and behavioral findings were observed after the first month of treatment with enhancement evident in the following period.

Abnormal involuntary movements: a study of dopaminergic receptor interaction.

UNLABELLED: Abnormal involuntary movements caused by chronic levodopa treatment in Parkinson's disease, tardive dyskinesia resulting from long-term treatment with neuroleptics, and Huntington's disease all seem to be related to functional alteration and/or derangement of the DA/ACh systems. Recent data show the presence of different types of DA receptors D1 and D2, which seem to be involved in the pathogenesis of AIM: an alteration of their mutual equilibrium could account for movements disorders. In addition, hypofunction of the ACh system also seems to play a role in the pathogenesis of AIM. The purpose of this study was to verify an alteration of DA/ACh relationships by evaluating the clinical responses to pharmacological stimuli in patients affected by AIM secondary to chronic levodopa and chronic neuroleptic treatment. The following drugs were used to evaluate the DA receptors: lisuride (0.007 mg/kg i.v.) and tiapride (2.85 mg/kg i.v.) as agonist and antagonist, respectively, at D2 receptors; oxopentphylline (2.85 mg/kg i.v.) and alpha-flupenthixol (.057 mg/kg p.o.) as agonist and antagonist, respectively, at D1 receptors. Levodopa plus carbidopa (250 mg + 25 mg) was also used. The ACh system was studied using orphenadrine (1.1 mg/kg i.v.) as an antagonist and physostigmine (0.014 mg/kg i.v.) and neostigmine (0.26 mg/kg i.v.) as agonists. Our results suggest an involvement mainly of D1 receptors in the pathogenesis of TD, whereas D2 receptors seem to be important in the onset of AIM after chronic levodopa treatment in Parkinson's disease.

[The computerized electroencephalogram in evaluating the action of vasoactive and eumetabolic drugs in chronic cerebrovascular disorders]. / L'elettroencefalogramma computerizzato nella valutazione dell'attività dei farmaci vasoattivi e eumetabolici nei disturbi cerebro-vascolari cronici.

In this work the authors estimated the effect, on cortical bioelectric activity, of two groups of drugs commonly used in the so-called chronic vascular cerebropathies. Through the computerized analysis of EEG the authors estimated vasoactive drugs (papaverine hydrochloride and xanthinol-nicotinate) and eumetabolic drugs (cytidin, uridin, cytidin + 1-glutamine association) in two groups of subjects (healthy volunteers and patients suffering from stabilized conditions of acute cerebrovascular insufficiency). As to vasoactive drugs, a different action of papaverine hydrochloride as compared to xanthinol-nicotinate was pointed out. Eumetabolic drugs showed an action of electroencephalographic activation statistically significant only if administered associated between them and with glutamine.