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  • 1
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    Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy
    Wiley ; 2023
    In:  Journal of Neuroimaging Vol. 33, No. 4 ( 2023-07), p. 575-581
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 33, No. 4 ( 2023-07), p. 575-581
    Abstract: The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel‐based lesion symptom mapping (VLSM). Methods Patients with imaging‐confirmed first‐ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90‐day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age‐ and sex‐matched patients with first‐ever ischemic strokes without PSE after 90 days served as controls for the VLSM analysis. Results The stroke database contained 809 patients (mean age: 68.4 ± 14.2 years) with first‐ever imaging‐confirmed ischemic strokes without history of epilep. Incidence of PSE after 90‐day follow‐up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90‐day follow‐up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE ( p   〈  .05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere‐specific VLSM analysis shows associations between PSE and damaged voxels in the left‐hemispheric temporo‐occipital transition zone. Conclusions The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo‐occipital cortex are vulnerable to develop PSE.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.v33.4
    DOI: 10.1111/jon.13110
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2035400-9
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  • 2
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    Value of initial C‐reactive protein levels in status epilepticus outcome prediction
    Wiley ; 2021
    In:  Epilepsia Vol. 62, No. 4 ( 2021-04)
    Details
    In: Epilepsia, Wiley, Vol. 62, No. 4 ( 2021-04)
    Abstract: The role of neuroinflammation in the pathophysiology of seizures is increasingly recognized, and the evaluation of potential biochemical markers of inflammatory processes in seizures and status epilepticus (SE), such as C‐reactive protein (CRP), has gained attention. The present study assessed the first CRP level obtained in an SE episode regarding its value for SE outcome prediction. Among 362 admissions for SE during the study period, 231 episodes satisfied the inclusion criteria. Higher initial CRP concentrations were independently associated with in‐hospital mortality and poor functional outcome at discharge in logistic regression models adjusting for SE severity, severity of SE etiology, and development of treatment refractoriness. Therefore, initial CRP levels may add to the prediction of SE prognosis. The pathomechanisms through which CRP is linked with the prognosis of SE, however, remain to be established.
    Type of Medium: Online Resource
    ISSN: 0013-9580 , 1528-1167
    URL: Issue
    URL: Article
    DOI: 10.1111/epi.v62.4
    DOI: 10.1111/epi.16842
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2002194-X
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  • 3
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    Accuracy of Dose-Saving Artificial-Intelligence-Based 3D Angiography (3DA) for Grading of Intracranial Artery Stenoses: Preliminary Findings
    MDPI AG ; 2023
    In:  Diagnostics Vol. 13, No. 4 ( 2023-02-14), p. 712-
    Details
    In: Diagnostics, MDPI AG, Vol. 13, No. 4 ( 2023-02-14), p. 712-
    Abstract: Background and purpose: Based on artificial intelligence (AI), 3D angiography (3DA) is a novel postprocessing algorithm for “DSA-like” 3D imaging of cerebral vasculature. Because 3DA requires neither mask runs nor digital subtraction as the current standard 3D-DSA does, it has the potential to cut the patient dose by 50%. The object was to evaluate 3DA’s diagnostic value for visualization of intracranial artery stenoses (IAS) compared to 3D-DSA. Materials and methods: 3D-DSA datasets of IAS (nIAS = 10) were postprocessed using conventional and prototype software (Siemens Healthineers AG, Erlangen, Germany). Matching reconstructions were assessed by two experienced neuroradiologists in consensus reading, considering image quality (IQ), vessel diameters (VD1/2), vessel-geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of IAS (e.g., location, visual IAS grading [low-/medium-/high-grade] and intra-/poststenotic diameters [dintra-/poststenotic in mm] ). Using the NASCET criteria, the percentual degree of luminal restriction was calculated. Results: In total, 20 angiographic 3D volumes (n3DA = 10; n3D-DSA = 10) were successfully reconstructed with equivalent IQ. Assessment of the vessel geometry in 3DA datasets did not differ significantly from 3D-DSA (VD1: r = 0.994, p = 0.0001; VD2:r = 0.994, p = 0.0001; VGI: r = 0.899, p = 0.0001). Qualitative analysis of IAS location (3DA/3D-DSA:nICA/C4 = 1, nICA/C7 = 1, nMCA/M1 = 4, nVA/V4 = 2, nBA = 2) and the visual IAS grading (3DA/3D-DSA:nlow-grade = 3, nmedium-grade = 5, nhigh-grade = 2) revealed identical results for 3DA and 3D-DSA, respectively. Quantitative IAS assessment showed a strong correlation regarding intra-/poststenotic diameters (rdintrastenotic = 0.995, pdintrastenotic = 0.0001; rdpoststenotic = 0.995, pdpoststenotic = 0.0001) and the percentual degree of luminal restriction (rNASCET 3DA = 0.981; pNASCET 3DA = 0.0001). Conclusions: The AI-based 3DA is a resilient algorithm for the visualization of IAS and shows comparable results to 3D-DSA. Hence, 3DA is a promising new method that allows a considerable patient-dose reduction, and its clinical implementation would be highly desirable.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics13040712
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662336-5
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  • 4
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    Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury
    American Medical Association (AMA) ; 2021
    In:  JAMA Network Open Vol. 4, No. 7 ( 2021-07-19), p. e2115859-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 4, No. 7 ( 2021-07-19), p. e2115859-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2021.15859
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
    detail.hit.zdb_id: 2931249-8
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  • 5
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    Cerebral lesions sites in neurosarcoidosis: a lesion mapping study
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Neurology
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC
    Abstract: Sarcoidosis is a granulomatous disease of unknown etiology affecting the central nervous system in up to 15% of the patients. Diagnosis of neurosarcoidosis is very challenging due to the heterogeneity of its clinical manifestation. This study intended to evaluate the distribution of cerebral lesion sites and the potential presence of specific lesion clusters in neurosarcoidosis patients using voxel-based lesion symptom mapping (VLSM). Methods Patients with neurosarcoidosis were retrospectively identified and included between 2011 and 2022. Cerebral lesion sites were correlated voxel-wise with presence and absence of neurosarcoidosis using non-parametric permutation test. Multiple sclerosis patients served as controls for the VLSM-analysis. Results Thirty-four patients (mean age 52 ± 15 years) of whom 13 were diagnosed with possible, 19 with probable and 2 with confirmed neurosarcoidosis were identified. Lesion overlap of neurosarcoidosis patients demonstrated a distribution of white matter lesions in all brain areas, with a periventricular predilection similar to multiple sclerosis. In contrast to multiple sclerosis controls, no propensity for lesions in proximity of the corpus callosum was observed. Neurosarcoidosis lesions appeared smaller and lesion volume was lower in the neurosarcoidosis cohort. The VLSM analysis showed minor associations between neurosarcoidosis and damaged voxels in the bilateral frontobasal cortex. Conclusions The VLSM analysis yielded significant associations in the bilateral frontal cortex, suggesting that leptomeningeal inflammatory disease with following cortical involvement is a quite specific feature in neurosarcoidosis. Lesion load was lower in neurosarcoidosis than in multiple sclerosis. However, no specific pattern of subcortical white matter lesions in neurosarcoidosis was revealed.
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-023-11863-3
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1421299-7
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  • 6
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    Diese kardialen Komplikationen drohen nach Schlaganfall
    Springer Science and Business Media LLC ; 2017
    In:  NeuroTransmitter Vol. 28, No. 12 ( 2017-12), p. 40-47
    Details
    In: NeuroTransmitter, Springer Science and Business Media LLC, Vol. 28, No. 12 ( 2017-12), p. 40-47
    Type of Medium: Online Resource
    ISSN: 1436-123X , 2196-6397
    URL: Article
    DOI: 10.1007/s15016-017-5794-6
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
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  • 7
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    “Virtual stent” – clinical evaluation and user experience of on-the-fly stent simulation in treatment of cerebral aneurysms
    SAGE Publications ; 2022
    In:  Interventional Neuroradiology Vol. 28, No. 5 ( 2022-10), p. 581-587
    Details
    In: Interventional Neuroradiology, SAGE Publications, Vol. 28, No. 5 ( 2022-10), p. 581-587
    Abstract: Predicting final stent position can be challenging when treating cerebral aneurysms. Third-Party software proved helpful in selecting proper stents in treatment planning. Recent angiographic systems provide basic stent simulation capabilities integrated in the post-processing software to simulate stent position. Goal of this analysis was to evaluate the simulation process and correlation with definite stent position. Materials and Methods Thirty-three datasets with fusiform (n = 10) and saccular (n = 23) aneurysms, treated with stent or flow-diverter, were processed. A “virtual stent” of the same (nominal) size was simulated and its position was compared to the treatment result. Simulated length was rated in five grades (too short, shorter, equal, longer, too long), with regard to side-branches, anchoring zone etc. Simulation quality (centerline recognition/adherence to vessel margins) was rated in three grades (no, minor or major corrections required). Results Simulation was successful in 32/33 cases (97%), with one abortive attempt (3%). In 27/33 simulations (82%), there was no need for centerline refinement. Minor corrections were necessary in four and major corrections in two cases. Simulated nominal length was rated “equal” in 14/33 (42%) cases and “shorter” or “longer” – but within acceptable range – in each 9/33 (27%) cases. Conclusion Basic stent simulation tools available with genuine angiographic workplace software can provide good simulation capabilities without need for third-party equipment. They can facilitate treatment planning and help to avoid shortage of devices. Yet, lack of calculation of foreshortening in large vessel diameters leaves the user to rely on their experience to account for device-specific properties.
    Type of Medium: Online Resource
    ISSN: 1591-0199 , 2385-2011
    URL: Article
    DOI: 10.1177/15910199211053131
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2571161-1
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  • 8
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    Invasiveness and Clinical Outcomes of Off-Hour Admissions in Patients with Intracerebral Hemorrhage
    Elsevier BV ; 2020
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 29, No. 2 ( 2020-02), p. 104505-
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 29, No. 2 ( 2020-02), p. 104505-
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2019.104505
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2052957-0
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  • 9
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    Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage : A Retrospective Multicenter Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 2 ( 2021-02), p. 611-619
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 2 ( 2021-02), p. 611-619
    Abstract: The impact of platelets on hematoma enlargement (HE) of intracerebral hemorrhage (ICH) is not yet sufficiently elucidated. Especially the role of reduced platelet counts on HE and clinical outcomes is still poorly understood. This study investigated the influence of thrombocytopenia on HE, functional outcome, and mortality in patients with ICH with or without prior antiplatelet therapy (APT). Methods: Individual participant data of multicenter cohort studies (multicenter RETRACE program [German-Wide Multicenter Analysis of Oral Anticoagulation-Associated Intracerebral Hemorrhage] and single-center UKER-ICH registry [Universitätsklinikum Erlangen Cohort of Patients With Spontaneous ICH] ) were grouped into APT and non-APT ICH patients according to the platelet count, that is, with or without thrombocytopenia (cells 〈 150×10 9 /L). Of all patients, 51.5% (1124 of 2183) were on vitamin K antagonist. Imbalances in baseline characteristics including proportions of vitamin K antagonist patients were addressed using propensity score matching. Outcome analyses included HE ( 〉 33%), as well as mortality and functional outcome, after 3 months using the modified Rankin Scale, dichotomized into favorable (modified Rankin Scale score, 0–3) and unfavorable (modified Rankin Scale score, 4–6). Results: Of overall 2252 ICH patients, 11.4% (52 of 458) under APT and 14.0% (242 of 1725) without APT presented with thrombocytopenia on admission. The proportion of patients with HE was not significantly different between patients with or without thrombocytopenia among APT and non-APT ICH patients after propensity score matching (HE: APT patients: 9 of 40 [22.5%] thrombocytopenia versus 27 of 115 [23.5%] nonthrombocytopenia, P =0.89; non-APT patients: 54 of 174 [31.0%] thrombocytopenia versus 106 of 356 [29.8%] nonthrombocytopenia, P =0.77). In both (APT and non-APT) propensity score matching cohorts, there were no significant differences regarding functional outcome. Mortality after 3 months did not differ among non-APT patients, whereas the mortality rate was significantly higher for APT patients with thrombocytopenia versus APT patients with normal platelet count (APT: 29 of 46 [63.0%] thrombocytopenia versus 58 of 140 [41.4%] nonthrombocytopenia, P =0.01; non-APT: 95 of 227 [41.9%] thrombocytopenia versus 178 of 455 [39.1%] nonthrombocytopenia, P =0.49). Conclusions: Our study implies that thrombocytopenia does not affect rates of HE and functional outcome among ICH patients, neither in patients with nor without APT. In light of increased mortality, the significance of platelet transfusions for ICH patients with thrombocytopenia and previous APT should be explored in future studies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.031478
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Blood Pressure and Anticoagulation Reversal Management during Off-Hours in Oral Anticoagulation-Associated Intracerebral Hemorrhage
    S. Karger AG ; 2020
    In:  Cerebrovascular Diseases Vol. 49, No. 2 ( 2020), p. 177-184
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 49, No. 2 ( 2020), p. 177-184
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Prevention of hematoma enlargement in oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) focuses on blood pressure (BP) reduction and OAC reversal. We investigated whether treatment efficiency and clinical outcomes differ between OAC-ICH patients admitted outside versus during regular working hours. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Based on pooled data of multicenter cohort studies, we grouped OAC-ICH patients (vitamin K antagonist [VKA], non-vitamin K oral anticoagulant [NOAC] ) according to on- vs. off-hour admission. Primary outcome was the functional outcome using the modified Rankin scale (mRS) dichotomized into favorable (mRS 0–3) and unfavorable (mRS 4–6) and mortality at 3 months. Secondary outcome measures included the occurrence of hematoma enlargement, the proportions of patients with systolic BP & #x3c;140 mm Hg and with anticoagulation treatment achieving international normalized ratio (INR) levels & #x3c;1.3 at 4 h. Propensity score matching (PSM) was performed to account for imbalances in baseline characteristics. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The study population consisted of 76/126 NOAC-ICH patients and 1,005/1,470 VKA patients presenting during off-hours. Functional outcome and mortality rates were not significantly different among PSM patients with VKA-ICH and NOAC-ICH during on- vs. off-hours (mRS 4–6 VKA-ICH: on-hour: 239/357 [66.9%] vs. 253/363 [69.7%] off-hour; 〈 i 〉 p 〈 /i 〉 = 0.43; NOAC-ICH: on-hour 26/42 [61.9%] vs. off-hour: 37/57 [64.9%] ; 〈 i 〉 p 〈 /i 〉 = 0.76; mRS 6 VKA-ICH: on-hour: 127/357 [35.6%] vs. off-hour: 148/363 [40.8%] ; 〈 i 〉 p 〈 /i 〉 = 0.15; ­NOAC-ICH: on-hour 17/42 [40.5%] vs. off-hour: 16/57 [28.1%] ; 〈 i 〉 p 〈 /i 〉 = 0.20). There were no differences detectable regarding the secondary outcome measures (i.e., hematoma enlargement, the proportion of patients who achieved systolic BP levels & #x3c;140 mm Hg at 4 h as well as anticoagulation treatment achieving INR levels & #x3c;1.3 at 4 h) in OAC patients. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Our study implies that BP reduction and anticoagulation reversal management are well established and associated with similar rates of hematoma enlargement and clinical outcomes in on- vs. off-hour admitted OAC-ICH patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000507316
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1482069-9
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