Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Stroke, Volume 53, Issue Suppl_1, Page AWP223-AWP223, February 1, 2022. Introduction:Patent foramen ovale (PFO) is present in a significant number of ESUS patients and paradoxical embolism from venous thromboembolism (VTE) is often assumed to be the primary stroke mechanism. We hypothesized that paradoxical embolism is not the primary cause of stroke among ESUS patients with PFO based on markers of coagulation and hemostatic activation (MOCHA).Methods:ESUS patients presenting to the Emory Clinic from January 1, 2017 to December 31, 2020 were followed for a median of 13 months (IQR 8.1 – 21.7). MOCHA testing (d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) was done ≥14 days after stroke and considered abnormal if ≥2 markers were elevated.Results:Among 333 ESUS patients (median age 66 years, IQR 53 – 75), 70 (21%) had a PFO. Compared to PFO-, the PFO+ group was younger, had less comorbidities and higher frequency of migraine (Table). No significant difference in abnormal MOCHA among PFO+ and PFO- patients was found (34% vs 45%, p=0.127), including younger patients (

Stroke, Volume 53, Issue Suppl_1, Page ATP231-ATP231, February 1, 2022. Significance:Low frequency whole body vibration (LFV) at 40 Hz, a low impact form of exercise, for a month following mild transient middle-cerebral artery occlusion (tMCAO) reduces infarct volume and improves motor function in reproductively senescent, middle-aged female rats (1). In humans, LFV was shown to increase circulating levels of irisin, a skeletal muscle-derived hormone. Irisin has also been shown to play a crucial role in preserving mitochondrial function, preventing oxidative stress, and elevating expression of BDNF, among other neuroprotective measures. The current study aims to investigate the efficacy of LFV in ameliorating post-tMCAO cognitive deficits and to determine the putative role of irisin in conferring the benefits of LFV in middle-aged rats.Methods:Middle-aged rats of both sexes (5-8) were randomly assigned to tMCAO (90 min), or sham surgery followed by exposure to either LFV (twice a day for 15 min each for 5 days a week over a month) or no LFV treatment groups. Following the last LFV treatment, rats were tested for hippocampus-dependent learning and memory using a water maze followed harvesting brain and blood samples for histopathological and inflammatory marker analyses, respectively. In a parallel experiment in the absence of LFV, middle-aged female rats were randomly assigned to either saline or irisin treatment following tMCAO. Recombinant irisin was purchased from PeproTech (Rocky Hill, NJ). Rats were treated with irisin (0.2 μg/g BW; IP) or saline for a month followed by their brains were assessed by histopathology.Results:Post-tMCAO LFV significantly lessens cognitive deficits in rats of both sexes. It also significantly decreased circulating pro-inflammatory cytokines and increased serum levels of native irisin. Quantification of infarct volume irisin-treated rats demonstrated that, compared to saline, infarct volume was significantly reduced. Saline treatment resulted in 234 ± 30 mm3, while irisin treatment yielded 128 ± 34 mm3(p

Stroke, Volume 53, Issue Suppl_1, Page AWMP88-AWMP88, February 1, 2022. Introduction:There is increasing interest in endovascular therapy (EVT) for patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) presenting with low NIH Stroke Scale. Here, we assess the prevalence of LVO with low NIHSS and real-world trends in utilization of EVT in this population.Methods:We performed a cross-sectional study using the Texas Public Use Data File, which captures all inpatient admissions in the state from non-federal hospitals (10/01/2016-06/30/2020). AIS cases were defined as hospitalizations to acute care hospitals with a primary diagnosis of AIS using ICD-10-CM codes I63.x and NIHSS was determined using ICD-10-CM codes R29.700- R29.742. Low NIHSS was defined as

Stroke, Volume 53, Issue Suppl_1, Page ATP56-ATP56, February 1, 2022. Accurate and timely prehospital stroke diagnosis and detection of large vessel occlusion (LVO) are essential to ensure stroke patients are transported to hospitals that offer emergent reperfusion therapies. However, symptom based prehospital stroke scales often fail to identify LVO. Thus, a need exists for cost-effective and portable diagnostic tools, such as portable electroencephalography (EEG) to improve the accuracy of prehospital stroke diagnosis.Hypotheses: 1) Quantitative EEG measures will differ between LVO and non-LVO stroke patients, particularly in regards to brain slowing (ratio of low to high frequency oscillatory brain power) and brain asymmetry (ratio between oscillations in the affected and unaffected hemisphere) 2) Combining EEG with prehospital stroke scales will improve the accuracy of LVO detection.We enrolled patients with acute suspected stroke on presentation to an emergency department at a comprehensive stroke centre. Patients were rapidly evaluated with the Los Angeles Motor Scale followed by a 3-minute resting-state EEG recording using a modified Muse EEG headband (InteraXon). The LVO diagnosis and the extent of cerebral blood flow abnormalities were determined from CT angiography and CT perfusion imaging performed in close temporal proximity to the EEG recording.The study enrolled 74 patients (n= 8 LVO, n=66 non-LVO, including stroke mimics). Initial analysis suggests that LVO patients have trends towards brain slowing, as measured by the delta alpha ratio (LVO: mean = 1.21, SEM = 0.03; non-LVO: mean = 1.19, SEM = 0.01; p-value = 0.34). Additionally, LVO patients showed a trend towards increased brain asymmetry from 6-8 Hz, suggesting physiological differences between hemispheres specific to the theta frequency (LVO: mean = 0.02, SEM = 0.006; non-LVO: mean = 0.01, SEM = 0.002; p-value = 0.13). Quantitative measures will be assessed using classification trees to determine which combination of EEG and clinical features is most predictive of LVO.In conclusion, acute differences in brain activity between LVO and non-LVO patients can be detected with portable EEG, which when combined with clinical stroke scales, have the potential to improve the diagnosis and triage of suspected stroke patients in a prehospital setting.

Stroke, Volume 53, Issue Suppl_1, Page ATMP43-ATMP43, February 1, 2022. Background:Health equity and the reduced socioeconomic gap between communities are the main objectives of healthcare delivery in the US with a shifting focus towards social determinants of health. We aimed to compare stroke hospitalizations and outcomes in young patients with low median household income (LMHI) across two national cohorts a decade apart (2007 vs. 2017).Methods:We used National Inpatient Sample (2007 & 2017) to identify young-onset stroke hospitalizations (18-44 years, YOS) belonging to LMHI (0-25th quartile) using relevant codes. Demographics, comorbidities, adjusted risk of YOS and outcomes were compared between two cohorts.Results:Of 34249 LMHI YOS admissions, 13749 belonged to 2007 and 20500 to 2017 (median age 39 vs 38 years, p

Stroke, Volume 53, Issue Suppl_1, Page ATMP69-ATMP69, February 1, 2022. Introduction:Early neurological deterioration (END) in patients with large vessel occlusion (LVO) stroke with low NIHSS treated with medical management (MM) has been well described. However, the effect of END on 90-day disability outcomes relative to patients presenting with more severe stroke, remains undetermined.Methods:From our multi-center prospective registry across 4 comprehensive stroke centers, we identified patients with LVO (basilar, ICA, M1/2, or P1 identified on CTA or MRA) from January 2018 to June 2020. Low NIHSS was defined as 0-5, and END as a worsening of > 3 points. To determine the effect of END on outcomes, we used propensity score to match patients who presented with low NIHSS who suffered END by age and worsened NIHSS (i.e. subsequent, greater NIHSS) to patients who presented initially with LVO and comparable NIHSS.Results:Among 348 patients with LVO acute ischemic stroke, median age was 67 [IQR 59-76], 46.6% were female. 58 patients (17%) of the cohort had low NIHSS. Compared to the higher NIHSS group, low NIHSS group had less EVT performed (39.7% vs 78.3%, p=

Stroke, Volume 53, Issue Suppl_1, Page AWMP107-AWMP107, February 1, 2022. Introduction:Genetic reference panels and imputation approaches have improved greatly in the last 10 years. The development of the TOPMed reference plane has led to enhanced imputation quality and quantity of single nucleotide polymorphisms (SNPs) due to greater sample diversity among various population ancestries. We revisited our prior GWAS of recurrent stroke by utilizing the TOPMed imputation server.Methods:This GWAS used a Cox proportional hazards model of time to recurrent stroke with the Vitamin Intervention for Stroke Prevention clinical trial cohort. There were 2,100 genotyped patients (64% male) in total with an average age of 67.2 (±10.8) years and ancestry distribution of 1,725 (82%) European, 258 (12%) African, and 117 (6%) Other or Mixed ancestry. Genotyped samples underwent a strict quality control process. We utilized TOPMed for imputation which totaled 10,467,887 biallelic SNPs which was 14 times greater in number compared the original analysis.Results:Recurrent stroke was observed in 182 (8.7%) patients. We identified seven novel SNPS on chromosome 1 in addition to our previous finding, rs6664786. Interestingly all chromosome 1 SNPs were located within the LINCO1362 gene. This gene has an acute change in expression in the presence of smoking even after adjustment of relevant clinical factors. Two novel SNPs were found on chromosome 16 located in gene desert nearest the pseudo-gene RNU6-21P in an intergenic region downstream of the Cadherin-8 (CDH8) gene. Both SNPs and RNU6-21P have no previously reported clinical relevance, except for their relative position to CDH8. CDH8 is highly expressed in brain tissue.Conclusions:We identified several novel SNPs associated with recurrent stroke. Capitalizing on genetic imputation advancements allows potential new insights and discoveries with past trial cohorts. Understanding these insights may provide further mechanistic knowledge of recurrent stroke to develop potential therapeutic targets.

Stroke, Volume 53, Issue Suppl_1, Page ATP25-ATP25, February 1, 2022. Hypothesis:Hospital presentation for acute stroke may have been delayed during COVID-19. We hypothesize that stroke patients with mild symptoms (NIHSS

Stroke, Volume 53, Issue Suppl_1, Page AWP164-AWP164, February 1, 2022. Background:The outcome in stroke patients with ASPECTS of ≤5 who undergo Endovascular Thrombectomy(EVT) in Large Vessel Occlusion (LVO) is uncertain. We used machine learning models to predict 90-day home-time in these patients.Methods:We used the QuICR provincial stroke registry and administrative data from Southern Alberta to identify patients who underwent EVT from Jan 2015-Dec 2019. Imaging data were scored by 2-physician consensus. The primary outcome was the predicted 90-day home-time(number of days a patient is back at their premorbid living situation without an increase in level of care within 90 days of the stroke) using generalized boosting machine model with Gaussian distribution. Covariate contribution to hometime was determined using partial dependence plots.Results:Of 659 EVT patients, 82(12%) had baseline ASPECTS ≤5(mean age 69.8y, 44.6% females, 93% good-moderate collaterals, M1 occlusion(64.1%). Overall, patients with low ASPECTS had lower median predicted home-time by 2.8d. Holding other covariates constant, factors predicting lower 90d-home-time were diabetes mellitus(-14d), hypertension(-7d), and symptomatic intracerebral hemorrhage (sICH) on follow up scan(-14d). Home-time decreased with increasing age in both low and non-low ASPECTS groups, but the difference was larger in older age groups (Figure). There was no meaningful difference in predicted 90d-home-time by sex, atrial fibrillation, baseline NIHSS, occlusion site, tandem lesion, thrombolysis, or successful reperfusion.Conclusions:Among patients with low ASPECTS who underwent EVT, hypertension, diabetes and sICH predicted lower 90-d home-time. .

Stroke, Volume 53, Issue Suppl_1, Page ATMP59-ATMP59, February 1, 2022. Background/Purpose:Inherited thrombophilia testing in the acute inpatient setting is controversial and expensive, and in many cases does not change clinical management. We sought to determine the value of inpatient inherited thrombophilia testing for patients who presented with an isolated acute ischemic stroke or transient ischemic attack (TIA) without concurrent venous thromboembolism.Methods:We retrospectively analyzed a database comprising patients who were admitted for acute ischemic stroke or TIA in 2019 at Thomas Jefferson University Hospitals in Philadelphia, PA and had inherited thrombophilia testing performed during the hospital admission. Charts were reviewed to determine stroke risk factors, test results, and clinical management.Results:The study included 102 patients (median age 49.0 years, 53.9% female) who presented with acute ischemic stroke or TIA (including branch and central retinal artery occlusions) and underwent inpatient testing for factor V Leiden, prothrombin G20210A variant, hyperhomocysteinemia, PAI-1 elevation, and deficiencies of protein C and S and antithrombin. 406 tests were ordered, among which 14.0% resulted abnormal, and 41.2% of patients had at least one abnormal test. Patients without stroke risk factors were more likely to have an abnormal result (60.0% vs 35.1%, P = .028). However, 40% of abnormal tests were borderline positive antigen or activity assays that likely represented false positives. Considering only definitively positive results, there was no significant difference in the likelihood of a positive test in patients with vs without stroke risk factors (32.0% vs 26.0%, P = .557) or those under vs over age 50 years (30.2% vs 24.5%, P = .519). No patients with an abnormal result had their clinical management changed as a result. Charges for the tests totaled $182,994 USD.Conclusions:Inpatient inherited thrombophilia testing immediately following isolated acute arterial ischemic stroke or TIA was associated with high rates of false positive results and was expensive. Positive results did not change clinical management in a single case.

Stroke, Ahead of Print. Background and Purpose:Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans.Methods:Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity.Results:Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP

Stroke, Volume 53, Issue 2, Page 514-522, February 1, 2022. Background and Purpose:Associations of APOE genotypes with intracerebral hemorrhage (ICH) in preterm infants were previously described. In adults, APOE-ε4 genotype has been proposed as susceptibility factor for impaired recovery after cerebral insult. We here aim to determine APOE genotype-specific neurological consequences of neonatal ICH at school age.Methods:In this multicenter observational cohort study, very low birth weight (