Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach.

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely.

Intracerebral hemorrhage in COVID-19: A narrative review.

Coronavirus Disease 19 (COVID-19) pandemic affects the worldwide healthcare system and our understanding of this disease grows rapidly. Although COVID-19 is a mainly respiratory disease, neurological manifestations are not uncommon. The aim of this review is to report on the etiology, clinical profile, location, and outcome of patients with intracerebral hemorrhage (ICH) and COVID-19.

Frequency and Significance of Maneuvers to Dissect the Distal Internal Carotid Artery During Carotid Endarterectomy.

Objectives: To describe the frequency, factors associated with, and significance of surgical dissection maneuvers of the distal internal carotid artery (ICA) during carotid endarterectomy (CEA).

Methods: In this retrospective analysis of prospectively collected information in patients undergoing CEA, we recorded information on demographics, risk factors and comorbidities, dissection maneuvers of the distal ICA, other operative variables and neurological outcome measures.

Results: During the period July 2008 and February 2020 inclusive, 218 consecutive patients (180 males, median age 69.

Start low, go slow, but look far: the case of geriatric medicine in Balkan countries.

Purpose: To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021.

Methods: Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed.

An ischemic stroke as the presenting manifestation of rapidly progressive primary angiitis of central nervous system in a 17-year-old boy.

Background: Childhood primary angiitis of the central nervous system (cPACNS) is an increasingly recognized inflammatory brain disease in children.

Case Presentation: We present a case of a 17-year-old boy with recurrent ischemic events over a short time period. Diagnosis of angiography positive cPACNS was made based on neuroimaging findings while secondary causes or mimics of CNS vasculitis were meticulously excluded.

Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis.

Background And Purpose: Current guidelines do not provide firm directions on atrial fibrillation (AF) screening after ischemic stroke (IS). We sought to investigate the association of implantable cardiac monitoring (ICM) duration with the yield of AF detection in IS patients.

Methods: We included studies reporting AF detection rates by ICM in IS patients with negative initial AF screening.

Recognizing Physical Activity of Older People from Wearable Sensors and Inconsistent Data.

The physiological monitoring of older people using wearable sensors has shown great potential in improving their quality of life and preventing undesired events related to their health status. Nevertheless, creating robust predictive models from data collected unobtrusively in home environments can be challenging, especially for vulnerable ageing population. Under that premise, we propose an activity recognition scheme for older people exploiting feature extraction and machine learning, along with heuristic computational solutions to address the challenges due to inconsistent measurements in non-standardized environments.

Integrating an openEHR-based personalized virtual model for the ageing population within HBase.

Background: Frailty is a common clinical syndrome in ageing population that carries an increased risk for adverse health outcomes including falls, hospitalization, disability, and mortality. As these outcomes affect the health and social care planning, during the last years there is a tendency of investing in monitoring and preventing strategies. Although a number of electronic health record (EHR) systems have been developed, including personalized virtual patient models, there are limited ageing population oriented systems.

Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience.

Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset.

Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated.

Insights into the molecular mechanisms of stress and inflammation in ageing and frailty of the elderly.

Frailty is a natural state of physical, cognitive and mental decline that is expected in the elderly. The role of inflammation in the pathogenesis of frailty has been hypothesized, and so far many studies have been performed in order to understand the mechanism of action underlying this association. Recent studies support this hypothesis and show a clear association between inflammation, frailty, and age-related disease.

Efficacy, Safety, and Duration of a Frameless Fiducial-Less Brain Biopsy versus Frame-based Stereotactic Biopsy: A Prospective Randomized Study.

Background/objective: We compared the efficacy, duration, safety, length of hospital stay of a frameless fiducial-less brain biopsy with those of the standard frame-based stereotactic biopsy.

Patients And Methods: This prospective cohort study enrolled 56 adult patients: (1) for whom no conclusive diagnosis could be reached noninvasively; (2a) who had lesions involving deep-seated and eloquent areas, multifocal lesions, or lesions for which craniotomy and lesion removal was not indicated, or (2b) were poor candidates for craniotomy (> 80 years of age and/or with serious comorbidities). Frameless and frame-based biopsy were performed in 28 patients each RESULTS: A diagnosis was not made in four cases (14.

C-Reactive Protein and Frailty in the Elderly: A Literature Review.

Chronic inflammation is a well-established background process in many age-related diseases. Many recent studies investigate the use of various inflammatory biomarkers such as C-reactive protein (CRP), interleukin-6, and interleukin-1 as predictors of physical and cognitive performance among elders. The phenotype of frailty has also been associated with underlying inflammatory mechanisms.

Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis.

Background: Novel oral anticoagulants (NOACs) have shown to be both safe and effective for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). We conducted a network meta-analysis (NMA) using published data from secondary prevention subgroups of different phase III randomized clinical trials (RCTs) comparing individual NOACs with warfarin.

Methods: Eligible studies were identified by searching MEDLINE and SCOPUS and the Cochrane Central Register of Controlled Trials databases.

Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis: a systematic review and meta-analysis.

Objectives: The cumulative safety and efficacy measures of percutaneous transluminal angioplasty and stenting (PTAS) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (sICAS) have not previously been evaluated using a meta-analytical approach.

Methods: We conducted a systematic review and random effects meta-analysis of all available randomized controlled trials (RCTs) evaluating the safety and efficacy of PTAS (in comparison with medical therapy) for sICAS.

Results: Three RCTs (678 total patients) were included in the quantitative analysis.

Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: A systematic review and diagnostic test accuracy meta-analysis.

Objective: Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic ischemic stroke or transient ischemic attack has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach.

Methods: We performed a systematic literature review to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD, or both compared to the gold standard of TEE.

Trigeminal herpes zoster complicated by Ramsay Hunt syndrome.

We report the case of a 55-year-old woman with herpes zoster of the mandibular branch of the left trigeminal nerve, which was complicated within 4 days by ipsilateral Ramsay Hunt syndrome. Recently, a case of trigeminal herpes zoster and Ramsay Hunt syndrome was described, in which the MRI and CSF findings along with the clinical course urged the authors to suggest the possibility of transaxonal spread of the virus. In our case, the findings and particularly the temporal relation between the 2 conditions render more plausible other pathophysiological mechanisms, such as the spread of the virus through the CSF.

Motor unit number estimation and quantitative needle electromyography in stroke patients.

Objective: To evaluate the effect of upper motor neuron damage upon motor units' function by means of two separate and supplementary electrophysiological methods.

Methods: The abductor digiti minimi muscle of the non-paretic and the paretic side was studied in forty-six stroke patients with (a) motor unit number estimation (MUNE) - adapted multiple point stimulation method and (b) computerized quantitative needle electromyography (EMG) assessing the configuration of voluntary recruited motor unit potentials. Main outcome comparisons were focused on differences between non-paretic and paretic side.

Minimizing technical failure of percutaneous balloon compression for trigeminal neuralgia using neuronavigation.

Unlabelled: Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy.

Association of functional VKORC1 promoter polymorphism with occurrence and clinical aspects of ischemic stroke in a Greek population.

Genetic factors are considered to play an important role in determining the susceptibility to the occurrence, clinical course, and functional outcome of an acute ischemic stroke (IS). Undercarboxylation of specific vitamin K-dependent proteins, due to genetic polymorphisms of VKORC1, can affect both vascular calcification and thrombogenicity. We sought to determine the association of VKORC1 -1639G > A polymorphism with IS incidence, age of onset, severity of disease, and functional outcome after an acute IS.

Does farming have an effect on health status? A comparison study in west Greece.

Investigating the health status of agricultural workers is a challenging goal. Contradictory outcomes concerning farmers' health are reported in the literature. In this cross-sectional study, certain clinical and neurobehavioral health outcomes were compared between farmers and non-farmers living in the same rural area.

Association of monocyte chemoattractant protein-1 -2518A>G polymorphism with occurrence, severity, and outcome in ischemic stroke.

Monocyte chemoattractant protein-1 (MCP-1) is implicated in promoting atherosclerotic diseases, including stroke. Therefore, several studies have investigated the association between variants of the MCP-1 gene and risk of atherosclerotic diseases. We sought to determine the occurrence of MCP-1 -2518A>G polymorphism in patients with ischemic stroke (IS), and studied its association with the severity of disease and functional outcome after an acute IS.

The role of ghrelin, neuropeptide Y and leptin peptides in weight gain after deep brain stimulation for Parkinson's disease.

Background: The exact mechanism of weight gain (WG) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with idiopathic Parkinson's disease remains unknown.

Objectives: To investigate a possible involvement of ghrelin, neuropeptide Y (NPY) and leptin in WG after DBS.

Methods: Twenty-three Parkinson patients were submitted for body composition measurements and blood sampling 3 days before, and 3 and 6 months after STN DBS.

The multiple layers of signaling selectivity at protease-activated receptors.

The Protease-Activated Receptors (PARs) are G-protein-coupled receptors (GPCRs) characterized by a unique mechanism of activation. They carry built in their extended N-terminal structure their own activating agonist, in the form of a cryptic tethered ligand, unmasked by an irreversible proteolytic cleavage. Besides, PARs display several other particular properties, that converge and create interacting and intertwined layers of molecular processes regulating receptor's selective signaling with important biological and pharmacological consequences.