Publications by authors named "Giorli E"
Importance: : The spatial and temporal distribution of intracerebral hemorrhage (ICH) recurrence are largely unknown.
Objective: To assess timing and location of recurrent ICH events in relation to the index ICH event (adjacent ICH [adjICH] vs remote ICH [remICH]).
Design, Setting, And Participants: This cohort study was a pooled analysis of individual cohort studies from 2002 to 2021 among hospital-based European cohorts.
Statin use and long-term risk of recurrent intracerebral haemorrhage: the MUCH-Italy.
J Neurol Neurosurg Psychiatry
December 2024
Background: Whether statin use after spontaneous intracerebral haemorrhage (ICH) increases the risk of recurrent ICH is uncertain.
Methods: In the setting of the Multicentric Study on Cerebral Haemorrhage in Italy we followed up a cohort of 30-day ICH survivors, consecutively admitted from January 2002 to July 2014, to assess whether the use of statins after the acute event is associated with recurrent cerebral bleeding.
Results: 1623 patients (mean age, 73.
Article Synopsis
- Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are effective treatments for acute stroke, but their safety and efficacy in patients with atrial fibrillation (AF) are debated.
- A study analyzed data from two multicenter studies to compare outcomes of AF patients with acute ischemic stroke treated with reperfusion therapies versus those who weren't.
- Results showed that AF patients treated with reperfusion therapies had better functional outcomes and lower mortality rates compared to those who received conservative treatment.
Introduction: It is unclear which patients with non-traumatic (spontaneous) intracerebral haemorrhage (ICH) are at risk of developing acute symptomatic seizures (provoked seizures occurring within the first week after stroke onset; early seizures, ES) and whether ES predispose to the occurrence of remote symptomatic seizures (unprovoked seizures occurring more than 1 week after stroke; post-stroke epilepsy, PSE) and long-term mortality.
Patients And Methods: In the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) we examined the risk of ES and whether they predict the occurrence of PSE and all-cause mortality in a cohort of patients with first-ever spontaneous ICH and no previous history of epilepsy, consecutively hospitalized in 12 Italian neurological centers from 2002 to 2014.
Results: Among 2570 patients (mean age, 73.
Background: The identification of patients surviving an acute intracerebral hemorrhage who are at a long-term risk of arterial thrombosis is a poorly defined, crucial issue for clinicians.
Methods: In the setting of the MUCH-Italy (Multicenter Study on Cerebral Haemorrhage in Italy) prospective observational cohort, we enrolled and followed up consecutive 30-day intracerebral hemorrhage survivors to assess the long-term incidence of arterial thrombotic events, to assess the impact of clinical and radiological variables on the risk of these events, and to develop a tool for estimating such a risk at the individual level. Primary end point was a composite of ischemic stroke, myocardial infarction, or other arterial thrombotic events.
Article Synopsis
- The study investigates the best treatment approach for patients with mechanical heart valves experiencing acute ischemic strokes while on vitamin K antagonists, comparing bridging therapy with full dose heparin to nonbridging therapy without heparin.
- Data was collected from multiple centers via retrospective registries, with a focus on outcomes such as stroke, bleeding, and embolism after 90 days using propensity score matching to ensure accurate comparisons.
- Results indicated that while bridging therapy was associated with a higher incidence of adverse events, both strategies presented risks, with bridging patients showing a marginally increased risk for ischemic and bleeding complications compared to the nonbridging group.
I n the context of an adequate health care organization, the figure of the neurologist as an emergency operator (in the emergency room-ER-and/or in a dedicated outpatient clinic) is crucial for an effective functional connection with the territory (and therefore with general practitioners), a reduction in inappropriate ER accesses, specific diagnostic and therapeutic approaches to neurological emergencies in the ER and a reduction in nonspecific or even unnecessary instrumental investigations. In this position paper of the Italian Association of Emergency Neurology (ANEU: Associazione Neurologia dell'Emergenza Urgenza), these issues are addressed, and two important organizational solutions are proposed: 1) The Neuro Fast Track, as an outpatient organization approach strongly linked to general practitioners and non-neurological specialists and dedicated to cases with deferrable urgency (to be assessed within 72 h) 2) The identification of an emergency neurologist, who is engaged in ER assessments as a consultant and involved in the management of the semi-intensive care unit of the emergency neurology and the stroke unit according to an appropriate rotation, as well as in consultations for patients with neurological emergencies in inpatient wards The possibility of computerizing the screening of patients with deferrable urgency in the Neuro Fast Track is described. A dedicated app represents an important tool that can facilitate the identification of patients for whom deferred assessment is appropriate, the scheduling of neurological examinations and reductions in the booking time through a more rapid approach to specialist assessment and subsequent investigations.
View Article and Find Full Text PDFObjective: Epidemiological data to characterize the individual risk profile of patients with spontaneous cervical artery dissection (sCeAD) are rather inconsistent.
Methods And Results: In the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age = 47.3 ± 11.
Introduction: Recent anticoagulant intake represents a contraindication for thrombolysis in acute ischemic stroke. Idarucizumab reverses the anticoagulant effect of dabigatran, potentially allowing for thrombolysis. This nation-wide observational cohort study, systematic review, and meta-analysis evaluated the efficacy and safety of thrombolysis preceded by dabigatran-reversal in people with acute ischemic stroke.
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- A study was conducted on patients with atrial fibrillation who had an ischemic stroke while using nonvitamin K antagonist oral anticoagulants to determine rates and risk factors for recurrent ischemic and bleeding events.
- Over an average follow-up of about 15 months, 15.5% of the 1,240 patients experienced 207 events, including ischemic strokes and major bleeding incidents, with specific risk factors identified for each type of event.
- The rates of ischemic and bleeding events did not significantly differ between patients who changed their anticoagulant treatment and those who continued with it.
Objective: To explore the impact of antithrombotic therapy discontinuation in the postacute phase of cervical artery dissection (CeAD) on the mid-term outcome of these patients.
Methods: In a cohort of consecutive patients with first-ever CeAD, enrolled in the setting of the multicentre Italian Project on Stroke in Young Adults Cervical Artery Dissection, we compared postacute (beyond 6 months since the index CeAD) outcomes between patients who discontinued antithrombotic therapy and patients who continued taking antithrombotic agents during follow-up. Primary outcome was a composite of ischaemic stroke and transient ischaemic attack.
Background: Subclinical vascular brain lesions are highly prevalent in elderly patients with stroke. Little is known about predisposing factors and their impact on long-term outcome of patients with stroke at a young age.
Methods: We quantified magnetic resonance-defined subclinical vascular brain lesions, including lacunes and white matter hyperintensities, perivascular spaces and cerebral microbleeds, and assessed total small-vessel disease (SVD) score in patients with first-ever acute ischemic stroke aged 18 to 45 years, and followed them up, as part of the multicentre Italian Project on Stroke in Young Adults.
Article Synopsis
- The study aimed to evaluate the risks of recurrent ischemic events and severe bleeding in patients with acute posterior ischemic stroke (PS) and atrial fibrillation (AF) in relation to oral anticoagulant therapy (OAT) and timing of initiation.
- Researchers compared outcomes in 473 patients with PS to 1997 patients with anterior stroke (AS), focusing on events within 90 days of the initial stroke.
- Findings indicated that both PS and AS patients had similar risks of ischemic or hemorrhagic events at 90 days, regardless of when OAT was initiated.
Background And Purpose: Observational studies have suggested a link between fibromuscular dysplasia and spontaneous cervical artery dissection (sCeAD). However, whether patients with coexistence of the two conditions have distinctive clinical characteristics has not been extensively investigated.
Methods: In a cohort of consecutive patients with first-ever sCeAD, enrolled in the setting of the multicenter IPSYS CeAD study (Italian Project on Stroke in Young Adults Cervical Artery Dissection) between January 2000 and June 2019, we compared demographic and clinical characteristics, risk factor profile, vascular pathology, and midterm outcome of patients with coexistent cerebrovascular fibromuscular dysplasia (cFMD; cFMD+) with those of patients without cFMD (cFMD-).
Article Synopsis
- The study investigates when it's best to start oral anticoagulants after an ischemic stroke caused by atrial fibrillation, particularly focusing on patients who received thrombolysis or thrombectomy.
- It combines data from two studies conducted between 2012 and 2016, analyzing patients treated with either Vitamin K antagonists or non-vitamin K oral anticoagulants for secondary stroke prevention.
- Among 2159 patients included, the timing for starting anticoagulants was similar for those treated with reperfusion therapies and those not treated, with low rates of stroke or bleeding complications observed within 90 days.
Long-term consequences of cervical artery dissection (CeAD), a major cause of ischemic stroke in young people, have been poorly investigated. The Italian Project on Stroke at Young Age - Cervical Artery Dissection (IPSYS CeAD) project is a multicenter, hospital-based, consecutively recruiting, observational, cohort study aimed to address clinically important questions about long-term outcome of CeAD patients, which are not covered by other large-scale registries. Patients with radiologically diagnosed CeAD were consecutively included in the registry.
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- Migraine may increase the size of cerebral infarcts (areas of dead tissue due to lack of blood flow) in humans, similar to findings in animal studies.
- In a study of 591 patients with acute ischemic stroke, those with migraines had significantly larger infarct volumes compared to non-migraine sufferers, especially those with migraine with aura.
- The results suggest that migraine could make individuals more susceptible to severe brain injury during ischemic events, indicating a need for further research in this area.
Article Synopsis
- - This study investigates ischemic cerebrovascular events in patients with nonvalvular atrial fibrillation (AF) who are being treated with non-vitamin K antagonist oral anticoagulants (NOACs) to identify risk factors and understand the underlying mechanisms.
- - The research involved 713 patients who experienced ischemic strokes or transient ischemic attacks while on NOACs, and 700 who did not, revealing significant associations between these events and factors like low NOAC dosage, atrial enlargement, hyperlipidemia, and higher CHADS-VASc scores, which indicate greater stroke risk.
- - Findings suggest that while most strokes in this population were of cardioembolic origin, other factors such as being older,
Article Synopsis
- * Researchers analyzed data from 1,810 patients, discovering that 20% underwent this bridging therapy, and found that bridged patients had worse outcomes, with a higher rate of ischemic events and major bleeding.
- * The results indicate that bridging therapy significantly raises the risk of early complications compared to patients who did not receive it, prompting a reevaluation of its common use in clinical practice.
Introduction: Best medical treatments of ischemic stroke are admission to stroke unit, intravenous thrombolysis and, in selected cases, thrombectomy. Time from symptom onset to interventions is the best predictor of clinical outcome. In order to verify the effectiveness of an active education programme of awareness on the knowledge of stroke, we performed a local campaign "on the field".
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- The study examined the link between types of atrial fibrillation (paroxysmal vs. sustained) and the occurrence of early ischaemic recurrences after an acute stroke in patients.
- Out of 2150 patients, those with sustained atrial fibrillation experienced a higher percentage of early ischaemic recurrences (6.2%) compared to those with paroxysmal atrial fibrillation (3.3%).
- However, after considering other health risks, sustained atrial fibrillation did not show a significantly increased risk for early recurrence, suggesting that other factors may be more influential.
Background In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation ( HT ). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT , (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset.
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