P Wave Dispersion and Silent Atrial Fibrillation in Cryptogenic Stroke: The Pathogenic Role of Inflammation.

Background: Cryptogenic stroke (CS) represents 25% of ischemic strokes. Especially after CS, the detection of atrial fibrillation (AF) is important because it provides clues to the mechanism of stroke. However, the relationship between AF and stroke appears more complex than a simple cause-effect mechanism, suggesting that the association between AF and stroke may be due to other systemic and atrial factors including systemic inflammation that may lead to atrial remodeling and subsequent atrial cardiopathy.

Electrocardiographic Predictors of Silent Atrial Fibrillation in Cryptogenic Stroke.

Background: Prolonged screening for the presence of atrial fibrillation (AF) is recommended after cryptogenic stroke (CS) and different electrocardiographic markers of atrial cardiopathy have been proposed as tools to identify patients at high-risk for AF.

Aim: The aim of this study was to evaluate the relationship between different electrocardiographic parameters and in-hospital AF occurrence after acute CS.

Method: In total, 222 patients with CS underwent 12-lead resting electrocardiogram (ECG) at admission and 7-day in-hospital ECG monitoring in order to evaluate the possible occurrence of silent AF.

Efficacy of an ethyl alcohol gel in symptomatic disc herniation.

Purpose: To evaluate the clinical outcome of DiscoGel® chemonucleolysis for symptomatic disc herniation in patients who fail conservative treatment.

Material And Methods: Consecutive patients with symptomatic disc herniation confirmed on MRI who failed conservative management for at least 6 months were included. Visual analogue scale (VAS), Oswestry Disability Index (ODI) scores, and analgesic use were recorded at baseline, and 12 months after treatment.

Steroids Spinal Injections.

Spinal pain is a common condition leading to significant disability and high cost. Spinal injections have been demonstrated to be effective short-term treatments with cost-utility superior to numerous other treatments, including surgical procedures. Appropriate patient selection-based on clinical and imaging finding-and the use of image guidance associated with technical precautions improve the safety and effectiveness of spinal injection and overall patient outcomes.

Identification of a panel of cytokines in neonates with hypoxic ischemic encephalopathy treated with hypothermia.

Purpose: Inflammation is a crucial but understudied mechanism of neuronal injury after hypoxia-ischemia. The aim was to identify a panel of cytokines involved in brain injury in neonates with hypoxic ischemic encephalopathy (HIE).

Methods: Ten newborns with HIE undergoing to therapeutic hypothermia (TH, HIE Group) and 8 healthy newborns (CTRL Group) were enrolled.

Atrial Cardiopathy and Sympatho-Vagal Imbalance in Cryptogenic Stroke: Pathogenic Mechanisms and Effects on Electrocardiographic Markers.

Recently, atrial cardiopathy has emerged as possible pathogenic mechanism in cryptogenic stroke and many electrocardiographic (ECG) markers have been proposed in order to detect an altered atrial substrate at an early stage. The autonomic nervous system (ANS) plays a well-known role in determining significant and heterogeneous electrophysiological changes of atrial cardiomyocytes, that promote atrial fibrillation episodes in cardioembolic stroke. Conversely, the role of ANS in atrial cardiopathy and cryptogenic stroke is less known, as well as ANS effects on ECG markers of atrial dysfunction.

Inflammation and Atrial Electrical Remodelling in Patients With Embolic Strokes of Undetermined Source.

Background: About one third of ischaemic strokes are classified as embolic strokes of undetermined source (ESUS). A silent atrial fibrillation (AF) may play a pathogenic role in these strokes and P wave dispersion (PWD), representing an electrocardiographic (ECG) predictor for paroxysmal AF, thereby a potential marker of covert cardioembolism, was found to be increased in cryptogenic stroke. Furthermore, current evidence links AF to inflammation: inflammatory markers, such as high-sensitive C-reactive protein (hsCRP), have been related to the development and persistence of AF, possibly by promoting atrial remodelling.

Impaired Cerebral Perfusion in Multiple Sclerosis: Relevance of Endothelial Factors.

Magnetic resonance imaging techniques measuring in vivo brain perfusion and integrity of the blood-brain barrier have developed rapidly in the past decade, resulting in a wide range of available methods. This review first discusses their principles, possible pitfalls, and potential for quantification and outlines clinical application in neurological disorders. Then, we focus on the endothelial cells of the blood-brain barrier, pointing out their contribution in regulating vascular tone by production of vasoactive substances.

Covered versus uncovered self-expandable metal stent for palliation of primary malignant extrahepatic biliary strictures: a randomized multicenter study.

Background And Aims: Self-expandable metal stents (SEMSs) are used to relieve malignant biliary obstructions. We aimed to compare stent patency, the adverse events rate, and overall survival of covered versus uncovered self-conformable metal stents in patients with primary malignant extrahepatic biliary strictures, not eligible for surgery.

Methods: This is a multicenter randomized trial analyzing 158 patients with inoperable distal malignant biliary obstruction conducted in 5 Italian referral centers between December 2014 and October 2016.

Increased Arterial Stiffness is Associated with Poor Collaterals in Acute Ischemic Stroke from Large Vessel Occlusion.

Background: Cerebral collateral circulation is a network of arterial anastomotic channels capable of providing supplementary perfusion to brain regions in response to ischemic insults. Arterial stiffness could negatively affect collateral circulation development, by means of its effects on the structural intracerebral vasculature.

Objective: The aim of our study is to investigate a possible link between arterial stiffness and presence of collateral circulation in patients with acute ischemic stroke.

Previous use of Statins and Atrial Electrical Remodeling in Patients with Cryptogenic Stroke.

Background: In the general population the leading cause of cardioembolic stroke is atrial fibrillation (AF). A silent AF is also the possible cause of many cryptogenic strokes. P wave dispersion (PWD), a predictor of AF, has been proposed as a marker of silent AF occurrence in these strokes.

Increased arterial stiffness is an independent risk factor for hemorrhagic transformation in ischemic stroke undergoing thrombolysis.

Background: Hemorrhagic transformation (HT) is a multifactorial phenomenon and represents a possible complication of ischemic stroke, especially after thrombolytic treatment. Increased arterial stiffness has been associated with intracranial hemorrhage, but there is no evidence of association with HT after thrombolytic therapy. The aim of our study is to investigate a possible link between arterial stiffness and HT occurrence after thrombolytic therapy in patients with ischemic stroke.

C reactive protein in healthy term newborns during the first 48 hours of life.

Background: Early-onset neonatal sepsis (EOS) is a serious and potentially life-threatening disease in newborns. C reactive protein (CRP) is the most used laboratory biomarker for the detection of EOS. Little is known about normal reference values of CRP during the perinatal period as several factors are able to influence it.

Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study.

Objective/background: Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.

Oxygen Use in Neonatal Care: A Two-edged Sword.

In the neonatal period, the clinical use of oxygen should be taken into consideration for its beneficial and toxicity effects. Oxygen toxicity is due to the development of reactive oxygen species (ROS) such as OH that is one of the strongest oxidants in nature. Of note, generation of ROS is a normal occurrence in human and it is involved in a myriad of physiological reactions.

Neuroimaging of the Postoperative Spine.

Operative treatments of the spine are becoming increasingly more common for the availability of a wide range of surgical and minimally invasive procedures. MR imaging allows for excellent evaluation of both normal and abnormal findings in the postoperative spine. This article provides the basic tools to evaluate complications after different operative procedures and offers an overview on the main topics a radiologist may encounter during his or her professional carrier.

Ischemic Stroke after Heart Transplantation.

Cerebrovascular complications after orthotopic heart transplantation (OHT) are more common in comparison with neurological sequelae subsequent to routine cardiac surgery. Ischemic stroke and transient ischemic attack (TIA) are more common (with an incidence of up to 13%) than intracranial hemorrhage (2.5%).

Alteration of serum lipid profile, SRB1 loss, and impaired Nrf2 activation in CDKL5 disorder.

CDKL5 mutation is associated with an atypical Rett syndrome (RTT) variant. Recently, cholesterol homeostasis perturbation and oxidative-mediated loss of the high-density lipoprotein receptor SRB1 in typical RTT have been suggested. Here, we demonstrate an altered lipid serum profile also in CDKL5 patients with decreased levels of SRB1 and impaired activation of the defensive system Nrf2.

Early relapsing calcified cerebral embolism.

Calcified cerebral emboli are rarely reported, but may be recurrent and devastating. Misdiagnosis at interpretation of initial brain computed tomography (CT) scan may occur in up to 27% of cases. The purpose of this case report was to describe clinical, CT, and CT angiography findings in a 79-year-old woman undergoing early recurrent stroke from calcified cerebral embolism.