المؤلفون: Uhe, Tobias, Wasser, Katrin, Prettin, Christiane, Probst, Mareike, Essa, Hisham, Frank, Benedikt, Stolte, Benjamin, Milles, Lennart, Soda, Hassan, Hiermann, Erich, Rascher, Renate Weinhardt Alexandra, Stan, Marius, Kääb, Stefan, Michalski, Dominik, Kellert, Lars, Dimitriadis, Konstantinos, Kopczak, Anna, Küster, Bettina, Sinner, Moritz, Steiger, Ignaz, Kaffe, Maria, Clauß, Sebastian, Janowitz, Daniel, Thaler, Raffael, Kraft, Andrea, Schellinger, Peter, Glahn, Jörg, Schubert, Jan, Jenniges, Simone, Markmann-Boenke, Silke, Putzer, Anne-Sophie, Straeten, Michael Schwarze Vera, Wiemer, Marcus, Kallmünzer, Bernd, Macha, Kosmas, Etgen, Thorleif, Haupenthal, David, Balk, Stefanie, Kossel, Clara-Sophie, Häusler, Georg, Lehrieder, Dominik, Cidlinsky, Peter, Hametner, Christian, Vogl, Christine, Fischer, Thomas, Huttelmaier, Moritz, Schellinger, Peter D., Nordbeck, Octavian Maniuc Peter, von Hardenberg, Albrecht, Jünemann, Martin, Braun, Tobias, Viard, Maxime, Gerner, Stefan, Omar, AlHaj, Genau, Sonja, Olbricht, Linus, Wassenberg, Matthias, Langguth, Niklas, Fräbel, Christian, Baumgart, Romy, Kalra, Love-Preet, Diel, Norma, Hoffmann, Frank, Schönmuth, Bettine, Giebler, Anja, Weber, Lorenz, Bethke, Florian, Grond, Martin, Birringer, Jan, Lichte-Schneider, Sandra, Hütwohl, Daniela, Krause, Lars Udo, Petersen, Martina, Althaus, Katharina, Kirchmeier, Konstantin, Novikova, Liubov, Müller, Susanne, Ertl, Michael, Schellong, Sebastian, Brudzinski, Mirko, Gerk, Ulrich, Palisch, Holger, Heinzel, Frank R., Fett, Jana, Suntha, Avinash, Burian, Katja, Schmitz, Bettina, Gutwinski, Anna, Angermüller, Veronika, Alhammoud, Tameem, Cakiroglu, Hüsniye, Bach, Ullrich, Nabavi, Darius, Offermann, Jens, Crome, Olaf, Dimitrijeski, Boris, Meincke, Carsten, Hamann, Gerhard, Alber, Burkhard, Müller, Robert, Pallesen, Lars-Peder, Pütz, Volker, Hartmann, Christian, Berrouschot, Jörg, Stoll, Anett, Keilitz, Janina, Klunk, Dietrich, Voigt, Roman, Weber-Krüger, Mark, Kastrup, Andreas, Schröter, Andreas, Schmucker, Johannes, Pfeilschifter, Waltraud, Krämer, Christoffer, Wiemers, Milena, Simon, Micha, Finke, Alexander, Weiß, Christian, Hobohm, Carsten, Hamann, Gerhard F., Naupold, Katrin, Bley-Renning, Karen, Winter, Sabrina, Poli, Sven, Mengel, Annerose, Poli, Khouloud, Expósito, Alexandra Gómez, Mbroh, Joshua, Tieck, Maria, Rosenkranz, Michael, Mende, Meinhard, Boskamp, Stefan, Ritter, Nicolas, Seibel, Lena, Schöps, Christian, Ketzler, Rebecca, Nägele, Herbert, Sydow, Karsten, Kurka, Natalia, Schäfer, Jan Hendrik, Charisse, Daniel, Wagner, Marcus, Gruber, Katharina, Kohlhase, Konstantin, Lieschke, Franziska, Operhalski, Felix, Seiler, Alexander, Petzold, Gabor, Bode, Felix Jürgen, Stösser, Sebastian, Meißner, Julius, Ebrahimi, Taraneh, Gröschel, Sonja, Nordsiek, Julia, Beckonert, Niklas, Weissenborn, Karin, Große, Gerrit Maximilian, Worthmann, Hans, Hennemann, Ann-Katrin, Jochmann, Svenja, Gründahl, Julius, Al-Ayoubi, Jana, Ernst, Johanna, Uphaus, Timo, Bähr, Oliver, Gruber, Herbert, Benesch, Sonka, Pollinger, Thomas, Alachkar, Nawar, Busch, Sonia, Butz, Steffi, Forkmann, Mathias, Mahnkopf, Christian, Mischke, Thomas, Gröschel, Klaus, Schnupp, Steffen, Thomalla, Götz, Deb-Chatterji, Milani, Cheng, Bastian, Gelderblom, Mathias, Hoppe, Julia, Jensen, Märit, Schell, Maximilian, Schlemm, Eckhard, Marquardt, Lars, Wachter, Rolf, Kazarians, Haiko, Rheingans, Pia Franziska, Hötzer, Kai, Rose, Dietmar, Neumann-Haefelin, Tobias, Berthel, Jörg, Alijaj, Lirim, Krug, Joachim, Niethammer, Margit, Szöllösi, Géza-Attila, Wachter , Rolf, Obermann, Marc, Adochitei, Nicoletta, Strik, Herwig, Lenz, Arne, Steigerwald, Frank, Müller, Jörg, Honermann, Martin, Burgstaller, Marian Christoph, Kollmar, Rainer, Rashid, Maryam, Ganai, Ahmad Ajaz, Ossendorf, Saric, Majda, Tischer, Karl-Heinz, Toluli, Adela, Wollenweber, Frank Arne, Rahban, Laya, Silva, Thais Portugal, Lee, Miri, Grosch, Matthias Julius, Schäbitz, Wolf-Rüdiger, Minnerup, Jens, Liman, Jan, Nückel, Martin, Böhm, Magdalena, Uhe , Tobias, Köhrmann, Martin, Dichgans, Martin, Hahn, Marianne, Zuhorn, Frederic, Wulff, Leonard, Plümer, Jorge, Kok, Lena, Janz, Marcel, Kitsiou, Alkisti, Gehmeyr, Julian, Dabbagh, Alhuda, Huber, Charlotte, Pelz, Johann, Wartenberg, Katja, Brachmann, Johannes, Seidel, Mirko, Flissakowski, Oscar, Goschenhofer, Anna, Hussain, Rabia-Basari, Kim, Ina, Kinze, Stephan, Kroneberger, Christian, Lingnau, Michale, Lischewski, Dennis, Muhn, Florian, Laufs, Ulrich, Rogge, Witold, Schieffer, Miriam, Setayesh-Roonizi, Anuscheh, Sparenberg, Paul, Schertel, Jill Marie, Ringleb, Peter, Purrucker, Jan, Berberich, Anne, Heyse, Miriam, Ungerer, Matthias, Bauer, Gregor, Reichardt, Christine, Ebel, Bernhard, Milanković-Eberl, Dragana, Schwarte, Olav, Höcherl, Constanze, Asch, Eric-Manuel, Bojtschuk, Luisa, Frey, Maximilian, Gelbrich, Götz, Dlouhy, Tomas, Zickler, Philipp Patrick, Beier, Barbara, Braadt, Lino-Dominic, Gabrielyan, Inessa, Kermer, Pawel, Kaste, Matthias, Anter, Ahmed, Stirbulescu, Corina, Petroff, David, Meleshchenco, Nataliia, Burgholte, Friederike, Lüers, Claus, Steiner, Thorsten, Cierpinski, Mari-Carmen, Lichti, Bonowski, Lars, Eid, Hassan Abou, Vajda-Medina, Esteban

المصدر: American heart journal 265, 66 - 76 (2023). doi:10.1016/j.ahj.2023.06.016

مصطلحات موضوعية: info:eu-repo/classification/ddc/610, Humans, Infant, Atrial Fibrillation: complications, Atrial Fibrillation: diagnosis, Ischemic Stroke, Furylfuramide, Prospective Studies, Stroke: etiology, Stroke: prevention & control, Stroke: diagnosis, Electrocardiography, Ambulatory: methods, Embolism: diagnosis, Embolism: etiology, Embolism: prevention & control

جغرافية الموضوع: DE

الوصف: Atrial fibrillation (AF) is one of the most frequent causes of stroke. Several randomized trials have shown that prolonged monitoring increases the detection of AF, but the effect on reducing recurrent cardioembolism, ie, ischemic stroke and systemic embolism, remains unknown. We aim to evaluate whether a risk-adapted, intensified heart rhythm monitoring with consequent guideline conform treatment, which implies initiation of oral anticoagulation (OAC), leads to a reduction of recurrent cardioembolism.Find-AF 2 is a randomized, controlled, open-label parallel multicenter trial with blinded endpoint assessment. 5,200 patients ≥ 60 years of age with symptomatic ischemic stroke within the last 30 days and without known AF will be included at 52 study centers with a specialized stroke unit in Germany. Patients without AF in an additional 24-hour Holter ECG after the qualifying event will be randomized in a 1:1 fashion to either enhanced, prolonged and intensified ECG-monitoring (intervention arm) or standard of care monitoring (control arm). In the intervention arm, patients with a high risk of underlying AF will receive continuous rhythm monitoring using an implantable cardiac monitor (ICM) whereas those without high risk of underlying AF will receive repeated 7-day Holter ECGs. The duration of rhythm monitoring within the control arm is up to the discretion of the participating centers and is allowed for up to 7 days. Patients will be followed for at least 24 months. The primary efficacy endpoint is the time until recurrent ischemic stroke or systemic embolism occur.The Find-AF 2 trial aims to demonstrate that enhanced, prolonged and intensified rhythm monitoring results in a more effective prevention of recurrent ischemic stroke and systemic embolism compared to usual care.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/pmid:37422010; info:eu-repo/semantics/altIdentifier/issn/0002-8703; info:eu-repo/semantics/altIdentifier/issn/1097-6744; https://pub.dzne.de/record/259702Test; https://pub.dzne.de/search?p=id:%22DZNE-2023-00774%22Test

الإتاحة: https://doi.org/10.1016/j.ahj.2023.06.016Test
https://pub.dzne.de/record/259702Test
https://pub.dzne.de/search?p=id:%22DZNE-2023-00774%22Test

المؤلفون: Diel, Norma J., Gerner, Stefan T., Alhaj Omar, Omar, Kalder, Johannes, Manz, Enikö, Keschenau, Paula R., Struffert, Tobias, Brueckner, Thomas, Huttner, Hagen B., Doeppner, Thorsten R.

المساهمون: Justus-Liebig-Universität Gießen

المصدر: Neurological Research and Practice ; volume 5, issue 1 ; ISSN 2524-3489

مصطلحات موضوعية: Neurology (clinical), Neurology

الوصف: Background Endovascular thrombectomy (EVT) is highly effective in acute stroke patients with intracranial large vessel occlusion (LVO), however, presence of concomitant cervical occlusion of the internal carotid artery (ICA) may limit the endovascular access. This study describes feasibility and efficacy of a surgical carotid access (cutdown) to perform interdisciplinary recanalization therapy including carotid endarterectomy (CEA) followed by EVT for recanalization of intracranial LVO in stroke patients with tandem occlusions. Methods We identified stroke patients with tandem occlusions who underwent a combined surgical-endovascular approach over a 5-year period. Surgical cutdown was provided by a cardiovascular surgery team at the angio-suite followed by EVT performed by the neuroradiological team. Demographics, stroke characteristics, treatments including antithrombotic management, procedure times, and clinical follow-up were assessed. Results Four patients with acute stroke because of tandem occlusions received CEA followed by EVT (two patients after frustrating femoral catheterization, two as first-line approach). Successful recanalization (TICI ≥ 2b) via endovascular thrombectomy was achieved in all patients at a median of 28 min after successful surgical CEA. Intraprocedural complication was observed in one case (25%; i.e. ICA dissection). Conclusions This small study provides evidence that a combined interdisciplinary approach of CEA followed by EVT in the angio-suite in acute stroke patients with tandem occlusions is a feasible procedure in patients otherwise not accessible to endovascular recanalizing therapy and, therefore, high likelihood of developing large hemispheric infarction. Prospective data are warranted to identify patients who benefit from this combined approach as first-line therapy.

الإتاحة: https://doi.org/10.1186/s42466-023-00290-4Test

المؤلفون: Diel, Norma J., Gerner, Stefan T., Doeppner, Thorsten R., Juenemann, Martin, Maxhuni, Toska, Frühwald, Tobias, Worm, Andre, Alhaj Omar, Omar, Lytvynchuk, Lyubomyr, Struffert, Tobias, Bauer, Pascal, Huttner, Hagen B.

المصدر: Neurological Research & Practice; 5/16/2024, Vol. 6 Issue 1, p1-10, 10p

مصطلحات موضوعية: RETINAL artery, RETINAL artery occlusion, BLINDNESS, ISCHEMIC stroke, TREATMENT effectiveness, MONOCULAR vision

مستخلص: Background: Retinal artery occlusions lead to sudden, painless vision loss, affecting millions globally. Despite their significance, treatment strategies remain unestablished, contrasting with acute ischemic stroke (AIS), where IVT has proven efficacy. Similar to AIS, retinal artery occlusions demand urgent evaluation and treatment, reflecting the principle "time is retina". Even for patients with transient monocular vision loss, also known as amaurosis fugax (AF), pertinent guidelines meanwhile recommend immediate emergency assessment in a specialized facility. However, data on the clinical benefit and comparability with persistent occlusions are missing. This study aimed to compare the results of a comprehensive stroke-workup among patients with persistent retinal artery occlusions (RAO), including both central retinal (CRAO) and branch retinal artery occlusion (BRAO) and those with AF. Methods: Conducted at the University Hospital Giessen, Germany, this exploratory cross-sectional study enrolled patients with transient or permanent unilateral vision loss of non-arteritic origin. The primary outcome were differences between the two groups RAO and AF with regard to cardiovascular risk profiles and comorbidities, vascular and pharmacological interventions and clinical neurological and ophthalmological outcomes. Secondary outcome was a sub-group analysis of patients receiving IVT. Results: Out of 166 patients assessed, 76 with RAO and 40 with AF met the inclusion criteria. Both groups exhibited comparable age, gender distribution, and cardiovascular risk profiles. Notably, RAO patients did not show significantly more severe vascular comorbidities than AF patients. However, AF patients received vascular interventions more frequently. Pharmacological intervention rates were similar across groups. RAO patients had slightly worse neurological outcomes, and IVT did not yield favorable ophthalmological outcomes within any observed patients. Conclusion: The study found similar vascular burden and risk factors in patients with RAO and AF, with implications for clinical workflows. IVT for RAO may only be effective in very early treatment windows. This emphasizes the need for public awareness and collaborative protocols between ophthalmologists and neurologists to improve outcomes. [ABSTRACT FROM AUTHOR]

: Copyright of Neurological Research & Practice is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Alhaj Omar, Omar, Diel, Norma J, Gerner, Stefan T, Mück, Anna, Huttner, Hagen B, Krämer-Best, Heidrun H

المصدر: Case Rep Neurol Med ; ISSN:2090-6668 ; Volume:2024

الوصف: Myasthenic crises (MC) are potentially life-threatening acute exacerbations of myasthenia gravis (MG) characterized by profound muscle weakness, bulbar symptoms, and potential for respiratory failure. Intravenous immunoglobulins (IVIG) and plasma exchange (PLEX) are conventional treatments for myasthenic exacerbations. Recently, new therapeutic options for generalized acetylcholine-receptor antibody positive (AchR+) MG were approved as an add-on therapy. They mainly consist of complement C5 inhibitors such as eculizumab and ravulizumab and neonatal Fc receptor antagonists such as efgartigimod with the approval of more options pending, e.g., zilucoplan and rozanolixizumab. More therapeutic options are in the pipeline. Although the data show a quick and reliable treatment response, these medications have not been studied for the therapy of myasthenic crisis. We present the case of a 57-year-old male with his first episode of generalized myasthenia gravis (MG) and positive acetylcholine-receptor antibodies (AchR+) who was transferred to our neurological intensive care unit with worsening generalized weakness, dysphagia, and respiratory distress. The crisis was triggered by pneumonia due to dysphagia. He was diagnosed with myasthenic crisis and treated with intravenous pyridostigmine, plasmapheresis (PLEX), and continued prednisone. Initial improvement was followed by deterioration, requiring readmission and additional PLEX. After a further decline, efgartigimod was administered, leading to significant improvement within 48 hours, as evidenced by reduced MG-ADL and QMG scores. The patient continued to improve and was stable enough for transfer to a rehabilitation facility. This case illustrates the potential of efgartigimod as a novel treatment for refractory myasthenic crises.

العلاقة: https://doi.org/10.1155/2024/9455237Test; https://pubmed.ncbi.nlm.nih.gov/38939234Test; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211016Test/

الإتاحة: https://doi.org/10.1155/2024/9455237Test
https://pubmed.ncbi.nlm.nih.gov/38939234Test
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211016Test/