Anna Czlonkowska - Academia.edu (original) (raw)
Papers by Anna Czlonkowska
International Journal of Stroke, Sep 2, 2010
1 Luijckx GJ, Ukachoke C, Limapichat K, Heuts-van Raak EP, Lodder J. Brain: infarct causes under ... more 1 Luijckx GJ, Ukachoke C, Limapichat K, Heuts-van Raak EP, Lodder J. Brain: infarct causes under the age of 50; a comparison between an East-Asian (Thai) and a Western (Dutch) hospital series. J Clin Neurol Neurosurg 1993; 95:199–203. 2 Adams HP, Bendixen BH, Kappelle LJ et al. Classification of subtypes of acute ischaemic stroke. Definitions for use in a multicenter clinical trial. TOAST Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41. 3 Lee TH, Hsu WC, Chen CJ, Chen ST. Etiologic Study of young ischemic stroke in Taiwan. Stroke 2002; 33:1950–5. 4 Kwon SU, Kim JS, Lee JH, Lee MC. Ischemic stroke in Korean young adults. Acta Neurol Scand 2000; 101:19–24. 5 Awada A. Stroke in Saudi Arabian young adults: a study of 120 cases. Acta Neurol Scand 1994; 89:323–8.
International Journal of Clinical Practice, Oct 31, 2014
Acta Neurologica Scandinavica, Feb 20, 2014
The clinical usefulness of blood biomarkers in acute stroke is not yet fully established, especia... more The clinical usefulness of blood biomarkers in acute stroke is not yet fully established, especially after thrombolytic therapy. Our aim was to investigate the association between routine serum C-reactive protein (CRP) measured within 24 h after admission and outcome in ischaemic stroke patients treated with intravenous thrombolysis, adjusting for a history of recent infection. We analysed the data of consecutive stroke patients who received intravenous alteplase in our centre between October 2003 and December 2011, collected in a detailed prospective registry. Routine serum CRP was measured within 24 h from admission; concentration >5 ng/ml was considered elevated. Serum CRP was measured in 341 of 406 stroke patients treated with alteplase. Patients with elevated CRP (135/341, 42.5%) compared to those with normal CRP values, were significantly older, more frequently presented with a preexisting disability, comorbidities and suffered more severe strokes. They had a higher proportion of symptomatic intracranial haemorrhage according to ECASS II definition (7.2% vs 1.6%, P = 0.010), higher 3-month mortality (25.6% vs 11.3%, P = 0.001), and were less frequently alive and independent after 3 months (45.9% vs 63.7%, P = 0.002). However, those associations were not confirmed after adjustment for age, stroke severity, diabetes, congestive heart failure, lack of prestroke disability and signs of recent infection. According to our findings, elevated routine serum CRP measured within 24 h after admission does not seem to independently affect the outcome in patients receiving intravenous thrombolysis for stroke. However, further studies of blood samples taken directly before the treatment are needed.
Clinical and Applied Thrombosis-Hemostasis, Nov 8, 2011
Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine the frequency ... more Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine the frequency of DVT in patients with acute stroke, risk factors for its development, and its influence on the 3-month outcome. A total of 323 consecutive patients with acute stroke were enrolled. We performed ultrasound imaging within 7 days after stroke. Deep venous thrombosis was found in 8.7% of patients, only in those with ischemic stroke. Patients with DVT were more frequently female (71.4% vs 49.5%), had prestroke Modified Rankin scale (mRS) 3 to 5 (42.9% vs 15.3%), elevated C-reactive protein (CRP) serum level (65.4% vs 32.5%), and a trend toward elevated serum fibrinogen level (85.7% vs 70.1%; P ¼ .08). In a multivariate analysis, elevated CRP (odds ratio [OR] 3.15) and prestroke disability (OR 2.89) were independent risk factors for DVT. Deep venous thrombosis occurs in <10% of patients with acute stroke and does not significantly affect the 3-month outcome. Prestroke dependency and elevated CRP level at baseline are independent risk factors for DVT.
Journal of the Neurological Sciences, Oct 1, 2013
Background: Emotional well-being is closely related to health. A lot of medical illnesses are clo... more Background: Emotional well-being is closely related to health. A lot of medical illnesses are closely linked to disrupted mental health. Men with introvert personality are particularly at high risk of ischaemic stroke. Hypothesis/objective: Suppressed anger within the past 2 weeks is a risk for stroke. Patients with introvert personality are more likely to develop ischaemic stroke, whereas those with bad temper and recent rage outburst tend to present with intracranial haemorrhage. Patients and methods: Patients admitted to the ward with stroke (both ischaemic and haemorrhagic) were interviewed about whether they have suppressed anger over the past 2 weeks. Results: More than 50% of strokes admitted that they have suppressed anger or upset within the past 2 weeks. The suppressed anger intensified to maximum just 1-2 weeks prior to onset of the disease. In cryptogenic young stroke group who has no other medical risks, suppressed anger was clearly identified. Conclusion: Our findings suggest that suppressed anger is a clear risk for stroke. We hope that the public will become aware these finding. In order to prevent recurrent stroke, it is advisable not to suppress the anger and instead try to channel out the suppressed anger.
Journal of the Neurological Sciences, Oct 1, 2015
Pharmacotherapy in Psychiatry and Neurology
symptoms of WD are mainly symptoms of liver damage (from a mild increase in the activity of liver... more symptoms of WD are mainly symptoms of liver damage (from a mild increase in the activity of liver enzymes to liver failure) and the central nervous system (CNS) (mainly a wide spectrum of involuntary movements). The article aims to review currently proposed biomarkers of CNS damage in WD: 1) clinical; 2) structural (neuroimaging) and 3) molecular, including a proposal of their future role (prognostic, diagnostic or monitoring of response to treatment). Literature review. WD is one of the few metabolic diseases that can be treated if treatment is started early and is properly administered. Treatment of WD is based on drugs causing a negative copper balance in the body (drugs that chelate copper or zinc salts). Early diagnosis of the disease, early initiation of anti-copper therapy, regular monitoring of copper metabolism, evaluation of liver function and damage of central nervous system are essential for the good prognosis. We conducted a targeted literature review of articles in English available in PubMed, searching for "Wilson's disease", "biomarkers", "neurofilaments". Below we present summary of collected data. Conclusions. Despite treatment, 10% of patients with WD experience early neurological deterioration, 50% of patients with neurological symptoms show no improvement. New therapies of treatment for WD, possibilities of faster diagnosis and better monitoring of the treatment Review article / Artykuł poglądowy Biomarkers of the central nervous system injury in Wilson's disease Biomarkery uszkodzenia ośrodkowego układu nerwowego w chorobie Wilsona
Stroke, 2015
Introduction: Shorter door-to-needle time (DNT) improves treatment efficacy in acute ischemic str... more Introduction: Shorter door-to-needle time (DNT) improves treatment efficacy in acute ischemic stroke (AIS) patients. Still, there are groups of patients at increased risk of longer DNT. The goal of our study was to determine temporal trends of DNT. The second goal was to identify if baseline characteristics of patients treated with intravenous thrombolysis changed throughout the years and if such change (e.g. treating older patients) could have affected DNT. Methods: Prospectively collected data from the Safe Implementation of Treatments in Stroke - EAST (12 Central/Eastern European countries) registry between January 2005 and August 2013 were analyzed. Baseline patient characteristics over period 2005-2013 were analyzed descriptively and using ANOVA. DNT and association between DNT and the patient characteristics were analyzed using linear logistic regression. Obtained regression coefficients and descriptive statistics were used to simulate average DNT values in individual years du...
Neurologia i Neurochirurgia Polska, 2020
Aim of study. The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish... more Aim of study. The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish cohort the hypothesis that fluoxetine improves recovery after stroke. Clinical rationale for study. Some studies have suggested that fluoxetine may improve functional outcomes after stroke, but these results needed confirmation. Between 2012 and 2014, large clinical trials were initiated by the FOCUS Trial Collaboration. Recently, results from the UK, Sweden, Australia, New Zealand and Vietnam have been published. We here present the results of the FOCUS trial conducted in Poland. Material and methods. This was a randomised, double-blind, placebo-controlled study based on the FOCUS trial protocol. Patients who had a persisting neurological deficit were randomly assigned 2-15 days after stroke onset to receive for six months either fluoxetine 20 mg/day or a placebo. The primary outcome was functional status measured using the modified Rankin Scale (mRS) at six months after randomisation. Functional status at 12 months was also assessed, as was neurological deficit at six and 12 months. Data was also collected on adverse events. Results. Between 19 December 2014 and 13 March 2018, 30 patients were given fluoxetine and 31 were given a placebo. For the primary outcome, the distribution across mRS categories was similar for the fluoxetine and placebo groups at six months (common odds ratio 0.88; 95% confidence interval 0.31-2.50; p = 0.81), and there was no difference at 12 months (p = 0.864). There were no differences between groups in stroke recovery or in motor function recovery of the affected hand. There were no significant differences in any other secondary outcomes at six or 12 months. Patients given fluoxetine were less likely than those given the placebo to receive new antidepressant medication within six months (2 [6.67%] vs. 4 [12.90%]). Conclusions and clinical implications. Consistent with other trials based on the FOCUS protocol, fluoxetine did not improve motor recovery or general stroke outcome at six and 12 months in the Polish cohort studied. However, patients receiving fluoxetine required therapy with additional antidepressant medication less frequently.
The Lancet, 2021
Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent ... more Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.
Polski Przegląd Neurologiczny, 2019
Neurological Sciences, 2018
We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) popu... more We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) population based on a long-term prospective stroke registry. We retrospectively analyzed data collected in a detailed registry regarding consecutive patients admitted for first-ever ischemic stroke (IS) between January 2001 and December 2015. We used Org 10172 in Acute Stroke Treatment classification supplemented with ESUS criteria proposed by the Cryptogenic Stroke/ESUS International Working Group. Within the ESUS group, we additionally compared patients ≤ 60 and > 60 years of age. During the study period, there was a total of 3008 (1615 females and 1393 males) admissions of first-ever strokes. The most frequent cause was undetermined (38.7%), followed by cardioembolic (27.7%), large artery atherosclerosis (18.2%), small vessel disease (11.9%), and other determined (3.6%). We identified 326 patients as ESUS, which accounted for 10.8% of all strokes and 28% of strokes of undetermined etiology. ESUS patients were the youngest. Compared to all types of stroke but for those with small vessel disease, ESUS patients were most often independent before stroke and had the least severe neurological deficit at admission and the best outcome at discharge. ESUS patients ≤ 60 years were more frequently independent at discharge than ESUS patients > 60 years. Approximately 11% of patients from our registry met ESUS criteria. ESUS patients were younger when compared to all other stroke etiologies, suffered less severe strokes, and had more favorable outcome at discharge than other groups except for those with small vessel disease strokes.
European Journal of Neurology, 2017
Introduction: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in pa... more Introduction: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital (IHS) acute ischemic stroke (AIS) onset is associated with unfavourable functional outcomes at hospital discharge and in-hospital mortality compared to patients with outof-hospital stroke onset (OHS) treated with IVT. We sought to compare outcomes between IVT treated IHS and OHS patients by analysing propensity score matched (PSM) data from the SITS-EAST registry. Methods: We compared the following outcomes for all PSM patients: 1.symptomatic intracranial hemorrhage (sICH) defined with the SITS-MOST criteria, 2.favourable functional outcome Accepted Article This article is protected by copyright. All rights reserved. (FFO) defined as a modified Rankin Scale (mRS) score of 0-1 at three months, 3.Functional independence (FI) defined as a mRS score of 0-2 at three months, 4.3-month mortality. Results: Out of total 19,077 IVT-treated AIS patients, 196 IHS patients were matched to 5124 OHS patients, with no differences in all baseline characteristics (p>0.1). IHS had longer door-to-needle [90 min (60-140) vs. 65 (47-95), p<0.001] and door-to-imaging times [40 min (20-90) vs 24 (15-35), p<0.001] compared to OHS. No differences were detected in the rates of sICH (1.6% vs 1.9%, p=0.756), FFO (46.4% vs 42.3%, p=0.257), FI (60.7% vs. 60.0%,p=0.447) and mortality (14.3% vs 15.1%,p=0.764). The distribution of 3-month mRS-scores was similar in the two groups (p=0.273). Conclusions: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tPA delivery in patients with IHS.
Neurologia i Neurochirurgia Polska, 2017
Background: Medical complications often worsen the prognosis after stroke. Our aim was to investi... more Background: Medical complications often worsen the prognosis after stroke. Our aim was to investigate the association between particular noninfectious complications and hospital mortality of acute stroke patients admitted to an urban Polish stroke center, and changes in their occurrence from 1995 to 2015. Methods: This is a retrospective analysis of 5174 consecutive patients admitted for acute ischemic stroke or cerebral hemorrhage to a Polish urban stroke center between 1995 and 2015. The occurrence of complications was reported for years
Neurologia i neurochirurgia polska, Jan 5, 2017
Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a d... more Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47....
Neurologia i neurochirurgia polska
The aim of the study was to present our initial experience with the use of intravenous thrombolyt... more The aim of the study was to present our initial experience with the use of intravenous thrombolytic therapy in patients with acute ischaemic stroke in the 2nd Department of Neurology of the Institute of Psychiatry and Neurology in the years 2003-2007. The patients were selected and treated with recombinant tissue plasminogen activator (rt-PA, alteplase) according to the SITS-MOST (Safe Implementation of Thrombolysis in Stroke - Monitoring Study) protocol. We present the data on the first 100 patients treated with rt-PA in our department. The mean age of the treated patients was 67 years, the initial neurological deficit measured in the National Institutes of Health Stroke Scale (NIHSS) was 8 pts., the door-to-needle time was 82 minutes. At 3-month follow-up, 61% of patients had achieved modified Rankin scale score of 0-2. Fourteen percent had died within three months of stroke onset. We observed 2 symptomatic intracerebral haemorrhages and there were 17 cases of secondary asymptomat...
Neurologia i neurochirurgia polska
Recombinant tissue plasminogen activator (rt-PA, alteplase) for acute ischaemic stroke was provis... more Recombinant tissue plasminogen activator (rt-PA, alteplase) for acute ischaemic stroke was provisionally granted in Europe in 2002 and the granted license excluded many patient groups from treatment. Uncertainties about the balance of risk and benefit in several categories of patients still remain. The aim of the Third International Stroke Trial (IST-3) is to determine whether more patients can benefit from treatment. We present the rationale for the study and compare the characteristics of patients recruited to the study in Poland with those recruited in other countries. Patients recruited to IST-3 from May 5th 2000 to April 9th 2008 (in Poland from November 2nd 2003). We compared the baseline characteristics for patients recruited in Poland and other countries. 1118 patients were recruited, 179 from centres in Poland and 939 from other countries. There was no significant difference between Poland and other countries in mean age (73.0 vs. 74.7 years), or distribution of gender (53....
Bioelectromagnetics, Jan 23, 2015
Wilson's disease (WD) is a metabolic brain disease resulting from improper copper metabolism.... more Wilson's disease (WD) is a metabolic brain disease resulting from improper copper metabolism. Although pyramidal symptoms are rarely observed, subclinical injury is highly possible as copper accumulates in all brain structures. The usefulness of motor evoked potentials (MEPs) in pyramidal tracts damage evaluation still appears to be somehow equivocal. We searched for original papers assessing the value of transcranial magnetic stimulation elicited MEPs with respect to motor function of upper and lower extremity in WD. We searched PubMed for original papers evaluating use of MEPs in WD using key words: "motor evoked potentials Wilson's disease" and "transcranial magnetic stimulation Wilson's disease." We found six articles using the above key words. One additional article and one case report were found while viewing the references lists. Therefore, we included eight studies. Number of patients in studies was low and their clinical characteristic was va...
Neurologia i neurochirurgia polska
Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of ... more Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of the study was to assess the potential eligibility of patients for intravenous recombinant tissue plasminogen activator (rt-PA). We also investigated whether widespread information about stroke and organisational changes in the 2nd Department of Neurology influenced eligibility and the number of treated patients. An analysis of the 2nd Department of Neurology of the Institute of Psychiatry and Neurology database of stroke patients admitted in the years 1995-2003 and 2003-2005 was performed. Eligibility for rt-PA treatment was assessed using the criteria outlined by the SITS (Safe Implementation of Thrombolysis in Stroke) protocol. The number of patients eligible for thrombolysis was estimated and then compared with the number of treated patients. A total of 1541 patients with ischaemic stroke were admitted between 1 June 1995 and 1 November 2003, 18.7% within 2 hours of onset, 78% aged un...
Neurologia i neurochirurgia polska, 2003
Stroke morbidity increases with age. That is the reason why it affects especially the middle aged... more Stroke morbidity increases with age. That is the reason why it affects especially the middle aged and elderly. Life expectancy is longer for females than males by 10 years, that is why stroke is a major problem in women. Women die twice more frequently from stroke than men (16% vs. 8%). Stroke risk factors are basically the same in spite of gender. The most important are hypertension, diabetes, dyslipidaemia, atrial fibrillation, coronary heart disease, previous stroke, smoking, alcohol abuse, obesity and lack of physical activity. Their impact, however, is different in males and females. Women with diabetes, atrial fibrillation, myocardial infarction, obese, drinking excessive amounts of alcohol and smoking are more likely to suffer of stroke than males with the same burden. A less favourable outcome after stroke has been observed in female patients--higher mortality rates and disability. It is possible that poor prognosis is related to a drop in blood estrogen concentration after ...
International Journal of Stroke, Sep 2, 2010
1 Luijckx GJ, Ukachoke C, Limapichat K, Heuts-van Raak EP, Lodder J. Brain: infarct causes under ... more 1 Luijckx GJ, Ukachoke C, Limapichat K, Heuts-van Raak EP, Lodder J. Brain: infarct causes under the age of 50; a comparison between an East-Asian (Thai) and a Western (Dutch) hospital series. J Clin Neurol Neurosurg 1993; 95:199–203. 2 Adams HP, Bendixen BH, Kappelle LJ et al. Classification of subtypes of acute ischaemic stroke. Definitions for use in a multicenter clinical trial. TOAST Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41. 3 Lee TH, Hsu WC, Chen CJ, Chen ST. Etiologic Study of young ischemic stroke in Taiwan. Stroke 2002; 33:1950–5. 4 Kwon SU, Kim JS, Lee JH, Lee MC. Ischemic stroke in Korean young adults. Acta Neurol Scand 2000; 101:19–24. 5 Awada A. Stroke in Saudi Arabian young adults: a study of 120 cases. Acta Neurol Scand 1994; 89:323–8.
International Journal of Clinical Practice, Oct 31, 2014
Acta Neurologica Scandinavica, Feb 20, 2014
The clinical usefulness of blood biomarkers in acute stroke is not yet fully established, especia... more The clinical usefulness of blood biomarkers in acute stroke is not yet fully established, especially after thrombolytic therapy. Our aim was to investigate the association between routine serum C-reactive protein (CRP) measured within 24 h after admission and outcome in ischaemic stroke patients treated with intravenous thrombolysis, adjusting for a history of recent infection. We analysed the data of consecutive stroke patients who received intravenous alteplase in our centre between October 2003 and December 2011, collected in a detailed prospective registry. Routine serum CRP was measured within 24 h from admission; concentration >5 ng/ml was considered elevated. Serum CRP was measured in 341 of 406 stroke patients treated with alteplase. Patients with elevated CRP (135/341, 42.5%) compared to those with normal CRP values, were significantly older, more frequently presented with a preexisting disability, comorbidities and suffered more severe strokes. They had a higher proportion of symptomatic intracranial haemorrhage according to ECASS II definition (7.2% vs 1.6%, P = 0.010), higher 3-month mortality (25.6% vs 11.3%, P = 0.001), and were less frequently alive and independent after 3 months (45.9% vs 63.7%, P = 0.002). However, those associations were not confirmed after adjustment for age, stroke severity, diabetes, congestive heart failure, lack of prestroke disability and signs of recent infection. According to our findings, elevated routine serum CRP measured within 24 h after admission does not seem to independently affect the outcome in patients receiving intravenous thrombolysis for stroke. However, further studies of blood samples taken directly before the treatment are needed.
Clinical and Applied Thrombosis-Hemostasis, Nov 8, 2011
Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine the frequency ... more Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine the frequency of DVT in patients with acute stroke, risk factors for its development, and its influence on the 3-month outcome. A total of 323 consecutive patients with acute stroke were enrolled. We performed ultrasound imaging within 7 days after stroke. Deep venous thrombosis was found in 8.7% of patients, only in those with ischemic stroke. Patients with DVT were more frequently female (71.4% vs 49.5%), had prestroke Modified Rankin scale (mRS) 3 to 5 (42.9% vs 15.3%), elevated C-reactive protein (CRP) serum level (65.4% vs 32.5%), and a trend toward elevated serum fibrinogen level (85.7% vs 70.1%; P ¼ .08). In a multivariate analysis, elevated CRP (odds ratio [OR] 3.15) and prestroke disability (OR 2.89) were independent risk factors for DVT. Deep venous thrombosis occurs in <10% of patients with acute stroke and does not significantly affect the 3-month outcome. Prestroke dependency and elevated CRP level at baseline are independent risk factors for DVT.
Journal of the Neurological Sciences, Oct 1, 2013
Background: Emotional well-being is closely related to health. A lot of medical illnesses are clo... more Background: Emotional well-being is closely related to health. A lot of medical illnesses are closely linked to disrupted mental health. Men with introvert personality are particularly at high risk of ischaemic stroke. Hypothesis/objective: Suppressed anger within the past 2 weeks is a risk for stroke. Patients with introvert personality are more likely to develop ischaemic stroke, whereas those with bad temper and recent rage outburst tend to present with intracranial haemorrhage. Patients and methods: Patients admitted to the ward with stroke (both ischaemic and haemorrhagic) were interviewed about whether they have suppressed anger over the past 2 weeks. Results: More than 50% of strokes admitted that they have suppressed anger or upset within the past 2 weeks. The suppressed anger intensified to maximum just 1-2 weeks prior to onset of the disease. In cryptogenic young stroke group who has no other medical risks, suppressed anger was clearly identified. Conclusion: Our findings suggest that suppressed anger is a clear risk for stroke. We hope that the public will become aware these finding. In order to prevent recurrent stroke, it is advisable not to suppress the anger and instead try to channel out the suppressed anger.
Journal of the Neurological Sciences, Oct 1, 2015
Pharmacotherapy in Psychiatry and Neurology
symptoms of WD are mainly symptoms of liver damage (from a mild increase in the activity of liver... more symptoms of WD are mainly symptoms of liver damage (from a mild increase in the activity of liver enzymes to liver failure) and the central nervous system (CNS) (mainly a wide spectrum of involuntary movements). The article aims to review currently proposed biomarkers of CNS damage in WD: 1) clinical; 2) structural (neuroimaging) and 3) molecular, including a proposal of their future role (prognostic, diagnostic or monitoring of response to treatment). Literature review. WD is one of the few metabolic diseases that can be treated if treatment is started early and is properly administered. Treatment of WD is based on drugs causing a negative copper balance in the body (drugs that chelate copper or zinc salts). Early diagnosis of the disease, early initiation of anti-copper therapy, regular monitoring of copper metabolism, evaluation of liver function and damage of central nervous system are essential for the good prognosis. We conducted a targeted literature review of articles in English available in PubMed, searching for "Wilson's disease", "biomarkers", "neurofilaments". Below we present summary of collected data. Conclusions. Despite treatment, 10% of patients with WD experience early neurological deterioration, 50% of patients with neurological symptoms show no improvement. New therapies of treatment for WD, possibilities of faster diagnosis and better monitoring of the treatment Review article / Artykuł poglądowy Biomarkers of the central nervous system injury in Wilson's disease Biomarkery uszkodzenia ośrodkowego układu nerwowego w chorobie Wilsona
Stroke, 2015
Introduction: Shorter door-to-needle time (DNT) improves treatment efficacy in acute ischemic str... more Introduction: Shorter door-to-needle time (DNT) improves treatment efficacy in acute ischemic stroke (AIS) patients. Still, there are groups of patients at increased risk of longer DNT. The goal of our study was to determine temporal trends of DNT. The second goal was to identify if baseline characteristics of patients treated with intravenous thrombolysis changed throughout the years and if such change (e.g. treating older patients) could have affected DNT. Methods: Prospectively collected data from the Safe Implementation of Treatments in Stroke - EAST (12 Central/Eastern European countries) registry between January 2005 and August 2013 were analyzed. Baseline patient characteristics over period 2005-2013 were analyzed descriptively and using ANOVA. DNT and association between DNT and the patient characteristics were analyzed using linear logistic regression. Obtained regression coefficients and descriptive statistics were used to simulate average DNT values in individual years du...
Neurologia i Neurochirurgia Polska, 2020
Aim of study. The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish... more Aim of study. The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish cohort the hypothesis that fluoxetine improves recovery after stroke. Clinical rationale for study. Some studies have suggested that fluoxetine may improve functional outcomes after stroke, but these results needed confirmation. Between 2012 and 2014, large clinical trials were initiated by the FOCUS Trial Collaboration. Recently, results from the UK, Sweden, Australia, New Zealand and Vietnam have been published. We here present the results of the FOCUS trial conducted in Poland. Material and methods. This was a randomised, double-blind, placebo-controlled study based on the FOCUS trial protocol. Patients who had a persisting neurological deficit were randomly assigned 2-15 days after stroke onset to receive for six months either fluoxetine 20 mg/day or a placebo. The primary outcome was functional status measured using the modified Rankin Scale (mRS) at six months after randomisation. Functional status at 12 months was also assessed, as was neurological deficit at six and 12 months. Data was also collected on adverse events. Results. Between 19 December 2014 and 13 March 2018, 30 patients were given fluoxetine and 31 were given a placebo. For the primary outcome, the distribution across mRS categories was similar for the fluoxetine and placebo groups at six months (common odds ratio 0.88; 95% confidence interval 0.31-2.50; p = 0.81), and there was no difference at 12 months (p = 0.864). There were no differences between groups in stroke recovery or in motor function recovery of the affected hand. There were no significant differences in any other secondary outcomes at six or 12 months. Patients given fluoxetine were less likely than those given the placebo to receive new antidepressant medication within six months (2 [6.67%] vs. 4 [12.90%]). Conclusions and clinical implications. Consistent with other trials based on the FOCUS protocol, fluoxetine did not improve motor recovery or general stroke outcome at six and 12 months in the Polish cohort studied. However, patients receiving fluoxetine required therapy with additional antidepressant medication less frequently.
The Lancet, 2021
Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent ... more Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.
Polski Przegląd Neurologiczny, 2019
Neurological Sciences, 2018
We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) popu... more We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) population based on a long-term prospective stroke registry. We retrospectively analyzed data collected in a detailed registry regarding consecutive patients admitted for first-ever ischemic stroke (IS) between January 2001 and December 2015. We used Org 10172 in Acute Stroke Treatment classification supplemented with ESUS criteria proposed by the Cryptogenic Stroke/ESUS International Working Group. Within the ESUS group, we additionally compared patients ≤ 60 and > 60 years of age. During the study period, there was a total of 3008 (1615 females and 1393 males) admissions of first-ever strokes. The most frequent cause was undetermined (38.7%), followed by cardioembolic (27.7%), large artery atherosclerosis (18.2%), small vessel disease (11.9%), and other determined (3.6%). We identified 326 patients as ESUS, which accounted for 10.8% of all strokes and 28% of strokes of undetermined etiology. ESUS patients were the youngest. Compared to all types of stroke but for those with small vessel disease, ESUS patients were most often independent before stroke and had the least severe neurological deficit at admission and the best outcome at discharge. ESUS patients ≤ 60 years were more frequently independent at discharge than ESUS patients > 60 years. Approximately 11% of patients from our registry met ESUS criteria. ESUS patients were younger when compared to all other stroke etiologies, suffered less severe strokes, and had more favorable outcome at discharge than other groups except for those with small vessel disease strokes.
European Journal of Neurology, 2017
Introduction: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in pa... more Introduction: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital (IHS) acute ischemic stroke (AIS) onset is associated with unfavourable functional outcomes at hospital discharge and in-hospital mortality compared to patients with outof-hospital stroke onset (OHS) treated with IVT. We sought to compare outcomes between IVT treated IHS and OHS patients by analysing propensity score matched (PSM) data from the SITS-EAST registry. Methods: We compared the following outcomes for all PSM patients: 1.symptomatic intracranial hemorrhage (sICH) defined with the SITS-MOST criteria, 2.favourable functional outcome Accepted Article This article is protected by copyright. All rights reserved. (FFO) defined as a modified Rankin Scale (mRS) score of 0-1 at three months, 3.Functional independence (FI) defined as a mRS score of 0-2 at three months, 4.3-month mortality. Results: Out of total 19,077 IVT-treated AIS patients, 196 IHS patients were matched to 5124 OHS patients, with no differences in all baseline characteristics (p>0.1). IHS had longer door-to-needle [90 min (60-140) vs. 65 (47-95), p<0.001] and door-to-imaging times [40 min (20-90) vs 24 (15-35), p<0.001] compared to OHS. No differences were detected in the rates of sICH (1.6% vs 1.9%, p=0.756), FFO (46.4% vs 42.3%, p=0.257), FI (60.7% vs. 60.0%,p=0.447) and mortality (14.3% vs 15.1%,p=0.764). The distribution of 3-month mRS-scores was similar in the two groups (p=0.273). Conclusions: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tPA delivery in patients with IHS.
Neurologia i Neurochirurgia Polska, 2017
Background: Medical complications often worsen the prognosis after stroke. Our aim was to investi... more Background: Medical complications often worsen the prognosis after stroke. Our aim was to investigate the association between particular noninfectious complications and hospital mortality of acute stroke patients admitted to an urban Polish stroke center, and changes in their occurrence from 1995 to 2015. Methods: This is a retrospective analysis of 5174 consecutive patients admitted for acute ischemic stroke or cerebral hemorrhage to a Polish urban stroke center between 1995 and 2015. The occurrence of complications was reported for years
Neurologia i neurochirurgia polska, Jan 5, 2017
Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a d... more Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47....
Neurologia i neurochirurgia polska
The aim of the study was to present our initial experience with the use of intravenous thrombolyt... more The aim of the study was to present our initial experience with the use of intravenous thrombolytic therapy in patients with acute ischaemic stroke in the 2nd Department of Neurology of the Institute of Psychiatry and Neurology in the years 2003-2007. The patients were selected and treated with recombinant tissue plasminogen activator (rt-PA, alteplase) according to the SITS-MOST (Safe Implementation of Thrombolysis in Stroke - Monitoring Study) protocol. We present the data on the first 100 patients treated with rt-PA in our department. The mean age of the treated patients was 67 years, the initial neurological deficit measured in the National Institutes of Health Stroke Scale (NIHSS) was 8 pts., the door-to-needle time was 82 minutes. At 3-month follow-up, 61% of patients had achieved modified Rankin scale score of 0-2. Fourteen percent had died within three months of stroke onset. We observed 2 symptomatic intracerebral haemorrhages and there were 17 cases of secondary asymptomat...
Neurologia i neurochirurgia polska
Recombinant tissue plasminogen activator (rt-PA, alteplase) for acute ischaemic stroke was provis... more Recombinant tissue plasminogen activator (rt-PA, alteplase) for acute ischaemic stroke was provisionally granted in Europe in 2002 and the granted license excluded many patient groups from treatment. Uncertainties about the balance of risk and benefit in several categories of patients still remain. The aim of the Third International Stroke Trial (IST-3) is to determine whether more patients can benefit from treatment. We present the rationale for the study and compare the characteristics of patients recruited to the study in Poland with those recruited in other countries. Patients recruited to IST-3 from May 5th 2000 to April 9th 2008 (in Poland from November 2nd 2003). We compared the baseline characteristics for patients recruited in Poland and other countries. 1118 patients were recruited, 179 from centres in Poland and 939 from other countries. There was no significant difference between Poland and other countries in mean age (73.0 vs. 74.7 years), or distribution of gender (53....
Bioelectromagnetics, Jan 23, 2015
Wilson's disease (WD) is a metabolic brain disease resulting from improper copper metabolism.... more Wilson's disease (WD) is a metabolic brain disease resulting from improper copper metabolism. Although pyramidal symptoms are rarely observed, subclinical injury is highly possible as copper accumulates in all brain structures. The usefulness of motor evoked potentials (MEPs) in pyramidal tracts damage evaluation still appears to be somehow equivocal. We searched for original papers assessing the value of transcranial magnetic stimulation elicited MEPs with respect to motor function of upper and lower extremity in WD. We searched PubMed for original papers evaluating use of MEPs in WD using key words: "motor evoked potentials Wilson's disease" and "transcranial magnetic stimulation Wilson's disease." We found six articles using the above key words. One additional article and one case report were found while viewing the references lists. Therefore, we included eight studies. Number of patients in studies was low and their clinical characteristic was va...
Neurologia i neurochirurgia polska
Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of ... more Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of the study was to assess the potential eligibility of patients for intravenous recombinant tissue plasminogen activator (rt-PA). We also investigated whether widespread information about stroke and organisational changes in the 2nd Department of Neurology influenced eligibility and the number of treated patients. An analysis of the 2nd Department of Neurology of the Institute of Psychiatry and Neurology database of stroke patients admitted in the years 1995-2003 and 2003-2005 was performed. Eligibility for rt-PA treatment was assessed using the criteria outlined by the SITS (Safe Implementation of Thrombolysis in Stroke) protocol. The number of patients eligible for thrombolysis was estimated and then compared with the number of treated patients. A total of 1541 patients with ischaemic stroke were admitted between 1 June 1995 and 1 November 2003, 18.7% within 2 hours of onset, 78% aged un...
Neurologia i neurochirurgia polska, 2003
Stroke morbidity increases with age. That is the reason why it affects especially the middle aged... more Stroke morbidity increases with age. That is the reason why it affects especially the middle aged and elderly. Life expectancy is longer for females than males by 10 years, that is why stroke is a major problem in women. Women die twice more frequently from stroke than men (16% vs. 8%). Stroke risk factors are basically the same in spite of gender. The most important are hypertension, diabetes, dyslipidaemia, atrial fibrillation, coronary heart disease, previous stroke, smoking, alcohol abuse, obesity and lack of physical activity. Their impact, however, is different in males and females. Women with diabetes, atrial fibrillation, myocardial infarction, obese, drinking excessive amounts of alcohol and smoking are more likely to suffer of stroke than males with the same burden. A less favourable outcome after stroke has been observed in female patients--higher mortality rates and disability. It is possible that poor prognosis is related to a drop in blood estrogen concentration after ...