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Papers by Gregory Kapinos

Journal of the Neurological Sciences, 2017

Neurocritical Care Management of the Neurosurgical Patient, 2018

Migraine with prolonged aura can mimic an acuteischemic stroke (AIS), as each may present with ac... more Migraine with prolonged aura can mimic an acuteischemic stroke (AIS), as each may present with ac-companying headache and focal neurologic deficits.During the acute episode, perfusion imaging likeperfusion-weighted MRI (PWI) can show focal ab-normalities corresponding to the neurologic deficitsin both entities, making clinical distinction challeng-ing, especially considering the time urgency of AIStreatment. In this case report, we discuss how weutilized hyperacute PWI in conjunction with clinicalreasoning to propose the diagnosis of migraine-likeheadache with prolonged aura.

Journal of the Neurological Sciences, 2021

Epilepsy Research, 2020

Background: Cardiac tumors are an exceedingly rare phenomena. Papillary fibroelastomas are the se... more Background: Cardiac tumors are an exceedingly rare phenomena. Papillary fibroelastomas are the second most common benign cardiac tumors. Despite their propensity to cause embolic strokes and acute coronary syndrome, a major consideration is also that of symptomatic peripheral artery disease as a presentation. Case: A 77 year-old female with history of a prior transient ischemic attack and hypertension presented to the hospital with severe pain within her right great toe after undergoing partial amputation a couple of weeks prior. On physical exam, she was found to have absent pulses within the popliteal and right femoral arteries. In anticipation for further surgical intervention, pre-operative cardiac evaluation was performed with a transthoracic echocardiogram that showed an ejection fraction of 75%, no regional wall motion abnormalities, and a well defined, mobile mass within the left ventricle measuring 18x14mm. Decision-Making: Further cardiovascular evaluation was obtained, with transesophageal echocardiogram confirming the finding of a 18x12mm pedunculated mass attached to the septal wall of the left ventricle. Right lower extremity angiography revealed total occlusion of the proximal segments of the right anterior tibial and peroneal arteries, as well as a total occlusion within the distal segment of the posterior tibial artery. Due to the finding of a cardiac mass causing peripheral embolization, the decision for surgical resection was reached. Pathological examination confirmed the diagnosis of papillary fibroelastoma of the left ventricle. The patient tolerated the procedure well and made a successful recovery. Conclusions: This case highlights the importance of a complete cardiac evaluation for patients presenting with peripheral vascular disease without known risk factors. Furthermore, it reinforces the importance of the echocardiogram to identify or exclude cardiac tumors as a potential cause of peripheral embolic phenomena

Neurology, 2019

Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant b... more Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Neurology, 2018

Acute spontaneous intracerebral hemorrhage (ICH), the most severely disabling type of stroke, has... more Acute spontaneous intracerebral hemorrhage (ICH), the most severely disabling type of stroke, has few proven therapies. The mainstay of care remains acute blood pressure (BP)-lowering treatment, in order to mitigate hematoma expansion, perihematomal edema, and the attendant mass effects, each linked to early neurologic deterioration (END), death, and major disability. 1,2 More than 5 randomized clinical trials (RCTs) have proven the safety and support the efficacy of early intensive BP-lowering treatment, as opposed to conservative BP control. These trials include the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT-2) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-2) trials, which were recently compared 3 and compiled in a large meta-analysis. 4 Mounting evidence, 1 particularly ad hoc analyses of INTERACT-2, 5,6 suggests that the earlier the treatment, the steeper the drop, and the lower the BP achieved, the better the outcome, 1,6 halting radiologic or clinical deterioration 2 and, more importantly, improving quality of life and shifting toward better functional physical outcome at 3 months. 4-6 Furthermore, INTERACT-2 data revealed a dose effect with linear relationship between achieved systolic BP (SBP) and reducing hematoma growth 5 and improved functional outcome. 6

Journal of Clinical Neurophysiology, 2018

We propose a comprehensive review of the subject of epileptiform and potentially harmful EEG patt... more We propose a comprehensive review of the subject of epileptiform and potentially harmful EEG patterns that lie on the interictal continuum (IIC) to help with therapeutic decisionmaking and target future research. This approach to "electrophysiological SE" encompasses five dimensions of the IIC: it characterizes a periodic or rhythmic pattern, not only regarding its ictal morphology and potential harm with secondary neuronal injury, but also addresses the "metabolic footprint," clinical repercussion, and epileptogenic potential. Recent studies have attempted to determine and qualify the ictal nature and the epileptogenic potential (i.e., risk of subsequent acute seizures) of particular IIC patterns and their intrinsic EEG characteristics. Others have correlated non-convulsive seizures with cognitive outcomes beyond mortality; non-convulsive seizures and sporadic, periodic, or rhythmic discharges to encephalopathy severity; and the spectrum of periodic or rhythmic patterns to measurable secondary brain injury. Equivocal periodic or rhythmic patterns on the IIC are frequently encountered in critical care neurology where clinicians often incorporate advanced neuroimaging, metabolic neuromonitoring, and antiseizure drug short trials, in an effort to gauge these patterns. We propose portraying the IIC with a multiaxial graph to disambiguate each of these risks. Quantification along each axis may help calibrate therapeutic urgency. An adaptable scoring system assesses which quasi-ictal EEG patterns in this spectrum might reach the tipping point toward anti-seizure drug escalation, in neurocritically ill patients.

Neurology, 2017

Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by ... more Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.

Neurology: Clinical Practice, 2016

Neurology, May 16, 2017

Neurology, 2015

Seizures, predominantly nonconvulsive (NCSZ), complicate aneurysmal subarachnoid hemorrhage (SAH)... more Seizures, predominantly nonconvulsive (NCSZ), complicate aneurysmal subarachnoid hemorrhage (SAH) in about 10% of ruptures,1–3 with more seizures detected during continuous EEG (cEEG) monitoring for more than 24 hours. Seizures, especially nonconvulsive status epilepticus (NCSE), as well as interictal and background findings,1 have been strongly associated with a worsened functional outcome,1–3 while factors impacting cognitive outcome after SAH differ slightly.

Therapeutic Hypothermia and Temperature Management, 2015

This terminological review of 38 randomised clinical trials highlights the lack of consistency in... more This terminological review of 38 randomised clinical trials highlights the lack of consistency in defining ischemic and vasospastic events after subarachnoid hemorrhage. We subsequently propose a better terminology and novel classification based on best descriptiveness of the impairment or lesion. We also separate vasospasm from ischemia, concurring with the recommendations of world experts (Vergouwen et al. Stroke 2010) and we avoid disparate amalgamates of each subtypes of delayed cerebral ischemia / vasospasm. aan11d1/index.php 1 of 3 10/25/10 8:06 PM

Kapinos G, Janson CU, Yagudayev U, Walker Jr W, Harden C, Narayan RK. Continuous EEG for all grad... more Kapinos G, Janson CU, Yagudayev U, Walker Jr W, Harden C, Narayan RK. Continuous EEG for all grades of SAH patients developing DCI. Journal of Clinical Neurophysiology. 2014; supplement