Manuela Napoli - Academia.edu (original) (raw)
Papers by Manuela Napoli
Diagnostics, Mar 14, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Seminars in Ultrasound Ct and Mri, Oct 1, 2012
Clinical Neuropsychologist, Nov 23, 2018
Objective: A case report of a 74-year-old male presenting with an atypical multimodal semantic im... more Objective: A case report of a 74-year-old male presenting with an atypical multimodal semantic impairment. The patient was diagnosed with Waldenstr€ om macroglobulinemia (WM) for which he received allogeneic bone marrow transplantation (BMT) due to disease progression. Following BMT, he developed a sudden onset of semantic difficulties that have remained unchanged for eight years. No other cognitive functions have been affected and his activities of daily living remain fully preserved. Method: The patient was assessed at our neuropsychology unit with six neuropsychological evaluations over an 8-years follow-up period following BMT. Additional semantic tests were administered during the last three evaluations. Four MRI scans (at age 62, 66, 69 and 74) and 18F-FDG PET (at age 74) were obtained. Results: The patient presents a multimodal semantic impairment, including naming impairment, visual agnosia, prosopoanomia, associative prosopagnosia, topographical disorientation and impaired retrograde memory for public events. MRI scans and 18F-FDG PET revealed bilateral symmetrical atrophy (temporal > frontal) and inferior bilateral temporal lobe hypometabolism, respectively. Neuroradiological examination was unremarkable prior to BMT. Conclusion: Clinical diagnosis remains a challenge given the focal and stable nature of his deficits. We hypothesize that the BMT procedure might have resulted in the temporal lobe damage and subsequent semantic impairment. We recommend obtaining a thorough neuropsychological evaluation of patients who receive allogenic BMT, both prior to and following transplant.
Brain Sciences
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Neurological Sciences, Aug 1, 2023
Clinical Dysmorphology, Jul 1, 2018
Clinical Genetics Unit, Obstetric and Pediatric Department, Children Neuropsychiatry Unit, Neuror... more Clinical Genetics Unit, Obstetric and Pediatric Department, Children Neuropsychiatry Unit, Neuroradiology Unit, Azienda Unità Sanitaria Locale di Reggio Emilia IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy and Department of Pediatrics, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland Correspondence to Marzia Pollazzon, MD, Clinical Genetics Unit, Obstetric and Pediatric Department, Azienda Unità Sanitaria Locale di Reggio Emilia IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123 Reggio Emilia, Italy Tel: + 39 052 229 5462; fax: + 39 052 229 5909; e-mail: pollazzon.marzia@ausl.re.it
Cancers, Sep 22, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Biomedicines
Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteri... more Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteries, arterioles, capillaries, and venules in the brain. One of the most relevant and prevalent SVDs is cerebral amyloid angiopathy (CAA), whose pathological hallmark is the deposition of amyloid fragments in the walls of small cortical and leptomeningeal vessels. CAA frequently coexists with Alzheimer’s Disease (AD), and both are associated with cerebrovascular events, cognitive impairment, and dementia. CAA and AD share pathophysiological, histopathological and neuroimaging issues. The venular involvement in both diseases has been neglected, although both animal models and human histopathological studies found a deposition of amyloid beta in cortical venules. This review aimed to summarize the available information about venular involvement in CAA, starting from the biological level with the putative pathomechanisms of cerebral damage, passing through the definition of the peculiar angio...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
JAMA Neurology
ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients ... more ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC).ObjectiveTo determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion.Design, Setting, and ParticipantsThis international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021.ExposuresPrior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no p...
The Neurohospitalist
Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus be... more Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus belonging to the Flaviviridae family. TBEV transmission typically occurs through infected Ixodes tick bite or by consumption of unpasteurised milk from infected cattle. Case report: We report the clinical, neuroimaging, electroencephalogram (EEG), and laboratory (microbiological tests and spinal tap) data of a 6- year-old boy with Tick-borne encephalitis. Our patient presented with a biphasic course, initially with a myositis-like picture on his first admission to the emergency department, and after a few days with an encephalitic picture, resulting in a second hospitalization. EEG showed focal slow activity, while his brain magnetic resonance imaging (MRI) showed a signal abnormality, which completely resolved on repeat MRI after 3 months. Conclusion: To our knowledge, this is the youngest patient presenting with myositis in the first phase of Tick-borne encephalitis (TBE). In the presenc...
Rivista Di Neuroradiologia, Oct 1, 2012
-Syringomyelia is a disorder in which a cyst or cavity forms within the spinal cord. This cyst, c... more -Syringomyelia is a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called syrinx, can expand and elongate over time, destroying the spinal cord. We describe the case of a young patient with partial spontaneous regression of syringomyelia in Chiari I malformation, confirmed by magnetic resonance imaging three years after the diagnosis. During this period the patient did not experience any clinical symptoms. Although described in literature, spontaneous regression is an unusual event and very few cases have been reported. This case report supports the belief that conservative management together with both clinical and imaging periodic controls should be preferred in stable mild-symptomatic patients.
Rivista Di Neuroradiologia, Oct 1, 2012
Spinal solitary fibrous tumors (SFT) are very rare neoplasms occurring in the spinal canal, with ... more Spinal solitary fibrous tumors (SFT) are very rare neoplasms occurring in the spinal canal, with only 38 cases reported in ten years since the first description. We describe two cases of SFT of the spine and review 33 well-documented cases in the literature to define distinctive radiological and surgical features raising the suspicion of a spinal SFT before histological verification. A 67-year-old man with cervical myeloradiculopathy had a large extramedullary tumor of the cervical spinal canal extending from C4 to C7. On MRI the tumor was isointense on T1-sequences and hypointense on T2-sequences, and had marked contrast enhancement. At surgery, the tumor was intradural extramedullary, with no dural or root attachment, but it was adherent to the cord. Complete tumor removal was achieved with good outcome. A 75-year-old man with progressive thoracic myelopathy had an intramedullary tumor at C6 and C7 level, which was hypointense on T1-and T2-weighted images of MRI. At surgery, the tumor was intramedullary and strongly adherent to the cord; it was successfully removed. Both tumors were composed of elongated cells with a collagen-matrix background. Immunohistochemical staining was positive for vimentin, CD34, and bcl-2, and negative for EMA and S-100 protein. A careful analysis of our own and the other reported cases of spinal SFTs may disclose some peculiar features of this rare tumor. A spinal intramedullary or extramedullary tumor, hypointense on T2-weighted images of MRI, which intraoperatively shows hard consistency, scarce vascularization, no nerve root involvement, no or weak dural attachment, absence of arachnoidal interface, and adherence to the spinal cord may suggest the diagnosis of SFT.
Rivista Di Neuroradiologia, Dec 1, 2012
A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with ... more A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with transient vertebrobasilar ischemia, explored by magnetic resonance imaging (MRI) and digital angiography (DA). The embryology, clinical relevance and magnetic resonance findings of this arterial anomaly are discussed, with a review of six previously reported cases. Segmental aplasia was suggested in our case by magnetic resonance, and subsequently confirmed not only by time-of-flight magnetic resonance, but also by DA. Only ultrathin-slice T2-weighted images revealed the real finding of basilar artery hypoplasia. This sequence, not employed in previously reported cases, is mandatory to allow a clear differential diagnosis between basilar artery aplasia and hypoplasia.
Journal of Clinical Medicine, Dec 4, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
World Journal of Clinical Cases, May 16, 2022
Clinical neuroradiology, May 17, 2014
Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) showed a broad-based saccu... more Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) showed a broad-based saccular aneurysm of the posterior wall of the left supraclinoid carotid artery. Its maximum diameter was 35 mm and the neck/sac ratio was 0.6 (Fig. 1). Due to the aneurysm size and neck and the carotid localization, an endovascular approach with FDD was planned. A double antiplatelet therapy (75 mg daily of clopidogrel, in association with 150 mg of Aspirin) was administered 5 days before the procedure; the platelet response to the therapy was not tested before and after the treatment. Under general anesthesia, a femoral access was obtained by means of single-wall puncture with an 8F vascular sheath. The patient received a heparin bolus of 5000 IU (to achieve a targeted activated clotting time of 200-300 s after femoral puncture) followed by bolus injections of 1000 IU after 60 min. A 8F guiding catheter (Guider, Boston Scientific) was advanced into the left common carotid artery. Diagnostic angiograms were obtained to define the optimal projections. An intermediate catheter (Reflex 072 Catheter, Covidien) was advanced through the guiding catheter and placed into the left internal carotid artery (ICA); before the placement of the FDD, a micro-catheter (Echelon, Covidien) was introduced into the aneurysm sac. The length and size of the pipeline embolization device (PED) were chosen using the proximal ICA diameter near to the aneurysm neck, which was slightly ectatic. The distal tip of the first PED was placed into the proximal M1 segment, to improve the stability of the system; using the 'jailing' technique, a single PED (Covidien, Mansfield) (size 3.0 × 20 mm) was deployed, then 15 coils (Axium 3D, Covidien) were placed (Figs. 2 and 3). Due to the large defect of the vessel wall at the neck and lack of radial force of the PED, after the deployment, when
Journal of Neurology, Jul 3, 2021
Diagnostics, Mar 14, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Seminars in Ultrasound Ct and Mri, Oct 1, 2012
Clinical Neuropsychologist, Nov 23, 2018
Objective: A case report of a 74-year-old male presenting with an atypical multimodal semantic im... more Objective: A case report of a 74-year-old male presenting with an atypical multimodal semantic impairment. The patient was diagnosed with Waldenstr€ om macroglobulinemia (WM) for which he received allogeneic bone marrow transplantation (BMT) due to disease progression. Following BMT, he developed a sudden onset of semantic difficulties that have remained unchanged for eight years. No other cognitive functions have been affected and his activities of daily living remain fully preserved. Method: The patient was assessed at our neuropsychology unit with six neuropsychological evaluations over an 8-years follow-up period following BMT. Additional semantic tests were administered during the last three evaluations. Four MRI scans (at age 62, 66, 69 and 74) and 18F-FDG PET (at age 74) were obtained. Results: The patient presents a multimodal semantic impairment, including naming impairment, visual agnosia, prosopoanomia, associative prosopagnosia, topographical disorientation and impaired retrograde memory for public events. MRI scans and 18F-FDG PET revealed bilateral symmetrical atrophy (temporal > frontal) and inferior bilateral temporal lobe hypometabolism, respectively. Neuroradiological examination was unremarkable prior to BMT. Conclusion: Clinical diagnosis remains a challenge given the focal and stable nature of his deficits. We hypothesize that the BMT procedure might have resulted in the temporal lobe damage and subsequent semantic impairment. We recommend obtaining a thorough neuropsychological evaluation of patients who receive allogenic BMT, both prior to and following transplant.
Brain Sciences
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Neurological Sciences, Aug 1, 2023
Clinical Dysmorphology, Jul 1, 2018
Clinical Genetics Unit, Obstetric and Pediatric Department, Children Neuropsychiatry Unit, Neuror... more Clinical Genetics Unit, Obstetric and Pediatric Department, Children Neuropsychiatry Unit, Neuroradiology Unit, Azienda Unità Sanitaria Locale di Reggio Emilia IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy and Department of Pediatrics, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland Correspondence to Marzia Pollazzon, MD, Clinical Genetics Unit, Obstetric and Pediatric Department, Azienda Unità Sanitaria Locale di Reggio Emilia IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123 Reggio Emilia, Italy Tel: + 39 052 229 5462; fax: + 39 052 229 5909; e-mail: pollazzon.marzia@ausl.re.it
Cancers, Sep 22, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Biomedicines
Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteri... more Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteries, arterioles, capillaries, and venules in the brain. One of the most relevant and prevalent SVDs is cerebral amyloid angiopathy (CAA), whose pathological hallmark is the deposition of amyloid fragments in the walls of small cortical and leptomeningeal vessels. CAA frequently coexists with Alzheimer’s Disease (AD), and both are associated with cerebrovascular events, cognitive impairment, and dementia. CAA and AD share pathophysiological, histopathological and neuroimaging issues. The venular involvement in both diseases has been neglected, although both animal models and human histopathological studies found a deposition of amyloid beta in cortical venules. This review aimed to summarize the available information about venular involvement in CAA, starting from the biological level with the putative pathomechanisms of cerebral damage, passing through the definition of the peculiar angio...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
JAMA Neurology
ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients ... more ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC).ObjectiveTo determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion.Design, Setting, and ParticipantsThis international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021.ExposuresPrior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no p...
The Neurohospitalist
Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus be... more Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus belonging to the Flaviviridae family. TBEV transmission typically occurs through infected Ixodes tick bite or by consumption of unpasteurised milk from infected cattle. Case report: We report the clinical, neuroimaging, electroencephalogram (EEG), and laboratory (microbiological tests and spinal tap) data of a 6- year-old boy with Tick-borne encephalitis. Our patient presented with a biphasic course, initially with a myositis-like picture on his first admission to the emergency department, and after a few days with an encephalitic picture, resulting in a second hospitalization. EEG showed focal slow activity, while his brain magnetic resonance imaging (MRI) showed a signal abnormality, which completely resolved on repeat MRI after 3 months. Conclusion: To our knowledge, this is the youngest patient presenting with myositis in the first phase of Tick-borne encephalitis (TBE). In the presenc...
Rivista Di Neuroradiologia, Oct 1, 2012
-Syringomyelia is a disorder in which a cyst or cavity forms within the spinal cord. This cyst, c... more -Syringomyelia is a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called syrinx, can expand and elongate over time, destroying the spinal cord. We describe the case of a young patient with partial spontaneous regression of syringomyelia in Chiari I malformation, confirmed by magnetic resonance imaging three years after the diagnosis. During this period the patient did not experience any clinical symptoms. Although described in literature, spontaneous regression is an unusual event and very few cases have been reported. This case report supports the belief that conservative management together with both clinical and imaging periodic controls should be preferred in stable mild-symptomatic patients.
Rivista Di Neuroradiologia, Oct 1, 2012
Spinal solitary fibrous tumors (SFT) are very rare neoplasms occurring in the spinal canal, with ... more Spinal solitary fibrous tumors (SFT) are very rare neoplasms occurring in the spinal canal, with only 38 cases reported in ten years since the first description. We describe two cases of SFT of the spine and review 33 well-documented cases in the literature to define distinctive radiological and surgical features raising the suspicion of a spinal SFT before histological verification. A 67-year-old man with cervical myeloradiculopathy had a large extramedullary tumor of the cervical spinal canal extending from C4 to C7. On MRI the tumor was isointense on T1-sequences and hypointense on T2-sequences, and had marked contrast enhancement. At surgery, the tumor was intradural extramedullary, with no dural or root attachment, but it was adherent to the cord. Complete tumor removal was achieved with good outcome. A 75-year-old man with progressive thoracic myelopathy had an intramedullary tumor at C6 and C7 level, which was hypointense on T1-and T2-weighted images of MRI. At surgery, the tumor was intramedullary and strongly adherent to the cord; it was successfully removed. Both tumors were composed of elongated cells with a collagen-matrix background. Immunohistochemical staining was positive for vimentin, CD34, and bcl-2, and negative for EMA and S-100 protein. A careful analysis of our own and the other reported cases of spinal SFTs may disclose some peculiar features of this rare tumor. A spinal intramedullary or extramedullary tumor, hypointense on T2-weighted images of MRI, which intraoperatively shows hard consistency, scarce vascularization, no nerve root involvement, no or weak dural attachment, absence of arachnoidal interface, and adherence to the spinal cord may suggest the diagnosis of SFT.
Rivista Di Neuroradiologia, Dec 1, 2012
A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with ... more A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with transient vertebrobasilar ischemia, explored by magnetic resonance imaging (MRI) and digital angiography (DA). The embryology, clinical relevance and magnetic resonance findings of this arterial anomaly are discussed, with a review of six previously reported cases. Segmental aplasia was suggested in our case by magnetic resonance, and subsequently confirmed not only by time-of-flight magnetic resonance, but also by DA. Only ultrathin-slice T2-weighted images revealed the real finding of basilar artery hypoplasia. This sequence, not employed in previously reported cases, is mandatory to allow a clear differential diagnosis between basilar artery aplasia and hypoplasia.
Journal of Clinical Medicine, Dec 4, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
World Journal of Clinical Cases, May 16, 2022
Clinical neuroradiology, May 17, 2014
Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) showed a broad-based saccu... more Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) showed a broad-based saccular aneurysm of the posterior wall of the left supraclinoid carotid artery. Its maximum diameter was 35 mm and the neck/sac ratio was 0.6 (Fig. 1). Due to the aneurysm size and neck and the carotid localization, an endovascular approach with FDD was planned. A double antiplatelet therapy (75 mg daily of clopidogrel, in association with 150 mg of Aspirin) was administered 5 days before the procedure; the platelet response to the therapy was not tested before and after the treatment. Under general anesthesia, a femoral access was obtained by means of single-wall puncture with an 8F vascular sheath. The patient received a heparin bolus of 5000 IU (to achieve a targeted activated clotting time of 200-300 s after femoral puncture) followed by bolus injections of 1000 IU after 60 min. A 8F guiding catheter (Guider, Boston Scientific) was advanced into the left common carotid artery. Diagnostic angiograms were obtained to define the optimal projections. An intermediate catheter (Reflex 072 Catheter, Covidien) was advanced through the guiding catheter and placed into the left internal carotid artery (ICA); before the placement of the FDD, a micro-catheter (Echelon, Covidien) was introduced into the aneurysm sac. The length and size of the pipeline embolization device (PED) were chosen using the proximal ICA diameter near to the aneurysm neck, which was slightly ectatic. The distal tip of the first PED was placed into the proximal M1 segment, to improve the stability of the system; using the 'jailing' technique, a single PED (Covidien, Mansfield) (size 3.0 × 20 mm) was deployed, then 15 coils (Axium 3D, Covidien) were placed (Figs. 2 and 3). Due to the large defect of the vessel wall at the neck and lack of radial force of the PED, after the deployment, when
Journal of Neurology, Jul 3, 2021