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Papers by Valeria Scavasine
Arquivos de Neuro-Psiquiatria, 2021
Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, wit... more Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis. Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD). Methods: In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Patients with neurosyphilis were excluded. All patients were classified according to the ASCOD phenotyping as SVD — when SVD was the potential causal mechanism (S1) — or non-SVD — when SVD was uncertain (S2), unlike (S3), or not detected (S0). Results: Syphilis was positive in 32 (12%) patients. When comparing patients with positive and negative serology, the only significant difference was SVD as the causal mechanism (S1) in pat...
Neurology, 2017
Objective: To compare the features of the right-to-left shunt (RLS) in contrasted Transcranial Do... more Objective: To compare the features of the right-to-left shunt (RLS) in contrasted Transcranial Doppler Ultrasound (cTCD) between ESUS and not-ESUS patients with stroke and PFO. Background: Recently the acronym ESUS has been used to describe patients with stroke of embolic features but without a confirmed source of emboli. There is a controversial correlation between PFO and ischemic stroke, which is considered more relevant in the absence of classical cardiovascular risk factors and compatible neuroimaging findings. Design/Methods: We selected 171 patients with stroke and PFO from the stroke database of the Hospital de Clinicas of Federal University of Parana and the Flumingnano Medical Institute in Curitiba-PR. Patients were assigned to either the not-ESUS group when there was a clear etiology for the event (n-ESUS=68), or to the ESUS group (ESUS=103) if no mechanism was found. Both groups were compared for the RLS features in cTCD. Results: There were no differences of age and gen...
Neurology, 2018
Objective: To analyze the long-term recurrence rate of stroke in patients with first-ever IS seco... more Objective: To analyze the long-term recurrence rate of stroke in patients with first-ever IS secondary to intracranial LAA in a Brazilian sample. Background: Ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) has a high recurrence rate, but data from the Southern Hemisphere is somewhat lacking. Design/Methods: A retrospective analysis was performed of all patients admitted to our hospital between October 2012 and September 2015 with first-ever IS. Stroke mechanism subtypes were classified as cardioembolism (CE), large-artery atherosclerosis (LAA), small-vessel occlusion (SVO), other determined etiologies (OTH), and stroke of undetermined etiology (UND). LAA was further classified as extracranial or intracranial. Patients were evaluated during outpatient follow-up for stroke recurrence. Results: We evaluated 359 first-ever ISs. Mean time of follow-up was 21.6±15.1 months; mean age was 64.4 ± 13.6 years; 177 patients (49.3%) were women, and 333 (92.8%) were C...
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2021
BACKGROUND Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischem... more BACKGROUND Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. METHODS This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death r...
Embolic Stroke of Undetermined Source (ESUS) is a non-lacunar infarct without proximal occlusive ... more Embolic Stroke of Undetermined Source (ESUS) is a non-lacunar infarct without proximal occlusive atherosclerosis or major-risk cardioembolic sources. Recent studies have demonstrated a high variability (ranging from 10-39%) in the proportion of ESUS patients, who are subsequently diagnosed with atrial fibrillation (AF) in a long-term follow-up. This result suggests that some groups of ESUS patients can present AF as underlying cause of stroke. 2-5 Approximately one-third of the patients who met the inclusion criteria for ESUS trials presented AF in continuous heart rhythm monitoring for up to three years. A higher AF prevalence was also observed with an increasing number of CHADS 2 risk factors. 6
Neurology, 2017
Objective: To report the cases of two patients who developed facial angioedema one hour after rec... more Objective: To report the cases of two patients who developed facial angioedema one hour after receiving intramuscular Generic, Government-provide Botulinum Toxin A (GGP-BTA), with a five-month interval between the two cases. Background: Allergic reactions after administration of Botulinum Toxin A are rare and have been reported with the use of commercially available formulations, but not with generic formulations. Design/Methods: Case reports Results: Patient 1: A male patient with left hemifacial spasm, who had already been treated with commercially available BTA (Botox®) with no significant side-effects, was treated with intramuscular injections of GGP-BTA on the affected muscles of the left side and additional injections in the periocular region of the right side for symmetry. About one hour following the procedure he developed a purplish-red oedema of the eyelids, as well as the left nasolabial fold. He was treated with IV Methylprednisolone, followed by oral 60 mg qd of Prednis...
Arquivos de Neuro-Psiquiatria, 2021
Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic strok... more Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. Objective: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. Methods: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. Results: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). Acco...
Revista Médica da UFPR, 2014
Tromboembolismo pulmonar (TEP) submaciço caracteriza-se por disfunção ventricular direita ou elev... more Tromboembolismo pulmonar (TEP) submaciço caracteriza-se por disfunção ventricular direita ou elevação de marcadores de necrose miocárdica em pacientes normotensos. A melhor terapêutica para esses casos permanece controversa. Há evidências recentes na literatura apontando para o benefício da terapia com fibrinolítico em pacientes com baixo risco de sangramento. Apresentamos o caso de uma jovem de 17 anos com TEP submaciço, submetida a trombólise com alteplase, com excelente evolução clínica.
Parkinsonism & Related Disorders, 2016
Arquivos de Neuro-Psiquiatria, 2018
The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever i... more The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6–29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79–14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Co...
Cerebrovascular Diseases
Background: The role of patent foramen ovale is a field of debate and current publications have i... more Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients’ management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. Summary: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was revi...
Revista Médica da UFPR, 2016
Parkinsonism & Related Disorders, 2016
Arquivos de Neuro-Psiquiatria, 2021
Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, wit... more Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis. Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD). Methods: In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Patients with neurosyphilis were excluded. All patients were classified according to the ASCOD phenotyping as SVD — when SVD was the potential causal mechanism (S1) — or non-SVD — when SVD was uncertain (S2), unlike (S3), or not detected (S0). Results: Syphilis was positive in 32 (12%) patients. When comparing patients with positive and negative serology, the only significant difference was SVD as the causal mechanism (S1) in pat...
Neurology, 2017
Objective: To compare the features of the right-to-left shunt (RLS) in contrasted Transcranial Do... more Objective: To compare the features of the right-to-left shunt (RLS) in contrasted Transcranial Doppler Ultrasound (cTCD) between ESUS and not-ESUS patients with stroke and PFO. Background: Recently the acronym ESUS has been used to describe patients with stroke of embolic features but without a confirmed source of emboli. There is a controversial correlation between PFO and ischemic stroke, which is considered more relevant in the absence of classical cardiovascular risk factors and compatible neuroimaging findings. Design/Methods: We selected 171 patients with stroke and PFO from the stroke database of the Hospital de Clinicas of Federal University of Parana and the Flumingnano Medical Institute in Curitiba-PR. Patients were assigned to either the not-ESUS group when there was a clear etiology for the event (n-ESUS=68), or to the ESUS group (ESUS=103) if no mechanism was found. Both groups were compared for the RLS features in cTCD. Results: There were no differences of age and gen...
Neurology, 2018
Objective: To analyze the long-term recurrence rate of stroke in patients with first-ever IS seco... more Objective: To analyze the long-term recurrence rate of stroke in patients with first-ever IS secondary to intracranial LAA in a Brazilian sample. Background: Ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) has a high recurrence rate, but data from the Southern Hemisphere is somewhat lacking. Design/Methods: A retrospective analysis was performed of all patients admitted to our hospital between October 2012 and September 2015 with first-ever IS. Stroke mechanism subtypes were classified as cardioembolism (CE), large-artery atherosclerosis (LAA), small-vessel occlusion (SVO), other determined etiologies (OTH), and stroke of undetermined etiology (UND). LAA was further classified as extracranial or intracranial. Patients were evaluated during outpatient follow-up for stroke recurrence. Results: We evaluated 359 first-ever ISs. Mean time of follow-up was 21.6±15.1 months; mean age was 64.4 ± 13.6 years; 177 patients (49.3%) were women, and 333 (92.8%) were C...
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2021
BACKGROUND Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischem... more BACKGROUND Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. METHODS This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death r...
Embolic Stroke of Undetermined Source (ESUS) is a non-lacunar infarct without proximal occlusive ... more Embolic Stroke of Undetermined Source (ESUS) is a non-lacunar infarct without proximal occlusive atherosclerosis or major-risk cardioembolic sources. Recent studies have demonstrated a high variability (ranging from 10-39%) in the proportion of ESUS patients, who are subsequently diagnosed with atrial fibrillation (AF) in a long-term follow-up. This result suggests that some groups of ESUS patients can present AF as underlying cause of stroke. 2-5 Approximately one-third of the patients who met the inclusion criteria for ESUS trials presented AF in continuous heart rhythm monitoring for up to three years. A higher AF prevalence was also observed with an increasing number of CHADS 2 risk factors. 6
Neurology, 2017
Objective: To report the cases of two patients who developed facial angioedema one hour after rec... more Objective: To report the cases of two patients who developed facial angioedema one hour after receiving intramuscular Generic, Government-provide Botulinum Toxin A (GGP-BTA), with a five-month interval between the two cases. Background: Allergic reactions after administration of Botulinum Toxin A are rare and have been reported with the use of commercially available formulations, but not with generic formulations. Design/Methods: Case reports Results: Patient 1: A male patient with left hemifacial spasm, who had already been treated with commercially available BTA (Botox®) with no significant side-effects, was treated with intramuscular injections of GGP-BTA on the affected muscles of the left side and additional injections in the periocular region of the right side for symmetry. About one hour following the procedure he developed a purplish-red oedema of the eyelids, as well as the left nasolabial fold. He was treated with IV Methylprednisolone, followed by oral 60 mg qd of Prednis...
Arquivos de Neuro-Psiquiatria, 2021
Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic strok... more Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. Objective: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. Methods: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. Results: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). Acco...
Revista Médica da UFPR, 2014
Tromboembolismo pulmonar (TEP) submaciço caracteriza-se por disfunção ventricular direita ou elev... more Tromboembolismo pulmonar (TEP) submaciço caracteriza-se por disfunção ventricular direita ou elevação de marcadores de necrose miocárdica em pacientes normotensos. A melhor terapêutica para esses casos permanece controversa. Há evidências recentes na literatura apontando para o benefício da terapia com fibrinolítico em pacientes com baixo risco de sangramento. Apresentamos o caso de uma jovem de 17 anos com TEP submaciço, submetida a trombólise com alteplase, com excelente evolução clínica.
Parkinsonism & Related Disorders, 2016
Arquivos de Neuro-Psiquiatria, 2018
The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever i... more The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6–29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79–14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Co...
Cerebrovascular Diseases
Background: The role of patent foramen ovale is a field of debate and current publications have i... more Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients’ management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. Summary: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was revi...
Revista Médica da UFPR, 2016
Parkinsonism & Related Disorders, 2016