Sotirios Giannopoulos | University of Ioannina/Greece (original) (raw)
Papers by Sotirios Giannopoulos
Annals of neurology, Jan 2, 2016
Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral isc... more Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic ischemic stroke (IS) or transient ischemic attack (TIA) has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. We performed a systematic literature review to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Our literature search identified 35 eligible studies including 3067 patients. The pooled sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (9...
Journal of Neurology, Neurosurgery & Psychiatry, 2007
To present three cases of young adults with lateral medullary ischaemic events associated with a ... more To present three cases of young adults with lateral medullary ischaemic events associated with a hypoplastic vertebral artery (VA). All three patients had two additional atherosclerotic or non-atherosclerotic risk factors for stroke. Patients and methods: One female, aged 40 years, and two males, aged 38 and 37 years, each with two risk factors for stroke, presented to the emergency department with acute onset of symptoms and findings consistent with lateral medullary syndrome. All three patients underwent emergency CT scan of the brain followed by MRI and magnetic resonance angiography (MRA). Results: The CT scans were negative in all patients. MRI revealed a lateral medullary lesion in only one patient. All three patients had a hypoplastic VA ipsilateral to the clinical ischaemic event on MRA. Conclusions: Hypoplasia of VA is not considered a risk factor for stroke as it is a common variant in up to 75% of the general population. However, in our patients, hypoplastic VA coexisted with two risk factors and resulted in stroke. Thus although a hypoplastic VA may not be an uncommon asymptomatic finding, it may contribute to stroke if additional risk factors are present.
North American Journal of Medical Sciences, 2014
The click and tone-evoked auditory brainstem responses are widely used in clinical practice due t... more The click and tone-evoked auditory brainstem responses are widely used in clinical practice due to their consistency and predictability. More recently, the speech-evoked responses have been used to evaluate subcortical processing of complex signals, not revealed by responses to clicks and tones. Aims: Disyllable stimuli corresponding to familiar words can induce a pattern of voltage fl uctuations in the brain stem resulting in a familiar waveform, and they can yield better information about brain stem nuclei along the ascending central auditory pathway. Materials and Methods: We describe a new method with the use of the disyllable word "baba" corresponding to English "daddy" that is commonly used in many other ethnic languages spanning from West Africa to the Eastern Mediterranean all the way to the East Asia. Results: This method was applied in 20 young adults institutionally diagnosed as dyslexic (10 subjects) or light dyslexic (10 subjects) who were matched with 20 sex, age, education, hearing sensitivity, and IQ-matched normal subjects. The absolute peak latencies of the negative wave C and the interpeak latencies of A-C elicited by verbal stimuli "baba" were found to be signifi cantly increased in the dyslexic group in comparison with the control group. Conclusions: The method is easy and helpful to diagnose abnormalities affecting the auditory pathway, to identify subjects with early perception and cortical representation abnormalities, and to apply the suitable therapeutic and rehabilitation management.
The Clinical Journal of Pain, 2007
Anticonvulsants are widely used for treatment of painful diabetic neuropathy. Selective serotonin... more Anticonvulsants are widely used for treatment of painful diabetic neuropathy. Selective serotonin reuptake inhibitors (SSRIs) are not first-line drugs but are commonly prescribed medicines for chronic pain. The majority of patients are hesitant to use these drug groups, thus their compliance remains an issue. To compare patient compliance and the effectiveness of 2 SSRIs (paroxetine or citalopram) and 1 anticonvulsant (gabapentin) in patients with painful diabetic neuropathy. This was a 6 months prospective trial in 101 patients with painful diabetic neuropathy and minimum score of 2 on a pain intensity scale ranging of 0 to 4. Compliance was assessed with patient interviews and pill counts. Adverse events, early discontinuation or satisfaction with treatment were also evaluated. Patients receiving SSRIs reported greater satisfaction and fewer concerns of the side-effects with their treatment (P<0.05) compared with the patients taking gabapentin. There was statistically significant better mood in the SSRI group (P<0.05). Overall, 43.5% of those taking SSRIs noticed no effect on the pain control, 50% felt better, and 6.5% felt worse. Among the patients taking gabapentin, 51% felt better, 40.5% noticed no effect, and 8.5% felt worse. Finally, on the pill count, more patients on SSRIs (93.5%) than on gabapentin (82.9%) were taking over the 75% of their medication (P<0.05). The lack of negative effects on quality of life, the better compliance, and the comparable efficiency of SSRIs suggest that these drugs may be considered as alternative to gabapentin in painful diabetic neuropathy.
Catheterization and Cardiovascular Interventions, 2010
Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2013
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2014
Fatigue limits daily functioning of patients with multiple sclerosis (MS) and has a severe impact... more Fatigue limits daily functioning of patients with multiple sclerosis (MS) and has a severe impact on their quality of life. Fatigue is considered a result of biological, psychological and environmental factors. This study investigated the effect of the ambient temperature on the levels of fatigue during each season of the year in MS patients and a healthy population. Forty-five MS patients and 42 healthy people matched for age and sex participated in the study. Measurement of fatigue was based on the Fatigue Severity Scale.
Journal of Alzheimer's disease : JAD, 2014
The impact of statin therapy on dementia has been a hot topic of debate over the last decade and ... more The impact of statin therapy on dementia has been a hot topic of debate over the last decade and still remains highly controversial. Among all causes of dementia, vascular dementia (VaD) is the one type that is more likely to benefit from statins. To date no randomized clinical trials have been published and no systematic review has investigated a possible preventive effect of statins on the VaD subtype. In the present literature review, we tried to identify all available data on the effect of statins specifically in patients with VaD, and to further discuss this possible association. Our literature search highlighted two cross-sectional studies, two prospective cohort studies, and one retrospective cohort study. Two of the studies found a significant positive effect of statin treatment on VaD, depicted by the lower incidence of VaD in statin users, while the others reported non-significant associations. The relatively small numbers of VaD patients and statin users, as well as the presence of confounders and biases, make the interpretation of results extremely difficult. Statins may exert a benefit in the prevention of all-type dementia and VaD, through several mechanisms except for hyperlipidemia reduction. A well-designed randomized clinical trial is the ideal study design to address the effect of statin therapy in VaD and to draw final conclusions.
Stroke; a journal of cerebral circulation, 2014
This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Anal... more This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic Background and Purpose-Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods-We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results-We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Conclusions-Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism. (Stroke. 2014;45:1764-1770.)
Stroke; a journal of cerebral circulation, 2014
T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 1... more T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 15% to 35%. 1 In patients with cryptogenic stroke, PFO is more common, but a clear causative relationship is not well established. 2 Recurrent cerebrovascular events are frequent in medically treated patients with a history of paradoxical embolism 3 ; however, in more than one third of these patients concurrent pathogeneses (other than the sole presence of PFO) are identified. 4,5 Thus, it still remains unclear whether PFO is causally related to firstever or recurrent cerebral ischemia or constitutes an incidental finding of diagnostic work-up. 6,7 PFO size and the degree of functional shunting could represent potential risk factors for cerebral ischemia in medically treated patients with PFO. 8 PFOs in patients with cerebral ischemia are thought to be larger 9 and to be more frequently associated with atrial septal aneurysms, compared with the PFOs in asymptomatic patients. 10 Moreover, in transcranial Doppler (TCD) studies, large PFOs were found to be significantly associated with more microembolic signals compared with small PFOs. 11,12 However, data from other studies suggest that the shunt grade assessed with TCD is not associated with the brain infarct volume on computed tomography 13 and that Background and Purpose-Recurrent cerebrovascular events are frequent in medically treated patients with patent foramen ovale (PFO), but it still remains unclear whether PFO is a causal or an incidental finding. Further uncertainty exists on whether the size of functional shunting could represent a potential risk factor. The aim of the present study was to evaluate if the presence of PFO is associated with an increased risk of recurrent stroke or transient ischemic attack and to investigate further if this relationship is related to the shunt size.
Pediatric Emergency Care, 2008
We describe a case of a 14-year-old boy who presented to the emergency department with nausea, vo... more We describe a case of a 14-year-old boy who presented to the emergency department with nausea, vomiting, headache, and mental status changes. Noncontrast computed tomography scan of the brain in the emergency department revealed bilateral thalamic and striatocapsular infarcts. The patient was diagnosed with possible thrombosis of the thalamostriate veins, which was confirmed with urgent magnetic resonance venography (MRV). Magnetic resonance venography revealed that the thrombosis was extended to the straight sinus and the internal cerebral veins. Thrombosis of the straight sinus in children results in a rare stroke with inconsistent clinical manifestations, depending on collateral venous circulation of the thrombosed sinus. The diagnosis is quite difficult, especially when symptoms are nonspecific and variable. Timely diagnosis, based on the decision of performing emergency magnetic resonance imaging and MRV, followed by the administration of anticoagulation therapy may reverse this condition as in our patient who made an excellent recovery.
Internal Medicine, 2009
Cerebral venous thrombosis (CVT) may present with a variety of symptoms and findings consisting o... more Cerebral venous thrombosis (CVT) may present with a variety of symptoms and findings consisting of either only persistent headache, or slowly progressive stroke over several days, or even coma. CVT may develop in relation to hypercoagulable states. However, even after extensive investigation, a predisposing factor could not be identified in some cases. We report a case of CVT associated with heterozygous V Leiden mutation and sarcoidosis. Since most factor V gene heterozygous individuals do not exhibit clinical thrombotic events, the venous thrombosis of our patient suggests convergence of an inherited predisposition (heterozygous factor V Leiden mutation) with an acquired thrombogenic stimulus (sarcoidosis). Early diagnosis and treatment with anticoagulation is pivotal for a favorable outcome.
Sleep Medicine, 2009
We describe a 24-year-old man with episodes of intense desire to sleep for periods ranging from 2... more We describe a 24-year-old man with episodes of intense desire to sleep for periods ranging from 2 min to 3 h, episodes of generalized weakness and inability to speak without alteration of consciousness, frequent hypnagogic hallucinations during sleep and occasionally transient paralysis of limbs upon awakening. Brain MRI demonstrated elevation of the third ventricle, a characteristic lack of depiction of the corpus callosum and extension of the bihemispheric fissure to the third ventricle. We assume that structural changes of the base of frontal lobes, diencephalon and brainstem, can be accountable for symptomatic narcolepsy and cataplexy.
Although transcranial sonography is not yet an established diagnostic modality for dementia scree... more Although transcranial sonography is not yet an established diagnostic modality for dementia screening or differential diagnosis of Alzheimer's disease (AD) from vascular dementia (VaD), intracranial hemodynamic assessment may provide crucial information about the association between cognitive deterioration and vascular risk factors. We conducted a systematic narrative review of available literature through MEDLINE and EMBASE search to identify all available data about the evaluation of VaD patients with transcranial Doppler, and to discuss further the vascular disorders of the cerebral circulation in patients with vascular cognitive impairment. According to the available literature data to date, VaD patients were found to have lower mean flow velocity values in four studies (indicating cerebral hypoperfusion), higher pulsatility indices in three studies (indicating increased downstream vascular resistance), and more severe impairment of cerebrovascular reactivity in five studies (indicating exhausted vasodilatory reserve) compared to AD patients and controls. Microembolic signals were also found to be significantly more common in patients with VaD or AD compared to their age- and gender-matched controls, suggesting that asymptomatic microembolism, apart for being only marker of VaD, could presumably be involved in the genesis of dementia, and in the overlap between VaD and AD. Further studies with larger and carefully selected groups are required to eliminate potential confounders and to set specific cut-off values for the aforementioned hemodynamic parameters in demented patients and dementia subtypes.
Neurological Sciences, 2013
The potential effect of age and gender stratification in the outcome of patients with carotid art... more The potential effect of age and gender stratification in the outcome of patients with carotid artery stenosis undergoing carotid revascularization procedures (CRP) may have important implications in clinical practice. Both European Stroke Organization and American Heart Association guidelines suggest that age and sex should be taken into account when selecting a CRP for an individual patient. We reviewed available literature data through Medline and Embase. Our search was based on the combination of terms: age, gender, sex, carotid artery stenosis, carotid artery stenting (CAS) and carotid endarterectomy (CEA). Postoperative stroke and mortality rates increased with age after any CRP (CEA or CAS), especially in patients aged over 75 years. Older patients with carotid artery stenosis undergoing CAS were found to have a nearly double risk of stroke or death compared with CEA, while CEA was found to benefit more patients aged over 70 years with symptomatic carotid artery stenosis. Male patients with symptomatic or asymptomatic carotid artery stenosis had lower stroke/mortality rates and benefited more from CEA compared with females. For the periprocedural risk of stroke or death in patients with carotid artery stenosis after CAS no sex differences were found. Therefore, CEA appears to have lower perioperative risks than CAS in patients aged over 70 years, and thus should be the treatment of choice if not contraindicated. The periprocedural risk of CEA is lower in men than in women, while there was no effect of gender on the periprocedural risk of CAS.
International Journal of Rehabilitation Research, 2014
Fatigue in multiple sclerosis (MS) may be attributed to a variety of biological and psychological... more Fatigue in multiple sclerosis (MS) may be attributed to a variety of biological and psychological factors. Scales addressing the multidimensionality of fatigue are used in MS evaluation, although adequacy of data on their reliability and validity is questionable. The aim of the present study was to provide evidence for the validity and reliability of the Greek version of the Modified Fatigue Impact Scale (MFIS). The MFIS was translated into Greek and administered to 99 MS patients and 75 controls. Exploratory factor analysis was carried out and reliability measures were calculated. Discriminant validity was also assessed. The mean MFIS score was 33.8 (SD 17.8). Two factors (physical and cognitive) were extracted through factor analysis; a psychosocial factor was not identified. Reliability measures (intraclass correlation coefficient, Cronbach's α, Pearson's correlation) yielded high values. Patients and nonpatients differed statistically significantly in the MFIS scores; no statistically significant differences in MFIS score according to the type of MS were observed. It can be concluded that the Greek version of MFIS is valid and reliable, although questions about the scale dimensions remain. Further modifications and cultural adaptation of the scale may help create a useful tool for screening and assessment of fatigue in MS patients.
Cerebrovascular Diseases, 2008
We conducted a hospital-based case-control study to evaluate the association between the XbaI and... more We conducted a hospital-based case-control study to evaluate the association between the XbaI and PvuII restriction fragment length polymorphisms (RFLPs) in intron 1 of the estrogen receptor α (ERα) gene and breast cancer risk. The study population consisted of 205 histologically confirmed incident breast cancer cases and 205 age-matched controls with no present and previous history of cancer. The PvuII genotype distribution did not show any difference between cases and controls, but the adjusted odds ratio (OR) for the XbaI X allele containing genotypes was 0.4 (95% CI: 0.3-0.6) compared with the xx genotype. The decrease in the OR appeared to be more attributable to the postmenopausal women; the ORs were 0.3 (95% CI: 0.1-0.5) and 0.5 (95% CI: 0.3-0.9) for postmenopausal and premenopausal women, respectively. Our results therefore suggest that the ERα XbaI polymorphism modifies individual susceptibility to breast cancer in Korean women.
Archives of Neurology, 2006
Therapeutic advances in neurological disorders, 2014
There are growing concerns for the side effects of dabigatran etexilate (dabigatran), including h... more There are growing concerns for the side effects of dabigatran etexilate (dabigatran), including higher incidence of dyspepsia and gastrointestinal bleeding. We conducted a multicenter early implementation study to prospectively evaluate the safety, efficacy and adherence to dabigatran for secondary stroke prevention. Consecutive atrial fibrillation (AF) patients with ischemic stroke (IS) or transient ischemic attack (TIA) received dabigatran for secondary stroke prevention during their hospital stay according to American Heart Association recommendations at five tertiary care stroke centers. The study population was prospectively followed and outcomes were documented. The primary and secondary safety outcomes were major hemorrhage and all other bleeding events respectively defined according to RE-LY trial methodology. A total of 78 AF patients (mean age 71 ± 9years; 54% men; 81% IS, 19% TIA; median CHADS2 (Congestive heart failure, Hypertension, diabetes mellitus, age >75 years, prior stroke or TIA); range 2-5) score 4 were treated with dabigatran [(110mg bid (74%); 150mg bid (26%)]. During a mean follow-up period of 7 ± 5 months (range 1-18) we documented no cases of IS, TIA, intracranial hemorrhage, systemic embolism or myocardial infarction in AF patients treated with dabigatran. There were two (2.6%) major bleeding events (lower gastrointestinal bleeding) and two (2.6%) minor bleedings [hematuria (n = 1) and rectal bleeding (n = 1)]. Dabigatran was discontinued in 26% of the study population with high cost being the most common reason for discontinuation (50%). Our pilot data indicate that dabigatran appears to be safe for secondary stroke prevention during the first year of implementation of this therapy. However, high cost may limit the long-term treatment of AF patients with dabigatran, leading to early discontinuation.
Annals of neurology, Jan 2, 2016
Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral isc... more Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic ischemic stroke (IS) or transient ischemic attack (TIA) has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. We performed a systematic literature review to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Our literature search identified 35 eligible studies including 3067 patients. The pooled sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (9...
Journal of Neurology, Neurosurgery & Psychiatry, 2007
To present three cases of young adults with lateral medullary ischaemic events associated with a ... more To present three cases of young adults with lateral medullary ischaemic events associated with a hypoplastic vertebral artery (VA). All three patients had two additional atherosclerotic or non-atherosclerotic risk factors for stroke. Patients and methods: One female, aged 40 years, and two males, aged 38 and 37 years, each with two risk factors for stroke, presented to the emergency department with acute onset of symptoms and findings consistent with lateral medullary syndrome. All three patients underwent emergency CT scan of the brain followed by MRI and magnetic resonance angiography (MRA). Results: The CT scans were negative in all patients. MRI revealed a lateral medullary lesion in only one patient. All three patients had a hypoplastic VA ipsilateral to the clinical ischaemic event on MRA. Conclusions: Hypoplasia of VA is not considered a risk factor for stroke as it is a common variant in up to 75% of the general population. However, in our patients, hypoplastic VA coexisted with two risk factors and resulted in stroke. Thus although a hypoplastic VA may not be an uncommon asymptomatic finding, it may contribute to stroke if additional risk factors are present.
North American Journal of Medical Sciences, 2014
The click and tone-evoked auditory brainstem responses are widely used in clinical practice due t... more The click and tone-evoked auditory brainstem responses are widely used in clinical practice due to their consistency and predictability. More recently, the speech-evoked responses have been used to evaluate subcortical processing of complex signals, not revealed by responses to clicks and tones. Aims: Disyllable stimuli corresponding to familiar words can induce a pattern of voltage fl uctuations in the brain stem resulting in a familiar waveform, and they can yield better information about brain stem nuclei along the ascending central auditory pathway. Materials and Methods: We describe a new method with the use of the disyllable word "baba" corresponding to English "daddy" that is commonly used in many other ethnic languages spanning from West Africa to the Eastern Mediterranean all the way to the East Asia. Results: This method was applied in 20 young adults institutionally diagnosed as dyslexic (10 subjects) or light dyslexic (10 subjects) who were matched with 20 sex, age, education, hearing sensitivity, and IQ-matched normal subjects. The absolute peak latencies of the negative wave C and the interpeak latencies of A-C elicited by verbal stimuli "baba" were found to be signifi cantly increased in the dyslexic group in comparison with the control group. Conclusions: The method is easy and helpful to diagnose abnormalities affecting the auditory pathway, to identify subjects with early perception and cortical representation abnormalities, and to apply the suitable therapeutic and rehabilitation management.
The Clinical Journal of Pain, 2007
Anticonvulsants are widely used for treatment of painful diabetic neuropathy. Selective serotonin... more Anticonvulsants are widely used for treatment of painful diabetic neuropathy. Selective serotonin reuptake inhibitors (SSRIs) are not first-line drugs but are commonly prescribed medicines for chronic pain. The majority of patients are hesitant to use these drug groups, thus their compliance remains an issue. To compare patient compliance and the effectiveness of 2 SSRIs (paroxetine or citalopram) and 1 anticonvulsant (gabapentin) in patients with painful diabetic neuropathy. This was a 6 months prospective trial in 101 patients with painful diabetic neuropathy and minimum score of 2 on a pain intensity scale ranging of 0 to 4. Compliance was assessed with patient interviews and pill counts. Adverse events, early discontinuation or satisfaction with treatment were also evaluated. Patients receiving SSRIs reported greater satisfaction and fewer concerns of the side-effects with their treatment (P<0.05) compared with the patients taking gabapentin. There was statistically significant better mood in the SSRI group (P<0.05). Overall, 43.5% of those taking SSRIs noticed no effect on the pain control, 50% felt better, and 6.5% felt worse. Among the patients taking gabapentin, 51% felt better, 40.5% noticed no effect, and 8.5% felt worse. Finally, on the pill count, more patients on SSRIs (93.5%) than on gabapentin (82.9%) were taking over the 75% of their medication (P<0.05). The lack of negative effects on quality of life, the better compliance, and the comparable efficiency of SSRIs suggest that these drugs may be considered as alternative to gabapentin in painful diabetic neuropathy.
Catheterization and Cardiovascular Interventions, 2010
Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2013
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2014
Fatigue limits daily functioning of patients with multiple sclerosis (MS) and has a severe impact... more Fatigue limits daily functioning of patients with multiple sclerosis (MS) and has a severe impact on their quality of life. Fatigue is considered a result of biological, psychological and environmental factors. This study investigated the effect of the ambient temperature on the levels of fatigue during each season of the year in MS patients and a healthy population. Forty-five MS patients and 42 healthy people matched for age and sex participated in the study. Measurement of fatigue was based on the Fatigue Severity Scale.
Journal of Alzheimer's disease : JAD, 2014
The impact of statin therapy on dementia has been a hot topic of debate over the last decade and ... more The impact of statin therapy on dementia has been a hot topic of debate over the last decade and still remains highly controversial. Among all causes of dementia, vascular dementia (VaD) is the one type that is more likely to benefit from statins. To date no randomized clinical trials have been published and no systematic review has investigated a possible preventive effect of statins on the VaD subtype. In the present literature review, we tried to identify all available data on the effect of statins specifically in patients with VaD, and to further discuss this possible association. Our literature search highlighted two cross-sectional studies, two prospective cohort studies, and one retrospective cohort study. Two of the studies found a significant positive effect of statin treatment on VaD, depicted by the lower incidence of VaD in statin users, while the others reported non-significant associations. The relatively small numbers of VaD patients and statin users, as well as the presence of confounders and biases, make the interpretation of results extremely difficult. Statins may exert a benefit in the prevention of all-type dementia and VaD, through several mechanisms except for hyperlipidemia reduction. A well-designed randomized clinical trial is the ideal study design to address the effect of statin therapy in VaD and to draw final conclusions.
Stroke; a journal of cerebral circulation, 2014
This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Anal... more This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic Background and Purpose-Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods-We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results-We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Conclusions-Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism. (Stroke. 2014;45:1764-1770.)
Stroke; a journal of cerebral circulation, 2014
T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 1... more T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 15% to 35%. 1 In patients with cryptogenic stroke, PFO is more common, but a clear causative relationship is not well established. 2 Recurrent cerebrovascular events are frequent in medically treated patients with a history of paradoxical embolism 3 ; however, in more than one third of these patients concurrent pathogeneses (other than the sole presence of PFO) are identified. 4,5 Thus, it still remains unclear whether PFO is causally related to firstever or recurrent cerebral ischemia or constitutes an incidental finding of diagnostic work-up. 6,7 PFO size and the degree of functional shunting could represent potential risk factors for cerebral ischemia in medically treated patients with PFO. 8 PFOs in patients with cerebral ischemia are thought to be larger 9 and to be more frequently associated with atrial septal aneurysms, compared with the PFOs in asymptomatic patients. 10 Moreover, in transcranial Doppler (TCD) studies, large PFOs were found to be significantly associated with more microembolic signals compared with small PFOs. 11,12 However, data from other studies suggest that the shunt grade assessed with TCD is not associated with the brain infarct volume on computed tomography 13 and that Background and Purpose-Recurrent cerebrovascular events are frequent in medically treated patients with patent foramen ovale (PFO), but it still remains unclear whether PFO is a causal or an incidental finding. Further uncertainty exists on whether the size of functional shunting could represent a potential risk factor. The aim of the present study was to evaluate if the presence of PFO is associated with an increased risk of recurrent stroke or transient ischemic attack and to investigate further if this relationship is related to the shunt size.
Pediatric Emergency Care, 2008
We describe a case of a 14-year-old boy who presented to the emergency department with nausea, vo... more We describe a case of a 14-year-old boy who presented to the emergency department with nausea, vomiting, headache, and mental status changes. Noncontrast computed tomography scan of the brain in the emergency department revealed bilateral thalamic and striatocapsular infarcts. The patient was diagnosed with possible thrombosis of the thalamostriate veins, which was confirmed with urgent magnetic resonance venography (MRV). Magnetic resonance venography revealed that the thrombosis was extended to the straight sinus and the internal cerebral veins. Thrombosis of the straight sinus in children results in a rare stroke with inconsistent clinical manifestations, depending on collateral venous circulation of the thrombosed sinus. The diagnosis is quite difficult, especially when symptoms are nonspecific and variable. Timely diagnosis, based on the decision of performing emergency magnetic resonance imaging and MRV, followed by the administration of anticoagulation therapy may reverse this condition as in our patient who made an excellent recovery.
Internal Medicine, 2009
Cerebral venous thrombosis (CVT) may present with a variety of symptoms and findings consisting o... more Cerebral venous thrombosis (CVT) may present with a variety of symptoms and findings consisting of either only persistent headache, or slowly progressive stroke over several days, or even coma. CVT may develop in relation to hypercoagulable states. However, even after extensive investigation, a predisposing factor could not be identified in some cases. We report a case of CVT associated with heterozygous V Leiden mutation and sarcoidosis. Since most factor V gene heterozygous individuals do not exhibit clinical thrombotic events, the venous thrombosis of our patient suggests convergence of an inherited predisposition (heterozygous factor V Leiden mutation) with an acquired thrombogenic stimulus (sarcoidosis). Early diagnosis and treatment with anticoagulation is pivotal for a favorable outcome.
Sleep Medicine, 2009
We describe a 24-year-old man with episodes of intense desire to sleep for periods ranging from 2... more We describe a 24-year-old man with episodes of intense desire to sleep for periods ranging from 2 min to 3 h, episodes of generalized weakness and inability to speak without alteration of consciousness, frequent hypnagogic hallucinations during sleep and occasionally transient paralysis of limbs upon awakening. Brain MRI demonstrated elevation of the third ventricle, a characteristic lack of depiction of the corpus callosum and extension of the bihemispheric fissure to the third ventricle. We assume that structural changes of the base of frontal lobes, diencephalon and brainstem, can be accountable for symptomatic narcolepsy and cataplexy.
Although transcranial sonography is not yet an established diagnostic modality for dementia scree... more Although transcranial sonography is not yet an established diagnostic modality for dementia screening or differential diagnosis of Alzheimer's disease (AD) from vascular dementia (VaD), intracranial hemodynamic assessment may provide crucial information about the association between cognitive deterioration and vascular risk factors. We conducted a systematic narrative review of available literature through MEDLINE and EMBASE search to identify all available data about the evaluation of VaD patients with transcranial Doppler, and to discuss further the vascular disorders of the cerebral circulation in patients with vascular cognitive impairment. According to the available literature data to date, VaD patients were found to have lower mean flow velocity values in four studies (indicating cerebral hypoperfusion), higher pulsatility indices in three studies (indicating increased downstream vascular resistance), and more severe impairment of cerebrovascular reactivity in five studies (indicating exhausted vasodilatory reserve) compared to AD patients and controls. Microembolic signals were also found to be significantly more common in patients with VaD or AD compared to their age- and gender-matched controls, suggesting that asymptomatic microembolism, apart for being only marker of VaD, could presumably be involved in the genesis of dementia, and in the overlap between VaD and AD. Further studies with larger and carefully selected groups are required to eliminate potential confounders and to set specific cut-off values for the aforementioned hemodynamic parameters in demented patients and dementia subtypes.
Neurological Sciences, 2013
The potential effect of age and gender stratification in the outcome of patients with carotid art... more The potential effect of age and gender stratification in the outcome of patients with carotid artery stenosis undergoing carotid revascularization procedures (CRP) may have important implications in clinical practice. Both European Stroke Organization and American Heart Association guidelines suggest that age and sex should be taken into account when selecting a CRP for an individual patient. We reviewed available literature data through Medline and Embase. Our search was based on the combination of terms: age, gender, sex, carotid artery stenosis, carotid artery stenting (CAS) and carotid endarterectomy (CEA). Postoperative stroke and mortality rates increased with age after any CRP (CEA or CAS), especially in patients aged over 75 years. Older patients with carotid artery stenosis undergoing CAS were found to have a nearly double risk of stroke or death compared with CEA, while CEA was found to benefit more patients aged over 70 years with symptomatic carotid artery stenosis. Male patients with symptomatic or asymptomatic carotid artery stenosis had lower stroke/mortality rates and benefited more from CEA compared with females. For the periprocedural risk of stroke or death in patients with carotid artery stenosis after CAS no sex differences were found. Therefore, CEA appears to have lower perioperative risks than CAS in patients aged over 70 years, and thus should be the treatment of choice if not contraindicated. The periprocedural risk of CEA is lower in men than in women, while there was no effect of gender on the periprocedural risk of CAS.
International Journal of Rehabilitation Research, 2014
Fatigue in multiple sclerosis (MS) may be attributed to a variety of biological and psychological... more Fatigue in multiple sclerosis (MS) may be attributed to a variety of biological and psychological factors. Scales addressing the multidimensionality of fatigue are used in MS evaluation, although adequacy of data on their reliability and validity is questionable. The aim of the present study was to provide evidence for the validity and reliability of the Greek version of the Modified Fatigue Impact Scale (MFIS). The MFIS was translated into Greek and administered to 99 MS patients and 75 controls. Exploratory factor analysis was carried out and reliability measures were calculated. Discriminant validity was also assessed. The mean MFIS score was 33.8 (SD 17.8). Two factors (physical and cognitive) were extracted through factor analysis; a psychosocial factor was not identified. Reliability measures (intraclass correlation coefficient, Cronbach's α, Pearson's correlation) yielded high values. Patients and nonpatients differed statistically significantly in the MFIS scores; no statistically significant differences in MFIS score according to the type of MS were observed. It can be concluded that the Greek version of MFIS is valid and reliable, although questions about the scale dimensions remain. Further modifications and cultural adaptation of the scale may help create a useful tool for screening and assessment of fatigue in MS patients.
Cerebrovascular Diseases, 2008
We conducted a hospital-based case-control study to evaluate the association between the XbaI and... more We conducted a hospital-based case-control study to evaluate the association between the XbaI and PvuII restriction fragment length polymorphisms (RFLPs) in intron 1 of the estrogen receptor α (ERα) gene and breast cancer risk. The study population consisted of 205 histologically confirmed incident breast cancer cases and 205 age-matched controls with no present and previous history of cancer. The PvuII genotype distribution did not show any difference between cases and controls, but the adjusted odds ratio (OR) for the XbaI X allele containing genotypes was 0.4 (95% CI: 0.3-0.6) compared with the xx genotype. The decrease in the OR appeared to be more attributable to the postmenopausal women; the ORs were 0.3 (95% CI: 0.1-0.5) and 0.5 (95% CI: 0.3-0.9) for postmenopausal and premenopausal women, respectively. Our results therefore suggest that the ERα XbaI polymorphism modifies individual susceptibility to breast cancer in Korean women.
Archives of Neurology, 2006
Therapeutic advances in neurological disorders, 2014
There are growing concerns for the side effects of dabigatran etexilate (dabigatran), including h... more There are growing concerns for the side effects of dabigatran etexilate (dabigatran), including higher incidence of dyspepsia and gastrointestinal bleeding. We conducted a multicenter early implementation study to prospectively evaluate the safety, efficacy and adherence to dabigatran for secondary stroke prevention. Consecutive atrial fibrillation (AF) patients with ischemic stroke (IS) or transient ischemic attack (TIA) received dabigatran for secondary stroke prevention during their hospital stay according to American Heart Association recommendations at five tertiary care stroke centers. The study population was prospectively followed and outcomes were documented. The primary and secondary safety outcomes were major hemorrhage and all other bleeding events respectively defined according to RE-LY trial methodology. A total of 78 AF patients (mean age 71 ± 9years; 54% men; 81% IS, 19% TIA; median CHADS2 (Congestive heart failure, Hypertension, diabetes mellitus, age >75 years, prior stroke or TIA); range 2-5) score 4 were treated with dabigatran [(110mg bid (74%); 150mg bid (26%)]. During a mean follow-up period of 7 ± 5 months (range 1-18) we documented no cases of IS, TIA, intracranial hemorrhage, systemic embolism or myocardial infarction in AF patients treated with dabigatran. There were two (2.6%) major bleeding events (lower gastrointestinal bleeding) and two (2.6%) minor bleedings [hematuria (n = 1) and rectal bleeding (n = 1)]. Dabigatran was discontinued in 26% of the study population with high cost being the most common reason for discontinuation (50%). Our pilot data indicate that dabigatran appears to be safe for secondary stroke prevention during the first year of implementation of this therapy. However, high cost may limit the long-term treatment of AF patients with dabigatran, leading to early discontinuation.