Day 1 :
Keynote Forum
Anne L. Foundas
Brain Institute of Lousiana, USA
Keynote: Early Intervention In Vascular Cognitive Impairment
Biography:
Anne L. Foundas, M.D., FAAN completed her Medical Degree from the LSU School of Medicine (LSU-SOM) in New Orleans, and her Neurology Resdiency and Postdoctoral training at the Univisity of Florida School of Medicine. She is the Executive Director of the Brain Institute of Lousiana, a premier institute that promotes brain health through medical resaearch and education. She has worked as Professor of Neurology at Tulane University, Vice-Chair of Clinical Research at the LSU-SOM, and Chair of Neurology at UMKC-SOM. She has published more than 200 papers and has supervised the training of over 200 physicians, clinical researchers, and educators.
Abstract:
Vascular dementia (VaD) is one dementia subtype that occurs with increasing age. This diagnosis is found in about 20% of people with dementia. The world population is aging. It is estimated that by 2050 there will be over 1.6 billion people worldwide aged 65 and over (17% of the world’s population). The greatest risk for VaD is a history of vascular risk factors (e.g., hypertension, hyperlipidemia) and increasing age. These vascular risks are associated with microvascular disease and stroke. Many people with neurodegenerative diseases, like Alzheimer’s disease, also have microvascular disease and, therefore, have a mixed-type of dementia. These mixed-dementia patients often have a more malignant disease progression. Our clinical and research progrms focus on early intervention in individuals with vascular cognitive impairment, including innovative treatment approaches to change the trajectory of cognitive decline. This talk will include an overview of the clinical and pathological heterogeneity of VaD. The second part will emphasize clusters of patients with vascular cognitive impairment, including major cognitive markers that seem to be prevalent across clinical subtypes. In the third part preliminary data will be presented that highligts our clinical approach that includes the innovative use of neural stimulation and photobiomodulation. Our clinical research team uses a two-pronged approach to: (1) improve communication skills and functional independence in patients with a cognitive decline, and (2) facilitate early identification and treatment of at risk individuals. This discussion will focus on our innovative treatment approaches designed to enhance functional independence, improve communication skills, and reduce caregiver burden..
Keynote Forum
Ming-Hsiu, Wu
Chi Mei Medical Center, Liouying, Tainan, Taiwan
Keynote: E-BABE-Adiponectin Axis and Ischemic Stroke
Biography:
Ming-Hsiu, Wu received his M.D. degree at Kaohsiung Medical University, Taiwan and Ph.D. degree at National Chen Kung University, Taiwan. He is now the director of Division of Neurology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan. His major interests are relationship among adiponectin axis, obesity, and ischemic stroke. For caring dementia patients, he also pays his attention to the overlap between ischemic stroke and Alzheimer’s disease. He published a couple of papers regarding adiponectin axis and its therapeutic trial in cerebral ischemia, and clinical stroke care.
Abstract:
Adiponectin (APN) axis is composed of adiponectin and its receptors (ARs). Adiponectin, an adipokine which weights 30 kDa, is almost exclusively secreted by adipocytes. It exists as oliogmeric multimers, and a globular fragment (gAd). Aiponectin receptors is composed of type 1 and 2, and is responsible for adiponectin signaling.
Physiologically, adiponectin is mainly involved in insulin sensitivity and regulation of metabolism of glucose and lipids. Obesity decreased its circulating level for increased oxidative stress in accumulated fat.
Adiponectin exerts multiple protective mechanisms against cerebral ischemic injury including eNOS-dependent mechanism, anti-inflammation, anti-apoptosis, anti-oxidation, anti-apoptosis, and promotion of angiogenesis.
The results of recent meta-analysis studies about adiponectin and risk of stroke are inconsistent. Two studies reported no association of circulating adiponectin levels and risk of stroke, while another reported hyperadiponectinemia increased risk of ischemic stroke. Results from studies in assessing circulating adiponectin levels and the risk of stroke mortality are conflicting and inconsistent in its relationship with functional outcome.
Although many laboratory studies reported beneficial effects of adiponectin in the protection against cerebral ischemic injury, some in vitro evidence showed that activation of AR1 might render neurons vulnerable to ischemic death. Our study showed adiponectin was protective against cerebral ischemic injury through down-regulation of AR1 expression and up-regulation of AR2 expression and p38-mediated anti-apoptosis.
Finally, we believe that, with better understandings of adiponectin axis in cerebral ischemia basically and ischemic stroke clinically, adiponectin has the great potential to be applied in the future care and treatment of ischemic stroke.
Keynote Forum
Jiangang Shen
The University of Hong Kong, Hong Kong
Keynote: Oxidative Stress and Antioxidant: What We Should Do for Preventing Brain Damage and Improving Brain Repair in Stroke Treatment
Time : TBA
Biography:
Dr. Shen Jiangang is Professor in School of Chinese Medicine, University of Hong Kong. He also serves as Associate Director (Research) and Chair of Department of Research Postgraduate Students Committee in the School. Dr. Shen’s major research interests focus on molecular regulations of oxidative stress and redox signaling in brain damage and brain repair in post-stroke and neurodegenerative diseases. He is also interested in the experimental and clinical studies on Chinese herbal medicine for cerebral and cardiovascular diseases. His studies have been supported by many prestigious research funds from Hong Kong, Mainland China and others. He has published more than 150 peer-reviewed papers in prestigious academic journals and 14 book chapters. He received many academic and research awards and appointed as honor professorship 15 universities from China and USA. He serves as the editorial board members for many international academic journals including Toxicology and Applied Pharmacology, Scientific Reports and others.
Abstract:
Free radicals, including reactive oxygen species (ROS) and reactive nitrogen species (RNS), play important roles in ischemic brin injury. However, both ROS and RNS at low concentration could be redox signaling to maintain biological functions. Although antioxidant therapy revealed neuroprotective effects in stroke animal models, no promising neuroprotective effect has been reported in clinical trials on stroke patients. Thus, the efficacy of antioxidant therapy for stroke treatment is still a puzzle. Peroxynitrite, a representative RNS, is produced from the rapid reaction of NO and O2-. , but it has higher cytotoxic effects than its parent free radicals. Peroxynitrite could increase blood brain barrier (BBB) disruption and aggravate ischemic brain damage. We have explored the molecular targets of RNS in mediating the BBB disruption and brain damage in experimental rat models of cerebral ischemia-reperfusion injury. We found that RNS down-regulated caveolin-1 (Cav-1) in the ischemic brains. Importantly, the loss of Cav-1 activated nitric oxide synthase (NOS), amplified RNS production and activated matrix metalloproteinases (MMP), subsequently inducing the BBB disruption and aggravating cerebral ischemia-reperfusion injury. The feedback interaction of RNS/Cav-1/MMPs provides an amplifying mechanism for aggravating ischemic brain damage. Furthermore, we tested the potentials of targeting the RNS/Cav-1/MMP pathway for drug discovery and found that that medicinal plant compounds, such as glycyrrhizin and baicalin, could regulate the RNS/Cav-1/MMP signaling cascades and attenuate cerebral ischemia-reperfusion injury. Moreover, glycyrrhizin and baicalin revealed to scavenge RNS, inhibit MMPs activation and reduced the BBB damages and hemorrhagic transformation in ischemic stroke animal model with delayed thrombolytic treatment. Therefore, targeting the RNS/Cav-1/MMP pathway could be a promising therapeutic strategy for protecting against cerebral ischemia-reperfusion injury. On the other hand, peroxynitrite at low concentration could be a cellular redox signaling for promoting neural stem cell (NSCs) proliferation, self-renewal and neuronal differentiation in ischemic/hypoxic NSCs. Therefore, antioxidant therapy at early phage of ischemic brain injury might be benefit for reducing RNS-mediated brain damage. Whether the antioxidant therapy could be benefit for brain repair without affecting the redox regulations remain to be further investigated. The detrimental or benefit effects of RNS in brain damage or brain repair could depend on their concentrations and their microenvironments in the ischemic brain
Keynote Forum
Asem Ali
Diana Princess of Wales Hospital UK
Keynote: Importance of timely MRI brain Diffusion weighted Imaging in differentiating mimics of ischaemic stroke
Time : TBA
Biography:
Dr Asem Ali, Consultant physician in stroke medicine; Site: Diana, Princess of Wales Hospital UK
Abstract:
MRI brain with diffusion weighted imaging has become the best modality over last decade in the diagnosis management of acute stroke and mimics especially when done within 0 to 14 days. MRI studies in acute strokes are done retrospectively and they suggest 15-30% MRI negative stroke. MRI with DWI can be positive in few circumstances other than ischaemic stroke for example cerebral venous sinus thrombosis, epilepsy, hypoglycaemia, migraine, abscess, herpes simplex encephalitis, demyelinating disease, Mitochondrial encephalopathy lactic acidosis and stroke like episodes, and Posterior reversible encephalopathy.
Objectives: We surveyed the MRI scans of patients presenting with stroke like symptoms and analysed the incidence of MRI negative acute strokes and MRI positive non-strokes at our acute stroke service over 4-month period.
Methods: We collected data of patients admitted under seven stroke skilled consultants using patient case notes, MRI with DWI images and reports by radiologist, discharge letters and clinic follow up clinic letters.
Results: We reviewed total of 180 patients (89 male and 91 female) using above methods. Overall 98% of the patients had MRI with DWI done within 14 days of admission and among those 90% of patients had MRI within 72 hours of presentation to acute stroke service. A total of 88 (49%) patients had positive MRI and 92 (51%) MRI was negative.
MRI positive Non-stroke:
Total of 8% patients had positive MRI but diagnosed as non-stroke patients. Six stroke physicians have given 100% stroke diagnosis in all MRI positive scans. 18.8% were patient diagnosed as MRI non-stroke by one stroke physician and 75% of these patients the diagnosis was changed to stroke on follow up clinics by second consultant physician.
MRI negative Stroke: Total of 9.7% of patients were labelled as stroke whereas MRI with diffusion weighted imaging was negative. Five consultants diagnosed MRI negative scans patients 100% as non-stroke Only two physician diagnosed 16% (7 patients) and 5% (2 patients) of patients as MRI negative Stroke respectively. Among the group of 16% patients, second physician on follow up change the diagnosis to non-stroke in 70% (5 patients) to anxiety related symptoms, migraine with aura and Bell’s palsy, remaining 2 patients were followed up by the same physician and diagnosis not changes. In the other 5% group of patients, diagnosis remained the same given the persistence of symptoms on follow up and MRI done > 14 days later.
Conclusion: Our survey has challenged the previous studies which were conducted retrospectively. Survey concluded that most ischaemic stroke will show diffusion restriction on MRI DWI and MRI negative stroke are less than 5% if the scan is done within 10-14 days of acute symptoms. More prospective studies have to be done by Stroke physician in collaboration with the radiologists.We recommend that MDT approach to be taken in MRI negative stroke / MRI positive non-stroke patient history and examination to be reviewed.
Keynote Forum
Hans von Holst,
Karolinska Institutet, Sweden
Keynote: Cytotoxic brain tissue edema as a complication to stroke and traumatic brain injury – How to deal with the new etiology.
Time : TBA
Biography:
Hans von Holst received his Medical Doctor´s degree in 1976 and specialist in Neurosurgery 1982 at Karolinska University Hospital. In 1985 he earned his PhD and Associate Professorship in Neurosurgery, Clinical Neuroscience at Karolinska Institutet. During 1991-1996 he was appointed as Chairman of the Dept of Neurosurgery and Division Manager of the Neuroclinics at Karolinska University Hospital, respectively. He has been appointed as senior neurosurgeon from 1974 to 2015. Between 1995-2015 he was appointed as Professor in Neuroengineering at the Royal Institute of Technology. He has published around 150 original papers in reputed journals, reviews and books and has been serving as an editorial board member in several journals.
Abstract:
Cytotoxic brain tissue edema, which is found in both grey and white matter cells, is a complicated secondary consequence to ischemic injury following cerebral diseases such as stroke and traumatic brain injury (TBI). To some extent the pathophysiological mechanisms are known, however far from complete. A new hypothesis regarding the etiology to cytotoxic brain edema is presented. The hypothesis is that the internal energy of semi-static mechanical forces following stroke and external energy of dynamic impact due to TBI result in the disruption of non-covalent and covalent bonds in protein and nucleotide structures. The unfolded proteins attract water molecules while the disruption of nucleotides such as adenosine-tri-phosphates causes a dysfunction in ion hemostasis and which may tentatively explain the etiology to cytotoxic edema. Our studies using computer models show that the kinetic energy following an impact to the head has the potential to break the chemical bonds in the protein and nucleotide structures resulting in cytotoxic brain tissue edema. Since folding of mature proteins is very much dependent on normal energy supply, the protein synthesis cannot continue during the ischemic process. Under such conditions very little of the energy rich ATP can be produced and which may result in disturbance between extra- and intracellular ion metabolism. By using a folded protein in laboratory investigation the present hypothesis has the potential to be confirmed and, hence, develop new drugs for therapeutic use.
Keynote Forum
Felipe Padilla-Vazquez
Instituto Nacional de NeurologÃa y NeurocirugÃa, Mexico
Keynote: A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations
Time : TBA
Biography:
Felipe Padilla Vazquez Specialist in Neurointervention, Neuropathic Endovascular Therapy, Cerebrovascular Diseases, Column Surgery, CNS Oncological Surgery, Headaches, Neuropathic Pain and present time he is Member of the Mexican Society of Neurological Surgery AC.
Abstract:
Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs.
This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1–4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis.
A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061–0.188), 2 point OR = (0.227 95% CI; 0.153–0.338), 3 point OR = (3.292 95% CI; 2.325–4.661), and 4 point OR = (23.304 95% CI; 11.077–49.027).
- Stroke, Stroke Rehabilitation, Neurodegenerative Disorders, Cerebrovascular Disorders, CNS Disorder
Location: TBA
Session Introduction
Souvik Sen
University of South Carolina School of Medicine, USA
Title: Gum disease a new risk factor for stroke
Biography:
Abstract:
Background and Purpose—Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk.
Methods—In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs).
Results—In the ARIC study 10362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ2 trend P<0.0001); the incidence rate for ischemic stroke/1000-person years was 1.29 for PPC-A (health), 2.82 for PPC-B, 4.80 for PPC-C, 3.81 for PPC-D, 3.50 for PPC-E, 4.78 for PPC-F, and 5.03 for PPC-G (severe periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2–5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3–3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63–0.94).
Conclusions—We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke.
Sarkis G. Morales-Vidal
Loyola University Chicago Stritch School of Medicine, USA
Title: Neurologic Complications of Fat Embolism Syndrome
Biography:
Dr. Sarkis Morales Vidal is a neurologist in Broadview, Illinois. He received his medical degree from Universidad Central del Este Facultad de Medicina and has been in practice between 11-20 years.
Abstract:
Purpose of Review Fat embolism syndrome (FES) is a rare disorder with potentially devastating neurologic complications. This article reviews the history, pathophysiology, clinical features, diagnosis, and treatment of FES with a focus on its neurologic aspects. Recent Findings The neurologic complications of FES are more commonly recognized with current diagnostic testing and increase awareness of the disorder. FES may present initially with neurologic manifestations. Prompt diagnosis of FES and of its neurologic manifestations could be lifesaving. This includes respiratory support and management of neurological complications. Summary The classic clinical triad of pulmonary insufficiency, neurologic disturbances, and petechial skin rash typically presents 24 to 72 h following an initial insult, most commonly a traumatic long bone fracture. Early onset (< 24 h) and delayed onset (> 72 h) have been described. Neurologic manifestations may include ischemic/hemorrhagic strokes, retinal ischemia, seizures, autonomic dysfunction, and diffuse brain injury. Diagnosis remains clinical. Management consists mainly of supportive care
Tomoya Kamide
International Medical Center, Saitama Medical University, Japan
Title: Factors associated with early seizures after surgery of unruptured intracranial aneurysms
Biography:
Tomoya Kamide has completed his MD at the age of 25 years and PhD at the age of 32 years from Kanazawa University. He is the assistannt professor of Neurosurgery, department of cerebrovascular surgery, international medical center, Saitama Medical University. He has published more than 10 papers in reputed journals.
Abstract:
Objective: The aim of the study was to better define the incidence of and risk factors for early seizures after repair of unruptured intracranial aneurysms in modern microsurgical techniques.
Patients and Methods: The medical records of 414 consecutive patients who underwent neck clipping of unruptured intracranial aneurysms in our institution over a 5-year period were retrospectively reviewed. Clinical and neuroimaging variables were analyzed to investigate putative predictors of perioperative seizures using multivariate logistic regression analysis.
Results: Overall, 24 patients (5.8%) developed seizures within 14 days of surgery without routine prophylactic use of anticonvulsants. Eleven patients experienced partial seizures, while 13 experienced secondary generalized seizures. The interval between surgery and seizure onset was less than 6 hours in 8 patients, 6–24 hours in 3, and 1–14 days in 11. History of dialysis (odds ratio [OR] = 77.6, 95% confidence interval [CI] 7.5–1783.4, P < 0.001), and presence of cerebral contusion (OR = 5.1, 95% CI 1.3–16.9, P = 0.02) or infarction (OR = 13.9, 95% CI 3.9–48.5, P < 0.001) detected by postoperative computed tomography were independent and significant risk factors. No patients with early seizures went on to develop refractory epilepsy.
Conclusions: Dialysis and iatrogenic brain damage were associated with a higher risk of early seizures after aneurysm surgery. Our data support the selective use of anticonvulsants during the perioperative period of elective aneurysm surgery.
Tanzida Haque
Stockport NHS Foundation Trust, UK
Title: Loop Closure Audit on Management of Post-Thrombolysis ICH
Biography:
Junior Clinical Fellow, Stockport NHS Foundation Trust, UK
Abstract:
Introduction: Reperfusion therapy with Alteplase has made a dramatic change in the management of acute ischemic stroke. Bleeding is one of the major complications of this therapy. Despite exclusion criteria, patients still bleed as a complication of this medication. Despite clearly agreed guidelines, clinical practice seems to differ widely amongst various practitioners. Several areas of concern identified and attempted to be addressed in the last audit since 2017. Loop closure audit undertaken to assess change in practice to enhance patient care and safety.
Aim: The Loop Closure audit was to establish improvement on areas of previous underperformances, especially sub-optimal BP monitoring and to look additionally at other potential factors that might have contributed to recent concerns on increased incidence of bleed after thrombolysis
Result: Post Thrombolysis BP Management is far from satisfactory with major deficit in standard. Hourly BP monitoring rate has been improved although BP measurement every 15 minutes post thrombolysis period has deteriorated from 85% to 60% . The rate of inappropriate referrals has dropped from 65% to 37%. More than 50% who bled did not have appropriate blood tests done (previously 60%). 60% of thrombolysed patients had NIHSS between 7—16 which shows the trend to have remained unchanged and which is also in keeping with national recommendation. 50% bled between 6-24 hours (previous 30%) and 27% bled after more than 24 hours (previous 55%). Death rate remains high in Post Thrombolysis bleed, around 40%. The mortality rate remains persistently higher.
Angie Logan
NIHR Clinical Doctoral Research Fellow and Clinical Specialist Physiotherapist Stroke and Neurology in West Cornwall, UK
Title: Standing Practice In Rehabilitation Early after Stroke (SPIRES)
Biography:
Angie Logan is a Clinical Specialist Physiotherapist in Stroke and Neurology and a Clinical Doctoral Research Fellow funded by the National Institute for Health Research (NIHR). She is leading her research across Cornwall and Devon in South West England and continues to work clinically with patients in West Cornwall.
Abstract:
People with severe stroke experience significant muscle weakness which means that they spend much of their time in bed or sitting. This inactivity can cause their muscles to become even weaker and stiffer and may lead them to experience sudden drops in blood pressure when they move from lying to standing (orthostatic hypotension (OH)). This further interferes with their ability to participate in intensive stroke rehabilitation, overall recovery and quality of life. Currently physiotherapy for people with severe stroke concentrates on practising tasks such as getting in and out of bed into a chair that are important for independence and achieving safe discharge home. Standing up early after a stroke may help strengthen muscles, reduce OH and minimise or prevent muscles becoming stiff and weaker. This trial aims to assess whether it is possible for people with severe stroke to use a standing frame to practise functional movements such as standing and moving between sitting and standing during their hospital-based rehabilitation. Fifty people with a severe stroke will be recruited from four different Stroke Rehabilitation Units in Cornwall and Devon. Using a computer programme, participants will be randomly allocated to either (1) functional standing frame programme (30 minutes) and 15 minutes of usual physiotherapy, or (2) 45 minutes of usual physiotherapy only. They will have one physiotherapy session per day, with a target of a minimum of five times per week for three weeks
Hiroki Kobayashi
International Medical Center, Saitama Medical University, Japan
Title: Clinical features and treatment outcome of ruptured distal ACA aneurysm
Biography:
Hiroki Kobayashi has completed his MD at the age of 25 years from Kagoshima University. He is the assistant professor of Neurosurgery, department of cerebrovascular surgery, international medical center, Saitama Medical University
Abstract:
Background: Aneurysms of the distal anterior cerebral artery (ACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated.
Objective: To clarify the clinical features and treatment outcome of ruptured distal ACA aneurysms treated at our institute.
Methods: Between 2012 and 2018, a total of 37 consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms underwent surgical clipping or coil embolization at our institute. Clinical presentations, radiographic findings, and outcomes were reviewed retrospectively. Additionally, we analyzed risk factors of poor outcome (mRS 4-6) using multiple regression analysis.
Results: Nineteen patients (51.4%) were W.F.N.S grade IV-V, and frontal lobe hematomas occurred in 18 patients (48.7%). Five patients (13.5%) and thirteen patients (35.1%) manifested azygous or bihemispheric ACA and multiple aneurysms, respectively. Surgical clipping and endovascular coiling were performed in 28 patients (75.7%) and in 9 patients (24.3%) respectively, and aneurysms located at the A4-5 portions were mainly treated by surgical clipping (p=0.04). There were no statistical differences in procedure-related morbidity and mortality between those groups, but complete occlusion rate was higher in the surgical group (p<0.01). Favorable neurological outcome at discharge (mRS 0-3) was obtained in 23 patients (62.5%), and multiple regression analysis revealed W.F.N.S grade IV-V and frontal lobe hematomas were risk factors of poor outcome.
Conclusion: Our treatment result using surgical clipping and endovascular coiling was acceptable and poor W.F.N.S grade and frontal lobe hematoma were risk factors of poor prognosis.
Tori Hysko
University of Central Florida Medical School, USA
Title: The benefits and risks of using Alteplase as the first-line of treatment for stoke patients with low (<5) NIHSS scores: A retrospective study of Orlando Health’s stroke database
Biography:
Tori Hysko is a current second year student at the University of Central Florida Medical School, hoping match into a neurology residency. Prior, she completed her Masters in biomedical science at the University of South Florida and her undergraduate degree, with a major in neuroscience, at Wellesley College
Abstract:
Alteplase is a tissue plasminogen activator (tPA) that has been shown to be the most accessible and effective medical treatment for ischemic stroke with Class I level A evidence in favor of its use.1 However, its use in treatment of mild stroke remains controversial. We hypothesize that patients in the Orlando Health stoke database with a low NIHSS score (National Institutes of Health Stroke Scale; NIHSS < 5), who otherwise meet criteria, are not always treated with Alteplase.2,3 Our goal is to examine the variability of physician treatment and outcomes in mild stroke patients and to better understand why all physicians are not using tPA to treat mild stroke patients, despite its proven effectiveness4,5,7. We speculate the wide variability in treatment of mild strokes is due to the conflicting data seen in the stroke literature, ambiguity of the clinical guidelines, lack of understanding of the risk vs. benefit ratio in this population.6 If our hypothesis is correct, our results will help to educate the Orlando Health medical community on how to more effectively treat mild stroke patients. Our results will help guide future research efforts to revamp current stroke guidelines, which could ultimately improve patient’s functional outcomes and decrease the healthcare cost of mild strokes nationwide.
Segundo Mesa Castillo
Psychiatric Hospital of Havana, Cuba
Title: Direct evidence of viral infection and mitochondrial alterations in the brain of fetuses at high risk for schizophrenia
Biography:
Segundo Mesa Castillo. As Specialist in Neurology, he worked for 10 years in the Institute of Neurology of Havana, Cuba. He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990. At present he is member of the Scientific Board of the Psychiatric Hospital of Havana and give lectures to residents in psychiatry.
Abstract:
There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus [1]. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations [2]. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of the gametes or the amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.
1. Yolken RH, Torrey EF. Viruses, schizophrenia and bipolar disorders. Clin Microbiol Rev 1995; 8: 131-145.
2. Mesa CS. An ultrastructural study of the temporal lobe and peripheral blood in schizophrenic patients. Rev Neurol 2001; 33: 619-623.
Tammi McGill-Carter
Neurodevelopmental Specialist, Gary and a Master’s of Arts Degree from the Chicago School of Professional Psychology, Merrillville, USA
Title: Tardive Dyskinesia and Akathasia: A Dopamine System Theory Clinical Review
Biography:
Dr. Tammi McGill-Carter Neurodevelopmental Specialist Gary and a Master’s of Arts Chicago School of professional Psychology Merrillville Indiana, USA
Abstract:
Long term use of first-generation Anti-psychotics (FGAs) have been theorized in the formation of motion disorders Tardive Dyskinesia and Akathasia and due to the breakdown in the Extra Pyramidal System (EPS) located in the Basal Ganglia (Lehne, 2013). The Second-generation Anti-psychotics (SGAs) were sourced to be the “treatment” of TD by blocking dopamine receptors with dopamine agonists of the D2-D5 receptors while also being seen as the genesis of AK. However, the blocking of the receptors in both motion disorders is a theory known as the dopamine blockage theory, despite the intermingle of other neurotransmitters such as Serotonin and Norepinephrine
Athena Sharifi Razavi
Mazandaran University of Medical Sciences Iran
Title: Evaluation of Selenium Supplementation in Ischemic Stroke Outcome
Biography:
Assitant Professor in Mazandaran University of Medical Sciences, Iran
Abstract:
Introduction: Selenium is a trace element essential to human health, that protect against cellular damage by oxygen radicals through selenoproteins. Ischemic stroke is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing stroke patients with antioxidant nutrients may improve survival.
Method: This was a randomized, double-blind ,placebo controlled study on consecutive ischemic stroke patients admitted in Buali sina Hospital, Sari, Iran, during 2015-2017. Inclusion criteria was accepted ischemic stroke by brain CT or MRI during last 72 with volume of at list one third of MCA territory. The patients were randomized into two therapeutic groups, one receiving Vial selenium 2000 microgram stat and 1000 microgram daily for 5 days and the other 40 cc normal saline stat and 20 cc daily for 5 days. Primary outcome measures with National Institutes of Health Stroke Scale(NIHSS) and modified Rankin Scale (MRS). Secondary Outcome Measures with Barthel index 3 months after discharge.
Results: 40 ischemic stroke patients(18 females, 22 males) with mean age of 68.2 ± 10 years were investigated. Differences in NIHSS and Barthel index were not significant between the two groups; but differences in mRS was significant in case group(p<0.00).
Conclusion: Selenium can improve short term ischemic stroke outcome, but it not influence the long term outcome.
Victor Manolov
Medical University in Sofia, Bulgaria
Title: Evaluation of iron homeostasis parametrs in patients with obstructive sleep apnea
Biography:
Victor Manolov has completed his PhD at Medical University in Sofia, Bulgaria. He is working as Assist. Prof. at Department of Clinical laboratory and clinical immunology at the same University. His interests are in neurology, pediatrics, gynecology, endocrinology and clinical laboratory. He has published more than 20 papers in reputed journals
Abstract:
Obstructive sleep apnea syndrome (OSA) is defined as a combination of symptoms as a result of intermittent, recurrent constraint and / or complete airway overhead airway overflow (sleep disturbance). OSA is associated with the development of insulin resistance, arterial hypertension, metabolic syndrome, systemic atherosclerosis and increased cardiovascular risk. 49 patients with OSA were included; age 44.1 ± 7.7. Their results were compared to sex and age matched healthy control. CBC, serum iron, ferritin, hsCRP, hepcidin, homocysteine and vitamin B12 were measured in the included groups. IMT and FMT were used for atherosclerotic changes evaluation. We found increased serum hepcidin levels in OSA patients with IMT and FMD changes (129.9 ± 20.4 μg/L) compared to control group (20.9 ± 1.7 μg/L); P<0.001. A positive correlation was found in OSA patients with atherosclerotic changes between IMT and FMD to serum hepcidin levels (r=0.811, r=0.829, resp.; P<0.005). Serum hepcidin correlates positively to homocysteine and vitamin B12 in OSA patients (r=0.809, r=0.855, resp.; P<0.01). Brain-vascular disease risk factors are connected to obstructive sleep apnea syndrome. Disregulation of iron homeostasis is one of the main risk atherogenesis factors. Early hepcidin quantification might predict an atherosclerosis occurrence in OSA patients, which might be very important for better clinical diagnosis and practice.
Acknowledgements: This project is sponsored by MU-Sofia, as part of Grant Д-52/2018.
Biography:
Consultants, Poland
Abstract:
Case report: A 61-year-old female patient after ischemic stroke with left-sided paresis and neuropsychological disorders. Rehabilitation was carried out in accordance with the ICD-9 procedures over 3 weeks with additional sessions with a neuropsychologist, occupational therapist and speech therapist. The subjective and objective condition of the patient partially improved and the program was recommended to be continued at home.
Discussion: Stroke causes cognitive disorders, including those affecting higher cortical functions. Their etiopathogenesis and the resulting problems hindering the rehabilitation program are presented.
Conclusions: Cognitive and emotional disorders which restrict functioning and rehabilitation processes are found in the patient. Neuropsychological therapy was an essential part of the treatment, which was helpful in the improvement the patient’s quality of life.