Tag Archives: stroke

Development of a low-grade glioma in an ischemic brain territory that evolved into a glioblastoma. A case report and brief literature review

DOI: 10.2478/amma-2022-0015

Introduction: Glioblastoma is one of the most common and aggressive brain tumours with a very high mortality rate. It often evolves from a late or misdiagnosed astrocytoma. Stroke is one of the most common pathologies of the brain, affecting approximately 1.1 million Europeans each year. This article presents the sequential development of a low-grade astrocytoma in an ischemic brain territory into a high-grade glioblastoma.
Case presentation: A 59-year-old patient presented to our hospital with severe headache and transient loss of balance and vision. Clinical findings and control imaging revealed the presence of an ischemic brain area in the left temporal lobe of the brain. Monthly brain magnetic resonance imaging (MRI) follow-up revealed the development of a low-grade astrocytoma in the ischemic territory, which later evolved into a glioblastoma.
Conclusions: Patients who suffer from a stroke should be closely monitored via MRI to prevent the rare development of tumour pathology in the affected territory.

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General Characteristics and Quality of Stroke-Related Online Information – A Cross-Sectional Assessment of the Romanian and Hungarian Websites

DOI: 10.2478/amma-2018-0023

Background: The quality of online health-related information may affect users’ understanding and medical decision-making with dramatic impact, particularly in case of stroke.
Objective: The objective of this study was to assess the quality of information about stroke on the Romanian and Hungarian websites in terms of completeness and accuracy.
Methods: The research was designed as an observational cross-sectional study. The sample included 25 Romanian and 25 Hungarian websites presenting information about stroke for the general public. General characteristics such as website ownership, main goal, website genre and medical approach were identified by the evaluators using a predetermined set of common instructions. The completeness and accuracy of the information were assessed by two independent assessors against a quality benchmark.
Results: Overall, most of the websites were owned by private commercial companies (42%), had educational goal (66%), were designed as medical web-portals (46%) and had a conventional medicine approach (72%). Mean completeness score was 5.6 points (SD± 1.9) for Romanian sites and 4.1 points (SD ± 2.4) for Hungarian sites (p = 0.017). Mean accuracy score was 6.2 points (SD ± 1.1) for Romanian sites and 7.0 points (SD ± 0.7) for Hungarian sites (p = 0.02).
Conclusions: The information about stroke on the Romanian and Hungarian websites had poor quality. Although we found statistically significant differences between the quality scores of the two language sub-samples and two site characteristics associated with significantly higher quality, the practical relevance of these findings for online health information seekers should be interpreted with caution.

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The Impact of Modifiable Risk Factors on the Short-term Outcome of Stroke

Objective: The high stroke morbidity and related mortality in Central-Eastern European countries might be related to several factors. In this study we used a large, database from Tîrgu Mureș (Romania) to investigate the impact of risk factors on the short-term outcome of stroke. We opted for this method as hospital databases usually provide more detailed information on risk factors, stroke severity and correlated outcome than population based registries.
Methods: We analyzed the data of 1478 consecutively hospitalized stroke patients during a period of one year, regardless of the ward they were admitted to. We recorded risk factors, stroke severity and correlated with the short-term outcome (i.e. in-hospital outcome, assessed by Glasgow Outcome Scale) of stroke.
Results: Significantly more men and patients with a lower age than the European average were admitted. 26% of admitted patients had a previous cerebrovascular disease in their history. The prevalence of modifiable risk factors such as hypertension, diabetes, hyperlipidaemia, smoking, etc was higher than in other European countries. Overall case fatality was 10.4% and 75% of discharged patients had some degree of disability. Outcome at discharge was worse with higher systolic and diastolic blood pressure, increased heart rate, higher serum glucose, higher white blood cell count as well as decreased consciousness and increased age.
Conclusions: In this large hospital based database we found an alarming number of untreated and frequently aggregated risk factors. Our findings emphasize the role of modifiable risk factors as well as indicate major opportunities for more efficient stroke prevention.

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Dissection of the Cervico-Cerebral Arteries – Ultrasonographic Characteristics

Background: Dissection of the cervical and cerebral arteries represents the leading cause of non-atherosclerotic stroke in young adults. The diagnosis can be difficult as the presentation may be variable. The ultrasound (US) examination is the first diagnostic procedure, because is non invasive and informative.
The aim of this study was to analyse the ultrasonographical characteristics of the cervico-cerebral artery dissections (CCAD).
Patients and methods: We analyzed 8 consecutive cases of CCAD examined in the Ultrasound Laboratory of Neurology Clinic I from Tîrgu Mureş, Romania over a 3-year period. The mean age of the patients was 39.5±12.1 (min. 24, max. 60), the male/female ratio: 1.
Results: In 5 cases the diagnosis was established based on the ultrasound findings, in 2 cases was confirmed by angiography and in one case by MRI angiography. In 3 cases the CCAD occurred at the level of the proximal internal carotid artery (ICA), in 2 cases at distal ICA, in one case the common carotid artery, in 1-1 cases the proximal and distal part of the vertebral arteries. The most frequent ultrasound finding suggestive for CCAD was the hypoechogenic wall haematoma (3 cases). The hyperechogenic intimal flap occurred in 2 cases, the classical double lumen only in one case. In three cases the ultrasound examination revealed only indirect signs of occlusion. In one case the ultrasound findings were not suggestive for ICA dissection, the diagnosis was confirmed based on the angiography findings.
Conclusions: Color duplex ultrasound examination is an important diagnostic method in the diagnosis of CCAD with good sensitivity and specificity. The most frequent ultrasound finding in CCAD is the hypoechogenic mural haematoma. In patients with suspected CAD and negative US, repeated US examinations and further diagnostic imaging, as angiography, MRI, MRI angiography must be performed.

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Incidence of Stroke and CHADS2 Score in Patients with Paroxysmal, Persistent or Permanent Atrial Fibrillation: Prognosis at 1 Year of Follow-Up

Objectives: our main endpoints were to determine the incidence of fatal or nonfatal stroke either ischemic or hemorrhagic or transient ischaemic attack, associated with paroxysmal versus persistent and permanent atrial fibrillation (AF), in patients receiving oral anticoagulation therapy (OAC) compared to antiplatelet group, and to test the accuracy of CHADS2 score for the prediction of tromboembolic and hemorrhagic complications, at one year follow up. Secondary endpoints were the hospitalization rate, case fatality at one year and rate of progression of paroxysmal to persistent/permanent AF.
Material and methods: we performed a retrospective (2007–2008) observational study on 468 patients admitted to our department with paroxysmal, persistent and permanent nonvalvular AF, on oral anticoagulation or antiplatelet therapy. We compared the incidence of thromboembolic and hemorrhagic events in patients with paroxysmal AF, persistent and permanent AF, and in patients undergoing anticoagulation versus antiplatelet therapy.
Results: we found a statistically difference between the group of patients treated with OAC and the one treated with antiplatelet therapy in favor for the OAC group of AF in what concerns one year rate of stroke. We also found a statistical difference between the CHADS2 score values and the rate of stroke after during one year.
Conclusions: permanent form of atrial fibrillation carries a higher risk of tromboembolic events than persistent and paroxysmal AF. OAC therapy is superior to platelet therapy in all forms of cardiac arrhythmia in preventing the tromboembolic events. CHADS2 score is a good predictor for stroke.

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The Influence of Acute Phase Blood Pressure on Stroke Outcome: To Treat Or Not To Treat?

Romania ranks third in stroke mortality among countries reporting vascular statistics. Acute phase blood pressure has a major influence on stroke outcome. This review aims to give an overview of available data regarding the prevalence of extreme (both low and high) values of blood pressure in acute phase of stroke, impact of blood pressure on stroke prognosis, recommendations on the management of blood pressure, available national data, large ongoing internationl trials with possible impact on stroke guidelines.
The consensus of the EUSI panel is that “emergency administration of antihypertensive agents should be withheld unless the diastolic blood pressure is >120 mm Hg or unless the systolic blood pressure is >220 mm Hg. The panel remains concerned by the evidence that aggressive lowering of blood pressure among patients may cause neurological worsening, and the goal is to avoid overtreating patients with stroke until definitive data are available”.

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