Silent Brain Infarction: A Missed Opportunity for Prevention (Preprint)

2020 ◽  
Author(s):  
Meytal Tsadok ◽  
Harel Gilutz ◽  
Jonathan Streifler ◽  
Galit Benbenishty ◽  
Nurit Man ◽  
...  
Keyword(s):  
Brain Infarction ◽  
The Elderly ◽  
Unstructured Data ◽  
Brain Ct ◽  
Cardiovascular Comorbidities ◽  
Brain Tomography ◽  
Silent Brain Infarction ◽  
The Brain ◽  
Report Text ◽  
Missed Opportunity

BACKGROUND : Silent brain infarction (SBI) is prevalent in 10%-30% of the elderly, predicting future stroke and cryptogenic dementia. SBI may also be "administrative" due to communication errors between radiologists and caregivers. OBJECTIVE To study the documentation gap between a brain infarction in a computerized brain tomography (brain-CT) report and diagnosis in the Electronic medical record (EHR). METHODS This is a multicenter retrospective observational study, using Clalit's HMO integrated data. We studied 1,339 brain-CT unstructured data from brain-CT reports and EHRs of patients aged 50-80. Patients were categorized by the presence or absence of brain infarction in the brain CT report and then compared to the presence of stroke diagnoses in the corresponding patient EHR. We divided the patient cohort into four groups: with/without Brain infarction in the brain-CT report and with/without stroke diagnoses in the EHR. RESULTS Among the brain-CT reports with Brain infarction, there was a missing EHR documentation in 38.1% of cases. Missing documentation was more likely associated with the identification of lacunar infarctions (P<0.01), with inadequate documentation of other cardiovascular comorbidities and risk factors as well as lower rates of secondary prevention medication (P<0.01). Factors showing significant association with missing documentation in the EHR were a non-stroke neurological indication (P<0.001), a Brain infarction that was mentioned only in the brain-CT report text (and not in summary) (P<0.001), and lacunar infarction (P<0.009). CONCLUSIONS Brain infarction can be silent both clinically and administratively. The main informational barrier is most likely due to interdisciplinary miscommunication. Unstructured computerized report processing can help in closing this gap and potentially improve care. CLINICALTRIAL non

High Prevalence of Silent Brain Infarction in Patients Presenting with Mechanical Heart Valve Thrombosis

2012 ◽  
Vol 12 (5) ◽  
pp. 345-348 ◽  
Author(s):  
Parag Barwad ◽  
Amol Raheja ◽  
Raghunandan Venkat ◽  
Shyam S. Kothari ◽  
Vinay Bahl ◽  
...  
Keyword(s):  
Heart Valve ◽  
Brain Infarction ◽  
Mechanical Heart Valve ◽  
High Prevalence ◽  
Valve Thrombosis ◽  
Silent Brain Infarction ◽  
Heart Valve Thrombosis

scholarly journals The analysis of the connection between plaque morphology of the asymptomatic carotid stenosis and ischemic brain lesions

2013 ◽  
Vol 70 (11) ◽  
pp. 993-998 ◽  
Author(s):  
Djordje Milosevic ◽  
Janko Pasternak ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Pavle Milosevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Brain Infarction ◽  
Statistical Significance ◽  
Brain Parenchyma ◽  
Plaque Morphology ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Silent Brain Infarction

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

scholarly journals What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

2021 ◽  
Vol 6 (1) ◽  
pp. e000717
Author(s):  
Panu Teeratakulpisarn ◽  
Phati Angkasith ◽  
Thanakorn Wannakul ◽  
Parichat Tanmit ◽  
Supatcha Prasertcharoensuk ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
High Risk ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Skull Fracture ◽  
Brain Ct ◽  
Baseline Characteristics ◽  
Gcs Score ◽  
The Brain

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

scholarly journals Importance of Nanoparticles for the Delivery of Antiparkinsonian Drugs

Pharmaceutics ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 508
Author(s):  
Sara Silva ◽  
António J. Almeida ◽  
Nuno Vale
Keyword(s):  
Side Effects ◽  
Dopaminergic Neurons ◽  
Lewy Bodies ◽  
Pharmacokinetic Profile ◽  
The Elderly ◽  
Motor Symptoms ◽  
Administration Routes ◽  
Pharmaceutical Therapy ◽  
Drug Pharmacokinetic ◽  
The Brain

Parkinson’s disease (PD) affects around ten million people worldwide and is considered the second most prevalent neurodegenerative disease after Alzheimer’s disease. In addition, there is a higher risk incidence in the elderly population. The main PD hallmarks include the loss of dopaminergic neurons and the development of Lewy bodies. Unfortunately, motor symptoms only start to appear when around 50–70% of dopaminergic neurons have already been lost. This particularly poses a huge challenge for early diagnosis and therapeutic effectiveness. Actually, pharmaceutical therapy is able to relief motor symptoms, but as the disease progresses motor complications and severe side-effects start to appear. In this review, we explore the research conducted so far in order to repurpose drugs for PD with the use of nanodelivery systems, alternative administration routes, and nanotheranostics. Overall, studies have demonstrated great potential for these nanosystems to target the brain, improve drug pharmacokinetic profile, and decrease side-effects.

scholarly journals From Exercise to Cognitive Performance: Role of Irisin

2021 ◽  
Vol 11 (15) ◽  
pp. 7120
Author(s):  
Mirko Pesce ◽  
Irene La Fratta ◽  
Teresa Paolucci ◽  
Alfredo Grilli ◽  
Antonia Patruno ◽  
...  
Keyword(s):  
The Elderly ◽  
Peroxisome Proliferator ◽  
Peroxisome Proliferator Activated Receptor ◽  
Beneficial Effects ◽  
General Exercise ◽  
Fibronectin Type Iii ◽  
Exercise Induced ◽  
Fibronectin Type Iii Domain ◽  
The Brain

The beneficial effects of exercise on the brain are well known. In general, exercise offers an effective way to improve cognitive function in all ages, particularly in the elderly, who are considered the most vulnerable to neurodegenerative disorders. In this regard, myokines, hormones secreted by muscle in response to exercise, have recently gained attention as beneficial mediators. Irisin is a novel exercise-induced myokine, that modulates several bodily processes, such as glucose homeostasis, and reduces systemic inflammation. Irisin is cleaved from fibronectin type III domain containing 5 (FNDC5), a transmembrane precursor protein expressed in muscle under the control of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). The FNDC5/irisin system is also expressed in the hippocampus, where it stimulates the expression of the neurotrophin brain-derived neurotrophic factor in this area that is associated with learning and memory. In this review, we aimed to discuss the role of irisin as a key mediator of the beneficial effects of exercise on synaptic plasticity and memory in the elderly, suggesting its roles within the main promoters of the beneficial effects of exercise on the brain.

Epilepsy and Related Disorders

2018 ◽  
Author(s):  
Barbara Dworetzky ◽  
Jong Woo Lee
Keyword(s):  
Differential Diagnosis ◽  
Generic Drugs ◽  
Sudden Change ◽  
Epileptic Seizures ◽  
Quality Measures ◽  
The Elderly ◽  
Childhood And Adolescence ◽  
Nonepileptic Seizures ◽  
Infancy And Early Childhood ◽  
The Brain

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy.  This review contains 7 figures, 10 tables, and 33 references. Key Words: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

Natural product-based nanomedicine: Recent advances and issues for the treatment of Alzheimer's disease

2021 ◽  
Vol 20 ◽  
Author(s):  
Choy Ker Woon ◽  
Wong Kah Hui ◽  
Razif Abas ◽  
Muhammad Huzaimi Haron ◽  
Srijit Das ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Natural Products ◽  
Medicinal Plants ◽  
Drug Transport ◽  
The Elderly ◽  
Current Evidence ◽  
Alternative Approach ◽  
Progressive Neurodegeneration ◽  
The Brain

: Alzheimer's disease (AD) affects the elderly and is characterized by progressive neurodegeneration caused by different pathologies. The most significant challenges in treating AD include the inability of medications to reach the brain because of its poor solubility, low bioavailability, and the presence of the blood-brain barrier (BBB). Additionally, current evidence suggests the disruption of BBB plays an important role in the pathogenesis of AD. One of the critical challenges in treating AD is the ineffective treatments and its severe adverse effects. Nanotechnology offers an alternative approach to facilitate the treatment of AD by overcoming the challenges in drug transport across the BBB. Various nanoparticles (NP) loaded with natural products were reported to aid in drug delivery for the treatment of AD. The nano- sized entities of NP are great platforms for incorporating active materials from natural products into formulations that can be delivered effectively to the intended action site without compromising the material’s bioactivity. The review highlights the applications of medicinal plants, their derived components, and various nanomedicine-based approaches for the treatment of AD. The combination of medicinal plants and nanotechnology may lead to new theragnostic solutions for the treatment of AD in the future.

Abstract 2791: Silent Brain Infarction Predicts Cardiovascular Events And Mortality In Long-term Hemodialysis Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Toru Aoyama ◽  
Hideki Ishii ◽  
Hiroshi Takahashi ◽  
Takanobu Toriyama ◽  
Toru Aoyama ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Brain Infarction ◽  
Cox Proportional Hazards ◽  
Powerful Predictor ◽  
Cardiac Events ◽  
Cox Proportional Hazards Models ◽  
Silent Brain Infarction ◽  
Cv Disease ◽  
Overall Mortality

Background: The cardiovascular (CV) events and mortality are significantly higher in hemodialysis (HD) patents compared to the general population. Although it is of clinical concern to predict the occurrence of CV events in long-term HD patients, more powerful predictor has under exploration. We investigated as to whether silent brain infarction (SBI) would be a predictable factor for future CV events and mortality in a large cohort of patients with long-term HD patients. Methods: After cranial magnetic resonance imaging to detect SBI, 202 long-term HD patients (7.1 ± 5.9 years) without symptomatic stroke were prospectively followed up until the incident of CV events (stroke, cardiac events, and death). We analyzed the prognostic role of SBI in CV events with the Kaplan-Meier method and Cox proportional hazards analysis. Results: The prevalence of SBI was quite higher compared to the previous reports (71.8% in all the patients). In overall patients, 60 patients suffered from CV disease (31 for coronary artery disease, 7 for congestive heart failure, 14 for symptomatic stroke) and 29 patients died (16 for CV death) during a follow up period (mean= 23 ± 13 months). In subgroup analysis regarding the presence of SBI, CV event-free survival rate for 4 years was significantly lower in the patients with SBI compared to those without SBI (54.6% vs. 86.7%, p=0.0003). CV and overall mortality were also significantly higher in SBI patients compared with No-SBI patients (CV mortality; 20.5 % vs. 4.3 %, overall mortality; 29.0% vs. 9.1% p< 0.01, respectively). Cox proportional hazards models showed that the presence of SBI was a significant predictor of cerebrovascular and CV events and CV and overall mortality even after adjustment for other CV risk factors listed on the Table . Conclusion: SBI detected with MRI would be powerful predictor of CV events and mortality in long-term HD patients. Hazard ratio (HR) of SBI for future events and mortality

scholarly journals Immunosenescence of Natural Killer Cells, Inflammation, and Alzheimer’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Corona Solana ◽  
Raquel Tarazona ◽  
Rafael Solana
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nk Cells ◽  
Natural Killer ◽  
Nk Cell ◽  
Neurodegenerative Disorder ◽  
The Elderly ◽  
Lymphoid Cells ◽  
Target Cells ◽  
The Brain

Alzheimer’s disease (AD) represents the most common cause of dementia in the elderly. AD is a neurodegenerative disorder characterized by progressive memory loss and cognitive decline. Although the aetiology of AD is not clear, both environmental factors and heritable predisposition may contribute to disease occurrence. In addition, inflammation and immune system alterations have been linked to AD. The prevailing hypothesis as cause of AD is the deposition in the brain of amyloid beta peptides (Aβ). Although Aβ have a role in defending the brain against infections, their accumulation promotes an inflammatory response mediated by microglia and astrocytes. The production of proinflammatory cytokines and other inflammatory mediators such as prostaglandins and complement factors favours the recruitment of peripheral immune cells further promoting neuroinflammation. Age-related inflammation and chronic infection with herpes virus such as cytomegalovirus may also contribute to inflammation in AD patients. Natural killer (NK) cells are innate lymphoid cells involved in host defence against viral infections and tumours. Once activated NK cells secrete cytokines such as IFN-γ and TNF-α and chemokines and exert cytotoxic activity against target cells. In the elderly, changes in NK cell compartment have been described which may contribute to the lower capacity of elderly individuals to respond to pathogens and tumours. Recently, the role of NK cells in the immunopathogenesis of AD is discussed. Although in AD patients the frequency of NK cells is not affected, a high NK cell response to cytokines has been described together with NK cell dysregulation of signalling pathways which is in part involved in this altered behaviour.

Sign in / Sign up

Export Citation Format

Share Document