Letter: Treatment of Huntington's chorea.
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Amantadine↗
Biomedical subjects
L Candelise
Publications and source records attributed to L Candelise.
Dexamethasone and stroke.
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Cerebrovascular Disorders↗
Influence of different screening procedures on the stroke prevalence estimates: the Italian Longitudinal Study on Aging.
Stroke prevalence surveys are more and more needed for health care and facility planning. Prevalence estimates and costs of the definition procedure may vary depending on different screening strategies. We evaluated the impact of these different strategies on the overall diagnostic procedure and on stroke prevalence estimates in the Italian Longitudinal Study on Aging. A population sample of 5, 632 individuals aged 65-84 years was screened for stroke by a simple question on previous stroke diagnosis, questions on possible stroke symptoms and a simple neurological examination. Those screened positive by any of these procedures were fully examined by a neurologist for conclusive diagnosis. We determined the positive predictive value of each procedure on the final stroke diagnosis and calculated prevalence as if each procedure had been used separately. Using the three procedures combined, the prevalence rate was 6.0% (95% confidence interval, 5.4-6.7%). If each procedure had been used as the unique screening tool, the rates would have been 5.1% (4.5-5. 7%), 4.1% (3.6-4.7%) and 2.3% (1.9-2.7%), and positive predictive values 66.4, 55.2 and 45.1%, respectively. Different screening procedures can affect stroke prevalence estimates. Compared to more complex screening strategies, the use of a simple question about previous diagnosis as the unique screening tool leads to only a slight underestimation of stroke prevalence and avoids a 66% increase in the number of subjects to be examined in a second-level specialist evaluation, potentially reducing the costs of the overall diagnostic procedure.
Age Factors↗
Negative interaction of aspirin and streptokinase in acute ischemic stroke: further analysis of the Multicenter Acute Stroke Trial-Italy.
BACKGROUND: Thrombolytic therapy improves the functional outcome in acute ischemic stroke, but the risk of death and cerebral hemorrhage remains high. Aspirin given together with a thrombolytic agent may worsen the risk-to-benefit ratio. We performed a further Multicenter Acute Stroke Trial-Italy (MAST-I) which is the only randomized, controlled trial that has tested the effect of this combination to evaluate the risk of aspirin use plus streptokinase. PATIENTS AND METHODS: We made a post hoc analysis of the MAST-I results comparing streptokinase plus aspirin (156 patients) with streptokinase alone (157 patients). We evaluated the risk of death and cerebral hemorrhage. RESULTS: The combined regimen significantly increased early case fatality from day 3-10 (53 vs. 30; OR 2.1; CI 1.2-3.6). The death excess was solely due to treatments and was not explained by the main prognostic predictors (multifactorial analysis). The cause of death in the combination group was mainly cerebral (42 vs. 24; OR 2.0; CI 1.3-3.7) and associated with hemorrhagic transformation (22 vs. 11; OR 2.2; CI 1.0-5.0). The rate of stroke reoccurrence was not increased in patients treated with streptokinase alone (15 vs. 11; OR 1.4; CI 0.6-3.4). CONCLUSIONS: Stroke patients treated with streptokinase plus aspirin have an increased risk of early death, probably due to cerebral hemorrhagic complications. Whenever thrombolytics are chosen for acute stroke treatment, aspirin and other antiplatelet agents should be avoided.
Acute Disease↗
A randomized trial of aspirin and sulfinpyrazone in patients with TIA.
In a double-blind multicenter study, 124 patients with transient ischemic attacks were randomly allocated to one of two groups treated with aspirin (ASA) or sulfinpyrazone respectively. Patients were followed up to assess the relative efficacy of the two treatments in the prevention of the outcomes of stroke, myocardial infarction, vascular death, and worsening or no improvement of TIAs. No significant difference was observed between the two treatments at the end of the follow-up period. Statistical analysis revealed a significant interaction of sex, treatment, and occurrence of events. Analysis of the results according to sex showed that male patients treated with ASA had a highly significant benefit (p less than 0.001) with a 53% risk reduction for further events. In female patients, sulfinpyrazone showed a favorable trend which was not statistically significant.
Adult↗
Recurrent ischemic attacks in two young adults with lupus anticoagulant.
Two young adults with lupus anticoagulant had multiple attacks of cerebrovascular ischemia in different arterial territories. Cerebral angiography was normal. One patient had a new episode during anticoagulant therapy, but has remained asymptomatic on antiplatelet treatment. In the other, further events occurred during treatment with platelet-inhibiting drugs, but there have been no recurrences with adequate anticoagulant therapy. Lupus anticoagulants are possible causes of otherwise unexplained thromboembolic events. Due to the variable mode of action of these immunoglobulins, platelet-inhibiting drugs may in some cases be considered as a prophylactic alternative to anticoagulant treatment.
Adult↗
Italian multicenter study on reversible cerebral ischemic attacks: population characteristics and methodology.
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Age Factors↗
Italian multicenter study on reversible cerebral ischemic attacks: III--Influence of age and risk factors on cerebrovascular atherosclerosis.
The influence of age and other risk factors (history of hypertension and diabetes, cigarette smoking, dyslipidemia) on cerebral atherosclerosis was studied in 462 patients with RIA who had cerebral angiography. The degree of atherosclerosis was quantified using extracranial and intracranial cerebrovascular scores (ECS, ICS) based on the number and severity of the lesion in 11 extracranial and 21 intracranial arterial segments. Thirty-six percent of the patients under age 45 had a normal angiogram compared with 17% of the patients over 45. In the subgroup of patients with abnormal angiogram the mean ECS and ICS vascular scores were not significantly different in the two age groups. Cigarette smoking was the only risk factor to show a strong association with the extracranial score, and it was independent of the effect of age and other risk factors.
Adult↗
The Italian Multicenter Study of reversible cerebral ischemic attacks: IV--Blood pressure components and atherosclerotic lesions.
Utilizing the initial BP assessment in the 462 patients who entered the Italian Multicenter Study of reversible cerebral ischemia, an analysis of the effect of each BP component in respect of presence, extent and severity of atherosclerotic lesions, as displayed by angiography, was carried out separately for lesions located at either intra- or extracranial level. In a multivariate statistical model, among the following variables: sex, age, systolic BP, diastolic BP, cholesterol and smoking, systolic BP was found the best predictor of extent and severity of atherosclerotic lesions at extracranial level. None of the same variables was predictive of the severity of intracranial atherosclerosis. The results of this clinical study may confirm the indication, coming from physiopathologic observations, of a predominant role of systolic hypertension in the process of maintenance and acceleration of atherosclerosis in the large pre-cerebral arteries.
Age Factors↗
Italian multicenter study on reversible cerebral ischemic attacks: VI--Prognostic factors and follow-up results.
A total of 462 patients (mean age 52 years) affected by reversible focal ischemic attacks (RIAs) were followed prospectively in 8 neurologic institutions in Italy for 4 years. All cases were evaluated with a cerebral angiography and 21% of angiograms were normal. At the end of the follow-up period the cumulated probability for death, stroke, cardiac event and new RIA was respectively 7%, 8%, 3% and 36%. The predictive value of the baseline characteristics of this series was evaluated by a multifactorial analysis which showed that RIA and stroke (specific cerebrovascular risk) were more likely to develop in patients with a history of more than one RIA and in those in whom multiple vascular territories were involved. Moreover, previous myocardial infarction, intermittent claudication, angina pectoris, time elapsed since the first attack, and duration and severity of the attack itself were independently associated with general cardiovascular risk (death, stroke and myocardial infarction). We conclude that predictive factors, and thus also pathogenetic mechanisms, may be different for general cardiovascular risk and specific cerebrovascular risk in RIA patients.
Adult↗
Therapy against brain swelling in stroke patients. A retrospective clinical study on 227 patients.
The effectiveness of cerebral antiedema agents in stroke has been questioned. Animal and clinical work is inconclusive about steroids and osmotic drugs. A retrospective study of a continuous series of 227 stroke patients treated in the acute stage (some with dexamethasone alone, some with dexamethasone plus hyperosmotic mannitol infusions, and some without antiedema therapy) showed no significant difference in the ten-day survival rate. On this criterion, there is no ground for the systematic use of such agents against this type of brain swelling.
Acute Disease↗
[Haloperidol, reserpine, l-dopa and amantidine in the treatment of Huntington chorea (author's transl)].
Two drugs that should reduce striatal dopamine activity (haloperidol and reserpine) and two other drugs that should increase it (L-Dopa and amantadine) have been successively adminstered to six patients suffering from Huntington's Chorea. The most effective treatment in reducing hyperkinesis was haloperidol, followed by reserpine. Treatment with L-Dopa did not have appreciable effect, on this type of involuntary movements. Against some theoretical expectations administration of amantadine was followed by a slight improvement in the control of involuntary activity.
Adult↗