Biomedical subjects

Lucilla Parnetti

Publications and source records attributed to Lucilla Parnetti.

30 records · Page 2Linked to original sources

PubMedDate not supplied

Stroke prevention and statin treatment.

Randomized trials with statins have shown a modest but significant absolute reduction in the incidence of stroke in patients with a previous myocardial infarction. The reasons for the positive statin effect on stroke endpoint are unclear, because a link between serum cholesterol level and stroke never has been established. However, positive results of statin trials were mainly obtained in patients with an average or a low serum cholesterol level. Statins have a good overall safety profile. Statins reduced stroke incidence in high-risk (mainly coronary heart disease, diabetics, and hypertensives) population even with a normal baseline blood cholesterol level. In patients with prior strokes, statins reduce the incidence of coronary events, but it is not yet proven if drugs of this class actually reduce the incidence of recurrent strokes in terms of secondary prevention.

Clinical Trials as Topic↗

PubMedDate not supplied

Efficacy of thrombolytic (rt-PA) therapy in old stroke patients: the Perugia Stroke Unit experience.

The use of intravenous recombinant tissue plasminogen activator (rt-PA) administered within 3 hrs from symptom onset is beneficial in selected patients independent of age; although oldest patients (> or = 80 years) are excluded a priori. We report an experience relative to rt-PA treatment in the oldest patients including outcome at 3 months. Data were from the hospital-based Perugia Stroke Registry. Seventy-two consecutive acute stroke patients, fulfilling NINDS and EUSI-criteria were treated with rt-PA of these 23 patients (30.5%) were > or = 80 years. The median and mean age were, respectively, 72.5 and 71.1 +/- 12.7 years (range 35-94). The proportion of favorable outcome at 3-months did not differ between groups (55% elderly versus 51.1% of younger patients). Proportions of unfavorable outcome and death from baseline were similar in both groups of patients. Age did not influence prognosis in patients treated with rt-PA. The oldest stroke patients should not be excluded from rt-PA treatment on the basis of age per se.

Adult↗

PubMedDate not supplied

Characteristics of delayed admission to stroke unit.

Early admission to stroke unit (SU) and factors that may cause admission delay represent relevant issues to obtain an optimal management of acute stroke. This study was aimed at recording timing from clinical onset to admission to our SU and to identify the reasons for delay. We prospectively examined acute stroke patients consecutively admitted to the Perugia SU. Baseline characteristics of stroke patients, stroke type and etiology, time from symptom onset to arrival in the SU were obtained from the Hospital-Based Perugia Stroke Registry. 60.8% of 2,213 consecutive stroke patients admitted to the SU arrived within 6 hrs and 39.2% after 6 hrs. Underestimation of symptoms was the cause of delay in 48.7% of cases. Younger age, especially for females, ischemic stroke, mild and/or unspecific symptoms and the underestimation of symptoms seem to be the main reasons for delayed arrival in the SU. To increase the proportion of stroke patients arriving in the SU within 3 hr of symptom onset, it is necessary to improve public and general practitioner awareness of stroke through educational programs.

Adult↗

PubMedDate not supplied

Multimodal use of computed tomography in early acute stroke, part 1.

Brain Computed tomography (CT) scan has been used in the past to exclude a hemorrhagic stroke, to determine a possible cause of the stroke patient symptoms, and to demonstrate a stabilized area of hypoperfusional flow. Several results from CT scan studies suggested that we could have new information on prognosis and outcome, localization, and risk of infarction. In this view, CT scan in acute stroke may contribute, using objective measures, to evaluate the inclusion in clinical and therapeutical trials, such as thrombolytic therapy. The lack of consensus among clinicians does not allow a secure and definitive system of CT scan evaluation. Besides its common uses, more recently brain CT scan provides new techniques utilizing advanced algorithms of reconstruction, with promising properties not yet completely verified, to highlight more aspects of acute stroke in the early phase. Despite this limitation, progress on neuroradiological techniques reinforces the concept that brain CT scan remains the key of studies, as well as of validation and routine treatment in terms of feasibility, low cost, and widely availability.

Acute Disease↗

PubMedDate not supplied

The Perugia hospital-based Stroke Registry: report of the 2nd year.

This study reports the characteristics of stroke patients admitted to our hospital in the period Jan 1st, 1998-Dec 31st 1999. Seven hundred and ninety seven consecutive subjects (412 males; mean age 71 +/- 13 years) with a first-ever stroke were registered. Two-thirds of patients (65%) were admitted to the Stroke Unit (SU). The remaining part was managed in six general medicine wards (GM) or other services [neurosurgery and intensive care units (ICU+ NS)]. Ischemic stroke occurred in 534 subjects (67%). The high prevalence (30.1%) of haemorrhages can be partly explained by the presence of specialized neurosurgical services. Athero-thrombotic infarctions occurred in 21.7% of patients, lacunar in 24.7%, cardioembolic in 18.1%, other determined in 6.1%, and other undetermined in 27.5%. Overall hospital mortality was 10%. In cerebral hemorrhage mortality was 18% (44/240) vs. 6.3% (32/534) in ischemic stroke (p < 0.05). The distribution of stroke types and mortality was similar to other previous reports.

Adult↗

PubMedDate not supplied

Heart-brain relationship: atrial fibrillation and stroke.

In Western countries, stroke is the second cause of death and the first cause of disability. Cardiogenic embolism is the most frequent cause of recurrent strokes. Nonvalvular atrial fibrillation (NVAF) is the most common source of cardiogenic embolism, with a stroke recurrence rate of about 10% per year. Randomised trials have shown that anticoagulation and aspirin are safe in patients with NVAF, leading to 70% and 22% risk reduction of strokes, respectively. Many potential candidates to anticoagulation fail to receive the appropriate treatment for primary and secondary prevention. More efforts should be spent to increase the number of treated subjects, in order to achieve effective prevention on stroke.

Atrial Fibrillation↗

PubMedDate not supplied

Hyperhomocyst(e)inemia: a risk factor for cerebrovascular disease.

Many case-control and cohort studies have identified a strong, independent and dose-related association between moderate hyperhomocyst(e)inemia and atherosclerotic vascular disease, with respect to the pathogenetic link between hyperhomocyst(e)inemia and stroke, the possible role in inducing an endothelial wall damage deserves special attention. Some prospective cohort studies have failed to demonstrate a positive association between elevated homocyst(e)ine (Hcy) levels and stroke. Further studies are needed, in order to better characterize the association between Hcy concentrations and risk of stroke.

Biomarkers↗

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Phospholipid autoantibodies: time for a new immuno-assay?

Antiphospholipid (aPL) antibodies are a wide and heterogeneous group of closely related immunoglobulins that have specificity for a number of phospholipids (PLs), PL-binding proteins, including beta2 glycoprotein I (beta2GP1), prothrombin, and PL-protein complexes. Antiphospholipid antibodies are currently detected by a standard solid-phase immunoassay such as anticardiolipin (aCL) antibodies. Although the association between aCL antibodies and thrombosis is well recognized, their role in stroke pathogenesis, and the possibility that they are an independent stroke risk factors in the general stroke population, remains to be determined. There are other negatively charged PL, largely represented within the cellular membrane and involved in the coagulation. Different studies have demonstrated a positive correlation among other aPL and stroke.

Antibodies, Antiphospholipid↗

PubMedDate not supplied

Genetics of ischemic stroke.

Genetic factors are important in the pathogenesis of cerebrovascular diseases. Stroke represents a multifactorial polygenic disorder where the role of environmental factors is quite well defined as opposed to the role of genetic factors which needs to be further elucidated. Several genes affecting hemostasis, renin-angiotensin system, nitric oxide production, homocysteine metabolism and lipid metabolism have been investigated in stroke even if with conflicting results. The genetic approach could permit, in the future, a better characterization of stroke patients and a more effective individual preventive and therapeutic approach.

Brain Ischemia↗

PubMedDate not supplied

The inflammatory response in cerebral ischemia: focus on cytokines in stroke patients.

This paper outlines the characteristics of the inflammatory reaction to brain ischemia with the aim of underlying its relevance and specific implication in the pathogenesis of this disorder. The attention is focused on cytokines, major inflammatory mediators produced in the central nervous system and in the periphery in the context of the response to brain injury. The available data on cytokines in patients with stroke are reviewed to investigate the characteristics of the inflammatory response in human samples and to elucidate if the production of these inflammatory molecules may be related to the clinical outcome.

Brain Ischemia↗

PubMedDate not supplied

Brain CT-scan in acute stroke patients: silent infarcts and relation to outcome.

Silent infarcts (SIs) are common findings in stroke patients, but their clinical significance remains controversial. Aim of this study was to evaluate the prevalence of SI in consecutive stroke patients, characteristics, associated factors, and influence on in-hospital mortality. The population consisted of 191 patients, consecutively admitted for an acute stroke. Of 191 patients, 74 had SI on CT-scan. Silent infarcts were often multiple, right sided, lacunar. We found SI more frequently in older patients, smokers, with an ischemic stroke having small vessel disease as presumed cause. In our study SI were associated with ageing, smoke habit and lacunar stroke. Silent infarcts size influenced the rate of in-hospital mortality.

Adult↗

PubMedDate not supplied

Brain CT scan in acute ischemic stroke: early signs and functional outcome.

There is evidence that an improvement of the diagnostic abilities could have a value for prognosis and therapy of the ischemic stroke. New neuroradiological strategies could be used with an amelioration of the evaluation and standardization of the ischemic damage. The value of early vascular sign remains controversial as a predictor of patient outcome. Early parenchymal changes are related to a poor outcome. The risk of hemorrhagic transformation increases with trombolytic therapy and especially with the onset of therapy. Between hemorrhagic transformation, only the large hematomas seems to be related to early deterioration and death. Brain Computed Tomography (CT) examination can give information about prognosis and therapeutic choice.

Brain↗