Browsing by Author "Pinho e Melo, T"
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- Chiropractic Manipulation: Reasons for Concern?Publication . Gouveia, LO; Castanho, P; Ferreira, JJ; Guedes, MM; Falcão, F; Pinho e Melo, TChiropractic's popularity is rising among the general population. Moreover, few studies have been conducted to properly evaluate its safety. We report three cases of serious neurological adverse events in patients treated with chiropractic manipulation. The first case is a 41 years old woman who developed a vertebro-basilar stroke 48 h after cervical manipulation. The second case represents a 68 years old woman who presented a neuropraxic injury of both radial nerves after three sessions of spinal manipulation. The last case is a 34 years old man who developed a cervical epidural haematoma after a chiropractic treatment for neck pain. In all three cases there were criteria to consider a causality relation between the neurological adverse events and the chiropractic manipulation. The described serious adverse events promptly recommend the implementation of a risk alert system.
- Early EEG Predicts Poststroke EpilepsyPublication . Bentes, C; Martins, H; Peralta, AR; Morgado, C; Casimiro, C; Franco, AC; Fonseca, AC; Geraldes, R; Canhão, P; Pinho e Melo, T; Paiva, T; Ferro, JObjective: Electroencephalography (EEG) can identify biomarkers of epileptogenesis and ictogenesis. However, few studies have used EEG in the prediction of poststroke seizures. Our primary aim was to evaluate whether early EEG abnormalities can predict poststroke epilepsy. Methods: A prospective study of consecutive acute anterior circulation ischemic stroke patients, without previous epileptic seizures, who were admitted to a stroke unit over 24 months and followed for 1 year. All patients underwent standardized clinical and diagnostic assessment during the hospital stay and after discharge. Video-EEG was performed in the first 72 h (first EEG), daily for the first 7 days, in case of neurological deterioration, at discharge, and at 12 months after stroke. The occurrence of epileptic seizures in the first year after stroke (primary outcome) was evaluated clinically and neurophysiologically during the hospital stay and at 12 months. A telephone interview was also performed at 6 months. The primary outcome was the occurrence of at least one unprovoked seizure (poststroke epilepsy). Secondary outcomes were the occurrence of at least one acute symptomatic seizure and (interictal and/or ictal) epileptiform activity on at least one EEG during the hospital stay for acute stroke. The first EEG variables were defined using international criteria/terminology. Bivariate and multivariate analyses with adjustment for age, admission National Institutes of Health Stroke Scale (NIHSS) score, and Alberta Stroke Program Early CT Score (ASPECTS) were performed. Results: A total of 151 patients were included; 38 patients (25.2%) had an acute symptomatic seizure and 23 (16%) had an unprovoked seizure.The first EEG background activity asymmetry and first EEG with interictal epileptiform activity were independent predictors of poststroke epilepsy during the first year after stroke (P = 0.043 and P = 0.043, respectively). No EEG abnormality independently predicted acute symptomatic seizures. However, the presence of periodic discharges on the first EEG was an independent predictor of epileptiform activity (p = 0.009) during the hospital stay. Significance: An early poststroke EEG can predict epilepsy in the first year after stroke, independently from clinical and imaging-based infarct severity.
- Epilepsia Partialis Continua After an Anterior Circulation Ischaemic StrokePublication . Bentes, C; Franco, AC; Peralta, A; Viana, P; Martins, H; Morgado, C; Casimiro, C; Fonseca, C; Geraldes, R; Canhão, P; Pinho e Melo, T; Paiva, T; Ferro, JMBackground and purpose: Although cerebrovascular disorders are the main cause of epilepsia partialis continua (EPC) in adulthood, the frequency of EPC after stroke is unknown. The aim was to prospectively ascertain its frequency 1 year after an ischaemic stroke. Methods: This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, previously independent, with an admission National Institutes of Health Stroke Scale score ≥4, an acute ischaemic lesion on imaging and no previous epileptic seizures. During admission patients received standardized diagnostic and medical care and were submitted to a neurophysiological evaluation protocol. One year after stroke, patients were re-evaluated by an epilepsy expert neurologist and performed a video-electroencephalogram with electromyography co-registration whenever myoclonus was observed during neurological examination for jerk-locked back averaging analysis (JLBA). EPC was defined as continuously repeated fragments of epileptic seizures, with preserved consciousness, lasting at least 1 h, and representing locally restricted epileptic activity. Results: In all, 151 acute anterior circulation stroke patients were consecutively included and prospectively evaluated, but 23 died in the first year. One year after stroke, from 127 patients alive, 117 (92.1%) underwent clinical and neurophysiological evaluation. In two (1.7%) patients, EPC diagnosis was made both by clinical and electroencephalographic criteria, namely JLBA. Both patients had a history of remote symptomatic seizures and one of them acute symptomatic seizures and non-convulsive status epilepticus criteria during the first 7 days after stroke. Conclusions: Despite its low frequency, the high stroke incidence makes post-stroke EPC relevant. This study draws attention to this recognizable condition with therapeutic and eventually prognostic implications.
- Global Impact of COVID-19 on Stroke Care and IV ThrombolysisPublication . Nogueira, RG; Qureshi, MM; Abdalkader, M; Martins, SO; Yamagami, H; Qiu, Z; Mansour, OY; Sathya, A; Czlonkowska, A; Tsivgoulis, G; Aguiar de Sousa, D; Demeestere, J; Mikulik, R; Vanacker, P; Siegler, JE; Kõrv, J; Biller, J; Liang, CW; Sangha, NS; Zha, AM.; Czap, AL; Holmstedt, CA; Turan, TN; Ntaios, G; Malhotra, K; Tayal, A; Loochtan, A; Ranta, A; Mistry, EA; Alexandrov, AW; Huang, DY; Yaghi, S; Raz, E; Sheth, SA; Mohammaden, MH; Frankel, M; Bila Lamou, EG; Aref, HM; Elbassiouny, A; Hassan, F; Menecie, T; Mustafa, W; Shokri, HM; Roushdy, T; Sarfo, FS; Alabi, TO; Arabambi, B; Nwazor, EO; Sunmonu, TA; Wahab, K; Yaria, J; Mohammed, HH; Adebayo, PB; Riahi, AD; Sassi, SB; Gwaunza, L; Ngwende, GW; Sahakyan, D; Rahman, A; Ai, Z; Bai, F; Duan, Z; Hao, Y; Huang, W; Li, G; Li, W; Liu, G; Luo, J; Shang, X; Sui, Y; Tian, L; Wen, H; Wu, B; Yan, Y; Yuan, Z; Zhang, H; Zhang, J; Zhao, W; Zi, W; Leung, TW; Chugh, C; Huded, V; Menon, B; Pandian, JD; Sylaja, PN; Usman, FS; Farhoudi, M; Hokmabadi, ES; Horev, A; Reznik, A; Sivan Hoffmann, R; Ohara, N; Sakai, N; Watanabe, D; Yamamoto, R; Doijiri, R; Tokuda, N; Yamada, T; Terasaki, T; Yazawa, Y; Uwatoko, T; Dembo, T; Shimizu, H; Sugiura, Y; Miyashita, F; Fukuda, H; Miyake, K; Shimbo, J; Sugimura, Y; Yagita, Y; Takenobu, Y; Matsumaru, Y; Yamada, S; Kono, R; Kanamaru, T; Yamazaki, H; Sakaguchi, M; Todo, K; Yamamoto, N; Sonoda, K; Yoshida, T; Hashimoto, H; Nakahara, I; Kondybayeva, A; Faizullina, K; Kamenova, S; Zhanuzakov, M; Baek, JH; Hwang, Y; Lee, JS; Lee, SB; Moon, J; Park, H; Seo, JH; Seo, KD; Sohn, SI; Young, CJ; Ahdab, R; Wan Zaidi, WA; Aziz, ZA; Basri, HB; Chung, LW; Ibrahim, AB; Ibrahim, KA; Looi, I; Tan, WY; Yahya, NW; Groppa, S; Leahu, P; Al Hashmi, AM; Imam, YZ; Akhtar, N; Pineda-Franks, MC; Co, CO; Kandyba, D; Alhazzani, A; Al-Jehani, H; Tham, CH; Mamauag, MJ; Venketasubramanian, N; Chen, CH; Tang, SC; Churojana, A; Akil, E; aykaç, O; Ozdemir, AO; Giray, S; Hussain, SI; John, S; Le Vu, H; Tran, AD; Nguyen, HH; Nhu Pham, T; Nguyen, TH; Nguyen, TQ; Gattringer, T; Enzinger, C; Killer-Oberpfalzer, M; Bellante, F; De Blauwe, S; Vanhooren, G; De Raedt, S; Dusart, A; Lemmens, R; Ligot, N; Pierre Rutgers, M; Yperzeele, L; Alexiev, F; Sakelarova, T; Bedeković, MR; Budincevic, H; Cindric, I; Hucika, Z; Ozretic, D; Saric, MS; Pfeifer, F; Karpowic, I; Cernik, D; Sramek, M; Skoda, M; Hlavacova, H; Klecka, L; Koutny, M; Vaclavik, D; Skoda, O; Fiksa, J; Hanelova, K; Nevsimalova, M; Rezek, R; Prochazka, P; Krejstova, G; Neumann, J; Vachova, M; Brzezanski, H; Hlinovsky, D; Tenora, D; Jura, R; Jurák, L; Novak, J; Novak, A; Topinka, Z; Fibrich, P; Sobolova, H; Volny, O; Krarup Christensen, H; Drenck, N; Klingenberg Iversen, H; Simonsen, CZ; Truelsen, TC; Wienecke, T; Vibo, R; Gross-Paju, K; Toomsoo, T; Antsov, K; Caparros, F; Cordonnier, C; Dan, M; Faucheux, JM; Mechtouff, L; Eker, O; Lesaine, E; Ondze, B; Peres, R; Pico, F; Piotin, M; Pop, R; Rouanet, F; Gubeladze, T; Khinikadze, M; Lobjanidze, N; Tsiskaridze, A; Nagel, S; Ringleb, PA; Rosenkranz, M; Schmidt, H; Sedghi, A; Siepmann, T; Szabo, K; Thomalla, G; Palaiodimou, L; Sagris, D; Kargiotis, O; Klivenyi, P; Szapary, L; Tarkanyi, G; Adami, A; Bandini, P; Calabresi, P; Frisullo, G; Renieri, L; Sangalli, D; Pirson, A; Uyttenboogaart, M; van den Wijngaard, I; Kristoffersen, ES; Brola, W; Fudala, M; Horoch-Lyszczarek, E; Karlinski, M; Kazmierski, R; Kram, P; Rogoziewicz, M; Kaczorowski, R; Luchowski, P; Sienkiewicz-Jarosz, H; Sobolewski, P; Fryze, W; Wisniewska, A; Wiszniewska, M; Ferreira, P; Ferreira, P; Fonseca, L; Marto, JP; Pinho e Melo, T; Nunes, AP; Rodrigues, M; Tedim Cruz, V; Falup-Pecurariu, C; Krastev, G; Mako, M; de Leciñana, MA; Arenillas, JF; Ayo-Martin, O; Cruz Culebras, A; Tejedor, ED; Montaner, J; Pérez-Sánchez, S; Tola Arribas, MA; Rodriguez Vasquez, A; Mayza, M; Bernava, G; Brehm, A; Machi, P; Fischer, U; Gralla, J; Michel, PL; Psychogios, MN; Strambo, D; Banerjee, S; Krishnan, K; Kwan, J; Butt, A; Catanese, L; Demchuk, AM; Field, T; Haynes, J; Hill, MD.; Khosravani, H; Mackey, A; Pikula, A; Saposnik, G; Scott, CA; Shoamanesh, A; Shuaib, A; Yip, S; Barboza, MA; Barrientos, JD; Portillo Rivera, LI; Gongora-Rivera, F; Novarro-Escudero, N; Blanco, A; Abraham, M; Alsbrook, D; Altschul, D; Alvarado-Ortiz, AJ; Bach, I; Badruddin, A; Barazangi, N; Brereton, C; Castonguay, A; Chaturvedi, S; Chaudry, SA; Choe, H; Choi, JA; Dharmadhikari, S; Desai, K; Devlin, TG; Doss, VT; Edgell, R; Etherton, M; Farooqui, M; Frei, D; Gandhi, D; Grigoryan, M; Gupta, R; Hassan, AE; Helenius, J; Kaliaev, A; Kaushal, R; Khandelwal, P; Khawaja, AM; Khoury, NN; Kim, BS; Kleindorfer, DO; Koyfman, F; Lee, VH; Leung, LY; Linares, G; Linfante, I; Lutsep, HL; Macdougall, L; Male, S; Malik, AM; Masoud, H; McDermott, M; Mehta, BP; Min, J; Mittal, M; Morris, JG; Multani, SS; Nahab, F; Nalleballe, K; Nguyen, CB; Novakovic-White, R; Ortega-Gutierrez, S; Rahangdale, RH; Ramakrishnan, P; Romero, JR; Rost, N; Rothstein, A; Ruland, S; Shah, R; Sharma, M; Silver, B; Simmons, M; Singh, A; Starosciak, AK; Strasser, SL; Szeder, V; Teleb, M; Tsai, JP; Voetsch, B; Balaguera, O; Pujol Lereis, VA; Luraschi, A; Almeida, MS; Cardoso, FB; Conforto, A; De Deus Silva, L; Varrone Giacomini, L; Oliveira Lima, F; Longo, AL; Magalhães, PSC; Martins, RT; Mont'alverne, F; Mora Cuervo, DL; Costa Rebello, L; Valler, L; Zetola, VF; Lavados, PM; Navia, V; Olavarría, VV; Almeida Toro, JM; Amaya, PFR; Bayona, H; Corredor, A; Rivera Ordonez, CE; Mantilla Barbosa, DK; Lara, O; Patiño, MR; Diaz Escobar, LF; Dejesus Melgarejo Fariña, DE; Cardozo Villamayor, A; Zelaya Zarza, AJ; Barrientos Iman, DM; Rodriguez Kadota, L; Campbell, B; Hankey, GJ.; Hair, C; Kleinig, T; Ma, A; Tomazini Martins, R; Sahathevan, R; Thijs, V; Salazar, D; Yuan-Hao Wu, T; Haussen, DC; Liebeskind, D; Yavagal, DR; Jovin, TG; Zaidat, OO; Nguyen, TNObjective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
- Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in PortugalPublication . Carvalho Dias, M; Soares dos Reis, R; Santos, JV; Paiva Nunes, A; Ferreira, P; Maia, B; Fragata, I; Reis, J; Ramos Lopes, J; Cruz, L; Santo, G; Machado, E; Gabriel, D; Felgueiras, R; Dória, H; Carneiro, A; Correia, M; Veloso, LM; Barros, P; Gregório, T; Carvalho, A; Ribeiro, M; Teotónio, P; Neto, L; Pinho e Melo, T; Canhão, P; Filipe, JP; Moreira, G; Azevedo, E; Silva, ML; Campos Costa, E; Oliveira, G; Pereira, L; Neves, L; Rodrigues, M; Marto, JP; Calado, S; Grenho, F; Branco, G; Baptista, T; Rocha, J; Ferreira, C; Pinho, J; Amorim, JM; Araújo, JM; Neiva, RM; Viana, J; Lobo, M; Freitas, A; Tedim Cruz, V; Sargento-Freitas, J; Castro Lopes, JIntroduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Discussion: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.
- Post-Stroke Seizures Are Clinically UnderestimatedPublication . Bentes, C; Martins, H; Peralta, AR; Casimiro, C; Morgado, C; Franco, AC; Fonseca, AC; Geraldes, R; Canhão, P; Pinho e Melo, T; Paiva, T; Ferro, JMCerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment. Seizure occurrence was clinically evaluated during hospitalization and by a telephone interview at 6 months and a clinical appointment at 12 months after stroke. Video-EEG was performed in the first 72 h (1st EEG), daily after the 1st EEG for the first 7 days after the stroke, or later if neurological worsening, at discharge, and at 12 months. 151 patients were included (112 men) with a mean age of 67.4 (11.9) years. In the 1st year after stroke, 38 patients (25.2%) had an epileptic seizure. During hospitalization, 27 patients (17.9%) had epileptiform activity (interictal or ictal) in the EEG, 7 (25.9%) of them electrographic seizures. During the first week after stroke, 22 (14.6%) patients had a seizure and 4 (2.6%) non-convulsive status epilepticus criteria. Five (22.7%) acute symptomatic seizures were exclusively electrographic. At least one remote symptomatic seizure occurred in 23 (16%) patients. In the first 7 days after stroke, more than one-fifth of patients with seizures had exclusively electrographic seizures. Without a systematic neurophysiological evaluation the frequency of post-stroke seizures are clinically underestimated.
- Quantitative EEG and Functional Outcome Following Acute Ischemic StrokePublication . Bentes, C; Peralta, AR; Viana, P; Martins, H; Morgado, C; Casimiro, C; Franco, AC; Fonseca, AC; Geraldes, R; Canhão, P; Pinho e Melo, T; Paiva, T; Ferro, JMObjective: To identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers. Methods: Prospective cohort of 151 consecutive anterior circulation ischemic stroke patients followed for 12 months. EEG was recorded within 72 h and at discharge or 7 days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS ≥ 3), at discharge and 12 months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS. Results: Higher delta, lower alpha and beta relative powers (RP) predicted outcome. Indices with higher discriminative capacity were delta-theta to alpha-beta ratio (DTABR) and alpha RP. Outcome models including either of these and other clinical/imaging stroke outcome predictors were superior to models without qEEG data. In models with qEEG indices, infarct size was not a significant outcome predictor. Conclusions: DTAABR and alpha RP are the best qEEG indices and superior to ASPECTS in post-stroke outcome prediction. They improve the discriminative capacity of already known clinical and imaging stroke outcome predictors, both at discharge and 12 months after stroke. Significance: qEEG indices are independent predictors of stroke outcome.