Journal of the neurological sciences
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Case Reports
Subclavian steal syndrome secondary to Takayasu arteritis in a young female Caucasian patient.
Subclavian steal syndrome (SSS) is most frequently described in Caucasians aged over 50 years because of increased incidence of atherosclerosis in this population. Non-atherosclerotic etiologies of SSS are rare in Caucasians. We present a case of Subclavian Steal Syndrome secondary to Takayasu Arteritis (TA) in a 26 year-old female Caucasian patient. The present case underscores that despite the very low incidence of TA in Caucasians (0.8/1,000,000), this large-vessel vasculitis of unknown etiology should always be considered in the differential diagnosis of subclavian steal syndrome in Caucasian women aged less than 40 years.
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Fibroblast growth factors are important regulators of neuronal development. In this study, we observed fibroblast growth factor receptor 1 (FGFR1) immunoreactivity and its protein levels in the hippocampus proper (CA1-3 regions) of the gerbil at various time points after ischemia/reperfusion. In the sham-operated group, FGFR1 immunoreaction was not detected in the hippocampus proper. ⋯ From 2days after ischemia/reperfusion, FGFR1 immunoreaction was found in astrocytes, not in microglial cells, in the CA1 region: FGFR1 immunoreactivity and the number of astrocytes were significantly increased at 5days post-ischemia. Western blot analysis revealed that FGFR1 protein levels were also increased from 1day after ischemia/reperfusion. These results indicate that increase of FGFR1 in astrocytes of the ischemic CA1 region may be associated with gliosis followed by delayed neuronal death.
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The metabolic and hemodynamic processes in the edema surrounding spontaneous, supratentorial intracerebral hemorrhage (ICH) are poorly understood. Specifically, the local metabolic effects of autoregulatory failure have not been described previously. In the current observational pilot study, microdialysis and brain tissue oxygenation probes (P(br)O(2)) were placed in the perihemorrhagic edema using neuronavigation in five non-surgically treated patients with deep ICH. ⋯ This patient at the same time had the worst metabolic parameters and the poorest tissue oxygenation. We conclude that multimodality monitoring in the perihemorrhagic penumbra is feasible. A study in a larger population is needed to clarify the relationship between PRx and ORx in ICH patients, the local metabolic effects of autoregulatory failure and its relation to brain edema formation and clinical outcome.
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Comparative Study
Comparison between MRI screening and CT-plus-MRI screening for thrombolysis within 3 h of ischemic stroke.
Although MRI may provide much information on brain pathology to aid in patient selection for thrombolysis, the concern remains that MRI screening may increase time-to-treatment. We hypothesized that CT-plus-MRI screening might be a valuable time-efficient alternative for selection of patients requiring thrombolysis. ⋯ These results suggest that early patient selection using MRI may be more effective than reduction of times-to-treatment in improvement of thrombolytic outcomes.
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Randomized Controlled Trial
Long-term open-label study of pramipexole in patients with primary restless legs syndrome.
A phase III, open-label, long-term clinical study was performed to evaluate the safety and efficacy of pramipexole in a cohort of 141 Japanese patients with primary restless legs syndrome (RLS). The patients were started on pramipexole 0.25 mg/day and were subsequently maintained on that dose or switched to 0.125, 0.5, or 0.75 mg/day to achieve optimal efficacy and tolerability. The International Restless Legs Syndrome Study Group Rating Scale for restless legs syndrome (IRLS) score improved from 22.3+/-4.7 at baseline to 11.1+/-7.7 at week 8 and 4.9+/-5.9 at week 52. ⋯ RLS augmentation was not observed. Pramipexole 0.25-0.75 mg/day is efficacious, safe, and well tolerated in patients with RLS. Pramipexole showed good efficacy, particularly in patients with an IRLS total score <20.