The Diagnostic Pathway for Intracranial Tumours:A 10-Year North Denmark Region Cohort Study

Background: The complexity of intracranial tumours, both primary (originating in the brain or its supporting tissues) and secondary (metastases from other organs), presents significant challenges for diagnostic pathways. In Denmark, specific referral criteria (RCs) guide the diagnostic process for suspected intracranial tumours. This study is aimed at evaluating adherence to and efficacy of these RCs in detecting intracranial tumours. Materials and Methods: We conducted a single-center, retrospective cohort analysis of patients from the North Denmark region referred by the general practitioner to magnetic resonance imaging (MRI) due to suspected intracranial tumours from 2013 to 2022. Medical records were reviewed to assess adherence to the Danish RC and their effectiveness in detecting tumours. Results and Discussion: Among 2055 patients, intracranial tumours were identified in 207 cases (10%). Of these, 157 patients (11%) met the RC, while 50 patients (9%) did not meet the criteria. In the adherence group, tumour detection rates were 25% in patients with monosymptomatic focal neurological deficits, 20% with personality changes, 11% with seizures, 20% with headaches, and 24% in those presenting with more than one symptom. Regardless of RC adherence, intracranial tumours were identified in 43 out of 833 patients with headaches (5%). A prior history of cancer was documented in 253 cases, with a 12% tumour detection rate in these patients. Conclusion: In summary, intracranial tumour was detected in about 1 out of 10 imaging studies when following the Danish RCs for the diagnostic pathway. Monosymptomatic headache was a frequent RC and intracranial tumour was found in 5% of these patients. A medical history of tumour slightly increased the detection rate of intracranial tumours.</p

Early remote rehabilitation to improve health of the elderly after cardiac surgery – study protocol for a randomised trial

INTRODUCTION. Early rehabilitation is recommended after cardiac surgery to enhance recovery. However, due to precautions of sternum healing, the initiation of cardiac rehabilitation is often postponed for 6-8 weeks after surgery, leaving patients to face physical and emotional barriers on their own. This study aims to investigate whether early remote cardiac rehabilitation can enhance physical function and reduce the emotional challenges that older patients face after discharge. METHODS. In this bi-entre, randomised controlled trial, 120 patients older than 65 years of age undergoing open heart surgery are assigned to individualised exercise training and step counting supported by a mobile health app and weekly calls with a physiotherapist as an adjunct to standard care (intervention group), or standard care alone (control group) for six weeks after discharge. Outcomes are assessed at baseline, a six-week follow-up and a six-month follow-up. The primary outcome is change in the 30-second Chair Stand Test. Secondary outcomes include health-related quality of life, cost-effectiveness and prevalence of sarcopenia. CONCLUSIONS. This trial will determine if early remote rehabilitation after cardiac surgery can accelerate recovery and alleviate emotional distress, advocating for early post-discharge interventions through digitally delivered care.</p

A Rare Treatable Cause for Cognitive Impairment Study Type: Case Report

Background: Cerebral Amyloid Angiopathy related inflammation CAA-ri is a rare clinical complication of Cerebral Amyloid Angiopathy CAA, which is characterized by acute or subacute onset of neurological signs and symptoms such as headaches, seizures, dizziness, other focal signs, rapidly progressive cognitive decline as well as behavioral changes and psychiatric symptoms. Potentially reversible condition with treatment. Case report: We report a 79-year-old man with subacute progressive cognitive impairment, gait and gaze disturbances of 2 weeks duration. Neurological examination revealed pyramidal and cerebellar signs as well as mild cognitive decline in neuropsychological examination. Magnetic resonance imaging of the brain revealed CAA-ri with watershed infarcts. The patient responded well to steroids and immunosuppressive treatment with marked clinical improvement on further consultation's visits. Conclusion: CAA-ri diagnosis is supported by Boston Criteria 2, with characteristic changes in the Magnetic Resonance Imaging of the brain and it is potentially reversible with steroids and immunosuppressive therapy

Thrombolysis in The First Trimester of Pregnancy in Patent Foramen Ovale Related Ischemic Stroke

Background: Patent foramen ovale is described to be responsible for a high percent of ischemic stroke in young adults. Furthermore, ischemic stroke is considered to be one of the main pregnancy-related risk factors, contributing to maternal death. Minor stroke is however successfully managed with dual antiplatelet treatment, but presence of vascular occlusion represents a management challenge.Case presentation: We describe the case of a 29-year-old woman, who presented with an acute onset ischemic stroke with facial weakness and sensory symptoms in the left arm. Imaging showed signs of an embolic stroke with a distal middle cerebral artery occlusion not eligible for thrombectomy. The patient was successfully treated with thrombolysis. Diagnostic work-up revealed a considerable patent foramen ovale, which was occluded 13 months after delivery. The use of the PASCAL and ROPE-score is discussed to grade the clinical relevance of the patent foramen ovale in combination with the procoagulant state during pregnancy in our patient. Conclusion: Patent foramen ovale should be taken into account in ischemic stroke occurring during pregnancy in young women, especially in the first trimester. Possible further progression can be considered during the treatment decision regarding thrombolysis and/or endovascular intervention even in patients with a low NIHSS scor

Swallow Tail Sign on MRI—Is It Useful in a Diagnostic Workup in Drug-Naïve Parkinson's Disease?

ABSTRACT Background and Purpose To evaluate the diagnostic value of the Swallow Tail Sign (STS) on MRI as a paraclinical marker to support the initial diagnosis of early Parkinson's disease (PD). The STS is a hyperintense area in the substantia nigra pars compacta, observable in the healthy population, but absent in advanced PD. To our knowledge, no studies have investigated the STS presence in newly diagnosed, drug-naïve PD. Methods Axial 3D gradient echo susceptibility-weighted angiography 3-T sequences of 35 patients with clinically confirmed drug-naïve PD and 35 age-matched healthy controls were independently reviewed by an experienced neurologist and a neuroradiologist. Unilateral or bilateral STS absence constituted a PD rating. Accuracy was assessed against clinical diagnosis as the gold standard. Results The inter-rater agreement was substantial across all subjects (Cohen's kappa = 0.63). The association between the clinical diagnosis and the raters? assessment was statistically significant (p

Sick leave and homecare need in patients with transient ischaemic attack compared with ischaemic stroke: A nationwide follow-up study

Background and purposeEmerging evidence indicates lasting impairments in patients with transient ischaemic attack (TIA), which may be unexpected as symptoms per definition recover within 24 h. How these impairments impact return to work or the ability to maintain independence is unknown. The aim of our study was to investigate the need of sick leave or homecare following TIA compared with acute ischaemic stroke (AIS).Materials and methodsPatients registered with TIA in the Danish Stroke Registry from 2014 to 2021 were included. Information on sick leave benefits and use of homecare was obtained from national registries. The cumulative risk of sick leave or homecare was calculated and compared with AIS. A hazard rate ratio (HRR) for return to work was calculated.ResultsIn total, 29,261 TIA and 64,295 AIS events were included. For TIA, 6770 patients paid labour market contribution before TIA, of which 1240 patients (18.3%) received sick leave benefits after 5–12 weeks. For AIS 48.1% (5940 of 12,340) received sick leave benefits. The HRR for return to work was 2.37 (95% confidence interval 2.13–2.64). For patients aged 65–79, a total of 15.4% TIA (175 of 1136) and 30.6% AIS (1443 of 4716) started to receive homecare at 3 months. The HRR was 0.55 (95% confidence interval 0.49–0.62).ConclusionDespite the transient event almost one out of five working patients with TIA receive sick leave benefits 5–12 weeks after. Initiation of homecare was required in nearly one out of six patients with TIA aged 65–79 years

Perfusion Changes in Acute Stroke Treated with Theophylline as an Add-on to Thrombolysis:A Randomized Clinical Trial Subgroup Analysis

PURPOSE: Theophylline has been suggested to have a neuroprotective effect in ischemic stroke; however, results from animal stroke models and clinical trials in humans are controversial. The aim of this study was to assess the effect of theophylline on the cerebral perfusion with multiparametric magnetic resonance imaging (MRI). METHODS: The relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) in the infarct core, penumbra, and unaffected tissue were measured using multi-parametric MRI at baseline and 3‑h follow-up in patients treated with theophylline or placebo as an add-on to thrombolytic therapy. RESULTS: No significant differences in mean rCBF, rCBV, and rMTT was found in the penumbra and unaffected tissue between the theophylline group and the control group between baseline and 3‑h follow-up. In the infarct core, mean rCBV increased on average by 0.05 in the theophylline group and decreased by 0.14 in the control group (p < 0.04). Mean rCBF and mean rMTT in the infarct core were similar between the two treatment groups. CONCLUSION: The results indicate that theophylline does not change the perfusion in potentially salvageable penumbral tissue but only affects the rCBV in the infarct core. In contrast to the penumbra, the infarct core is unlikely to be salvageable, which might explain why theophylline failed in clinical trials. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s00062-021-01029-x) contains supplementary material, which is available to authorized users

Associative brain-computer interface training increases wrist extensor corticospinal excitability in patients with subacute stroke

In a recently developed associative rehabilitative brain-computer interface (BCI) system, electroencephalography (EEG) is used to identify the most active phase of the motor cortex during attempted movement and deliver precisely timed peripheral stimulation during training. This approach has been demonstrated to facilitate corticospinal excitability and functional recovery in patients with lower limb weakness following stroke. The current study expands those findings by investigating changes in corticospinal excitability following the associative BCI intervention in patients with post stroke with upper limb weakness. In a randomized controlled trial, 24 patients with subacute stroke, subdivided into an intervention group and a "sham" control group, performed 30 wrist extensions. The intervention comprised 30 pairings of single peripheral nerve stimulation at the motor threshold, timed so that the generated afferent volley arrived at the motor cortex during the peak negativity of the movement-related cortical potential (MRCP), which was identified with EEG. The sham group underwent the same intervention, though the intensity of the nerve stimulation was below the perception threshold. Immediately after training, patients in the associative group exhibited significantly larger amplitudes of muscular-evoked potentials, compared with pretraining measurements in response to transcranial magnetic stimulation. These changes persisted for at least 30 min and were not observed in the sham group. We demonstrate that motor-evoked potential amplitudes increased significantly following paired associative BCI training targeting upper limb muscles in patients with subacute stroke, which is in line with results from lower limb studies. NEW &amp; NOTEWORTHY We have demonstrated that a single training session with an associative brain-computer interface increased corticospinal excitability in patients suffering from upper limb weakness following stroke. This is the first time such an effect is described in the upper limb, which paves the way for effect augmentation of existing upper limb rehabilitation protocols. </p