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D Inzitari

Publications and source records attributed to D Inzitari.

At least 73 records · Page 4Linked to original sources
PubMed1998

Sex-related differences in human cerebral hemodynamics.

OBJECTIVES: To identify possible inter-hemispheric sex-related cerebral hemodynamic differences at rest, in healthy subjects by transcranial Doppler (TCD). SUBJECTS AND METHODS: Mean flow velocity (MV) was recorded by TCD in 96 (48 males, 48 females) right-handed volunteers. Mean age was similar in males and females, distribution of age-groups by sex was similar, too. RESULTS: Examining by sex MV values in each basal artery, left middle cerebral artery (MCA) showed a statistically significant difference (53.5+/-8.2 cm x s(-1) in males versus 58.5+/-10.4 cm x s(-1) in females, P=0.005, one-way ANOVA). Multiple regression models show a significant correlation between age and MV on each side, while sex correlates with MV on the left side. CONCLUSION: A sex-dependent hemispheric difference in MV in the left MCA at rest (females>males) in the younger population subgroup was identified. These data support recent observations on anatomical differences between sexes, referring a proportionally larger Broca area in females compared to males.

Adolescent↗
PubMed1998

White matter changes on CT and MRI: an overview of visual rating scales. European Task Force on Age-Related White Matter Changes.

Since the recognition of white matter changes on CT (leukoaraiosis), rating scales for the location and severity of white matter changes have been developed, mainly for research purposes, to investigate factors such as the relation with cognition, risk factors, and pathology. The main purpose of rating scales is to provide scores that can be used in statistical analyses. The development of the NINDS-AIREN criteria for vascular dementia have introduced a new application for these rating scales in investigating and delineating the amount of white matter changes on CT/MRI sufficient to fulfill the criteria. Furthermore, in Alzheimer's disease, recognition of white matter changes may serve to delineate homogeneous groups and help to identify patients with different symptomatology. We reviewed the existing rating scales for CT and MRI and judged their properties and reliability. The ideal rating scale does not yet exist, but different rating scales may serve different purposes, for which some recommendations are made.

Brain Ischemia↗
PubMed1998

Cytokines and cell adhesion molecules in cerebral ischemia: experimental bases and therapeutic perspectives.

The possibility of reopening an occluded cerebral artery by means of thrombolysis has renewed interest in a number of the several mechanisms that are active during acute cerebral ischemia. Over recent years, it has become apparent that leukocytes play a central role not only during the healing stage of brain infarction but also during the early phases of cerebral ischemia, when it is postulated that these cells produce harmful effects, particularly in the presence of reperfusion. This review is based on the critical analysis of more than 150 publications dealing with the role of leukocytes and some inflammatory mediators (cytokines, chemokines, and adhesion molecules) in cerebral ischemia. Animal studies indicate that leukocyte involvement is promoted by a variety of inflammatory molecules produced immediately after the onset of cerebral ischemia. Considerable experimental evidence suggests that these mediators play a key role in the progression from ischemia to irreversible injury (ie, cellular death and necrosis). However, the precise role of each molecule alone remains to be further elucidated as well as in relation to the complex network existing among different mediators. Progress in our understanding of the inflammatory mechanisms operating in cerebral ischemia has enabled the testing of new compounds with promising results in animals; in contrast, one recent controlled trial of an anti-leukocyte molecule in acute stroke patients showed negative results. This discrepancy may derive in part from our incomplete understanding of the complexity of the inflammatory mechanisms involved in cerebral ischemia. Our analysis suggests that until sufficient knowledge of the underlying disease mechanisms is acquired, more care should be taken when testing new and potentially efficacious drugs in stroke patients.

Animals↗
PubMed1998

Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry.

BACKGROUND AND PURPOSE: Inconsistent information about incidence and determinants of poststroke dementia might be related to patient attrition, partly because of nonapplicability of formal neuropsychological testing to a large proportion of patients registered in a definite setting. METHODS: Using a proxy-informant interview based on ICD-10 criteria, we determined dementia at stroke onset and 1 year after stroke in the 339 patients who survived, were available for follow-up, and were not demented at stroke onset of 635 patients entered over a 1-year period in a stroke registry taken at 2 community hospitals in Florence, Italy. RESULTS: Of the 339 patients, 57 (16.8%) proved to have poststroke dementia. These patients were older, more frequently female, and more often (multivariate odds ratio, 2.35; 95% CI, 1.21 to 4.58) had atrial fibrillation than those without dementia. Aphasia and the clinical features expressing the severity of the stroke event in the acute phase predicted poststroke dementia. CONCLUSIONS: In a hospital-based nonselected series of stroke survivors, despite the use of a method with low sensitivity for defining dementia, our study confirms that dementia is a frequent sequela of stroke and is mainly predicted by stroke severity. Certain determinants could be controlled in the prestroke phase, thus reducing its risk.

Age Distribution↗
PubMed1997

Emotional arousal and phobia in transient global amnesia.

OBJECTIVE: To evaluate the role of emotionally stressful or phobogenic events and phobic personality traits in transient global amnesia (TGA). DESIGN: Case-control study. SETTING: Tertiary care center. PATIENTS: Fifty-one case patients with TGA (mean +/- SD age, 62.7 +/- 6.7 years) compared with 51 control patients with transient ischemic attacks (mean +/- SD age, 63.8 +/- 6.7 years). MAIN OUTCOME MEASURES: Precipitant factors, life events, and phobic attitudes. RESULTS: Of the 25 TGA attacks that were triggered by a precipitant, 11 were possibly related to emotionally stressful or phobogenic situations. On a scale that measured phobic attitudes, the case patients with TGA scored significantly higher than the control patients with transient ischemic attacks (mean +/- SD total score, 15.21 +/- 11.0 vs 4.41 +/- 5.2; P < .001 by corrected analysis of variance for age, sex, and education). The amount of stressful live events in the year that preceded the attack did not differ between the case patients with TGA and the control patients with transient ischemic attacks. CONCLUSION: The results support the hypothesis that emotional arousal and phobia are involved in TGA.

Aged↗
PubMed1997

MRI and MR angiography of vertebral artery dissection.

A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients) MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in 7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic or rounded high signal on T1-weighted images in 10 patients examined 3-20 days after the onset of symptoms. The abnormal vessel stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent with occlusion of the dissected vessel in 6 of 8 patients.

Adult↗
PubMed1997

Vascular deaths in elderly neurological patients with leukoaraiosis.

OBJECTIVES: The prognostic significance of leukoaraiosis is still not completely elucidated. The objective was to examine survival and causes of death among elderly neurological patients with leukoaraiosis. METHODS: From 1 January 1994, vital status and causes of death were drawn from municipality lists and death certificates of 216 patients (mean age (SD) 70.6 (8.3) years) admitted to a geriatric unit who underwent cranial CT between 1 January 1984 and 31 December 1986 (mean observation period (SD) 8.4 (0.8) years). These patients had been enrolled for a study of clinical predictors of leukoaraiosis. Based on the presence of leukoaraiosis on CT, this group had been divided into two subgroups of patients, with and without leukoaraiosis. The difference in survival and causes of death between these groups formed the objective of the study. RESULTS: Survival time was shorter among the 90 patients with leukoaraiosis than among the 126 patients without (median survival time 4.07 v 7.78 years, log rank test P < 0.001). After controlling for age and other major death predictors, the risk of death remained significantly increased (relative risk (RR) = 1.64, 95% confidence interval (95% CI) 1.15-2.34) among patients with leukoaraiosis. Moreover, patients with leukoaraiosis had an almost threefold higher risk of dying from vascular causes than patients without (RR = 2.81, 95% CI 1.74-4.53). CONCLUSION: Leukoaraiosis is a predictor of vascular deaths in elderly neurological patients. Careful diagnostic evaluation and attention to preventive measures are required in patients with leukoaraiosis.

Aged↗
PubMed1997

Abnormal brain hemodynamic responses during passive orthostatic challenge in panic disorder.

OBJECTIVE: Autonomic dysregulation and cerebral blood flow (CBF) abnormalities have been reported in patients with anxiety disorders and, more recently, in panic disorder. Variations in the middle cerebral artery velocity (measured by transcranial Doppler technique), heart rate, and blood pressure during a tilting-table test were used as nonanxiogenic procedures to explore these abnormalities. METHOD: Mean flow velocity in the right middle cerebral artery, heart rate, and blood pressure were monitored at rest and during a 70 degrees tilting-table test. Three groups of patients were studied: 11 patients (eight women and three men; mean age = 31.1 years, SD = 8.0) with a diagnosis of panic disorder within 6 months of the onset of the disorder, nine asymptomatic patients (two men and seven women; mean age = 35.0, SD = 6.3) with a previous diagnosis of panic disorder who were in full remission of symptoms and had been drug free for at least 6 months, and 10 normal comparison subjects (two men and eight women; mean age = 31.1, SD = 5.2). RESULTS: Both patients with acute panic disorder and patients with remitted panic disorder showed a significant percent reduction of right middle cerebral artery mean flow velocity compared with normal subjects following tilting to the upright position. No significant differences were observed for blood pressure and heart rate. CONCLUSIONS: Patients with panic disorder, both during the acute phase of the illness and after clinical recovery, show an exaggerated drop in CBF during tilting. Since these findings are similar, although attenuated in intensity, to those which are observed in dysautonomic illnesses, one possible interpretation is that of panic disorder as a subclinical form of autonomic dysreactivity.

Acute Disease↗
PubMed1997

Disappearance of motor tics after Wernicke's encephalopathy in a patient with Tourette's syndrome.

Tourette's syndrome (TS) is a disease characterized by multiple motor and vocal tics as well as behavioral abnormalities. The anatomic substrates of this syndrome are not defined. We report a 48-year-old man with TS in whom motor tics disappeared after the onset of a midbrain syndrome related to thiamine deficiency (Wernicke's encephalopathy). MRI study showed a lesion in the dorsal area of the midbrain. This case suggests that loops located in the midbrain tegmentum may influence the presence of motor tics in patients with TS.

Humans↗
PubMed1996

The first Italian report on "Binswanger's disease".

The eponym "Binswanger's disease" is frequently used to indicate a form of vascular dementia characterized by white matter rarefaction and lacunar infarcts; however, it is difficult to find any consistency between this picture and the single case reported by Binswanger in 1894, which was vaguely defined both clinically and pathologically, and was probably a case of neurosyphilis. The first Italian report of a case of "Binswanger's disease" was published in 1958 by Donegani and Grattarola, who described a patient with a history of manic episodes followed by progressive mental deterioration. Pathological examination revealed changes mainly located in the hemispheric white matter, and the authors defined the patient as being affected by Binswanger's encephalopathy. Re-evaluation of this report indicates that the term "Binswanger's disease" has been applied to cases with non-specific clinical and pathological characteristics in the past. In this paper, we briefly compare Binswanger's original and the 1958 Italian case report, and discuss the current use of the term "Binswanger's disease".

Brain↗
PubMed1996

A preliminary open trial with nimodipine in patients with cognitive impairment and leukoaraiosis.

We treated, in a preliminary open trial, 31 patients presenting with cognitive impairment, progressive bilateral motor dysfunction, and leukoaraiosis on computed tomography (CT) with a 90-mg daily dose of nimodipine for a period as long as 1 year (minimum: 96 days, maximum: 424 days), to study the safety and possible effects on functional and cognitive conditions throughout this period. Of the 29 patients who had been followed for at least 9 months, most (82%) remained stable or improved as evaluated by the Global Deterioration Scale. A significant improvement was observed in the total Sandoz Clinical Assessment Geriatric scale score (44.66 +/- 7.17 at baseline vs. 36.86 +/- 9.34 at exit, analysis-of-variance time effect, p < 0.0001). These data indicate that nimodipine, chronically administered in patients presenting with cognitive impairment, progressive bilateral motor dysfunction, and leukoaraiosis on CT, is safe and might have beneficial effect, to be confirmed by a randomized trial.

Adult↗
PubMed1996

Incidence and risk factors of ischaemic and haemorrhagic stroke in Europe. EUROSTROKE: A collaborative study among research centres in Europe: rationale and design.

EUROSTROKE is a collaborative study among ten European research centres to investigate (1) the variation in incidence of fatal and non-fatal ischaemic and haemorrhagic stroke among populations in different European countries; (2) whether the observed differences in stroke incidence across countries can be explained by differences in prevalence of established cardiovascular risk factors; (3) the relative importance of selected dietary factors (potassium intake, smoking, alcohol consumption), haemostatic disturbances (fibrinogen) and co-morbidity (rheumatic heart disease, atrial fibrillation) compared to established risk factors as determinants of the occurrence of ischaemic and haemorrhagic stroke. The EUROSTROKE database is drawn from ten European population-based prospective follow-up studies (cohorts) and is designed as a case-control study nested within these ten ongoing studies.

Aged↗
PubMed1996

[Large trials in the secondary prevention of stroke].

To date, no drug has been demonstrated as efficacious in the treatment of acute ischemic stroke. Therefore, primary and secondary prevention play a fundamental role. Besides adequate control of risk factors, trials and meta-analyses have demonstrated that both medical and surgical therapy are effective in secondary prevention of stroke. In patients with atherothrombotic transient ischemic attack (TIA) or minor stroke and carotid stenosis > 70%, surgical therapy (endarterectomy) is the treatment of choice, while antiplatelet drugs are the elective treatment in the case of stenosis < 70%. Acetylsalicylic acid is the first choice medical treatment, but the optimal dosage is still a matter of debate. Ticlopidine has an efficacy similar to that of aspirin, but shows a certain number of side effects; recently a European study has shown the efficacy of dipyridamole, and the superiority of the combination dipyridamole-aspirin vs low-dose aspirin. In the secondary prevention of cardioembolic stroke, oral anticoagulants have higher efficacy than antiplatelet drugs, at least in selected groups of patients.

Anticoagulants↗
PubMed1995

The cardiovascular outcome of patients with motor impairment and extensive leukoaraiosis.

BACKGROUND AND METHODS: The long-term outcome of patients with motor impairment and extensive leukoaraiosis on computed tomographic scan is unknown. We studied the incidence of stroke, myocardial infarction, and death in 31 such patients (cases) and in 68 neurologic patients without leukoaraiosis (controls). The patients in both groups had a routine neurologic and cardiovascular assessment and were followed up for 51.9 +/- 20.1 (mean +/- SD) months (cases) and 49.5 +/- 18.6 months (controls). RESULTS: The 6-year risk of cumulative stroke, as determined by life table analysis, was 49% among cases and 16% among controls (hazard ratio, 3.0; 95% confidence interval, 1.2 to 7.5). The risk of stroke or myocardial infarction was 69% vs 36% (hazard ratio, 2.9; 95% confidence interval, 1.4 to 6.2). The stroke risk remained significantly increased among cases after adjustment for age, sex, and any conventional vascular risk factor, while it was reduced (hazard ratio, 2.5; 95% confidence interval, 0.8 to 7.4) after adjustment for history of lacunar stroke was corrected for and was almost halved (hazard ratio, 1.6; 95% confidence interval, 0.5 to 4.6) after adjustment for the presence of lacunar infarction images on computed tomographic scan. CONCLUSIONS: Patients with motor impairment and extensive leukoaraiosis have a very poor cardiovascular outcome. Lacunar infarction might be the major determinant of the outcome in these patients.

Brain Diseases↗
PubMed1993

Relation between MRI features and dementia in cerebrovascular disease patients with leukoaraiosis: a longitudinal study.

We examined selective MRI features (localization and degree of white matter abnormalities, cortical and subcortical atrophy) in relation to cognitive decline in patients with cerebrovascular disease (CVD) and leukoaraiosis (LA). We enrolled 6 female and 18 male CVD patients (mean age 66.2 +/- 6.6 years) whose Magnetic Resonance Images (MRI) revealed LA and who displayed a history of stroke or TIA; none showed signs of cortical infarcts or normal pressure hydrocephalus. Two blind raters independently scored MRI scans with a high level of agreement. All patients underwent extensive clinico-neuropsychological assessment upon admission to the study and 19 were followed for an average of 48 +/- 7.6 months. Twelve patients were initially classified as non-demented and 12 as demented. Three years later, one in the former group had become demented and mental impairment had worsened for 6 patients in the latter group; these 7 subjects were labeled as "decliners". Ventricular indexes were significantly higher in the demented group and correlated with severity of mental impairment, while the degree of LA was similar in demented and non-demented subjects. Neither white matter lesions nor sulcal and ventricular enlargement differed statistically between decliners and non-decliners.

Aged↗