PubMed Health⌕ Search

Biomedical subjects

D Inzitari

Publications and source records attributed to D Inzitari.

At least 127 records · Page 7Linked to original sources
PubMed1981

Progressive peroneal muscular atrophy (Charcot-Marie-Tooth disease) associated with beta-thalassemia trait and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. A clinical and nerve biopsy case.

The case of a 22 year old woman presenting progressive peroneal muscular atrophy (PMA) is described. Electrophysiological and pathological studies demonstrated features of hereditary motor and sensory neuropathy -HMSN- type I. Laboratory findings showed two erythrocytic defects: beta-thalassemia trait and a glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Unlike the past, these inherited disorders are associated with PMA.

Adult↗
PubMed1978

Another possible precipitating factor in multiple sclerosis: the exposure to organic solvents.

Recent clinical observations seem to indicate that a possible correlation may exist between the appearance of inflammatory diseases of the nervous system and exposure to organic solvents. In certain cases the patients could not be distinguished, either from the clinical or laboratory point of view, from typical cases of multiple sclerosis. These observations raise the problem of a possible action of organic solvents on the immunological responses, already described in different pathological conditions as a further possible precipitating factor in MS.

Adult↗
PubMed1978

A possible mechanism for cholesteryl ester formation during demyelination: lecithin:cholesterol acyltransferase (LCAT) activity in rat brain.

Lecithin:cholesterol acyltransferase (LCAT) activity has been examined in the rat by using a brain homogenate preparation as the phospholipid substrate and blood plasma as the enzyme source. LCAT activity was detected on using 60 mul of serum onwards. Successive experiments have also shown that LCAT activity is present in the edematous rat brain tissue homogenate when incubated with inactivated rat plasma as substrate. The results are discussed in relation to cholesteryl ester accumulation in brain during demyelinating diseases.

Animals↗
PubMedDate not supplied

Cardiac-gated phase MR imaging of aqueductal CSF flow.

The direction of CSF flow within the cerebral aqueduct was studied by cardiac-gated magnetic resonance (MR) phase images in five healthy volunteers and 10 patients with presumably normal cerebral CSF circulation. Caudal CSF flow was observed during systole and cranial flow during diastole. Using phantom based calibrations of the imager, aqueductal CSF velocities of 3-5 mm/s were calculated. Cardiac-gated phase MR is a potentially major tool for the investigation of the CSF circulation.

Adult↗
PubMedDate not supplied

Lower cranial nerve palsy due to dissection of the internal carotid artery: CT and MR imaging.

Three patients with unilateral lower cranial nerve palsy underwent contrast enhanced CT and magnetic resonance (MR) imaging for the investigation of possible compressive pathology in the region of the jugular foramen. Computed tomography revealed a mural crescentic hypodensity of the corresponding internal carotid artery (ICA) in two patients and a faulty visualization of the vessel in one. Magnetic resonance revealed a corresponding hyperintense lesion expanding the wall and narrowing the lumen of the cervical ICA on both T1- and T2-weighted images. Dissection of the ICA was confirmed by angiography in all three patients. Among the possible etiologies of lower cranial nerve palsy, a dissecting hematoma of the cervical ICA must be considered, which can be diagnosed by CT and MR.

Aortic Dissection↗
PubMedDate not supplied

Vascular risk factors linked to multiple lacunar infarcts.

BACKGROUND: The pathogenesis of lacunar infarcts is still incompletely established. Data from the literature suggest that vascular risk factors differ among patients with multiple (MLI) and single lacunar infarcts (SLI). We reexamined this hypothesis using stricter inclusion criteria and a less selected study population. METHODS: We evaluated 136 patients consecutively admitted for first-ever minor stroke to a general hospital with the characteristics of a community hospital. Vascular risk factors were studied by univariate and multivariate statistical analyses among the following subgroups of patients, classified according to CT findings: (a) with lacunar infarct; (b) with nonlacunar infarct (NLI); (c) with SLI; (d) with MLI; (e) with single, either lacunar or nonlacunar, infarct. RESULTS: No significant difference was observed between patients with lacunar infarcts and patients with NLI. Compared to patients with SLI or NLI, patients with MLI had significantly more often a family history of hypertension, cardiomegaly on the chest radiograph and CT leukoaraiosis as well as a higher systolic and diastolic blood pressure on admission. Logistic regression analysis selected CT leukoaraiosis, Rx cardiomegaly and admission diastolic blood pressure as independent, significant predictors of MLI. CONCLUSION: In patients with first-ever minor stroke, the risk factor profile differs according to the evidence of SLI or MLI on the CT scan. In terms of risk factors, patients with SLI seem more similar to those with NLI than those with MLI. Based on the predicting effect of variables linked with type and severity of arterial hypertension, the CT appearance of MLI might express a more univocal and specific cerebrovascular pathology (hypertensive arteriolosclerosis).

Aged↗
PubMedDate not supplied

Influence of different screening procedures on the stroke prevalence estimates: the Italian Longitudinal Study on Aging.

Stroke prevalence surveys are more and more needed for health care and facility planning. Prevalence estimates and costs of the definition procedure may vary depending on different screening strategies. We evaluated the impact of these different strategies on the overall diagnostic procedure and on stroke prevalence estimates in the Italian Longitudinal Study on Aging. A population sample of 5, 632 individuals aged 65-84 years was screened for stroke by a simple question on previous stroke diagnosis, questions on possible stroke symptoms and a simple neurological examination. Those screened positive by any of these procedures were fully examined by a neurologist for conclusive diagnosis. We determined the positive predictive value of each procedure on the final stroke diagnosis and calculated prevalence as if each procedure had been used separately. Using the three procedures combined, the prevalence rate was 6.0% (95% confidence interval, 5.4-6.7%). If each procedure had been used as the unique screening tool, the rates would have been 5.1% (4.5-5. 7%), 4.1% (3.6-4.7%) and 2.3% (1.9-2.7%), and positive predictive values 66.4, 55.2 and 45.1%, respectively. Different screening procedures can affect stroke prevalence estimates. Compared to more complex screening strategies, the use of a simple question about previous diagnosis as the unique screening tool leads to only a slight underestimation of stroke prevalence and avoids a 66% increase in the number of subjects to be examined in a second-level specialist evaluation, potentially reducing the costs of the overall diagnostic procedure.

Age Factors↗
PubMedDate not supplied

Validity of different linguistic versions of the Alzheimer's Disease Assessment Scale in an international multicentre Alzheimer's disease trial.

Owing to the involvement of Italian Centres in a multicentre, German-Italian therapeutical trial with Alzheimer's dementia patients, to be assessed with the Alzheimer's Disease Assessment Scale (ADAS), it was decided that the Italian centres would use an Italian version of the scale, derived from that used by the German centres. However, the lists of words for exploring verbal memory are not merely translated from the German version, but are composed of selective Italian words chosen according to linguistic criteria. This Italian version was validated following the same procedure adopted for validating the German version. We submitted this Italian version to an interrater reliability, test-retest reliability, concurrent validity, internal consistency and sensitivity evaluation, using demented patients. Based on the results of these tests this Italian version of the ADAS proved valid and reliable. Moreover, the results were strikingly comparable to those from the validation of the German version. Our work supports the validity, reliability and transnational comparability of national versions of the ADAS constructed following definite linguistic criteria.

Adult↗
PubMedDate not supplied

Assessment of inter-observer differences in the Italian multicenter study on reversible cerebral ischemia.

A standardized protocol was used for duplicate examination by two neurologists of the clinical history and neurological signs in 55 patients with reversible cerebral ischemia. One trained examiner from each of eight clinical centres involved in the Italian Cooperative Study on reversible cerebral ischemia participated in this research. Duplicate examination were compared in order to evaluate the percentage of agreement achieved in the responses. Several discrepancies relating to either historical data or neurological signs were detected. Possible causes of this disagreement are discussed. The inter-observer differences appear to be an important problem to be faced in cooperative studies on reversible ischemic attacks. The purpose of the study was to estimate these differences in the attempt to increase the degree of agreement by repeated training sessions and discussion between the different examiners. These efforts are needed to improve the quality of clinical investigations on reversible cerebral ischemia and to increase the validity of their results.

Evaluation Studies as Topic↗
PubMedDate not supplied

Italian multicenter study on reversible cerebral ischemic attacks: III--Influence of age and risk factors on cerebrovascular atherosclerosis.

The influence of age and other risk factors (history of hypertension and diabetes, cigarette smoking, dyslipidemia) on cerebral atherosclerosis was studied in 462 patients with RIA who had cerebral angiography. The degree of atherosclerosis was quantified using extracranial and intracranial cerebrovascular scores (ECS, ICS) based on the number and severity of the lesion in 11 extracranial and 21 intracranial arterial segments. Thirty-six percent of the patients under age 45 had a normal angiogram compared with 17% of the patients over 45. In the subgroup of patients with abnormal angiogram the mean ECS and ICS vascular scores were not significantly different in the two age groups. Cigarette smoking was the only risk factor to show a strong association with the extracranial score, and it was independent of the effect of age and other risk factors.

Adult↗
PubMedDate not supplied

The Italian Multicenter Study of reversible cerebral ischemic attacks: IV--Blood pressure components and atherosclerotic lesions.

Utilizing the initial BP assessment in the 462 patients who entered the Italian Multicenter Study of reversible cerebral ischemia, an analysis of the effect of each BP component in respect of presence, extent and severity of atherosclerotic lesions, as displayed by angiography, was carried out separately for lesions located at either intra- or extracranial level. In a multivariate statistical model, among the following variables: sex, age, systolic BP, diastolic BP, cholesterol and smoking, systolic BP was found the best predictor of extent and severity of atherosclerotic lesions at extracranial level. None of the same variables was predictive of the severity of intracranial atherosclerosis. The results of this clinical study may confirm the indication, coming from physiopathologic observations, of a predominant role of systolic hypertension in the process of maintenance and acceleration of atherosclerosis in the large pre-cerebral arteries.

Age Factors↗
PubMedDate not supplied

Italian multicenter study on reversible cerebral ischemic attacks: VI--Prognostic factors and follow-up results.

A total of 462 patients (mean age 52 years) affected by reversible focal ischemic attacks (RIAs) were followed prospectively in 8 neurologic institutions in Italy for 4 years. All cases were evaluated with a cerebral angiography and 21% of angiograms were normal. At the end of the follow-up period the cumulated probability for death, stroke, cardiac event and new RIA was respectively 7%, 8%, 3% and 36%. The predictive value of the baseline characteristics of this series was evaluated by a multifactorial analysis which showed that RIA and stroke (specific cerebrovascular risk) were more likely to develop in patients with a history of more than one RIA and in those in whom multiple vascular territories were involved. Moreover, previous myocardial infarction, intermittent claudication, angina pectoris, time elapsed since the first attack, and duration and severity of the attack itself were independently associated with general cardiovascular risk (death, stroke and myocardial infarction). We conclude that predictive factors, and thus also pathogenetic mechanisms, may be different for general cardiovascular risk and specific cerebrovascular risk in RIA patients.

Adult↗
PubMedDate not supplied

Tick-borne encephalitis (TBE) in Italy: report of the first clinical case.

Previous studies on the clinical features of meningoencephalitis in Italy did not help to indicate the nature of the causative agents. On the other hand during the past decade nine arboviruses were isolated in Italy, some of which are yet to prove pathogenic for man. A systematic study was carried out in cooperation between the Department of Neurology of the University of Florence and the Istituto Superiore di Sanità (Rome), in order to understand a possible role of arboviruses as etiologic agents of meningoencephalitis in Italy; in this preliminary communication the first clinical case of Tick-Borne Encephalitis (TBE) virus infection is described.

Adult↗
PubMedDate not supplied

[The molecular mechanisms of cerebral ischemia: the possible therapeutic interventions].

Therapeutic interventions for acute ischemic stroke have not yet been established in clinical practice. The recognition of an area of reduced blood flow in which neuronal death may be prevented has focused attention on treatments aiming at minimizing ischemic brain damage, if they are initiated within short time after occlusion. The combination of restoring blood flow and providing neuroprotection may be the most productive approach in human acute ischemic stroke, but this combined therapy requires testing through clinical trials. To gain insight into the molecular mechanisms of cerebral ischemia, this review examines the excito-toxic cascade, synthesis and role of nitric oxide and oxidants, gene regulation and possible neuroprotective therapeutic targets. As neuroprotectants, glutamate-antagonists, calcium-antagonists and free radical scavengers have been investigated. The role of nitric oxide is very complex, as it can be cytotoxic or cytoprotective in relation to sources, time of synthesis, and medium redox state. Animal gene studies suggest that nitric oxide produced by endothelial nitric oxide synthase may be advantageous, while nitric oxide produced by neuronal and inducible nitric oxide synthase disadvantageous. A treatment strategy could involve the use of selective inhibitors of different types of nitric oxide synthase. Cell death after cerebral ischemia occurs through the dual pathway of ischemic necrosis and apoptosis. Novel therapies may be directed at genes mediating either recovery or apoptosis. There are, as yet, no conclusive data concerning the safety and efficacy of neuroprotectants in humans. Differences between animal models and clinical conditions may justify the discrepancy between experimental data and clinical practice.

Animals↗
PubMedDate not supplied

Role of white matter lesions in cognitive impairment of vascular origin.

White matter changes are detected with high frequency by neuroimaging techniques in aged subjects with cerebrovascular risk factors or diseases and in cognitively impaired patients. Their direct role in causing cognitive deterioration has not been established, although their frequency is higher in demented subjects than in normal controls, and they are associated with specific cognitive deficits, particularly those related to impairment of frontal lobe functions. The aim of this paper is to critically review the existing knowledge about the role of white matter lesions in cognitive impairment of vascular origin. After reviewing the scarce evidence and the numerous clues suggesting a possible role of white matter lesions in causing mental decline, proposals are advanced about elements that could be a basis for revised criteria for vascular dementia for clinical trials. Finally, some items requiring future joint investigations in the fields of age-related white matter lesions are identified.

Cerebrovascular Disorders↗
PubMedDate not supplied

Is subcortical vascular dementia a clinical entity for clinical drug trials?

Several therapeutic trials have been performed for vascular dementia, with drugs differing in type and mechanism of action. The results have been almost invariably inconclusive. Given the current notion that there are different subtypes of vascular dementia according to pathophysiological mechanisms, it is reasonable to suspect that one of the main causes of the disappointing results was that the study samples included patients not fitting with the rationale of selective treatments. Testing this hypothesis is difficult because characterization of patients in relation to different subtypes of vascular dementia is not available for most studies. However, attempts are ongoing to reclassify patients entered in some trials for post hoc subgroup analyses with some preliminary interesting results. We propose that (1) specific subtypes of vascular dementia should be the target in any single trial using a treatment with a proper rationale; and (2) subcortical vascular dementia, caused by small vessel disease leading to lacunar infarcts and subcortical white matter changes, represents a clinically and radiologically well-defined entity to be considered for future trials designed specifically for testing adequate drugs.

Cerebral Cortex↗