Showing papers by "Luciano A. Sposato published in 2014"

Poststroke atrial fibrillation: Cause or consequence?: Critical review of current views

Abstract: Poststroke atrial fibrillation (AF) represents up to 1 of 4 overall AF cases in acute ischemic stroke Current guidelines recommend oral anticoagulation for every ischemic stroke patient in whom AF is diagnosed However, in some cases, AF detected after acute ischemic stroke may be short-lasting and perhaps a nonrecurrent autonomic and inflammatory epiphenomena of stroke The autonomic regulation of cardiac rhythm constitutes an integrated relay system The highest level of control is exerted by the cerebral cortex, particularly the insula The onset of AF may be associated with an imbalance of sympathetic and parasympathetic activity, a common consequence of insular infarctions This autonomic imbalance and an interruption in the cerebral regulation of the intrinsic cardiac autonomic system constitute the most likely mechanisms responsible for the autonomic pathway The role of inflammation in the genesis of AF within the first few days after ischemic stroke may occur through inflammatory mediators stimulating the intrinsic autonomic system and by direct damage to atrial myocardium To what extent poststroke AF is the cause or a consequence remains uncertain

Comparing Moral Judgments of Patients With Frontotemporal Dementia and Frontal Stroke

Abstract: IMPORTANCE Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups. OBSERVATIONS This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the control participants. There were no differences between the 2 conditions. CONCLUSIONS AND RELEVANCE Both disorders involved impairments in integrating intention and outcome information for moral judgment. This study was the first, to our knowledge, to directly compare a social cognition domain in 2 frontal pathologies with different etiology. Our results highlighted the importance of comparing patients with vascular lesions and patients with neurodegenerative diseases.

A peek behind the curtain: Peer review and editorial decision making at Stroke

Abstract: Editor’s Note: The mechanisms of peer review and editorial decision making often appear opaque to junior academic neurologists, especially those who have not yet published many papers or served as journal referees themselves. Previous entries in the NeuroGenesis career development series from the Editor-in-Chief have reviewed some of the reasons why faculty should participate as peer reviewers when given the opportunity and the factors that authors should consider in choosing appropriate journals for their own manuscripts. In this article, Sposato et al present the results of a systematic analysis of the editorial process at a leading neurology subspecialty journal; their findings will be of interest to readers at all stages of their careers who seek a better understanding of what goes on “behind the scenes” in journal decisions. — Bernard Chang, MD, NeuroGenesis Editor Objective: A better understanding of the manuscript peer-review process could improve the likelihood that research of the highest quality is funded and published. To this end, we aimed to assess consistency across reviewers’ recommendations, agreement between reviewers’ recommendations and editors’ final decisions, and reviewer- and editorlevel factors influencing editorial decisions at the journal Stroke. Methods: We analyzed all initial original contributions submitted to Stroke from January 2004 through December 2011. All submissions were linked to the final editorial decision (accept vs reject). We assessed the level of agreement between reviewers (intraclass correlation coefficient). We compared the initial editorial decision (accept, minor revision, major revision, and reject) across reviewers’ recommendations. We performed a logistic regression analysis to identify reviewer- and editor-related factors associated with acceptance as the final decision. Results: Of 12,902 original submissions to Stroke during the 8-year study period, the level of agreement between reviewers was between fair and moderate (intraclass correlation coefficient 50.55, 95% confidence interval [CI] 50.09– 0.75). Likelihood of acceptance was <5% if at least 1 reviewer recommended a rejection. In the multivariate analysis, higher reviewer-assigned priority scores were related to greater odds of acceptance (odds ratio [OR] 526.3, 95% CI 523.2–29.8), whereas higher number of reviewers (OR 50.54 per additional reviewer, 95% CI 50.50–0.59) and suggestions for reviewers by authors versus no suggestions (OR 50.83, 95% CI 50.73–0.94) had lesser odds of acceptance. Interpretation: This analysis of the peer-review process at Stroke identified several factors that might be targeted to improve the consistency and fairness of the overall process. ANN NEUROL 2014;00:000–000

Stroke Severity Score based on Six Signs and Symptoms The 6S Score: A Simple Tool for Assessing Stroke Severity and In-hospital Mortality.

Abstract: Background and Purpose Ascertaining stroke severity and predicting risk of in-hospital mortality is crucial to advise patients and families about medical decisions. We developed and tested the validity of a new stroke score, the 6S Score (Stroke Severity Score based on Six Signs and Symptoms), for quantifying ischemic stroke severity and predicting in-hospital mortality. Methods We prospectively assessed 210 consecutive acute ischemic stroke patients. The cohort was further divided into a derivation (n = 120) and a validation (n = 90) sample. From a total of 10 stroke signs and symptoms, we selected those with likelihood ratio’s P < 0.005. We tested the validity of the score for predicting in-hospital mortality by using receiver operating characteristic curves. We used a scatterplot and the Spearman’s test to evaluate the correlation between the 6S Score and the National Institutes of Health Stroke Scale as a marker of stroke severity. We used principal component and exploratory factor analyses for assessing qualitative aspects of the 6S Score. Results The C statistic for in-hospital mortality was 0.82 for the 6S Score and 0.86 for the National Institutes of health Stroke Scale, respectively, with no significant differences between each other (P = 0.79). The correlation between both scores was strong (Spearman’s rho 0.68, P < 0.001). The factor analyses showed a good balance between left/right hemispheres and anterior/posterior circulations. Conclusions The 6S Score may constitute a tool for easily assessing stroke severity and predicting stroke mortality. Further research is needed for further assessing its external validity.

Chapter 107 - Iatrogenic neurology

Abstract: Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.