-
BMC Emergency Medicine Sep 2019Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a...
INTRODUCTION
Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a number of clinical assessment tools have been developed and this review examines their diagnostic capabilities.
METHODS
Diagnostic performance of currently available clinical tools for identification of acute ischaemic and haemorrhagic strokes and stroke mimicking conditions was reviewed. A systematic search of the literature published in 2015-2018 was conducted using PubMed, EMBASE, Scopus and The Cochrane Library. Prehospital and in-hospital studies with a minimum sample size of 300 patients reporting diagnostic accuracy were selected.
RESULTS
Twenty-five articles were included. Cortical signs (gaze deviation, aphasia and neglect) were shown to be significant indicators of large vessel occlusion (LVO). Sensitivity values for selecting subjects with LVO ranged from 23 to 99% whereas specificity was 24 to 97%. Clinical tools, such as FAST-ED, NIHSS, and RACE incorporating cortical signs as well as motor dysfunction demonstrated the best diagnostic accuracy. Tools for identification of stroke mimics showed sensitivity varying from 44 to 91%, and specificity of 27 to 98% with the best diagnostic performance demonstrated by FABS (90% sensitivity, 91% specificity). Hypertension and younger age predicted intracerebral haemorrhage whereas history of atrial fibrillation and diabetes were associated with ischaemia. There was a variation in approach used to establish the definitive diagnosis. Blinding of the index test assessment was not specified in about 50% of included studies.
CONCLUSIONS
A wide range of clinical assessment tools for selecting subjects with acute stroke has been developed in recent years. Assessment of both cortical and motor function using RACE, FAST-ED and NIHSS showed the best diagnostic accuracy values for selecting subjects with LVO. There were limited data on clinical tools that can be used to differentiate between acute ischaemia and haemorrhage. Diagnostic accuracy appeared to be modest for distinguishing between acute stroke and stroke mimics with optimal diagnostic performance demonstrated by the FABS tool. Further prehospital research is required to improve the diagnostic utility of clinical assessments with possible application of a two-step clinical assessment or involvement of simple brain imaging, such as transcranial ultrasonography.
Topics: Diagnosis, Differential; Humans; Ischemic Attack, Transient; Sensitivity and Specificity; Severity of Illness Index; Stroke
PubMed: 31484499
DOI: 10.1186/s12873-019-0262-1 -
Brain and Language Sep 2023We systematically reviewed the literature on neural changes following anomia treatment post-stroke. We conducted electronic searches of CINAHL, Cochrane Trials, Embase,... (Review)
Review
We systematically reviewed the literature on neural changes following anomia treatment post-stroke. We conducted electronic searches of CINAHL, Cochrane Trials, Embase, Ovid MEDLINE, MEDLINE-in-Process and PsycINFO databases; two independent raters assessed all abstracts and full texts. Accepted studies reported original data on adults with post-stroke aphasia, who received behavioural treatment for anomia, and magnetic resonance brain imaging (MRI) pre- and post-treatment. Search results yielded 2481 citations; 33 studies were accepted. Most studies employed functional MRI and the quality of reporting neuroimaging methodology was variable, particularly for pre-processing steps and statistical analyses. The most methodologically robust data were synthesized, focusing on pre- versus post-treatment contrasts. Studies more commonly reported increases (versus decreases) in activation following naming therapy, primarily in the left supramarginal gyrus, and left/bilateral precunei. Our findings highlight the methodological heterogeneity across MRI studies, and the paucity of robust evidence demonstrating direct links between brain and behaviour in anomia rehabilitation.
Topics: Adult; Humans; Anomia; Aphasia; Neuroimaging; Neuronal Plasticity; Stroke
PubMed: 37633250
DOI: 10.1016/j.bandl.2023.105300 -
PLoS Medicine Mar 2023Depression is the most frequent psychiatric condition after stroke and is associated with negative health outcomes. We aim to undertake a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Depression is the most frequent psychiatric condition after stroke and is associated with negative health outcomes. We aim to undertake a systematic review and meta-analysis of the prevalence and natural history of depression after stroke.
METHODS AND FINDINGS
Studies published up to 4 November 2022 on Medline, Embase, PsycINFO, and Web of Science Core Collection were searched. We included studies of adults with stroke, where depression was assessed at a prespecified time point. Studies excluding people with aphasia and history of depression are excluded. Critical Appraisal Skills Programme(CASP) cohort study tool was used to assess risk of bias. A total of 77 studies were included in the pooled estimates of the prevalence of poststroke depression (PSD). The overall prevalence of depression was 27% (95% CI 25 to 30). Prevalence of depression was 24% (95% CI 21 to 28) by clinical interview and 29% (95% CI 25 to 32) by rating scales. Twenty-four studies with more than one assessment time point reported the natural history of PSD. Among people who were depressed within 3 months of stroke, 53% (95% CI 47 to 59) experienced persistent depression, while 44% (95% CI 38 to 50) recovered. The incidence of later depression (3 to 12 months after stroke) was 9% (95% CI 7 to 12). The cumulative incidence during 1 year after stroke was 38% (95% CI 33 to 43), and the majority (71% (95% CI 65 to 76)) of depression had onset within 3 months after stroke. The main limitation of the present study is that excluding people in source studies with severe impairments may produce imprecise estimates of the prevalence of PSD.
CONCLUSIONS
In this study, we observed that stroke survivors with early-onset depression (within 3 months after stroke) are at high risks for remaining depressed and make up two-thirds of the incident cases during 1 year after stroke. This highlights the need for ongoing clinical monitoring of patients depressed shortly after stroke.
TRIAL REGISTRATION
PROSPERO CRD42022314146.
Topics: Adult; Humans; Cohort Studies; Depression; Prevalence; Stroke; Longitudinal Studies
PubMed: 36976794
DOI: 10.1371/journal.pmed.1004200 -
Schizophrenia Research Feb 2020Voice atypicalities have been a characteristic feature of schizophrenia since its first definitions. They are often associated with core negative symptoms such as flat... (Meta-Analysis)
Meta-Analysis Review
Voice atypicalities have been a characteristic feature of schizophrenia since its first definitions. They are often associated with core negative symptoms such as flat affect and alogia, and with the social impairments seen in the disorder. This suggests that voice atypicalities may represent a marker of clinical features and social functioning in schizophrenia. We systematically reviewed and meta-analyzed the evidence for distinctive acoustic patterns in schizophrenia, as well as their relation to clinical features. We identified 46 articles, including 55 studies with a total of 1254 patients with schizophrenia and 699 healthy controls. Summary effect sizes (Hedges'g and Pearson's r) estimates were calculated using multilevel Bayesian modeling. We identified weak atypicalities in pitch variability (g = -0.55) related to flat affect, and stronger atypicalities in proportion of spoken time, speech rate, and pauses (g's between -0.75 and -1.89) related to alogia and flat affect. However, the effects were mostly modest (with the important exception of pause duration) compared to perceptual and clinical judgments, and characterized by large heterogeneity between studies. Moderator analyses revealed that tasks with a more demanding cognitive and social component showed larger effects both in contrasting patients and controls and in assessing symptomatology. In conclusion, studies of acoustic patterns are a promising but, yet unsystematic avenue for establishing markers of schizophrenia. We outline recommendations towards more cumulative, open, and theory-driven research.
Topics: Aphasia; Bayes Theorem; Humans; Schizophrenia; Speech; Voice
PubMed: 31839552
DOI: 10.1016/j.schres.2019.11.031 -
Zeitschrift Fur Naturforschung. C,... Jan 2023The COVID-19 mainly causes respiratory disorders with high infection and severe morbidity and mortality. Neurologists have concerns about potential neurological side... (Review)
Review
The COVID-19 mainly causes respiratory disorders with high infection and severe morbidity and mortality. Neurologists have concerns about potential neurological side effects, profits, and timing of COVID-19 vaccines. This study aimed to review systematically research for the COVID-19 vaccine and neurological complications. Data was searched in Scopus, ISI web of knowledge, Medline, PubMed, Wiley, Embase, International Clinical Trials Registry Platform and Clinical Trials, Cochrane Library, and Google Scholar. Two reviewer authors individually searched and assessed the titles and abstracts of all articles. The third reviewer resolved disagreement between them. Data were documented regarding study location, study design, type of complications, number of patients, various types of COVID-19 vaccine, and type of neurological complications. Six studies in COVID-19 vaccine and neurological complications include two studies about neurological manifestations after the mRNA vaccines, four records about side effects of vector-based vaccine were included in the study. The main neurological complication associated mRNA vaccines were body aches, paresthesia, and difficulty walking, erythema migrans lesion, fatigue, myalgia, and pain in the left lateral deltoid region. The major neurological complication related to vector-based vaccines were urinary retention difficulty, feeding and ambulating, arm soreness, mild fatigue, chills, left-sided facial droop, headaches, a generalized epileptic seizure, hemianopia, and mild aphasia, acute somnolence and right-hand hemiparesis, acute transverse myelitis, deep vein thrombosis in her left leg, a vigilance disorder and a twitching, a severe immobilizing opsoclonus myoclonus syndrome, and encephalitis. A large spectrum of severe neurological unfavorable has been reported. These complications could occur as a result of molecular stimulation and later neuronal damage. Generally, the advantages of COVID-19 vaccination are dominant on the risks of a neurological complication at both individual and population levels. Future investigations will be required to find any relationship between neurological complications and COVID-19 vaccines principally as new strains of the virus and new vaccines are technologically advanced against them.
Topics: Humans; Female; COVID-19 Vaccines; COVID-19
PubMed: 36087300
DOI: 10.1515/znc-2022-0092 -
Surgical Neurology International 2023Propeller-related injuries from motorboats are a major cause of injury in recreational water activities including severe and multiple lacerations that can promote... (Review)
Review
BACKGROUND
Propeller-related injuries from motorboats are a major cause of injury in recreational water activities including severe and multiple lacerations that can promote scarring, blood loss, traumatic, or surgical amputations. The real incidence of these accidents is still unclear. The authors here present a systematic review of the literature, focusing on head injury, and related recommendations for its evaluation and management, also reporting a case of a female patient injured by a motorboat propeller.
METHODS
A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of publication date. The following Mesh and free text terms were identified: "motorboat and propeller and injuries" (107 results).
RESULTS
A total of 12 papers were included in this systematic review. Only few case reports describing traumatic brain injury (TBI) have been documented. Out of a total of 90 cases analyzed, only five cases with TBI were reported. The authors also reported a case of a 12-year-old female, that during a boat trip, reported a severe polytrauma with concussive head trauma from a penetrating left fronto-temporo-parietal lesion, left mammary gland trauma and fracture of the left hand from falling into the water and impact with a motorboat propeller. She underwent an urgent left fronto-temporo-parietal decompressive craniectomy and then surgery with a multidisciplinary team. At the end of the surgical procedure, the patient was transferred to the pediatric intensive care unit. She was discharged on postoperative day 15. The patient was able to walk without assistance, with mild right hemiparesis and persistence of aphasia nominum.
CONCLUSION
Motorboat propeller injuries can result in extensive damage to soft tissue and bones with severe functional disability, amputations, and high mortality. There are still no recommendations and protocols for the management of motorboat propeller related injuries. Although there are several potential solutions that aim to prevent or ease motorboat-propeller injuries, there are still lack of consistent regulations.
PubMed: 37292416
DOI: 10.25259/SNI_219_2023 -
Brain Injury Sep 2022To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in... (Review)
Review
OBJECTIVE
To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research.
METHODS AND PROCEDURES
Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed.
OUTCOMES AND RESULTS
Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years.
CONCLUSIONS AND IMPLICATIONS
We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.
Topics: Child; Humans; Brain Injuries, Traumatic; Communication Disorders; Clinical Decision-Making; Cognition
PubMed: 36303459
DOI: 10.1080/02699052.2022.2111026 -
Journal of Communication Disorders 2021To evaluate effectiveness or non-inferiority of telerehabilitation for people with aphasia when compared to conventional face-to-face speech and language therapy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate effectiveness or non-inferiority of telerehabilitation for people with aphasia when compared to conventional face-to-face speech and language therapy.
MATERIALS AND METHODS
Five electronic databases (PUBMED, EMBASE, WEB OF SCIENCE, SCOPUS and the Cochrane Library) were searched. We extrapolated data from the included studies and evaluated the methodological quality using the Revised Cochrane risk-of-bias tool for Randomized Trials (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). A meta-analysis compared effects of intervention, and it was conducted using the Review Manager 5.3 software. GRADE profile to assess overall quality of evidence was carried out.
RESULTS
Out of a total of 1157 records, five studies met the inclusion criteria and were eligible for meta-analysis with a total of 132 participants with post-stroke aphasia.
DISCUSSION
Results revealed that telerehabilitation and face-to-face speech and language treatment are comparable with respect to the gains achieved in auditory comprehension (SMD = -0.02; 95% CI -0.39, 0.35), naming accuracy (SMD = -0.09; 95% CI -0.44, 0.25), Aphasia Quotient (MD = -2.18; 95% CI -16.00, 11.64), generalization (SMD = 0.77; 95% IC -0.95, 2.49) and functional communication skills (SMD = -0.08; 95% IC -0.54, 0.38).
CONCLUSION
Although evidence is still insufficient to guide clinical decision making due to the relatively low quality of the evidence identified, the analysis of the results suggest that telerehabilitation training for aphasia seems to be as effective as the conventional face-to-face treatment.
Topics: Aphasia; Comprehension; Humans; Speech Therapy; Telerehabilitation
PubMed: 34052617
DOI: 10.1016/j.jcomdis.2021.106111 -
Neuropsychology Review Oct 2023Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or... (Review)
Review
Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental Design Scale or the Physiotherapy Evidence Database - PsycBITE Rating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.
PubMed: 37792075
DOI: 10.1007/s11065-023-09607-1 -
Cerebellum (London, England) Dec 2023To date, cerebellar contribution to language is well established via clinical and neuroimaging studies. However, the particular functional role of the cerebellum in... (Meta-Analysis)
Meta-Analysis Review
To date, cerebellar contribution to language is well established via clinical and neuroimaging studies. However, the particular functional role of the cerebellum in language remains to be clarified. In this study, we present the first systematic review of the diverse language symptoms in spoken language after cerebellar lesion that were reported in case studies for the last 30 years (18 clinical cases from 13 papers), and meta-analysis using cluster analysis with bootstrap and symptom co-occurrence analysis. Seven clusters of patients with similar language symptoms after cerebellar lesions were found. Co-occurrence analysis revealed pairs of symptoms that tend to be comorbid. Our results imply that the "linguistic cerebellum" has a multiform contribution to language function. The most possible mechanism of such contribution is the cerebellar reciprocal connectivity with supratentorial brain regions, where the cerebellar level of the language network has a general modulation function and the supratentorial level is more functionally specified. Based on cerebellar connectivity with supratentorial components of the language network, the "linguistic cerebellum" might be further functionally segregated.
Topics: Humans; Language; Cerebellum; Language Disorders; Linguistics; Brain; Magnetic Resonance Imaging
PubMed: 36205825
DOI: 10.1007/s12311-022-01482-5