Day 1 :
- Stroke, Management of Stroke, Neurosurgery, Cerebrovascular Disorders, Neurology and Neurological Disorders, Neurodegeneration & Aging Disorders, Brain Disorders, Traumatic Brain Injury, Neurogenetic and Neurometabolic Disorders, Neuroinflammation
Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
Ananya Das have completed MD Pediatrics from Medical College ,Kolkata. Thereafter i have done senior residency in All India Institute Of Medical Sciences(AIIMS) in the Dept of Pediatrics. Now i am pursuing DM neurology in Sanjay Gandhi Post Graduate Institute of Medical Sciences(SGPGIMS). I have done my thesis work on post stroke rigidity.
Eskisehir Osmangazi University, Turkey
Emine Colak is currently working in the department of Medical Biology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Stroke is defined as a heterogeneous disease that causes dementia and depression and is classified as cerebrovascular accidents worldwide. Based on etiopathogenesis, stroke is examined in five subclasses as ischemic, hemorrhagic, subarachnoid hemorrhagic, cerebral venous thrombosis and spinal cord stroke. 85% of stroke cases are ischemic strokes that are caused by arterial occlusion or insufficient perfusion and can result in death or permanent damage to individuals. In the brain, ischemia and subsequent reperfusion processes trigger various pathophysiological processes including excitotoxicity, periinfarct depolarization, inflammation, nitric oxide production, free radical damage and cell death. As a result of ischemia-reperfusion (I/R) processes, different cell death cascades are triggered. Apoptosis pathways induced in the process of the brain I/R is one of the main cell death pathways. In recent studies, necroptosis, a cell death pathway, has been identified to be functional in the brain I/R process. The channels of pannexin-1 have a wide permeability specificity including cations, anions secondary messengers and metabolites and take part in various pathological processes such as cell differentiation, inflammation, and cell death. In the brain I/R process, the opening of the pannexin-1channels caused hypoxic depolarization, which may result in the cell death.
In this study, the effects of inhibition of pannexin-1 channels on the apoptosis and necroptosis in the brain I/R process were investigated. In our study, two hours of ischemia with clamp insertion to the right arteria carotis communis of the rats and then 24-hour reperfusion processes were provided. To investigate the effects of pannexin-1 channels inhibition, pan-caspase inhibitor Z-VAD-fmk and pannexin-1 channel inhibitor probenecid were used. Six experimental groups were formed in the study: sham, ischemia control, I/R control, I/R+Z-VAD-fmk, I/R+probenecid and I/R+Z-VAD-fmk+probenecid. Brain infarct volume was evaluated macroscopically by TTC staining. The accumulation of protein levels in tissues was determined by immunohistochemical studies using caspase 3, caspase 8, RIPK3 and MLKL antibodies.
As a result of the TTC staining, it was determined that both the use of apoptosis inhibitor Z-VAD-fmk and the pannexin-1 inhibitor probenecidin together decreased the infarct volume (p<0.001) and accordingly I/R injury. As a result of the IHC studies, it was determined that the levels of caspase 3, caspase 8, RIP3 and MLKL protein in brain tissues reached the highest level in the I/R process. It was determined that increased caspase 3 and caspase 8 protein levels decreased in I/R+Z-VAD-fmk and I/R+Z-VAD-fmk+probenecid groups, while MLKL and RIP3 expression decreased in I/R+probenecid and I/R+Z-VAD-fmk+probenecid groups.
As a result, it was determined that Pannexin-1 channels were involved in the progression of both apoptosis and necroptosis in I / R damage, and thus blocking these channels reduced the damage that occurred in the brain I / R process.
- Amarenco, P., Bogousslavsky, J., Caplan, L., Donnan, G., & Hennerici, M. (2009). Classification of stroke subtypes. Cerebrovascular diseases, 27(5), 493-501.
- Bargiotas, P., Krenz, A., Hormuzdi, S. G., Ridder, D. A., Herb, A., Barakat, W., . . . Schwaninger, M. (2011). Pannexins in ischemia-induced neurodegeneration. Proceedings of the National Academy of Sciences, 108(51), 20772-20777.
- Boyd-Tressler, A., Penuela, S., Laird, D. W., & Dubyak, G. R. (2014). Chemotherapeutic drugs induce ATP release via caspase-gated pannexin-1 channels and a caspase/pannexin-1-independent mechanism. Journal of Biological Chemistry, 289(39), 27246-27263.
- Culman, J., Nguyen-Ngoc, M., Glatz, T., Gohlke, P., Herdegen, T., & Zhao, Y. (2012). Treatment of rats with pioglitazone in the reperfusion phase of focal cerebral ischemia: a preclinical stroke trial. Experimental neurology, 238(2), 243-253.
- De Groot, H., & Rauen, U. (2007). Ischemia-reperfusion injury: processes in pathogenetic networks: a review. Paper presented at the Transplantation proceedings.
Gabriel Alejandro B. Baroque has completed his MD at the age of 28 from the University of Santo Tomas in Manila, Philippines. He is currently a Neurology resident in the same institution. He has been guided by Dr. Alejandro C. Baroque II and Dr. Imelda S. David, both esteemed professors and practicing in the fields of Neurology and Psychiatry.
We report a case of a 51-year old Filipino female with multifocal motor neuropathy who presented with chronic weakness of the left foot which without any sensory deficits.
With the history chronic progressive weakness, lack of sensory deficits, confirmatory by biochemical workups and diagnostics: an elevated ganglioside GM1 antibody test which revealed a titer of 1:12800, electromyography and nerve conduction confirmed the diagnosis of multifocal motor neuropathy.
Treatment of intravenous immunoglobulin with a dose of 2g/kg over 2-5 days was initiated and repeated every 2 months with noticeable improvement.
Multifocal motor neuropathy is a rare disorder which has a prevalence of 0.6 per 100,000 individuals. It is seen in more in males with a ratio of 2.7:1. It is described as a pure motor disease without sensory deficits which is predominantly seen in the upper extremities.7 The diagnosis for the disorder is supported by determination of ganglioside GM1 antibodies, electromyography and nerve conduction velocity study (EMG-NCV).2,3,4,5
East Avenue Medical Center, Philippines
Godard Espiritu Artajos, MD has completed his medical degree at age 26 years from the University of Santo Tomas Faculty of Medicine and Surgery. He is currently a Senior Resident-in-training under the Adult Neurology Program of the East Avenue Medical Center Department of Neurosciences, a tertiary government hospital in the heart of the Philippines. He aspires to pursue Neurophysiology fellowship abroad and go back to serve the Filipino people
Myasthenia gravis and High cervical disc herniation are uncommon diseases and rarely occurs at the same time. Each condition is caused by different etiologies and pathophysiology. We report a case of a 38-year old Filipino female who was admitted due to head drop. She experienced bowel and bladder incontinence and progressive proximal muscle weakness for nine months and eventually developed cranial muscle symptoms like dysphagia, dysphonia and ptosis. She was admitted as a case of cervical spine spondylosis but worsened after physical therapy despite IV steroids. Positive prostigmine test and repetitive nerve stimulation test confirmed presence of concomitant Myasthenia Gravis. In conclusion, we describe here a case of high cervical cord compression with superimposed myasthenia gravis. That the pattern of weakness caused by the spinal cord lesion can hide the classic fatigable pattern of weakness in myasthenia gravis. The presence of cranial muscle involvement and worsening of weakness after physical therapy favors myasthenia gravis. Early diagnosis of concurrent myasthenia and initiation of proper treatment helps in preventing possible complications that can prolong hospitalization in patients with high cervical cord compression.
University of Ghana, Ghana
Ophelia Anarfi is a final year PhD Candidate from the University of Ghana, Department of Psychology, Legon. She has her research interest centered on Stroke, Rehabilitation and recovery. She is a beneficiary of the Building of Next Generation (BANGA) in Africa, Project, University of Ghana.
Background: Religion plays a vital role in recovery of illness of which stroke is not an exception. Religion has been used as an effective coping strategy for stroke survivors as they deal with the illness.
Aims/Objectives: To determine how religion experiences such as engaging in payers and reading of scriptures and among others have direct influence alteration of emotions as the concept of neurotheology postulates that it affects neural changes especially the functions of the hippocampus and the amygdala.
Methods: 10 stroke survivors were recruited from the Stroke Unit and the Physiotherapy Unit of the Korle-Bu Teaching Hospital (KBTH) to participate in an in-depth individual interviews. The stroke survivors were asked the question “What are the religious practices, values and beliefs that are related to the culture which aids in recovery after stroke?” and how they feel after they had engaged in such experiences as well as the positive and negative impact of religion to health and recovery after stroke?”
Expected Results: It was observed that most used religion as a buffer in coping with the condition. The religious practices and experiences that related to recovery after stroke included reading and meditating of scriptures, prayers, consultation, directions from and prayers offered by pastors. The topmost impact of religion on mood as a form of recovery was the ability to remain calm, state of tranquility and a sense of inner peace and after engaging in such religious experiences.
Conclusion: Most of the religious practices and experiences were considered to aid in recovery after stroke; and most especially the role of religion serving as a source of emotional equilibrium.
Shahid Beheshti University of Medical Sciences, Iran
CADASIL, Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy, is an inherited small vessels disease that characterized by central nervous system dysfunctions caused by mutations in the Notch-3 gene. Clinical manifestations accrue due to brain’s vasculopathy, neurodegeneration, and immune system reaction. We describe here an effective method for treatment of CADASIL by using mesenchymal stem cell therapy. A CADASIL case, 36 years old man, neuroimaging and genetic analysis for Notch-3 confirmed the diagnosis, is reported. In the present case, two stem cell injections have been performed at intervals of three weeks. The patient had no significant complications in the post-transplant period. No immediate or delayed side effects following MSC infusion were observed. He developed neither malignancy nor unwanted cells or any infectious complications 18 months after the transplantation, we performed a Cerebral MRI showed stable cerebral lesions and his gate and balance improved. Anti-HLA Antibody measurement confirmed that the patient's immune system was not stimulated by injected cells.With regard to his neurological symptoms, Scale for the assessment and rating of ataxia (SARA), The Multiple Sclerosis Functional Composite measure (MSFC), Quality of Life Assessment (QOL) and Cognitive Functioning Status (ACE-R), the patient did not has further deterioration of his previous clinical status in the follow up period of 18 months.Further studies need to be performed to show the generalizability of the results.
National Institute of Nuclear Medicine and Allied Sciences, Bangladesh
Nasreen Sultana completed her Medical graduation in 1993 from Chittagong University and post graduate course 'Doctor of Medicine' in Nuclear Medicine from BSM Medical University, Bangladesh in 2005. She got trained in Advanced Vascular Imaging in 2005 from Thomas Jefferson University and Research Institute, Venezuela under WFUMB fellowship. She has been serving as a physician specialist in ultrasound imaging, nuclear imaging and radionuclide therapy at National Institute of Nuclear Medicine and Allied sciences (NINMAS) since 2006. Her scientific papers were awarded by ARCCNM in 2004, 2006 and 2009. She has trainings in Molecular Neuroimaging from Utah University, USA and Osaka Medical University, Japan both in 2017. She has been an academic faculty member of NINMAS (www.ninmas.org) under faculty of medicine of BSMMU, a member in board of directors of AOFNMB and a fellow of Asian Nuclear Medicine Board. She has been act as reviewer of Bangladesh J.Nucl. Medicine, Journal E Cronicón UK .London and also editorial board member of Journal EC Neurology, UK.London.
Stroke and cerebrovascular diseases are major causes of mortality, morbidity, and disability. Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. Rehabilitation services have not yet been integrated into the Bangladesh health system.Nuclear medicine imaging can play an important role in the diagnosis of stroke risk, the differential diagnosis of vascular and parenchymal cerebral abnormalities, and the understanding and management of post-stroke recovery.Nuclear Medicine, primarily via tomographic methods, has made substantial contributions to the considerate of the hemodynamic and metabolic significances of cerebrovascular diseases. Many of the pathophysiologic processes and consequences that follow stroke, including completed infarct core, adjacent penumbra, and diaschisis, have been investigated with Nuclear Medicine, and stroke outcome may be related to these phenomena. Several techniques, including vasodilatory stress imaging with regional cerebral blood flow (rCBF) single-photon emission computed tomography (SPECT), oxygen extraction methods with positron emission tomography (PET), and spectroscopic imaging with magnetic resonance spectroscopic imaging, offer ways to distinguish vascular from parenchymal dysfunction and to determine whether any observed abnormalities in cerebral blood flow are primary for secondary disease manifestations. Here we want to share our experiences regarding clinically diagnosed stroke with nuclear imaging at our institution.
Yeditepe Üniversity, Turkey
Damlasu Altınoz is currently working as Faculty of Health Sciences in the Department of Physiotherapy and Rehabilitation in the university of Yeditepe University, Turkey.
Introduction: AOT (Action Observation Training) is a physical rehabilitation approach that provokes motor function improvement by activating the mirror neuron system.
Objective:This systematic review aims to assess whether action observation enhances upper limb motor performance in patients with neurological disorder.
Method: Trials were searched on The Cochrane Central Register of Controlled Trials (CENTRAL) and 4 more databases. Also, reference lists were screened for relevant articles. Risk of bias evaluated according to PEDro Scale. According to result of these scores the trials which have score least than 5 are excluded (range 0 –10 points, increasing score indicates increased quality).
Results:Fifteen RCTs, which met the criteria for inclusion were identified. According to that, 697 sample included.Ten studies proved the efficacy of AOT in functional recovery on upper limb in stroke (seven in chronic, three in subacute. However,only one study involving patients in the acute stroke showed significantly higher improvement of functional dexterity in the group performing the conventional therapy. Also, one study is suggested that AOT may be a promising approach in the rehabilitation of bradykinesia in patients with Parkinson’s disease. Other two studies also indicated that AOT improves upper limb motor function in children with cerebralpalsy. However, one study showed no difference between two groups in children with cerebral palsy.
Saeed T Saeed Consultant Stroke/internal medicine at Hazm Mebaireek General Hospital part of Hamad Medical Corporation, relocated to Qatar from London (UK) on May 2018. Undertaken all my training and postgraduate degree in the United Kingdom. I started my carrier as Consultant in Stroke/internal medicine on Feb 2017 at one of the prestigious Hospital in London called Royal London hospital-Bart’s Health NHS Trust, it is one the biggest Trust in the UK and consider of the biggest hospital around Europe.
A standardized definition of “young adults” is lacking. People under 40, 45, 50, or even 55 years of age have been classified as young adults.
Strokes in young adults are reported as comprise 10%–15% of all stroke patients. The nature and aetiology of stroke in young adults is different from that in older patients. Stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of stroke in young adults.
Stroke was caused by atherosclerotic large artery disease in 4%, cardio embolism in 24%, small vessel disease in 9%, another determined aetiology in 30%, and undetermined aetiology in 33%. Modifiable risk factors for stroke, such as dyslipidemia, smoking, and hypertension, are highly prevalent in the young stroke population. The best form of secondary stroke prevention is directed toward stroke aetiology as well as treatment of additional risk factors. A systematic review on the incidence of stroke in young adults was published by Marini et al, who analyzed 29 studies including 3,589 patients under 45 years of age with first-ever stroke, published between 1980 and 2009. Crude rates ranged from 5.76/100,000 to 39.79/100,000.
Etiologic diagnosis of stroke in young adults requires a different and more complex diagnostic work-up than that of stroke in older adults.
Mater Misericordiae University Hospital, Ireland
Donna Eaton is an internationally trained thoracic surgeon who was appointed at the Mater hospital Dublin in 2013. She has extensive experience in minimally invasive surgery including thoracoscopic and robotic surgery. Since taking up practice in Ireland, she has expanded the range of minimally invasive surgical approaches and specialist procedures offered to patients in the Republic of Ireland.
Introduction: There is a clear relationship between the left atrial appendage (LAA) and stroke in patients with non-valvular AF. Recently, device closure of the LAA has emerged as a safe and effective alternative to anti-coagulation for some patients. We present our experience of minimally invasive clipping of the LAA.
Results: We have performed thoracoscopic occlusion of the LAA using an epicardial clip (AtriClip) in 15 patients. LAA clipping was performed as a stand-alone procedure, a hybrid procedure (in combination with catheter based ablation), part of a totally thoracoscopic AF ablation procedure or as an adjuvant in patients undergoing left thoracoscopic operations (e.g. lobectomy, lung biopsy). The clip is deployed epicardially over the base of the LAA under direct vision, effectively and reproducibly occluding the LAA.
In all cases the clip achieved complete LAA exclusion. It can be easily deployed via a minimally invasive surgical approach requiring only a short (30-45 minute) general anesthetic. We have found minimally invasive LAA closure to be a safe, reliable and well-tolerated procedure.
Discussion: Unlike endocardial devices this method allows immediate cessation of anticoagulation medications, as the clip is placed epicardially there is no requirement for anticoagulation post deployment and no risk of complications related to device migration.