Radosław Kaźmierski

Educational level and cognitive impairment in patients with Parkinson disease

BACKGROUND AND PURPOSE Parkinson disease (PD) is a risk factor for dementia. In addition, specific cognitive deficits can occur in PD patients without dementia. A patients level of education could have an influence on the development of cognitive impairment in PD. The aim of this study was to examine the relationship between the level of education and cognitive performance in non-demented patients with PD. MATERIAL AND METHODS Thirty-seven consecutive, nondemented PD patients and 40 healthy controls fulfilled the inclusion criteria and were enrolled in the case-control study. Each of the controls and PD patients were classified, for the purpose of this study, into one of three groups (low, intermediate, higher), categorized by the number of years of education. There were no differences in education and age between the controls and PD patients. All of the subjects were evaluated with a battery of neuropsychological tests: Mini-Mental State Examination, Trail Making Tests, Stroop Test, Mental Rotation Test, and Verbal Fluency Test. RESULTS Less (low and intermediate) education was correlated with poor results from tests. The comparison of all groups of PD patients and controls demonstrated that PD subjects received lower test scores, especially for the low and intermediate groups. However, no statistically significant difference was reached between educationally advanced PD patients and the appropriate control subjects. CONCLUSIONS As compared to the controls, most non-demented PD patients presented executive-type cognitive dysfunction. The higher educational level, however, was associated with a lower risk of cognitive deterioration. We conclude that higher education might have protective effects in cognitive decline in PD.

Ultrasound-based markers of carotid atherosclerosis correlate well with the number of classical atherosclerotic risk factors

BACKGROUND AND PURPOSE Ultrasound-based indicators such as mean or maximal carotid intima-media thickness (CIMT) and cross-sectional plaque area (C-SPA) have been shown to be measurable indices of atherosclerosis. We investigated whether those indicators correlated with the number of atherosclerotic risk factors assessed in routine clinical practice. MATERIALS AND METHODS The study involved a group of 150 patients (median age, 65 years). High-resolution ultrasound was used to assess CIMT and C-SPA of their common and internal carotid arteries. The number of risk factors derived from clinical examination (e.g., hypertension, diabetes, smoking), haematological test, acute phase proteins, serum lipoproteins, homocysteine, and body mass index was assessed. RESULTS Plaques occurred in 85 patients (57% of participants). The median plaque area was 21 mm2 (10.7-46.5 mm2), and the mean CIMT was 0.88 mm (standard deviation, 0.28 mm). The study found significant associations among most of the single as well as the total number of risk factors and mean and maximal CIMT and C-SPA. The differences among the groups of patients with different numbers of risk factors were more evident in terms of the maximal and mean CIMT than in the case of C-SPA. Assessment of C-SPA could be statistically underpowered because only 57% of the investigated subjects had plaques in their carotid arteries. CONCLUSIONS We found a significant correlation between the total number of atherosclerosis risk factors and carotid atherosclerosis as measured by ultrasonography. Along with an increase of the number of risk factors, a gradual increase of CIMT and C-SPA was observed.

The taxonomy statistic uncovers novel clinical patterns in a population of ischemic stroke patients.

In this paper, we describe a simple taxonomic approach for clinical data mining elaborated by Marczewski and Steinhaus (M-S), whose performance equals the advanced statistical methodology known as the expectation-maximization (E-M) algorithm. We tested these two methods on a cohort of ischemic stroke patients. The comparison of both methods revealed strong agreement. Direct agreement between M-S and E-M classifications reached 83%, while Cohen’s coefficient of agreement was κ = 0.766(P < 0.0001). The statistical analysis conducted and the outcomes obtained in this paper revealed novel clinical patterns in ischemic stroke patients. The aim of the study was to evaluate the clinical usefulness of Marczewski-Steinhaus’ taxonomic approach as a tool for the detection of novel patterns of data in ischemic stroke patients and the prediction of disease outcome. In terms of the identification of fairly frequent types of stroke patients using their age, National Institutes of Health Stroke Scale (NIHSS), and diabetes mellitus (DM) status, when dealing with rough characteristics of patients, four particular types of patients are recognized, which cannot be identified by means of routine clinical methods. Following the obtained taxonomical outcomes, the strong correlation between the health status at moment of admission to emergency department (ED) and the subsequent recovery of patients is established. Moreover, popularization and simplification of the ideas of advanced mathematicians may provide an unconventional explorative platform for clinical problems.

Expansion of the Classification System for Eagle Syndrome

Background: In 1937, Watt Eagle reported the first 2 cases of a syndrome that is now named after him. The syndrome is caused by an elongated styloid process and classically presents with unilateral pain or foreign body sensation in the throat, often includes dysphagia and otalgia, and occasionally includes unilateral facial and neck pain (1). Objective: To elaborate on the types of Eagle syndrome. Case Report: A previously healthy 51-year-old actor presented to our stroke unit with slight, right-sided hemiparesis and motor aphasia. When the patient was required to turn his head to the left and downward for a performance, he felt dizzy, experienced vision symptoms (which he described as the pictures moved), and had difficulty finishing his line because of problems with speaking. After the last performance, the symptoms persisted. Physical examination, including blood pressure levels, was unremarkable. Results of blood tests and findings on cardiologic examination, including echocardiography and 5-day Holter electrocardiographic monitoring, were normal. Magnetic resonance imaging of the head showed restricted diffusion consistent with ischemic stroke (and other conditions) in the left hemisphere in the vascular territory between the middle and anterior cerebral artery. Findings on contrast-enhanced magnetic resonance angiography of the carotid arteries were normal, but magnetic resonance angiography of the brain showed the absence of the A1 segment of the right anterior cerebral artery and hypoplasia of the P1 segment of the right posterior cerebral artery (Figure 1). Color-coded duplex ultrasonography revealed normal carotid arteries, but transcranial duplex ultrasonography showed no blood flow where the A1 segment of the right anterior cerebral artery should be or through the hypoplastic P1 segment of the right posterior cerebral artery. When the patient reproduced the head movements that he used during the performance, dynamic ultrasonography of the carotid artery showed that peak systolic blood velocity in the left internal carotid artery decreased from 31 cm/s to 12 cm/s, he felt dizzy, and symptoms resolved when he returned his head to the upright position. A 3-dimensional computed tomographic reconstruction (Figure 2) confirmed elongation of both styloid processes (48 mm on the left and 47 mm on the right; a styloid process is typically 25 to 30 mm in length, and lengths> 30 mm are considered elongated [2, 3]). Figure 1. Magnetic resonance imaging time-of-flight angiography of the circle of Willis showing the absence of the A1 segment of the right anterior cerebral artery (arrowhead). Figure 2. Elongated styloid processes (arrowheads) on computed tomographic reconstruction of the head. Transoral surgery removed the elongated styloid process on the left with no intra- or postoperative complications. After 3 years, the patient has only slight dysphasia. His language skills are sufficient for everyday communication but have not allowed him to resume his acting career. Discussion: We believe that this patient had a left-sided stroke because the elongated styloid process on this side compressed the nearby internal carotid artery, which probably induced transient vasospasm. In addition, the circle of Willis was unable to compensate with enough blood flow from the right because of the congenital absence of the A1 segment of the right anterior cerebral artery and hypoplasia of the P1 segment of the right posterior cerebral artery. Two types of Eagle syndrome have been described. In the classic type, an elongated styloid process impinges on a cranial nerve (V, VII, IX, or X); in the variant type (stylocarotid syndrome), the elongated styloid process compresses or protrudes into the carotid artery (35). Compression can cause transient neurologic symptoms, including transient ischemic attacks, and repeated compression or protrusion can lead to a dissection, which can cause a stroke. Prior reports of the stylocarotid syndrome have not considered the circle of Willis. We therefore propose extending the classification of Eagle syndrome to include the stylocarotid form without a structural change in the carotid artery but with compression and vasospasm of this artery that usually result in a transient ischemic attack when the circle of Willis is normal and can cause a stroke when the circle of Willis is incomplete.

Standards in neurosonology. Part III.

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description. Practical criteria for the diagnosis of certain pathologies in accordance with the latest literature were also presented. Furthermore, additional comments were included in some of the sections. Part I discusses standards for the performance, documentation and description of different ultrasound methods (Duplex, Doppler). Part II and III are devoted to standards for specific clinical situations (vasospasm, monitoring after the acute stage of stroke, detection of a right-toleft shunts, confirmation of the arrest of the cerebral circulation, an assessment of the functional efficiency of circle of Willis, an assessment of the cerebrovascular vasomotor reserve as well as the measurement of substantia nigra hyperechogenicity).

Standardy badań ultrasonograficznych. Neurosonologia. Część III

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description. Practical criteria for the diagnosis of certain pathologies in accordance with the latest literature were also presented. Furthermore, additional comments were included in some of the sections. Part I discusses standards for the performance, documentation and description of different ultrasound methods (Duplex, Doppler). Part II and III are devoted to standards for specific clinical situations (vasospasm, monitoring after the acute stage of stroke, detection of a right-to-left shunts, confirmation of the arrest of the cerebral circulation, an assessment of the functional efficiency of circle of Willis, an assessment of the cerebrovascular vasomotor reserve as well as the measurement of substantia nigra hyperechogenicity).