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47


Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry

Ntaios, George; Michel, Patrik; Georgiopoulos, Georgios; Guo, Yutao; Li, Wencheng; Xiong, Jing; Calleja, Patricia; Ostos, Fernando; González-Ortega, Guillermo; Fuentes, Blanca; Alonso de Leciñana, María; Díez-Tejedor, Exuperio; García-Madrona, Sebastian; Masjuan, Jaime; DeFelipe, Alicia; Turc, Guillaume; Gonçalves, Bruno; Domigo, Valerie; Dan, Gheorghe-Andrei; Vezeteu, Roxana; Christensen, Hanne; Christensen, Louisa Marguerite; Meden, Per; Hajdarevic, Lejla; Rodriguez-Lopez, Angela; Díaz-Otero, Fernando; García-Pastor, Andrés; Gil-Nuñez, Antonio; Maslias, Errikos; Strambo, Davide; Werring, David J; Chandratheva, Arvind; Benjamin, Laura; Simister, Robert; Perry, Richard; Beyrouti, Rahma; Jabbour, Pascal; Sweid, Ahmad; Tjoumakaris, Stavropoula; Cuadrado-Godia, Elisa; Campello, Ana Rodríguez; Roquer, Jaume; Moreira, Tiago; Mazya, Michael V; Bandini, Fabio; Matz, Karl; Iversen, Helle K; González-Duarte, Alejandra; Tiu, Cristina; Ferrari, Julia; Vosko, Milan R; Salzer, Helmut J F; Lamprecht, Bernd; Dünser, Martin W; Cereda, Carlo W; Quintero, Ángel Basilio Corredor; Korompoki, Eleni; Soriano-Navarro, Eduardo; Soto-Ramírez, Luis Enrique; Castañeda-Méndez, Paulo F; Bay-Sansores, Daniela; Arauz, Antonio; Cano-Nigenda, Vanessa; Kristoffersen, Espen Saxhaug; Tiainen, Marjaana; Strbian, Daniel; Putaala, Jukka; Lip, Gregory Y H
Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.
PMCID:7359900
PMID: 32787707
ISSN: 1524-4628
CID: 4930562

Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Campbell, Bruce C V; Majoie, Charles B L M; Albers, Gregory W; Menon, Bijoy K; Yassi, Nawaf; Sharma, Gagan; van Zwam, Wim H; van Oostenbrugge, Robert J; Demchuk, Andrew M; Guillemin, Francis; White, Philip; Dávalos, Antoni; van der Lugt, Aad; Butcher, Kenneth S; Cherifi, Aboubaker; Marquering, Henk A; Cloud, Geoffrey; Macho Fernández, Juan M; Madigan, Jeremy; Oppenheim, Catherine; Donnan, Geoffrey A; Roos, Yvo B W E M; Shankar, Jai; Lingsma, Hester; Bonafé, Alain; Raoult, Hélène; Hernández-Pérez, María; Bharatha, Aditya; Jahan, Reza; Jansen, Olav; Richard, Sébastien; Levy, Elad I; Berkhemer, Olvert A; Soudant, Marc; Aja, Lucia; Davis, Stephen M; Krings, Timo; Tisserand, Marie; San Román, Luis; Tomasello, Alejandro; Beumer, Debbie; Brown, Scott; Liebeskind, David S; Bracard, Serge; Muir, Keith W; Dippel, Diederik W J; Goyal, Mayank; Saver, Jeffrey L; Jovin, Tudor G; Hill, Michael D; Mitchell, Peter J; Berkhemer, Olvert A; Fransen, Puck Ss; Beumer, Debbie; van den Berg, Lucie A; Lingsma, Hester F; Yoo, Albert J; Schonewille, Wouter J; Vos, Jan Albert; Nederkoorn, Paul J; Wermer, Marieke Jh; van Walderveen, Marianne Aa; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Brouwer, Patrick A; Emmer, Bart J; de Bruijn, Sebastiaan F; van Dijk, Lukas C; Kappelle, Jaap; Lo, Rob H; van Dijk, Ewoud J; de Vries, Joost; de Kort, Paul L M; van Rooij, Willem Jan J; van den Berg, Jan S P; van Hasselt, Boudewijn A A M; Aerden, Leo A M; Dallinga, René J; Visser, Marieke C; Bot, Joseph C J; Vroomen, Patrick C; Eshghi, Omid; Schreuder, Tobien H C M L; Heijboer, Roel J J; Keizer, Koos; Tielbeek, Alexander V; den Hertog, Heleen M; Gerrits, Dick G; van den Berg-Vos, Renske M; Karas, Giorgos B; Steyerberg, Ewout W; Flach, Zwenneke; Marquering, Henk A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Beenen, Ludo F M; van den Berg, René; Koudstaal, Peter J; van Zwam, Wim H; Roos, Yvo B W E M; van der Lugt, Aad; van Oostenbrugge, Robert J; Majoie, Charles B L M; Dippel, Diederik W J; Brown, Martin M; Liebig, Thomas; Stijnen, Theo; Andersson, Tommy; Mattle, Heinrich; Wahlgren, Nils; van der Heijden, Esther; Ghannouti, Naziha; Fleitour, Nadine; Hooijenga, Imke; Puppels, Corina; Pellikaan, Wilma; Geerling, Annet; Lindl-Velema, Annemieke; van Vemde, Gina; de Ridder, Ans; Greebe, Paut; de Bont-Stikkelbroeck, José; de Meris, Joke; Janssen, Kirsten; Struijk, Willy; Licher, Silvan; Boodt, Nikki; Ros, Adriaan; Venema, Esmee; Slokkers, Ilse; Ganpat, Raymie-Jayce; Mulder, Maxim; Saiedie, Nawid; Heshmatollah, Alis; Schipperen, Stefanie; Vinken, Stefan; van Boxtel, Tiemen; Koets, Jeroen; Boers, Merel; Santos, Emilie; Borst, Jordi; Jansen, Ivo; Kappelhof, Manon; Lucas, Marit; Geuskens, Ralph; Barros, Renan Sales; Dobbe, Roeland; Csizmadia, Marloes; Hill, M D; Goyal, M; Demchuk, A M; Menon, B K; Eesa, M; Ryckborst, K J; Wright, M R; Kamal, N R; Andersen, L; Randhawa, P A; Stewart, T; Patil, S; Minhas, P; Almekhlafi, M; Mishra, S; Clement, F; Sajobi, T; Shuaib, A; Montanera, W J; Roy, D; Silver, F L; Jovin, T G; Frei, D F; Sapkota, B; Rempel, J L; Thornton, J; Williams, D; Tampieri, D; Poppe, A Y; Dowlatshahi, D; Wong, J H; Mitha, A P; Subramaniam, S; Hull, G; Lowerison, M W; Sajobi, T; Salluzzi, M; Wright, M R; Maxwell, M; Lacusta, S; Drupals, E; Armitage, K; Barber, P A; Smith, E E; Morrish, W F; Coutts, S B; Derdeyn, C; Demaerschalk, B; Yavagal, D; Martin, R; Brant, R; Yu, Y; Willinsky, R A; Montanera, W J; Weill, A; Kenney, C; Aram, H; Stewart, T; Stys, P K; Watson, T W; Klein, G; Pearson, D; Couillard, P; Trivedi, A; Singh, D; Klourfeld, E; Imoukhuede, O; Nikneshan, D; Blayney, S; Reddy, R; Choi, P; Horton, M; Musuka, T; Dubuc, V; Field, T S; Desai, J; Adatia, S; Alseraya, A; Nambiar, V; van Dijk, R; Wong, J H; Mitha, A P; Morrish, W F; Eesa, M; Newcommon, N J; Shuaib, A; Schwindt, B; Butcher, K S; Jeerakathil, T; Buck, B; Khan, K; Naik, S S; Emery, D J; Owen, R J; Kotylak, T B; Ashforth, R A; Yeo, T A; McNally, D; Siddiqui, M; Saqqur, M; Hussain, D; Kalashyan, H; Manosalva, A; Kate, M; Gioia, L; Hasan, S; Mohammad, A; Muratoglu, M; Williams, D; Thornton, J; Cullen, A; Brennan, P; O'Hare, A; Looby, S; Hyland, D; Duff, S; McCusker, M; Hallinan, B; Lee, S; McCormack, J; Moore, A; O'Connor, M; Donegan, C; Brewer, L; Martin, A; Murphy, S; O'Rourke, K; Smyth, S; Kelly, P; Lynch, T; Daly, T; O'Brien, P; O'Driscoll, A; Martin, M; Daly, T; Collins, R; Coughlan, T; McCabe, D; Murphy, S; O'Neill, D; Mulroy, M; Lynch, O; Walsh, T; O'Donnell, M; Galvin, T; Harbison, J; McElwaine, P; Mulpeter, K; McLoughlin, C; Reardon, M; Harkin, E; Dolan, E; Watts, M; Cunningham, N; Fallon, C; Gallagher, S; Cotter, P; Crowe, M; Doyle, R; Noone, I; Lapierre, M; Coté, V A; Lanthier, S; Odier, C; Durocher, A; Raymond, J; Weill, A; Daneault, N; Deschaintre, Y; Jankowitz, B; Baxendell, L; Massaro, L; Jackson-Graves, C; Decesare, S; Porter, P; Armbruster, K; Adams, A; Billigan, J; Oakley, J; Ducruet, A; Jadhav, A; Giurgiutiu, D-V; Aghaebrahim, A; Reddy, V; Hammer, M; Starr, M; Totoraitis, V; Wechsler, L; Streib, S; Rangaraju, S; Campbell, D; Rocha, M; Gulati, D; Silver, F L; Krings, T; Kalman, L; Cayley, A; Williams, J; Stewart, T; Wiegner, R; Casaubon, L K; Jaigobin, C; Del Campo, J M; Elamin, E; Schaafsma, J D; Willinsky, R A; Agid, R; Farb, R; Ter Brugge, K; Sapkoda, B L; Baxter, B W; Barton, K; Knox, A; Porter, A; Sirelkhatim, A; Devlin, T; Dellinger, C; Pitiyanuvath, N; Patterson, J; Nichols, J; Quarfordt, S; Calvert, J; Hawk, H; Fanale, C; Frei, D F; Bitner, A; Novak, A; Huddle, D; Bellon, R; Loy, D; Wagner, J; Chang, I; Lampe, E; Spencer, B; Pratt, R; Bartt, R; Shine, S; Dooley, G; Nguyen, T; Whaley, M; McCarthy, K; Teitelbaum, J; Tampieri, D; Poon, W; Campbell, N; Cortes, M; Dowlatshahi, D; Lum, C; Shamloul, R; Robert, S; Stotts, G; Shamy, M; Steffenhagen, N; Blacquiere, D; Hogan, M; AlHazzaa, M; Basir, G; Lesiuk, H; Iancu, D; Santos, M; Choe, H; Weisman, D C; Jonczak, K; Blue-Schaller, A; Shah, Q; MacKenzie, L; Klein, B; Kulandaivel, K; Kozak, O; Gzesh, D J; Harris, L J; Khoury, J S; Mandzia, J; Pelz, D; Crann, S; Fleming, L; Hesser, K; Beauchamp, B; Amato-Marzialli, B; Boulton, M; Lopez-Ojeda, P; Sharma, M; Lownie, S; Chan, R; Swartz, R; Howard, P; Golob, D; Gladstone, D; Boyle, K; Boulos, M; Hopyan, J; Yang, V; Da Costa, L; Holmstedt, C A; Turk, A S; Navarro, R; Jauch, E; Ozark, S; Turner, R; Phillips, S; Shankar, J; Jarrett, J; Gubitz, G; Maloney, W; Vandorpe, R; Schmidt, M; Heidenreich, J; Hunter, G; Kelly, M; Whelan, R; Peeling, L; Burns, P A; Hunter, A; Wiggam, I; Kerr, E; Watt, M; Fulton, A; Gordon, P; Rennie, I; Flynn, P; Smyth, G; O'Leary, S; Gentile, N; Linares, G; McNelis, P; Erkmen, K; Katz, P; Azizi, A; Weaver, M; Jungreis, C; Faro, S; Shah, P; Reimer, H; Kalugdan, V; Saposnik, G; Bharatha, A; Li, Y; Kostyrko, P; Santos, M; Marotta, T; Montanera, W; Sarma, D; Selchen, D; Spears, J; Heo, J H; Jeong, K; Kim, D J; Kim, B M; Kim, Y D; Song, D; Lee, K-J; Yoo, J; Bang, O Y; Rho, S; Lee, J; Jeon, P; Kim, K H; Cha, J; Kim, S J; Ryoo, S; Lee, M J; Sohn, S-I; Kim, C-H; Ryu, H-G; Hong, J-H; Chang, H-W; Lee, C-Y; Rha, J; Davis, Stephen M; Donnan, Geoffrey A; Campbell, Bruce Cv; Mitchell, Peter J; Churilov, Leonid; Yan, Bernard; Dowling, Richard; Yassi, Nawaf; Oxley, Thomas J; Wu, Teddy Y; Silver, Gabriel; McDonald, Amy; McCoy, Rachael; Kleinig, Timothy J; Scroop, Rebecca; Dewey, Helen M; Simpson, Marion; Brooks, Mark; Coulton, Bronwyn; Krause, Martin; Harrington, Timothy J; Steinfort, Brendan; Faulder, Kenneth; Priglinger, Miriam; Day, Susan; Phan, Thanh; Chong, Winston; Holt, Michael; Chandra, Ronil V; Ma, Henry; Young, Dennis; Wong, Kitty; Wijeratne, Tissa; Tu, Hans; Mackay, Elizabeth; Celestino, Sherisse; Bladin, Christopher F; Loh, Poh Sien; Gilligan, Amanda; Ross, Zofia; Coote, Skye; Frost, Tanya; Parsons, Mark W; Miteff, Ferdinand; Levi, Christopher R; Ang, Timothy; Spratt, Neil; Kaauwai, Lara; Badve, Monica; Rice, Henry; de Villiers, Laetitia; Barber, P Alan; McGuinness, Ben; Hope, Ayton; Moriarty, Maurice; Bennett, Patricia; Wong, Andrew; Coulthard, Alan; Lee, Andrew; Jannes, Jim; Field, Deborah; Sharma, Gagan; Salinas, Simon; Cowley, Elise; Snow, Barry; Kolbe, John; Stark, Richard; King, John; Macdonnell, Richard; Attia, John; D'Este, Cate; Saver, Jeffrey L; Goyal, Mayank; Diener, Hans-Christoph; Levy, Elad I; Bonafé, Alain; Mendes Pereira, Vitor; Jahan, Reza; Albers, Gregory W; Cognard, Christophe; Cohen, David J; Hacke, Werner; Jansen, Olav; Jovin, Tudor G; Mattle, Heinrich P; Nogueira, Raul G; Siddiqui, Adnan H; Yavagal, Dileep R; von Kummer, Rüdiger; Smith, Wade; Turjman, Francis; Hamilton, Scott; Chiacchierini, Richard; Amar, Arun; Sanossian, Nerses; Loh, Yince; Devlin, T; Baxter, B; Hawk, H; Sapkota, B; Quarfordt, S; Sirelkhatim, A; Dellinger, C; Barton, K; Reddy, V K; Ducruet, A; Jadhav, A; Horev, A; Giurgiutiu, D-V; Totoraitis, V; Hammer, M; Jankowitz, B; Wechsler, L; Rocha, M; Gulati, D; Campbell, D; Star, M; Baxendell, L; Oakley, J; Siddiqui, A; Hopkins, L N; Snyder, K; Sawyer, R; Hall, S; Costalat, V; Riquelme, C; Machi, P; Omer, E; Arquizan, C; Mourand, I; Charif, M; Ayrignac, X; Menjot de Champfleur, N; Leboucq, N; Gascou, G; Moynier, M; du Mesnil de Rochemont, R; Singer, O; Berkefeld, J; Foerch, C; Lorenz, M; Pfeilschifer, W; Hattingen, E; Wagner, M; You, S J; Lescher, S; Braun, H; Dehkharghani, S; Belagaje, S R; Anderson, A; Lima, A; Obideen, M; Haussen, D; Dharia, R; Frankel, M; Patel, V; Owada, K; Saad, A; Amerson, L; Horn, C; Doppelheuer, S; Schindler, K; Lopes, D K; Chen, M; Moftakhar, R; Anton, C; Smreczak, M; Carpenter, J S; Boo, S; Rai, A; Roberts, T; Tarabishy, A; Gutmann, L; Brooks, C; Brick, J; Domico, J; Reimann, G; Hinrichs, K; Becker, M; Heiss, E; Selle, C; Witteler, A; Al-Boutros, S; Danch, M-J; Ranft, A; Rohde, S; Burg, K; Weimar, C; Zegarac, V; Hartmann, C; Schlamann, M; Göricke, S; Ringlestein, A; Wanke, I; Mönninghoff, C; Dietzold, M; Budzik, R; Davis, T; Eubank, G; Hicks, W J; Pema, P; Vora, N; Mejilla, J; Taylor, M; Clark, W; Rontal, A; Fields, J; Peterson, B; Nesbit, G; Lutsep, H; Bozorgchami, H; Priest, R; Ologuntoye, O; Barnwell, S; Dogan, A; Herrick, K; Takahasi, C; Beadell, N; Brown, B; Jamieson, S; Hussain, M S; Russman, A; Hui, F; Wisco, D; Uchino, K; Khawaja, Z; Katzan, I; Toth, G; Cheng-Ching, E; Bain, M; Man, S; Farrag, A; George, P; John, S; Shankar, L; Drofa, A; Dahlgren, R; Bauer, A; Itreat, A; Taqui, A; Cerejo, R; Richmond, A; Ringleb, P; Bendszus, M; Möhlenbruch, M; Reiff, T; Amiri, H; Purrucker, J; Herweh, C; Pham, M; Menn, O; Ludwig, I; Acosta, I; Villar, C; Morgan, W; Sombutmai, C; Hellinger, F; Allen, E; Bellew, M; Gandhi, R; Bonwit, E; Aly, J; Ecker, R D; Seder, D; Morris, J; Skaletsky, M; Belden, J; Baker, C; Connolly, L S; Papanagiotou, P; Roth, C; Kastrup, A; Politi, M; Brunner, F; Alexandrou, M; Merdivan, H; Ramsey, C; Given Ii, C; Renfrow, S; Deshmukh, V; Sasadeusz, K; Vincent, F; Thiesing, J T; Putnam, J; Bhatt, A; Kansara, A; Caceves, D; Lowenkopf, T; Yanase, L; Zurasky, J; Dancer, S; Freeman, B; Scheibe-Mirek, T; Robison, J; Rontal, A; Roll, J; Clark, D; Rodriguez, M; Fitzsimmons, B-Fm; Zaidat, O; Lynch, J R; Lazzaro, M; Larson, T; Padmore, L; Das, E; Farrow-Schmidt, A; Hassan, A; Tekle, W; Cate, C; Jansen, O; Cnyrim, C; Wodarg, F; Wiese, C; Binder, A; Riedel, C; Rohr, A; Lang, N; Laufs, H; Krieter, S; Remonda, L; Diepers, M; Añon, J; Nedeltchev, K; Kahles, T; Biethahn, S; Lindner, M; Chang, V; Gächter, C; Esperon, C; Guglielmetti, M; Arenillas Lara, J F; Martínez Galdámez, M; Calleja Sanz, A I; Cortijo Garcia, E; Garcia Bermejo, P; Perez, S; Mulero Carrillo, P; Crespo Vallejo, E; Ruiz Piñero, M; Lopez Mesonero, L; Reyes Muñoz, F J; Brekenfeld, C; Buhk, J-H; Krützelmann, A; Thomalla, G; Cheng, B; Beck, C; Hoppe, J; Goebell, E; Holst, B; Grzyska, U; Wortmann, G; Starkman, S; Duckwiler, G; Jahan, R; Rao, N; Sheth, S; Ng, K; Noorian, A; Szeder, V; Nour, M; McManus, M; Huang, J; Tarpley, J; Tateshima, S; Gonzalez, N; Ali, L; Liebeskind, D; Hinman, J; Calderon-Arnulphi, M; Liang, C; Guzy, J; Koch, S; DeSousa, K; Gordon-Perue, G; Haussen, D; Elhammady, M; Peterson, E; Pandey, V; Dharmadhikari, S; Khandelwal, P; Malik, A; Pafford, R; Gonzalez, P; Ramdas, K; Andersen, G; Damgaard, D; Von Weitzel-Mudersbach, P; Simonsen, C; Ruiz de Morales Ayudarte, N; Poulsen, M; Sørensen, L; Karabegovich, S; Hjørringgaard, M; Hjort, N; Harbo, T; Sørensen, K; Deshaies, E; Padalino, D; Swarnkar, A; Latorre, J G; Elnour, E; El-Zammar, Z; Villwock, M; Farid, H; Balgude, A; Cross, L; Hansen, K; Holtmannspötter, M; Kondziella, D; Hoejgaard, J; Taudorf, S; Soendergaard, H; Wagner, A; Cronquist, M; Stavngaard, T; Cortsen, M; Krarup, L H; Hyldal, T; Haring, H-P; Guggenberger, S; Hamberger, M; Trenkler, J; Sonnberger, M; Nussbaumer, K; Dominger, C; Bach, E; Jagadeesan, B D; Taylor, R; Kim, J; Shea, K; Tummala, R; Zacharatos, H; Sandhu, D; Ezzeddine, M; Grande, A; Hildebrandt, D; Miller, K; Scherber, J; Hendrickson, A; Jumaa, M; Zaidi, S; Hendrickson, T; Snyder, V; Killer-Oberpfalzer, M; Mutzenbach, J; 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BACKGROUND:CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. METHODS:/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0-2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered. FINDINGS:=0·94). Mismatch volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic core volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low. INTERPRETATION:Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. FUNDING:Medtronic.
PMID: 30413385
ISSN: 1474-4465
CID: 5121972

Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data

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Hopkins, L N; Snyder, K; Sawyer, R; Hall, S; Costalat, V; Riquelme, C; Machi, P; Omer, E; Arquizan, C; Mourand, I; Charif, M; Ayrignac, X; Menjot de Champfleur, N; Leboucq, N; Gascou, G; Moynier, M; du Mesnil de Rochemont, R; Singer, O; Berkefeld, J; Foerch, C; Lorenz, M; Pfeilschifer, W; Hattingen, E; Wagner, M; You, S J; Lescher, S; Braun, H; Dehkharghani, S; Belagaje, S R; Anderson, A; Lima, A; Obideen, M; Haussen, D; Dharia, R; Frankel, M; Patel, V; Owada, K; Saad, A; Amerson, L; Horn, C; Doppelheuer, S; Schindler, K; Lopes, D K; Chen, M; Moftakhar, R; Anton, C; Smreczak, M; Carpenter, J S; Boo, S; Rai, A; Roberts, T; Tarabishy, A; Gutmann, L; Brooks, C; Brick, J; Domico, J; Reimann, G; Hinrichs, K; Becker, M; Heiss, E; Selle, C; Witteler, A; Al-Boutros, S; Danch, M-J; Ranft, A; Rohde, S; Burg, K; Weimar, C; Zegarac, V; Hartmann, C; Schlamann, M; Göricke, S; Ringlestein, A; Wanke, I; Mönninghoff, C; Dietzold, M; Budzik, R; Davis, T; Eubank, G; Hicks, W J; Pema, P; Vora, N; Mejilla, J; Taylor, M; Clark, W; Rontal, A; Fields, J; Peterson, B; Nesbit, G; Lutsep, H; Bozorgchami, H; Priest, R; Ologuntoye, O; Barnwell, S; Dogan, A; Herrick, K; Takahasi, C; Beadell, N; Brown, B; Jamieson, S; Hussain, M S; Russman, A; Hui, F; Wisco, D; Uchino, K; Khawaja, Z; Katzan, I; Toth, G; Cheng-Ching, E; Bain, M; Man, S; Farrag, A; George, P; John, S; Shankar, L; Drofa, A; Dahlgren, R; Bauer, A; Itreat, A; Taqui, A; Cerejo, R; Richmond, A; Ringleb, P; Bendszus, M; Möhlenbruch, M; Reiff, T; Amiri, H; Purrucker, J; Herweh, C; Pham, M; Menn, O; Ludwig, I; Acosta, I; Villar, C; Morgan, W; Sombutmai, C; Hellinger, F; Allen, E; Bellew, M; Gandhi, R; Bonwit, E; Aly, J; Ecker, R D; Seder, D; Morris, J; Skaletsky, M; Belden, J; Baker, C; Connolly, L S; Papanagiotou, P; Roth, C; Kastrup, A; Politi, M; Brunner, F; Alexandrou, M; Merdivan, H; Ramsey, C; Given Ii, C; Renfrow, S; Deshmukh, V; Sasadeusz, K; Vincent, F; Thiesing, J T; Putnam, J; Bhatt, A; Kansara, A; Caceves, D; Lowenkopf, T; Yanase, L; Zurasky, J; Dancer, S; Freeman, B; Scheibe-Mirek, T; Robison, J; Rontal, A; Roll, J; Clark, D; Rodriguez, M; Fitzsimmons, B-Fm; Zaidat, O; Lynch, J R; Lazzaro, M; Larson, T; Padmore, L; Das, E; Farrow-Schmidt, A; Hassan, A; Tekle, W; Cate, C; Jansen, O; Cnyrim, C; Wodarg, F; Wiese, C; Binder, A; Riedel, C; Rohr, A; Lang, N; Laufs, H; Krieter, S; Remonda, L; Diepers, M; Añon, J; Nedeltchev, K; Kahles, T; Biethahn, S; Lindner, M; Chang, V; Gächter, C; Esperon, C; Guglielmetti, M; Arenillas Lara, J F; Martínez Galdámez, M; Calleja Sanz, A I; Cortijo Garcia, E; Garcia Bermejo, P; Perez, S; Mulero Carrillo, P; Crespo Vallejo, E; Ruiz Piñero, M; Lopez Mesonero, L; Reyes Muñoz, F J; Brekenfeld, C; Buhk, J-H; Krützelmann, A; Thomalla, G; Cheng, B; Beck, C; Hoppe, J; Goebell, E; Holst, B; Grzyska, U; Wortmann, G; Starkman, S; Duckwiler, G; Jahan, R; Rao, N; Sheth, S; Ng, K; Noorian, A; Szeder, V; Nour, M; McManus, M; Huang, J; Tarpley, J; Tateshima, S; Gonzalez, N; Ali, L; Liebeskind, D; Hinman, J; Calderon-Arnulphi, M; Liang, C; Guzy, J; Koch, S; DeSousa, K; Gordon-Perue, G; Haussen, D; Elhammady, M; Peterson, E; Pandey, V; Dharmadhikari, S; Khandelwal, P; Malik, A; Pafford, R; Gonzalez, P; Ramdas, K; Andersen, G; Damgaard, D; Von Weitzel-Mudersbach, P; Simonsen, C; Ruiz de Morales Ayudarte, N; Poulsen, M; Sørensen, L; Karabegovich, S; Hjørringgaard, M; Hjort, N; Harbo, T; Sørensen, K; Deshaies, E; Padalino, D; Swarnkar, A; Latorre, J G; Elnour, E; El-Zammar, Z; Villwock, M; Farid, H; Balgude, A; Cross, L; Hansen, K; Holtmannspötter, M; Kondziella, D; Hoejgaard, J; Taudorf, S; Soendergaard, H; Wagner, A; Cronquist, M; Stavngaard, T; Cortsen, M; Krarup, L H; Hyldal, T; Haring, H-P; Guggenberger, S; Hamberger, M; Trenkler, J; Sonnberger, M; Nussbaumer, K; Dominger, C; Bach, E; Jagadeesan, B D; Taylor, R; Kim, J; Shea, K; Tummala, R; Zacharatos, H; Sandhu, D; Ezzeddine, M; Grande, A; Hildebrandt, D; Miller, K; Scherber, J; Hendrickson, A; Jumaa, M; Zaidi, S; Hendrickson, T; Snyder, V; Killer-Oberpfalzer, M; Mutzenbach, J; Weymayr, F; Broussalis, E; Stadler, K; Jedlitschka, A; Malek, A; Mueller-Kronast, N; Beck, P; Martin, C; Summers, D; Day, J; Bettinger, I; Holloway, W; Olds, K; Arkin, S; Akhtar, N; Boutwell, C; Crandall, S; Schwartzman, M; Weinstein, C; Brion, B; Prothmann, S; Kleine, J; Kreiser, K; Boeckh-Behrens, T; Poppert, H; Wunderlich, S; Koch, M L; Biberacher, V; Huberle, A; Gora-Stahlberg, G; Knier, B; Meindl, T; Utpadel-Fischler, D; Zech, M; Kowarik, M; Seifert, C; Schwaiger, B; Puri, A; Hou, S; Wakhloo, A; Moonis, M; Henniger, N; Goddeau, R; Massari, F; Minaeian, A; Lozano, J D; Ramzan, M; Stout, C; Patel, A; Tunguturi, A; Onteddu, S; Carandang, R; Howk, M; Ribó, M; Sanjuan, E; Rubiera, M; Pagola, J; Flores, A; Muchada, M; Meler, P; Huerga, E; Gelabert, S; Coscojuela, P; Tomasello, A; Rodriguez, D; Santamarina, E; Maisterra, O; Boned, S; Seró, L; Rovira, A; Molina, C A; Millán, M; Muñoz, L; Pérez de la Ossa, N; Gomis, M; Dorado, L; López-Cancio, E; Palomeras, E; Munuera, J; García Bermejo, P; Remollo, S; Castaño, C; García-Sort, R; Cuadras, P; Puyalto, P; Hernández-Pérez, M; Jiménez, M; Martínez-Piñeiro, A; Lucente, G; Dávalos, A; Chamorro, A; Urra, X; Obach, V; Cervera, A; Amaro, S; Llull, L; Codas, J; Balasa, M; Navarro, J; Ariño, H; Aceituno, A; Rudilosso, S; Renu, A; Macho, J M; San Roman, L; Blasco, J; López, A; Macías, N; Cardona, P; Quesada, H; Rubio, F; Cano, L; Lara, B; de Miquel, M A; Aja, L; Serena, J; Cobo, E; Albers, Gregory W; Lees, Kennedy R; Arenillas, J; Roberts, R; Minhas, P; Al-Ajlan, F; Salluzzi, M; Zimmel, L; Patel, S; Eesa, M; Martí-Fàbregas, J; Jankowitz, B; Serena, J; Salvat-Plana, M; López-Cancio, E; Bracard, S; Ducrocq, Xavier; Anxionnat, René; Baillot, Pierre-Alexandre; Barbier, Charlotte; Derelle, Anne-Laure; Lacour, Jean-Christophe; Richard, Sébastien; Samson, Yves; Sourour, Nader; Baronnet-Chauvet, Flore; Clarencon, Frédéric; Crozier, Sophie; Deltour, Sandrine; Di Maria, Federico; Le Bouc, Raphael; Leger, Anne; Mutlu, Gurkan; Rosso, Charlotte; Szatmary, Zoltan; Yger, Marion; Zavanone, Chiara; Bakchine, Serge; Pierot, Laurent; Caucheteux, Nathalie; Estrade, Laurent; Kadziolka, Krzysztof; Leautaud, Alexandre; Renkes, Céline; Serre, Isabelle; Desal, Hubert; Guillon, Benoît; Boutoleau-Bretonniere, Claire; Daumas-Duport, Benjamin; De Gaalon, Solène; Derkinderen, Pascal; Evain, Sarah; Herisson, Fanny; Laplaud, David-Axel; Lebouvier, Thibaud; Lintia-Gaultier, Alina; Pouclet-Courtemanche, Hélène; Rouaud, Tiphaine; Rouaud Jaffrenou, Violaine; Schunck, Aurélia; Sevin-Allouet, Mathieu; Toulgoat, Frederique; Wiertlewski, Sandrine; Gauvrit, Jean-Yves; Ronziere, Thomas; Cahagne, Vincent; Ferre, Jean-Christophe; Pinel, Jean-François; Raoult, Hélène; Mas, Jean-Louis; Meder, Jean-François; Al Najjar-Carpentier, Amen-Adam; Birchenall, Julia; Bodiguel, Eric; Calvet, David; Domigo, Valérie; Godon-Hardy, Sylvie; Guiraud, Vincent; Lamy, Catherine; Majhadi, Loubna; Morin, Ludovic; Naggara, Olivier; Trystram, Denis; Turc, Guillaume; Berge, Jérôme; Sibon, Igor; Menegon, Patrice; Barreau, Xavier; Rouanet, François; Debruxelles, Sabrina; Kazadi, Annabelle; Renou, Pauline; Fleury, Olivier; Pasco-Papon, Anne; Dubas, Frédéric; Caroff, Jildaz; Godard Ducceschi, Sophie; Hamon, Marie-Aurélie; Lecluse, Alderic; Marc, Guillaume; Giroud, Maurice; Ricolfi, Frédéric; Bejot, Yannick; Chavent, Adrien; Gentil, Arnaud; Kazemi, Apolline; Osseby, Guy-Victor; Voguet, Charlotte; Mahagne, Marie-Hélène; Sedat, Jacques; Chau, Yves; Suissa, Laurent; Lachaud, Sylvain; Houdart, Emmanuel; Stapf, Christian; Buffon Porcher, Frédérique; Chabriat, Hugues; Guedin, Pierre; Herve, Dominique; Jouvent, Eric; Mawet, Jérôme; Saint-Maurice, Jean-Pierre; Schneble, Hans-Martin; Turjman, Francis; Nighoghossian, Norbert; Berhoune, Nadia-Nawel; Bouhour, Françoise; Cho, Tae-Hee; Derex, Laurent; Felix, Sandra; Gervais-Bernard, Hélène; Gory, Benjamin; Manera, Luis; Mechtouff, Laura; Ritzenthaler, Thomas; Riva, Roberto; Salaris Silvio, Fabrizio; Tilikete, Caroline; Blanc, Raphael; Obadia, Michaël; Bartolini, Mario Bruno; Gueguen, Antoine; Piotin, Michel; Pistocchi, Silvia; Redjem, Hocine; Drouineau, Jacques; Neau, Jean-Philippe; Godeneche, Gaelle; Lamy, Matthias; Marsac, Emilia; Velasco, Stephane; Clavelou, Pierre; Chabert, Emmanuel; Bourgois, Nathalie; Cornut-Chauvinc, Catherine; Ferrier, Anna; Gabrillargues, Jean; Jean, Betty; Marques, Anna-Raquel; Vitello, Nicolas; Detante, Olivier; Barbieux, Marianne; Boubagra, Kamel; Favre Wiki, Isabelle; Garambois, Katia; Tahon, Florence; Ashok, Vasdev; Voguet, Charlotte; Coskun, Oguzhan; Guedin, Pierre; Rodesch, Georges; Lapergue, Bertrand; Bourdain, Frédéric; Evrard, Serge; Graveleau, Philippe; Decroix, Jean Pierre; Wang, Adrien; Sellal, François; Ahle, Guido; Carelli, Gabriela; Dugay, Marie-Hélène; Gaultier, Claude; Lebedinsky, Ariel Pablo; Lita, Lavinia; Musacchio, Raul Mariano; Renglewicz-Destuynder, Catherine; Tournade, Alain; Vuillemet, Françis; Montoro, Francisco Macian; Mounayer, Charbel; Faugeras, Frederic; Gimenez, Laetitia; Labach, Catherine; Lautrette, Géraldine; Denier, Christian; Saliou, Guillaume; Chassin, Olivier; Dussaule, Claire; Melki, Elsa; Ozanne, Augustin; Puccinelli, Francesco; Sachet, Marina; Sarov, Mariana; Bonneville, Jean-François; Moulin, Thierry; Biondi, Alessandra; De Bustos Medeiros, Elisabeth; Vuillier, Fabrice; Courtheoux, Patrick; Viader, Fausto; Apoil-Brissard, Marion; Bataille, Mathieu; Bonnet, Anne-Laure; Cogez, Julien; Kazemi, Apolline; Touze, Emmanuel; Leclerc, Xavier; Leys, Didier; Aggour, Mohamed; Aguettaz, Pierre; Bodenant, Marie; Cordonnier, Charlotte; Deplanque, Dominique; Girot, Marie; Henon, Hilde; Kalsoum, Erwah; Lucas, Christian; Pruvo, Jean-Pierre; Zuniga, Paolo; Bonafé, Alain; Arquizan, Caroline; Costalat, Vincent; Machi, Paolo; Mourand, Isabelle; Riquelme, Carlos; Bounolleau, Pierre; Arteaga, Charles; Faivre, Anthony; Bintner, Marc; Tournebize, Patrice; Charlin, Cyril; Darcel, Françoise; Gauthier-Lasalarie, Pascale; Jeremenko, Marcia; Mouton, Servane; Zerlauth, Jean-Baptiste; Lamy, Chantal; Hervé, Deramond; Hassan, Hosseini; Gaston, André; Barral, Francis-Guy; Garnier, Pierre; Beaujeux, Rémy; Wolff, Valérie; Herbreteau, Denis; Debiais, Séverine; Murray, Alicia; Ford, Gary; Muir, Keith W; White, Philip; Brown, Martin M; Clifton, Andy; Freeman, Janet; Ford, Ian; Markus, Hugh; Wardlaw, Joanna; Lees, Kennedy R; Molyneux, Andy; Robinson, Thompson; Lewis, Steff; Norrie, John; Robertson, Fergus; Perry, Richard; Dixit, Anand; Cloud, Geoffrey; Clifton, Andrew; Madigan, Jeremy; Roffe, Christine; Nayak, Sanjeev; Lobotesis, Kyriakos; Smith, Craig; Herwadkar, Amit; Kandasamy, Naga; Goddard, Tony; Bamford, John; Subramanian, Ganesh; Lenthall, Rob; Littleton, Edward; Lamin, Sal; Storey, Kelley; Ghatala, Rita; Banaras, Azra; Aeron-Thomas, John; Hazel, Bath; Maguire, Holly; Veraque, Emelda; Harrison, Louise; Keshvara, Rekha; Cunningham, James
BACKGROUND:Evidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the association between baseline imaging features and safety and efficacy of EVT in acute ischaemic stroke caused by anterior large-vessel occlusion. METHODS:In this meta-analysis of individual patient-level data, the HERMES collaboration identified in PubMed seven randomised trials in endovascular stroke that compared EVT with standard medical therapy, published between Jan 1, 2010, and Oct 31, 2017. Only trials that required vessel imaging to identify patients with proximal anterior circulation ischaemic stroke and that used predominantly stent retrievers or second-generation neurothrombectomy devices in the EVT group were included. Risk of bias was assessed with the Cochrane handbook methodology. Central investigators, masked to clinical information other than stroke side, categorised baseline imaging features of ischaemic change with the Alberta Stroke Program Early CT Score (ASPECTS) or according to involvement of more than 33% of middle cerebral artery territory, and by thrombus volume, hyperdensity, and collateral status. The primary endpoint was neurological functional disability scored on the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included symptomatic intracranial haemorrhage, parenchymal haematoma type 2 within 5 days of randomisation, and mortality within 90 days. For the primary analysis, we used mixed-methods ordinal logistic regression adjusted for age, sex, National Institutes of Health Stroke Scale score at admission, intravenous alteplase, and time from onset to randomisation, and we used interaction terms to test whether imaging categorisation at baseline modifies the association between treatment and outcome. This meta-analysis was prospectively designed by the HERMES executive committee but has not been registered. FINDINGS:=0·012). INTERPRETATION:EVT achieves better outcomes at 90 days than standard medical therapy across a broad range of baseline imaging categories, including infarcts affecting more than 33% of middle cerebral artery territory or ASPECTS less than 6, although in these patients the risk of symptomatic intracranial haemorrhage was higher in the EVT group than the control group. This analysis provides preliminary evidence for potential use of EVT in patients with large infarcts at baseline. FUNDING:Medtronic.
PMID: 30264728
ISSN: 1474-4465
CID: 5121962

A massive core for a cluster of galaxies at a redshift of 4.3

Miller, T B; Chapman, S C; Aravena, M; Ashby, M L N; Hayward, C C; Vieira, J D; Weiß, A; Babul, A; Béthermin, M; Bradford, C M; Brodwin, M; Carlstrom, J E; Chen, Chian-Chou; Cunningham, D J M; De Breuck, C; Gonzalez, A H; Greve, T R; Harnett, J; Hezaveh, Y; Lacaille, K; Litke, K C; Ma, J; Malkan, M; Marrone, D P; Morningstar, W; Murphy, E J; Narayanan, D; Pass, E; Perry, R; Phadke, K A; Rennehan, D; Rotermund, K M; Simpson, J; Spilker, J S; Sreevani, J; Stark, A A; Strandet, M L; Strom, A L
Massive galaxy clusters have been found that date to times as early as three billion years after the Big Bang, containing stars that formed at even earlier epochs1-3. The high-redshift progenitors of these galaxy clusters-termed 'protoclusters'-can be identified in cosmological simulations that have the highest overdensities (greater-than-average densities) of dark matter4-6. Protoclusters are expected to contain extremely massive galaxies that can be observed as luminous starbursts 7 . However, recent detections of possible protoclusters hosting such starbursts8-11 do not support the kind of rapid cluster-core formation expected from simulations 12 : the structures observed contain only a handful of starbursting galaxies spread throughout a broad region, with poor evidence for eventual collapse into a protocluster. Here we report observations of carbon monoxide and ionized carbon emission from the source SPT2349-56. We find that this source consists of at least 14 gas-rich galaxies, all lying at redshifts of 4.31. We demonstrate that each of these galaxies is forming stars between 50 and 1,000 times more quickly than our own Milky Way, and that all are located within a projected region that is only around 130 kiloparsecs in diameter. This galaxy surface density is more than ten times the average blank-field value (integrated over all redshifts), and more than 1,000 times the average field volume density. The velocity dispersion (approximately 410 kilometres per second) of these galaxies and the enormous gas and star-formation densities suggest that this system represents the core of a cluster of galaxies that was already at an advanced stage of formation when the Universe was only 1.4 billion years old. A comparison with other known protoclusters at high redshifts shows that SPT2349-56 could be building one of the most massive structures in the Universe today.
PMID: 29695849
ISSN: 1476-4687
CID: 3083692

Neonatal pain experienced with the caregiver has life-long consequences for pain and emotion [Meeting Abstract]

Opendak, M M; Perry, R; Barr, G A; Sullivan, R M
Objectives: Human infants born prematurely experience repeated noxious medical procedures, but maternal contact can attenuate the behavioral response to these procedures. However, the mechanisms by which the mother reduces pain or the enduring impact of using the mother as an analgesic stimulus are unknown. By use of an animal model of early life pain with and without the mother, we monitored behavior at different points across the lifespan. Methods: Infant rats were given mild tail shocks (0.5 mA, 1 second every 4 minutes for 32 minutes) either with the mother present or absent for five consecutive days. Two age ranges were chosen to represent the sensitive period for pain programming (PN5-9) and the age at which maternal presence has major neurobehavioral effects, including suppression of amygdala activity (PN10-14). In infancy, neural pain responses were assessed via cFos expression in brain areas associated with pain, as well as behavioral measures related to pain response. In adulthood, pain thresholds, social behavior, and unlearned fear behavior were assessed as a function of infant pain experience. Results: Activity and ultrasonic vocalizations after treatment from PN5-9 and PN10-14 were reduced by the mother's presence during exposure to painful shock. After treatment at PN10-14 pups only, Fos expression in the periaqueductal gray and basolateral and medial amygdala was elevated by the shock alone and reduced by the mother. Adults treated at PN5-9 had reduced carrageenan-induced hyperalgesia and reduced social behavior but no changes in fear behavior if they had undergone pain-mother pairings. In contrast, when treated at PN10-14, the adult had no change in hyperalgesia and showed disruption of social behavior. Shock with or without the mother decreased unlearned fear responding only if treated at PN10-14. The social behavior deficits were normalized by 2 weeks of environmentally enriched rearing after weaning. Conclusions: Our results provide evidence that maternal presence during early life pain reduces pain responses in both infancy and adulthood, but it is also associated with long-term changes in emotionality. The results of these studies aid in our understanding of the impact of nursery procedures that are used to attenuate pain on later outcomes focused on affective behaviors and potentially provide a strategy to reduce those effects
EMBASE:613991179
ISSN: 1527-5418
CID: 2401642

NeuroTribes: The Legacy of Autism and the Future of Neurodiversity [Book Review]

Perry, Richard
ISI:000382514600014
ISSN: 1527-5418
CID: 2250292

Asperger's Disorder on Life Support

Perry, Richard
PMID: 24535576
ISSN: 0162-3257
CID: 1103322

Neurobiology of secure infant attachment and attachment despite adversity: a mouse model

Roth, T L; Raineki, C; Salstein, L; Perry, R; Sullivan-Wilson, T A; Sloan, A; Lalji, B; Hammock, E; Wilson, D A; Levitt, P; Okutani, F; Kaba, H; Sullivan, R M
Attachment to an abusive caregiver has wide phylogenetic representation, suggesting that animal models are useful in understanding the neural basis underlying this phenomenon and subsequent behavioral outcomes. We previously developed a rat model, in which we use classical conditioning to parallel learning processes evoked during secure attachment (odor-stroke, with stroke mimicking tactile stimulation from the caregiver) or attachment despite adversity (odor-shock, with shock mimicking maltreatment). Here we extend this model to mice. We conditioned infant mice (postnatal day (PN) 7-9 or 13-14) with presentations of peppermint odor and either stroking or shock. We used (14) C 2-deoxyglucose (2-DG) to assess olfactory bulb and amygdala metabolic changes following learning. PN7-9 mice learned to prefer an odor following either odor-stroke or shock conditioning, whereas odor-shock conditioning at PN13-14 resulted in aversion/fear learning. 2-DG data indicated enhanced bulbar activity in PN7-9 preference learning, whereas significant amygdala activity was present following aversion learning at PN13-14. Overall, the mouse results parallel behavioral and neural results in the rat model of attachment, and provide the foundation for the use of transgenic and knockout models to assess the impact of both genetic (biological vulnerabilities) and environmental factors (abusive) on attachment-related behaviors and behavioral development.
PMCID:4047794
PMID: 23927771
ISSN: 1601-183X
CID: 2349392

Anaphylactoid reaction to paliperidone palmitate extended-release injectable suspension in a patient tolerant of oral risperidone [Case Report]

Perry, Richard; Wolberg, James; DiCrescento, Steven
PURPOSE: A probable anaphylactoid reaction to the injectable formulation of the atypical antipsychotic paliperidone in a patient with established tolerability to oral risperidone is reported. SUMMARY: A 19-year-old man with schizophreniform disorder was admitted to the emergency department experiencing command hallucinations and persecutory delusions. The patient was treated with oral risperidone during which time his presenting symptoms improved; no risperidone-related adverse effects were noted. Due to concerns about long-term adherence to daily risperidone use, it was decided to initiate once-monthly injections of paliperidone palmitate extended-release suspension. Within 15 minutes of the first paliperidone injection, the patient developed flushing of the face, neck, and head, and he soon developed chills, rigors, and difficulty breathing; after treatment to resolve those symptoms, oral risperidone was restarted. No further drug-related problems occurred during the man's hospital stay. The pharmacy subsequently received notice that the medication lot from which the patient had received the paliperidone dose had been recalled due to reports of cracked syringes, but a possible link between the syringe defect and the man's anaphylactoid symptoms could not be determined. The temporal relationship between paliperidone palmitate administration and the onset of the man's symptoms, as well as application of the Naranjo nomogram, indicated a probable anaphylactoid reaction associated with the paliperidone formulation. CONCLUSION: A man who had tolerated oral risperidone developed an anaphylactoid reaction after receiving an injection of paliperidone palmitate extended-release suspension. After recovering from the reaction, the patient again received oral risperidone without adverse effects.
PMID: 22180550
ISSN: 1535-2900
CID: 1808602

Early diagnosis of Asperger's disorder: lessons from a large clinical practice

Perry, Richard
PMID: 15502605
ISSN: 0890-8567
CID: 48036