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Sami Curtze - Top 30 Publications

Sex Differences and Functional Outcome After Intravenous Thrombolysis.

Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. The purpose of this study was to compare outcome after IVT between women and men with regard to age in a large multicenter European cohort reflecting daily clinical practice of acute stroke care.

Cerebral microbleeds in acute ischemic stroke: A red flag for IV thrombolysis.

Cerebral white matter lesions and post-thrombolytic remote parenchymal hemorrhage.

Parenchymal hematoma (PH) following intravenous thrombolysis (IVT) in ischemic stroke can occur either within the ischemic area (iPH) or as a remote PH (rPH). The latter could be, at least partly, related to cerebral amyloid angiopathy, which belongs to the continuum of cerebral small vessel disease. We hypothesized that cerebral white matter lesions (WMLs)-an imaging surrogate of small vessel disease-are associated with a higher rate of rPH.

Repeated Intravenous Thrombolysis for Early Recurrent Stroke: Challenging the Exclusion Criterion.

Intravenous thrombolysis (IVT) within 4.5 hours from symptom onset improves functional outcome in patients with acute ischemic stroke. Its use in patients with previous stroke within the preceding 3 months is contraindicated because of the assumed higher risk of intracranial hemorrhage. In addition, tissue-type plasminogen activator may itself promote neurotoxicity and blood-brain barrier disruption. However, safety and effectiveness of repeated IVT is essentially unknown in patients with early (<3 months) recurrent stroke (ERS), because they were excluded from thrombolysis trials. This article reports the largest case series of repeated IVT in ERS.

Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke.

We compared outcome and complications in patients with stroke treated with intravenous thrombolysis (IVT) who could not live alone without help of another person before stroke (dependent patients) versus independent ones.

Frequency of MELAS main mutation in a phenotype-targeted young ischemic stroke patient population.

Mitochondrial diseases, predominantly mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS), may occasionally underlie or coincide with ischemic stroke (IS) in young and middle-aged individuals. We searched for undiagnosed patients with MELAS in a target subpopulation of unselected young IS patients enrolled in the Stroke in Young Fabry Patients study (sifap1). Among the 3291 IS patients aged 18-55 years recruited to the sifap1 study at 47 centers across 14 European countries, we identified potential MELAS patients with the following phenotypic features: (a) diagnosed cardiomyopathy or (b) presence of two of the three following findings: migraine, short stature (≤165 cm for males; ≤155 cm for females), and diabetes. Identified patients' blood samples underwent analysis of the common MELAS mutation, m.3243A>G in the MTTL1 gene of mitochondrial DNA. Clinical and cerebral MRI features of the mutation carriers were reviewed. We analyzed blood samples of 238 patients (177 with cardiomyopathy) leading to identification of four previously unrecognized MELAS main mutation carrier-patients. Their clinical and MRI characteristics were within the expectation for common IS patients except for severe hearing loss in one patient and hyperintensity of the pulvinar thalami on T1-weighted MRI in another one. Genetic testing for the m.3243A>G MELAS mutation in young patients with IS based on phenotypes suggestive of mitochondrial disease identifies previously unrecognized carriers of MELAS main mutation, but does not prove MELAS as the putative cause.

Severe cerebral white matter lesions in ischemic stroke patients are associated with less time spent at home and early institutionalization.

Cerebral white matter lesions are one imaging surrogate for cerebral small vessel disease. These white matter lesions are associated with increased morbidity and mortality in both the general population and ischemic stroke patients.

Undetermined stroke with an embolic pattern--a common phenotype with high early recurrence risk.

Undetermined strokes with an embolic pattern (USEP) represent a common phenotype. We assessed their frequency and compared USEP with cardioembolic stroke with a known source and non-cardioembolic stroke etiology.

White Matter Lesions Double the Risk of Post-Thrombolytic Intracerebral Hemorrhage.

Cerebral white matter lesions (WMLs), a surrogate for small-vessel disease, are common in patients with stroke and may be related to an increased intracranial bleeding risk after intravenous thrombolysis in acute ischemic stroke. We aimed to investigate the risk of symptomatic intracerebral hemorrhage (sICH) in the presence of WMLs in a large cohort of ischemic stroke patients treated with intravenous thrombolysis.

Cerebral computed tomography-graded white matter lesions are associated with worse outcome after thrombolysis in patients with stroke.

Compared with other stroke causes, small-vessel disease is associated with better 3-month outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. Another question is the impact of coexisting cerebral white matter lesions (WMLs; a surrogate marker of small-vessel disease) on outcome, which was addressed in the current study.

Extent of secondary intraventricular hemorrhage is an independent predictor of outcomes in intracerebral hemorrhage: data from the Helsinki ICH Study.

Intraventricular hemorrhage is a severe subtype of intracerebral hemorrhage associated with high mortality and poor outcome.

White matter lesions are associated with hospital admissions because of hip-fractures and trauma after ischemic stroke.

Cerebral white matter lesions (WMLs), a surrogate for cerebral small-vessel disease, have been shown to be associated with decreasing mobility, gait instability, and falls. The aim of this study was to investigate whether WMLs of the brain are associated with increased incidence of hospital admissions because of any trauma and hip-fractures in a cohort of patients with stroke.

The CAVE score for predicting late seizures after intracerebral hemorrhage.

Seizures are a common complication of intracerebral hemorrhage (ICH). We developed a novel tool to quantify this risk in individual patients.

Post-stroke depression and depression-executive dysfunction syndrome are associated with recurrence of ischaemic stroke.

Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence.

Validation of the DRAGON score in 12 stroke centers in anterior and posterior circulation.

The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation.

Association of prestroke statin use and lipid levels with outcome of intracerebral hemorrhage.

It is unclear whether blood lipid profiles and statin use before intracerebral hemorrhage (ICH) are associated with its outcome.

Body temperature, blood infection parameters, and outcome of thrombolysis-treated ischemic stroke patients.

Body temperature, inflammation, and infections may modify response to thrombolytic therapy. We studied their associations with clinical improvement after intravenous thrombolysis and three-month outcome.

Poststroke dementia is associated with recurrent ischaemic stroke.

To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up.

Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study.

Although many stroke patients are young or middle-aged, risk factor profiles in these age groups are poorly understood.

SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage.

The purpose of this study was to provide a simple and practical clinical classification for the etiology of intracerebral hemorrhage (ICH).

Carotid embolectomy and endarterectomy for symptomatic complete occlusion of the carotid artery as a rescue therapy in acute ischemic stroke.

Emergency endarterectomy of an occluded internal carotid artery (ICA) has not been investigated as an option of rescue therapy for severe acute ischemic stroke in the era of intravenous (IV) thrombolysis treatment neither as a primary treatment nor after failed IV thrombolysis. Data from the pre-IV thrombolysis era are conflicting and therefore emergency endarterectomy has not been recommended. The number of patients reaching the emergency room within the IV thrombolysis time window has vastly grown due to advanced acute stroke treatment protocols. The efficacy of mechanical thrombectomy as a primary or add-on to IV thrombolysis therapy option is being actively investigated. We herein report 2 cases of acute ischemic stroke with computerized tomography (CT) angiography-documented occlusion of an ICA that were treated with emergency carotid endarterectomy and embolectomy to restore cerebral blood flow. Both cases presented with severe stroke symptoms and signs not responding to IV thrombolysis and showed severe CT-perfusion deficits mainly representing ischemic penumbra. Blood flow was surgically restored after 5 h of symptom onset. Both patients achieved a favorable outcome. We conclude that timely surgical approach of acute ICA occlusion after failed thrombolysis as a rescue therapy may be a viable option in well-selected patients.

Diagnosis and treatment of cerebral sinus thrombosis.

Cerebral sinus thrombosis is a rare disease appearing mostly in young women. Typical symptoms include headache, convulsions, visual deterioration and various symptoms of neurological deficits. Magnetic resonance imaging of the brain and venous sinuses is the diagnostic cornerstone, whereby an obstructed venous sinus, thrombus mass and potential intracerebral lesions such as venous infarction or hemorrhage are diagnosed. Anticoagulant therapy should be initiated immediately once the diagnosis is confirmed.

Outcome by stroke etiology in patients receiving thrombolytic treatment: descriptive subtype analysis.

treating ischemic stroke with thrombolytic therapy is effective and safe, but limited data exist on its efficacy and safety in different etiologic subtypes.

Post-thrombolytic hyperglycemia and 3-month outcome in acute ischemic stroke.

Treating hyperglycemia in acute ischemic stroke may be beneficial, but knowledge on its prognostic value and optimal target glucose levels is scarce. We investigated the dynamics of glucose levels and the association of hyperglycemia with outcomes on admission and within 48 h after thrombolysis.

Off-label thrombolysis is not associated with poor outcome in patients with stroke.

Numerous contraindications included in the license of alteplase, most of which are not based on scientific evidence, restrict the portion of patients with acute ischemic stroke eligible for treatment with alteplase. We studied whether off-label thrombolysis was associated with poorer outcome or increased rates of symptomatic intracerebral hemorrhage compared with on-label use.

Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: the Helsinki Young Stroke Registry.

Data on mortality and its prognostic factors after an acute ischemic stroke in young adults are scarce and based on relatively small heterogeneous patient series.

Dynamic changes in traction forces with DC electric field in osteoblast-like cells.

Primary bovine osteoblasts and human osteosarcoma cells exposed to direct-current electric fields undergo processes of retraction and elongation ultimately resulting in the realignment of the long cellular axis perpendicular to the electric field. The time taken for this reorientation was inversely correlated to field strength within a certain range. Cellular force output during reorientation was analyzed using a simple modification of traction force microscopy. The first detectable reaction was an increase in average traction force magnitude occurring between 10 and 30 seconds of electric field exposure. In the following 2 to 15 minutes traction forces at margins tangential to the electric field decreased below their initial values. Phase-contrast microscopy revealed elongating protrusions at these margins several minutes later. We could not correlate the initial traction changes with any change in intracellular free calcium levels measured using the fluorescent dye Fura-2 AM.

The osteoblast mechano-receptor, microgravity perception and thermodynamics.

Mechano-sensing in cells is tightly obliged with changes in intracellular free calcium (IFC), regulation of specific genes and activation of specific second messenger systems. To investigate whether single non-professional cells like osteoblasts can detect microgravity through the mechano-sensor, measurements on a sub-orbital rocket and parabolic flights observing the IFC and gene expression were performed. We find that microgravity did neither effect IFC nor gene expression. Thermal and mechanical noise within cells is too high in relation to the change of force due to the change from gravity to microgravity. Complementary force measurements have shown that cells exert high forces on the substrate and that these high forces have to be applied for activation.