Browsing by Author "Millers, Andrejs"
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Item Acute Ischemic Stroke Endovascular Treatment of Patients with Large Vessel Occlusions(2015-01-01) Balodis, Arturs; Radzina, Maija; Miglāne, Evija; Valante, Ramona; Millers, Andrejs; Kupčs, Kārlis; Rīga Stradiņš University; Department of Neurology and NeurosurgeryMechanical thrombectomy as an active treatment method has recently been chosen for patients with large artery occlusions and thrombolysis beyond a time window. The aim of our study was to evaluate the results of endovascular treatment in patients with proximal vessel occlusion, compare this group with the intravenous thrombolysis group, and to identify possible criteria of active treatment. The prospective study included 81 patients hospitalised in the Pauls Stradiņš Clinical University Hospital due to acute ischemic stroke; 48 of them received mechanical thrombectomy and 33-intravenous thrombolysis. Thrombectomy (TE) was performed using Solitaire FR stent retrievers. The NIHSS score was used for evaluation of early therapy results and mRS (modified Rankin Scale) was used for late therapy results. ASPECTS was used to define the lesion size using imaging on admission and after treatment. Median NIHSS on admission was higher in the TE group-16 (range 12 to 19) than in the TL group-12 (range 8 to 15) (p < 0.05). Ninety days after treatment, mRS (0-2) was seen in 67% of patients in the TE group (n = 29), and 34% of patients in the TL group (n = 9) patients (p < 0.05). Median ASPECTS was lower in TE group-5, in comparison to the TL group-7 (p < 0.01) Mortality frequency was higher in the TL group (p > 0.05). Frequency of symptomatic intracerebral haemorrhages was similar in the groups. Mechanical thrombectomy can achieve better late functional outcome than thrombolysis in a selected patients group.Item Aferento redzes ceļu izpēte neirodeģeneratīvu procesu analīzei pacientiem ar multiplo sklerozi. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2016) Pastare, Daina; Millers, Andrejs; Laganovska, GunaMultiplā skleroze ir hroniska autoimūna demielinizējoša un neirodeģeneratīva centrālās nervu sistēmas saslimšana. Pasaulē ir vairāk nekā divi miljoni pacientu ar multiplo sklerozi, un šī slimība ir biežākais netraumatiskas invaliditātes cēlonis gados jauniem cilvēkiem. Kaut gan multiplā skleroze ir plaši pētīta, tās patoģenēze vēl aizvien nav skaidra. Turklāt šī slimība nav pilnībā izārstējama un tās gaita katram individuālam pacientam nav prognozējama. Ir nepieciešami bioloģiskie marķieri, ar kuru palīdzību iedalīt pacientus, prognozēt un monitorēt slimības gaitu, kā arī paredzēt un kontrolēt terapijas efektivitāti. Multiplā skleroze bieži rada redzes traucējumus. Promocijas darbs “Aferento redzes ceļu izpēte neirodeģeneratīvu procesu analīzei pacientiem ar multiplo sklerozi” veltīts aferento redzes ceļu kā multiplās sklerozes klīniskā modeļa izpētei. Būtiska aferento redzes ceļu priekšrocība ir tā, ka tie ir pieejami detalizētai un tiešai strukturālai un funkcionālai izpētei. Aferentie redzes ceļi akūta redzes nerva neirīta gadījumā reprezentē akūtu centrālās nervu sistēmas bojājumu, bet subklīniskas, hroniskas retinopātijas un optiskas neiropātijas gadījumā ataino difūzu hronisku bojājumu. Promocijas darba mērķis bija izpētīt aferento redzes ceļu izmaiņu nozīmīgumu multiplās sklerozes radītu neirodeģeneratīvu procesu izvērtējumā. Pētniecības darbā tika veikti neiroloģiski, oftalmoloģiski un radioloģiski izmeklējumi 76 pacientiem ar recidivējoši remitējošu multiplo sklerozi ar un bez redzes nerva neirīta pazīmēm anamnēzē. Pētījuma rezultāti liecina, ka pacientiem ar multiplo sklerozi ir ar iepriekšēju klīnisku redzes nerva iekaisuma epizodi nesaistītas izmaiņas aferentajā redzes sistēmā. Šīs izmaiņas ir gan funkcionālas, gan strukturālas, un vērojama to savstarpēja korelācija. Turklāt neiro-deģeneratīvas izmaiņas aferentajā redzes sistēmā korelē ar slimības ilgumu, invaliditātes pakāpi, kā arī demielinizējošu perēkļu skaitu un lokalizāciju galvas smadzenēs un galvas smadzeņu atrofiju. Pētījumā noteikta labākā metode klīniska redzes nerva neirīta apstiprināšanai, kā arī izstrādāts modelis tīklenes nervu šķiedru slāņa bojājuma prognozēšanai, izmantojot funkcionālas izmeklēšanas metodes. Noskaidrots, ka aferento redzes sistēmu raksturojošus parametrus iespējams izmantot, lai iegūtu informāciju par subklīniski noritošiem neirodeģeneratīviem procesiem.Item Aferento redzes ceļu izpēte neirodeģeneratīvu procesu analīzei pacientiem ar multiplo sklerozi. Promocijas darbs(Rīgas Stradiņa universitāte, 2016) Pastare, Daina; Millers, Andrejs; Laganovska, GunaMultiplā skleroze ir hroniska autoimūna demielinizējoša un neirodeģeneratīva centrālās nervu sistēmas saslimšana. Pasaulē ir vairāk nekā divi miljoni pacientu ar multiplo sklerozi, un šī slimība ir biežākais netraumatiskas invaliditātes cēlonis gados jauniem cilvēkiem. Kaut gan multiplā skleroze ir plaši pētīta, tās patoģenēze vēl aizvien nav skaidra. Turklāt šī slimība nav pilnībā izārstējama un tās gaita katram individuālam pacientam nav prognozējama. Ir nepieciešami bioloģiskie marķieri, ar kuru palīdzību iedalīt pacientus, prognozēt un monitorēt slimības gaitu, kā arī paredzēt un kontrolēt terapijas efektivitāti. Multiplā skleroze bieži rada redzes traucējumus. Promocijas darbs “Aferento redzes ceļu izpēte neirodeģeneratīvu procesu analīzei pacientiem ar multiplo sklerozi” veltīts aferento redzes ceļu kā multiplās sklerozes klīniskā modeļa izpētei. Būtiska aferento redzes ceļu priekšrocība ir tā, ka tie ir pieejami detalizētai un tiešai strukturālai un funkcionālai izpētei. Aferentie redzes ceļi akūta redzes nerva neirīta gadījumā reprezentē akūtu centrālās nervu sistēmas bojājumu, bet subklīniskas, hroniskas retinopātijas un optiskas neiropātijas gadījumā ataino difūzu hronisku bojājumu. Promocijas darba mērķis bija izpētīt aferento redzes ceļu izmaiņu nozīmīgumu multiplās sklerozes radītu neirodeģeneratīvu procesu izvērtējumā. Pētniecības darbā tika veikti neiroloģiski, oftalmoloģiski un radioloģiski izmeklējumi 76 pacientiem ar recidivējoši remitējošu multiplo sklerozi ar un bez redzes nerva neirīta pazīmēm anamnēzē. Pētījuma rezultāti liecina, ka pacientiem ar multiplo sklerozi ir ar iepriekšēju klīnisku redzes nerva iekaisuma epizodi nesaistītas izmaiņas aferentajā redzes sistēmā. Šīs izmaiņas ir gan funkcionālas, gan strukturālas, un vērojama to savstarpēja korelācija. Turklāt neiro-deģeneratīvas izmaiņas aferentajā redzes sistēmā korelē ar slimības ilgumu, invaliditātes pakāpi, kā arī demielinizējošu perēkļu skaitu un lokalizāciju galvas smadzenēs un galvas smadzeņu atrofiju. Pētījumā noteikta labākā metode klīniska redzes nerva neirīta apstiprināšanai, kā arī izstrādāts modelis tīklenes nervu šķiedru slāņa bojājuma prognozēšanai, izmantojot funkcionālas izmeklēšanas metodes. Noskaidrots, ka aferento redzes sistēmu raksturojošus parametrus iespējams izmantot, lai iegūtu informāciju par subklīniski noritošiem neirodeģeneratīviem procesiem.Item Antiplatelet Resistance in Patients with Atherosclerosis(2019-08) Locāne, Sintija; Pūcīte, Elīna; Miglāne, Evija; Millers, Andrejs; Novasa, Arina; Ieviņa, Renija; Muravska, Tatjana; Department of Neurology and NeurosurgeryVariable platelet response to aspirin and clopidogrel is a well-known phenomenon in patients with coronary artery disease and ischemic cerebral stroke. The objective of the present study was to evaluate the frequency and possible risk factors of antiplatelet resistance in patients with cerebrovascular and cardiovascular diseases. The VerifyNow system was used to evaluate adenosine-5-diphosphate and platelet P2YI2 receptor function in patients with cerebrovascular and cardiovascular disease, who received dual antiplatelet therapy. Aspirin resistance was defined as aspirin reaction units (ARU) >= 550. Clopidogrel resistance was defined as Platelet Reaction Units (PRU) > 230. In the group of cerebrovascular diseases there were 13.2% (n = 27) patients with aspirin and 24.5% (n = 50) with clopidogrel resistance. However, in the cardiovascular group there were 20% (n = 9) aspirin and 11.1% (n = 5) clopidogrel resistant patients. In the cerebrovascular group, aspirin resistant patients had a lower triglyceride level (p = 0.001, r = 0.26) than aspirin sensitive patients. Clopidogrel resistant patients had a significantly higher level of glycated haemoglobin (HbA1C) (p = 0.016, r = 023), triglycerides (p = 0.033, r = 0.16) and lower level of high-density lipoproteins (p = 0.027, r = 0.16) than clopidogrel sensitive patients. In the cardiovascular group, patients who were resistant to aspirin had a significantly higher high-density lipoprotein level (p = 0.038, r = 0.31). No other factors differed significantly between the aspirin or clopidogrel resistant and sensitive patients in the cardiovascular group. Aspirin resistance was more common in patients with cardiovascular disease, and clopidogrel resistance in patients with cerebrovascular disease, although the difference was not significant. Our findings indicate that diabetes mellitus and an elevated level of lipoproteins could be risk factors for aspirin or clopidogrel resistance in patients with cerebrovascular diseases. Further studies should be conducted using larger patient cohorts with balanced groups of patients to investigate clinical aspects of antiplatelet resistance.Item Association of Schimmelpenning Syndrome with Astrocytoma (WHO Grade 3) : Case Report(2024-10-14) Tumova, Aija; Auslands, Kaspars; Millers, Andrejs; Priede, Zanda; Buks, Māris; Ozola, Agnese; Ozoliņa, Elīna; Bicāns, Kārlis; Ulmanis, Rūdolfs; Department of Neurology and NeurosurgerySchimmelpenning syndrome, or epidermal nevus syndrome, is a rare, neurocutaneous disorder characterized by skin abnormalities, such as epidermal nevi, and involvement of the central nervous system, including intracranial tumors. There are only a few reported cases of intracranial tumors associated with Schimmelpenning syndrome. In most cases, a single nucleotide mutation in the RAS family proto-oncogenes, like HRAS or KRAS genes, can result in the genetic mosaicism that is responsible for the clinical manifestations of this syndrome. The authors present a case report of a woman with Schimmelpenning syndrome who sought medical help with complaints of progressive headache and dizziness. The radiological and histopathological findings indicated an astrocytoma, IDH-mutant (WHO grade 3). The molecular analysis revealed pathogenic changes in the oncogenic HRAS gene with a prevalence of 31%. The patient underwent surgical treatment and had no neurological sequelae. By presenting such a clinical case, attention is paid to the interrelationship between genetic syndromes and intracranial tumors.Item CARDIOEMBOLIC STROKE IN LATVIA : PREVENTION AND LONG-TERM OUTCOME(Central Bohemia University, 2016) Pucite, Elina; Jurjans, Kristaps; Miglane, Evija; Lurina, Baiba; Kalējs, Oskars; Millers, Andrejs; Priede, Zanda; Department of Neurology and Neurosurgery; Department of Internal DiseasesNTRODUCTION:Untreated non-valvular atrial fibrillation is one of major causes of stroke. The goalof the study was to evaluate the use of antithrombotic medication stroke prevention and assess long-term stroke outcome.METHODS:This study involved 531 cardio embolicstroke patients of thePaul’sStradins Clinical University Hospital, Riga, Latvia,in 2014. After dischargethe patients or their relatives were interviewed by phone after 30, 90, 180, and 365 days. Standardized questions were asked about the patients’abilities and use of prescribed secondary prevention medication. Theresults were compared between patient groups, assigned according to prescribed medications. RESULTS:Of all the patients included in the study,8.9% were using oral anticoagulants before stroke onset. One year after discharge,1.44% of patients were not using any preventivemedication, 23.56%were using antiplatelet agents, 43.27% warfarin,and 31.73% target-specificoralanticoagulants. The one-year mortality ratewas 40.7%. The mortality rate was significantly higher in the patient group using no secondary preventivemedication or antiplatelet agents compared to the patient group that used oral anticoagulants. CONCLUSION:Cardio embolicstroke primary and secondary prevention in Latvia islacking. The study outcomes suggest that action is neededto increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation. Poor function outcomes, dementia,and patients’incompliance limits the use of oral anticoagulants in secondary preventionItem Carotid Artery Stenosis Correlation with Hyperhomocysteinemia in Stroke Patient Group: a Prospective Study(2010-01-01) Kenina, Viktorija; Priede, Zanda; Auce, Pauls; Suna, Normunds; Millers, Andrejs; Department of Neurology and NeurosurgeryIntroduction. Stroke is the second most common cause of death worldwide and one of the major causes of long-term disability. Carotid artery stenosis is an independent risk factor for ischemic stroke and related forms of atherosclerotic vascular disease. Aim of the Study was to examine plasma homocysteine (tHcy) levels in the stroke patient's group with significant carotid artery stenosis, to determine hyperhomocysteinemia correlation with degree of carotid artery stenosis. Materials and methods. This study was prospective and all patients (n=102) included in the study were hospitalized in Pauls Stradins Clinical University hospital in Clinic of Neurology with diagnosis of acute ischemic stroke. In the group of significant carotidal stenosis we included 48 patients with various degree of stenosis ranging from 50% to total occlusion. Evaluations of stenosis of extracranial carotid arteries were done by duplex ultrasonography method. The blood of these patients was tested for homocysteine level by ELISA (IMMULITE 2000). Results. Study did not demonstrated statistically significant difference between levels of tHcy in all groups. Mean homocysteine level was not significantly higher in the symptomatic carotid stenosis patient's group. Also there were no significant differences between levels of homocysteine in patient group with different degree of stenosis. Conclusions. We found no meaningful association between a high tHcy level and extent of carotid stenosis.Item Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment(2019) Pūcīte, Elīna; Krievina, Ildze; Miglāne, Evija; Erts, Renārs; Krievins, Dainis; Millers, Andrejs; Department of Neurology and NeurosurgeryBackground: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT). Methods: Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months followup periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only. Results: Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period. Conclusion: Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.Item Characteristics and Injury Patterns in Traumatic Brain Injury Related to E-Scooter Use in Riga, Latvia : Multicenter Case Series(2024-04) Saulitis, Agnis; Kocane, Evelina; Dolgopolova, Julija; Kalnins, Ritvars; Auslands, Kaspars; Rancans, Kristaps; Valeinis, Egils; Millers, Andrejs; Department of Neurology and NeurosurgeryBackground and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years—2022 and 2023—after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1–Q3, 20.25–37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted.Item Cytomegalovirus chronic infection as a risk factor for stroke : A prospective study(2010-01-01) Ķeniņa, Viktorija; Auce, Pauls; Priede, Zanda; Irbe, Inese; Vainšteina, Lana; Smeltere, Elvira; Millers, Andrejs; Rīga Stradiņš UniversityStroke is the second most common cause of death in the world and a major cause of long-term disability. Chronic infection is an independent risk factor for ischemic stroke and related forms of atherosclerotic vascular disease. The aim of our study was to compare the plasma Cytomegalovirus (CMV) immunoglobulin G antibody level in a patient and control group, and to determine the association of CMV chronic infection with ischemic stroke, and with stroke subtype. The present study does not present a cogent demonstration that cytomegalovirus chronic infection is a risk factor of stroke. Further studies are necessary to clarify the effective prophylactic measures to determine other significant risk factors for stroke.Item Delayed Spinal Arachnoiditis with Syringomyelia Following Aneurysmal Subarachnoid Haemorrhage : A Case Report with Patient Experience(2024-06-10) Jain, Nityanand; Jaunozoliņa, Līga; Putraima, Inga; Auslands, Kaspars; Millers, Andrejs; Faculty of Medicine; Department of Neurology and NeurosurgeryBackground and importance Syringomyelia or the formation of fluid-filled cysts within the spinal cord associated with delayed spinal arachnoiditis is an uncommon complication of aneurysmal subarachnoid haemorrhage. To date, about 18 cases have been reported in medical literature, with just two reported in patients under the age of 35 years. Clinical presentation A 27-year-old female patient complained of sudden, severe headaches in the occipital region, nuchal rigidity, and drowsiness when she presented at our institution. A head computed tomography scan revealed intraventricular bleeding in the lateral and fourth ventricles with more extensive haemorrhaging in the frontal horns. A left posterior inferior cerebellar artery (PICA) aneurysm was confirmed via digital subtraction angiogram, and endovascular embolization was done. Two years later, the patient reported intense pain in the lower back along with symptoms suggestive of spinal cord compression. Spinal magnetic resonance imaging (MRI) showed spinal adhesions from C1 to L4, syringomyelia with some vasogenic oedema extending from T3 to T9 level, and a cyst in the lumbar region. Consequently, a right hemilaminectomy was performed along with microsurgical release of arachnoid adhesions and placement of a subdural drain. Radiological and symptomatic improvements were observed. Since then, the patient's clinical condition has remained stable during the past three years of follow-up visits. Conclusions Literature on optimal treatment modalities and patient prognosis is scarce and debated. The time for symptom improvement depends on the level and extent of spinal cord involvement. Rehabilitation may be required for most patients, as complete symptomatic recovery may not be attainable.Item Duodenal Perforation due to Inferior Vena Cava Filter in a Multi-morbid Young Patient: First Clinical Case Report in Latvia(2022-09) Strautmane, Sintija; Rumba, Roberts; Priede, Zanda; Millers, Andrejs; Kisis, Kaspars; Brikuns, Andrejs; Krieviņš, DainisABSTRACT Introduction: The inferior vena cava filter is known to be a safe and effective method for preventing fatal pulmonary artery thromboembolism. We report a case report of inferior vena cava filter perforation on duodenum in a multimorbid young patient undergoing full midline laparotomy and cavotomy. Case presentation: A 37-year-old male was admitted to a tertiary university hospital following recurrent episodes of epistaxis. In 2008, the patient developed traumatic subarachnoid haemorrhage with a following decompressive trepanation and bilateral pulmonary artery thromboembolism. An inferior vena cava filter was implanted. In 2021, due to suspected duodenal perforation, an urgent fibrogastroscopy was performed, revealing duodenal perforation caused by the inferior vena cava filter and aortic pseudoaneurysm. Vena cava filter evacuation was indicated; to date, no such operation has been performed in Latvia. The early postoperative period occurred without any complications. The patient was discharged 15 days after the surgical treatment in good overall health. Results: This was a clinical case report about a 37-year-old multimorbid patient with positive anamnesis of traumatic subarachnoid haemorrhage following decompressive trepanation and bilateral pulmonary artery thromboembolism and inferior vena cava filter implantation due to absolute contraindications to anticoagulant therapy. Conclusion: Inferior vena cava filters are generally safe but can cause clinically significant complications. The case of 37-year-old multimorbid patient with the main complaints of pain around the left ear and recurrent nose bleeds was discussed. On fibrogastroscopy, duodenal perforation caused by the inferior vena cava filter and aortic pseudoaneurysm were seen. Full midline laparotomy and cavotomy was performed. The patient was discharged in good overall health. Detailed assessment of the radiological findings, fibrogastroscopic studies and the novel treatment of a complicated disease occurring for the first time in Latvia proved successful for both patient recovery and outcome. Keywords: Cavotomy; Laparotomy; Multimorbidity; Inferior vena cava filter; Duodenal perforationItem Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II) : A randomised trial(2013) STICH II Investigators; Millers, Andrejs; Auslands, K.Background The balance of risk and benefit from early neurosurgical intervention for conscious patients with superficial lobar intracerebral haemorrhage of 10-100 mL and no intraventricular haemorrhage admitted within 48 h of ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment could improve outcome in these patients. Methods In this international, parallel-group trial undertaken in 78 centres in 27 countries, we compared early surgical haematoma evacuation within 12 h of randomisation plus medical treatment with initial medical treatment alone (later evacuation was allowed if judged necessary). An automatic telephone and internet-based randomisation service was used to assign patients to surgery and initial conservative treatment in a 1:1 ratio. The trial was not masked. The primary outcome was a prognosis-based dichotomised (favourable or unfavourable) outcome of the 8 point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. Analysis was by intention to treat. This trial is registered, number ISRCTN22153967. Findings 307 of 601 patients were randomly assigned to early surgery and 294 to initial conservative treatment; 298 and 291 were followed up at 6 months, respectively; and 297 and 286 were included in the analysis, respectively. 174 (59%) of 297 patients in the early surgery group had an unfavourable outcome versus 178 (62%) of 286 patients in the initial conservative treatment group (absolute difference 3·7% [95% CI -4·3 to 11·6], odds ratio 0·86 [0·62 to 1·20]; p=0·367). Interpretation The STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage.Item Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis(2019) Balodis, Arturs; Radziņa, Maija; Miglāne, Evija; Rudd, Anthony; Millers, Andrejs; Savlovskis, Janis; Kupčs, Kārlis; Department of RadiologyBackground Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven. Purpose To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment. Material and Methods In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT. All patients were selected for treatment based on clinical criteria, multimodal computed tomography (CT) imaging. Eighty-four patients were treated with bridging IVT followed by EVT; 62 patients were treated with EVT only. Results Bridging therapy did not influence endovascular procedure time (P = 0.71) or number of attempts needed (P = 0.63). Bleeding from any site was more common in the bridging group (27, 32%) vs. the EVT group (12, 19%) (P = 0.09). Functional independence modified Rankin Scale after 90 days was slightly higher in the bridging group (44%) vs. the EVT group (42%) (P = 0.14). Mortality did not differ significantly at 90 days: 17% in the bridging group vs. 21% in EVT alone (P = 0.57). Both treatment methods showed high recanalization rates: 94% in the bridging group and 89% for EVT alone. Conclusion Bridging treatment in LVO did not show benefits or elevated risks of complications in comparison to EVT only. The bridging group did not show significantly better neurological outcome or significant impact on procedural parameters vs. EVT aloneItem Evaluation of axonal optic nerve damage using visual evoked potentials and optical coherence tomography in patients with multiple sclerosis(2013) Pastare, Daina; Ķire, Ieva; Erts, Renars; Laganovska, Guna; Millers, Andrejs; Department of Neurology and Neurosurgery; Department of OphthalmologyBackground and Objective: Axonal tissue impairment plays a substantial role in the development of disability in multiple sclerosis. The aim of our study was to analyze the clinical utility of visual evoked potentials (VEP) and optical coherence tomography (OCT) in the diagnosis of optic nerve axonal damage and to determine the correlation between the retinal nerve fiber layer at the temporal quadrant (RNFLT) thickness and the VEP amplitude in multiple sclerosis patients with and without a history of acute optic neuritis (ON). Material and Methods: This cross-sectional study included 69 relapsing-remitting patients with multiple sclerosis from Pauls Stradins Clinical University Hospital, who were divided into 2 groups: with and without a history of ON. The RNFLT thickness and the VEP amplitude were measured. Results: A total of 25 clinically affected eyes were studied. VEP showed a higher sensitivity (64%) than OCT (50%) in supporting a clinical diagnosis of ON. A significant correlation was found between the RNFLT thickness in the temporal segment and the average VEP amplitude both in the eyes of MS patients with (rs=0.42, P=0.01) and without a history of ON (rs=0.44, P<0.001). Conclusions: The evidence from this study suggests that diagnostics of optic nerve axonal damage is feasible by means of using the average VEP amplitude instead of OCT alone. However, the combination of VEP and OCT increases the chance to confirm the existence of ON. A significant correlation was found between structural and functional vision parameters for both patients with and without a history of ON.Item Fatigue and associated factors in multiple sclerosis patients in Latvia(2018) Šetlere, Signe; Abelsen, Anete; Pastare, Daina; Millers, Andrejs; Residency Unit; Department of Neurology and NeurosurgerySum mary. Back ground and ob jec tives. Fa tigue is one of the most com mon symp toms of mul ti ple scle ro sis (MS). The aim of this study was to de ter mine the pres ence of fa tigue in MS pa tients in Lat via and its re la tion to life style fac tors, neu ro log i cal dis abil ity and de pres sion. Ma te rial and meth ods. This cross-sec tional study in cluded 117 par tic i pants (44 pa tients with MS and 73 healthy con trol group). Ap plied re search in stru ments were: Ex panded Dis - abil ity Sta tus Scale (EDSS), Pa tient Health Ques tion naire (PHQ-9), Fa tigue Se ver ity Scale (FSS), and the gen eral ques tion naire for the col lec tion of socio-de mo graphic, life style hab its and clin i cal data con structed for the pur poses of this study. Re sults. Mean FSS score was 3.9±1.9 in MS group. 26 (59.1%) patients had FSS score of 3.8 or more and were clas si fied as a fa tigue group (MSF) while 18 (40.9%) patients had FSS of 3.7 or less and were clas si fied as a non-fatigue (MSNF) group. There was sta tis ti cally sig - nif i cant dif fer ence be tween MSF and MSNF groups con sid er ing PHQ-9 score (p=0.019), FSS score (p<0.001) and EDSS score (p<0.001). Sig nif i cant cor re la tions of fa tigue with depres sion (r=0.48, p=0.001), fa tigue with neu ro log i cal dis abil ity (r=0.49, p=0.001) and fatigue with smok ing (r=0.29, p=0.054) were con firmed. Con clu sions. Fa tigue is a com mon symptom in MS pa tients in Lat via. This study supports sig nif i cant as so ci a tion be tween fa tigue and clin i cal fac tors (dis abil ity, de pres sion) and mod i fi able life style fac tor – smok ingItem Functional and Structural Evaluation of Afferent Visual System in Multiple Sclerosis Patients(2015-09-01) Pastare, Daina; Kire, Ieva; Erts, Renars; Laganovska, Guna; Millers, Andrejs; Department of Neurology and Neurosurgery; Department of OphthalmologyThere is insufficient information about the progress and variability of multiple sclerosis (MS). Afferent visual pathways are an appropriate MS clinical model. Optical coherence tomography (OCT) allows to perform precise measurements of axonal tissue in the retinal nerve fibre layer (RNFL). Visual evoked potentials (VEP) provide information about the functional status of visual pathways. The aim of our study was to use OCT and VEP to evaluate MS patients with and without optic neuritis (ON) history and to determine relationships between functional and structural changes. The cross-sectional study included 76 relapsing-remitting MS patients and 28 healthy controls. The lowest mean VEP N75/P100 amplitude was found in ON affected eyes (8.16 mkV, SD = 4.60). However, it was observed that the mean amplitude in patients without ON (M = 9.86; SD = 4.63) was by 4.64 mkV lower than in controls (p < 0.001). Similarly, the mean P 100 latency in ON eyes was 9.26 ms longer than in eyes of patients without ON history (p < 0.01). RNFL in the temporal segment (RNFLT) was the thinnest in ON eyes, and even in patient eyes without ON, it was thinner than in controls. We found a significant positive correlation between RNFLT and mean N75/P100 amplitude in patients without ON (rs = 0.43; p < 0.001), and after ON (rs = 0.45; p < 0.001). Both in patients without ON (rs =-0.40; p < 0.001) and in ON eyes we found a significant negative correlation (rs =-0.55; p > 0.001) between RNFLT and mean P100 latency. In summary, we found that deterioration in the visual system was not associated with the clinical ON episode. Regardless of ON symptoms in history, there exists correlation between functional and structural changes.Item Functional Disability and Brain MRI Volumetry Results among Multiple Sclerosis Patients during 5-Year Follow-Up(2023-06-04) Strautmane, Sintija; Balodis, Arturs; Teivāne, Agnete; Grabovska, Dagnija; Naudiņš, Edgars; Urbanovics, Daniels; Fišermans, Edgars; Mednieks, Jānis; Flintere-Flinta, Alīna; Priede, Zanda; Millers, Andrejs; Zolovs, Maksims; Department of Radiology; Department of Neurology and Neurosurgery; Statistics UnitBackground and Objectives: We aimed to determine the link between brain volumetry results and functional disability calculated using the Expanded Disability Status Scale (EDSS) among multiple sclerosis (MS) patients in relation to the provided treatment (disease-modifying therapies (DMTs)) during a 5-year follow-up period. Materials and Methods: A retrospective cohort study was performed enrolling 66 consecutive patients with a confirmed diagnosis of MS, predominantly females (62% (n = 41)). Relapsing–remitting (RR) MS was noted in 92% (n = 61) of patients, with the rest being patients with secondary progressive (SP) MS. The mean age was 43.3 years (SD 8.3 years).Item Health-Related Quality of Life among Patients with Severe Carotid Artery Stenosis(2015-01-01) Pucite, Elina; Šlisers, Marius; Miglāne, Evija; Krieviņš, Dainis; Millers, Andrejs; Blimhena, Inese; Department of Neurology and NeurosurgeryInformation about changes of health-related quality of life (HRQoL) after revascularisation as well how revascularisation procedure influences daily activities, cognitive functioning and general health is controversial. The objectives of our study were to evaluate and describe the HRQoL among patients with severe carotid artery disease; to evaluate the difference of HRQoL between symptomatic and asymptomatic carotid artery disease; and to explore the possible associations between some demographic and clinical characteristics of patients with carotid artery disease and HRQoL. The cross-sectional study included 33 patients who were referred for carotid artery endarterectomy. Data assessment was done one to three days before surgery. The HRQoL was assessed using the Medical Outcome Survey Form 36 (SF-36v2). Patients with symptomatic carotid artery disease had the lowest mean SF-36v2 scores for physical functioning, role-physical, general health and mental health. There was moderate correlation (rs= 0.441) between mean SF-36v2 scores of mental health and Montreal Cognitive Assessment Scale (MoCA) scores. There is also indirect indication for probable correlation between MoCA test scores and mean SF-36v2 scores of social functioning, which might become statistically significant if more patients would be included. Patients with severe carotid artery disease in our study had lower mean SF-36v2 scores for role-physical, for bodily pain and for perception about their health status (general health). HRQoL in patients with severe carotid artery, stenosis was poorer in patients with symptomatic carotid artery disease and was not affected by gender and other clinical characteristics.Item Hiperhomocisteinēmijas, chlamydophila pnumoniae un citomegalovīrusa saistība ar cerebrālu infarktu, tā apakštipiem un insulta riska faktoriem. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2011) Ķēniņa, Viktorija; Millers, Andrejs; Smeltere, Elvīra