Michael Moussouttas

Johnson University

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Mitchell Maltenfort

Children's Hospital of Philadelphia

Fred Rincón

Cooper University Hospital

Rodney Bell

Thomas Jefferson University

Nikolaos Papamitsakis

SUNY Downstate Health Sciences University

Jacqueline Urtecho

Thomas Jefferson University

Jack Jallo

Neurological Surgery

William McBride

Philadelphia University

Thanh Huynh

Dalat University

Ali Seifi

The University of Texas Health Science Center at San Antonio

Keith Dombrowski

University of South Florida

Cooperative Institutions

Thomas Jefferson University

Thomas Jefferson University Hospital

Neurological Surgery

Universitat Autònoma de Barcelona

Neurology, Inc

Yale University

Vall d'Hebron Hospital Universitari

Heidelberg University

Inserm

University Hospital of Bern

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Silent Cerebral Small Vessel Disease in Restless Legs Syndrome

SLEEP (2016)

Raffaele Ferri F. Cosentino Michael Moussouttas Bartolo Lanuzza Debora Aricò

Growing literature suggests that patients with restless legs syndrome (RLS) may be at increased risk for hypertension, heart disease, and stroke. Cerebral small vessel disease (SVD) is a known risk factor for clinical stroke. This study evaluated silent cerebral SVD by MRI in patients with RLS, in the absence of a history of previous clinical stroke or known stroke risk factors and taking into account disease duration.Fifty-three patients with RLS < 10 y were prospectively recruited along with 44 with RLS > 10 y and 74 normal controls. A magnetic resonance imaging study was obtained from all subjects and scans were analyzed for area and volume of SVD.There was a significant increase in SVD area in the entire group of RLS patients compared to controls (P = 0.036); this was almost entirely driven by the group with RLS > 10 y. SVD area and volume were significantly increased in patients with RLS > 10 y with respect to both controls (P < 0.0001 and P < 0.0014, respectively) and RLS < 10 y (P < 0.00022 and P < 0.003, respectively). Age, duration of RLS, and the interaction of age and duration of RLS were independent predictors of SVD disease. Duration of RLS was an independent predictor of the burden of cerebral SVD (area P < 0.00012 and volume P < 0.0025), whereas sex and insomnia were not.RLS duration should be taken into account when analyzing the association between RLS and cerebrovascular disease; our data support the hypothesis that a long-lasting RLS and its accompanying periodic limb movements in sleep are a risk factor for silent SVD and perhaps for the development of clinical stroke.

Restless Legs Syndrome

10.5665/sleep.5966

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Citations (36)

Emerging Therapies: ESPRIT

Stroke (2007)

Michael Moussouttas

Dipyridamole

Neurointensive care

Stroke

10.1161/01.str.0000259782.17562.fc

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Citations (2)

The Prevalence and Risk Factors of Acute Myocardial Infarction (AMI) After Acute Ischemic Stroke (AIS) in the United States

Ali Seifi Fred Rincón Michael Moussouttas Mitchell Maltenfort Matthew Vibbert

AMI were older age (a OR 1.01, 95% CI,1.01‐1.02, P=<0.0001), women (aOR 1.1, 95% CI, 1.01‐1.12, P=<0.0001), r‐tPA administraDon (aOR 1.3, 95% CI,1.2‐1.5, P=<0.0001), and black race (aOR 0.9, 95% CI,0.89‐0.97, P=<0.0001). The total cumulaDve mortality of the cohort was 1.8%. In‐hospital mortality was significantly associated with AMI (aOR 3.7, 95% CI,3.5‐3.9, P=<0.0001), older age (aOR 1.03, 95% CI,1.03‐1.03, P=<0.0001), women (aOR 1.04, 95% CI,1.02‐1.1, P=<0.0001), and r‐tPA adminsitraDon (aOR 2.0, 95% CI,1.8‐2.2, P=<0.0001), and black race vs. white (aOR 0.8, 95% CI,0.8‐0.91, P=<0.0001). On Kaplan‐Meier analysis, the survival fracDons for the AMI and no‐AMI groups diverged significantly over Dme in AIS paDents (log‐rank p<0.0001). CONCLUSION:

Stroke

Source

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Citations (0)

Announcement

Cerebrovascular Diseases (2005)

Nikolaos Papamitsakis Joseph Giacino E. Morandi G.P. Anzola Michael Moussouttas

10.1159/000086742

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Citations (0)

Emerging Therapies: Clopidogrel and Aspirin

Stroke (2005)

Michael Moussouttas

Stroke

10.1161/01.str.0000157951.72934.0b

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Citations (5)

Candidacerebral abscesses: a case report and review of the literature

Medical Mycology (2013)

Andrea M. Fennelly Amy Slenker Lara Murphy Jones Michael Moussouttas Joseph DeSimone

Cerebral abscess caused by Candida spp. is a rare disease, with a nonspecific presentation, little data on treatment, and generally poor outcomes. We present a case of this type of Candida infection in a 57-year-old man with a history of uncontrolled diabetes mellitus and intravenous drug abuse, and review the literature on this disease. Our patient had a good treatment outcome with liposomal amphotericin B and flucytosine, followed by oral fluconazole. Comorbidities include prior antibiotic use (52%), prior surgery (28%), malignancy (28%), stem cell or solid organ transplant (20%), prior corticosteroid use (16%), central venous catheter (CVC) insertion (10%), and burns (7%). Diagnosis requires a high index of suspicion, as clinical presentations and laboratory data can be nonspecific and difficult to differentiate from bacterial cerebral abscesses. In reviewed cases, 55% of blood cultures and 23% of cerebrospinal fluid (CSF) cultures were positive for Candida spp. and outcomes were poor, as the mortality rate of the non-autopsy cases reviewed was 69%.

Flucytosine

Central venous catheter

10.3109/13693786.2013.789566

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Citations (31)

Prevalence, timing, risk factors, and mechanisms of anterior cerebral artery infarctions following subarachnoid hemorrhage

Journal of Neurology (2012)

Michael Moussouttas Torrey A. Boland Lily Chang Ameesh Patel Jaime McCourt

Neuroradiology

Anterior cerebral artery

10.1007/s00415-012-6576-5

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Citations (13)

Hospital Mortality in Primary Admissions of Septic Patients With Status Epilepticus in the United States*

Critical Care Medicine (2013)

Jacqueline Urtecho Meredith Snapp Michael R. Sperling Mitchell Maltenfort Matthew Vibbert

To determine the prevalence of status epilepticus, associated factors, and relationship with in-hospital mortality in primary admissions of septic patients in the United States.Cross-sectional study.Primary admissions of adult patients more than 18 years old with a diagnosis of sepsis and status epilepticus from 1988 to 2008 identified through the Nationwide Inpatient Sample.A total of 7,669,125 primary admissions of patients with sepsis.None.During the 21-year study period, the prevalence of status epilepticus in primary admissions of septic patients increased from 0.1% in 1988 to 0.2% in 2008 (p < 0.001). Status epilepticus was also more common among later years, younger admissions, female gender, Black race, rural hospital admissions, and in those patients with organ dysfunctions. Mortality of primary sepsis admissions decreased from 20% in 1988 to 18% in 2008 (p < 0.001). Mortality in status epilepticus during sepsis decreased from 43% in 1988 to 28% in 2008. In-hospital mortality after admissions for sepsis was associated with status epilepticus, older age, and Black and Native American/Eskimo race; patients admitted to a rural or urban private hospitals; and patients with organ dysfunctions.Our analysis demonstrates that status epilepticus after admission for sepsis in the United States was rare. Despite an overall significant reduction in mortality after admission for sepsis, status epilepticus carried a higher risk of death. More aggressive electrophysiological monitoring and a high level of suspicion for the diagnosis of status epilepticus may be indicated in those patients with central nervous system organ dysfunction after sepsis.

10.1097/ccm.0b013e31828a3994

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Citations (18)

Thunderclap Headache With Normal CT and Lumbar Puncture

Stroke (2008)

Michael Moussouttas Stephan A. Mayer

Presentation (obstetrics)

Neuroradiology

10.1161/strokeaha.107.503169

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Citations (11)

Spontaneous internal carotid artery dissection with isolated vagus nerve deficit

Neurology (1998)

Michael Moussouttas Stanley Tuhrim

We report a 40-year-old man with dysphagia, right temporal pain, right pulsatile tinnitus, and dysphonia due to right vocal cord paralysis on laryngoscopy. Neurologic examination was notable only for decreased palate elevation on the right. MRI of the neck revealed a right internal carotid artery (ICA) dissection (figure). Figure. Magnetic resonance T2 axial image of right internal carotid artery dissection. Image shows presence of mural hematoma (hyperintense signal) at the base of the cranium in the region of the inferior jugular foramen. Discussion. Spontaneous extracranial ICA dissections may include cranial nerve deficits as part of the clinical presentation, and cranial nerves II to XII are all susceptible to injury.1 The mechanism of nerve damage varies depending on the vascular supply to that nerve and the anatomic proximity of that nerve to the ICA. Angiographic studies and clinical correlates have shown that cranial nerves III, IV, V1, VI and, occasionally, II derive vascular supply from the inferolateral trunk of the intracavernous …

Jugular foramen

Cranial nerves

Oculomotor nerve

Hypoglossal nerve

10.1212/wnl.51.1.317

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Citations (6)