Ivanka Vlachová

Publications (5)7.81 Total impact

• Article: Is atrial fibrillation associated with poor outcome after thrombolysis?

  Daniel Sanák, Roman Herzig, Michal Král, Andrea Bártková, Jana Zapletalová, Martin Hutyra, David Skoloudík, Ivanka Vlachová, Tomás Veverka, David Horák, Petr Kanovský
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  ABSTRACT: Atrial fibrillation (AF) is considered a predictor for severe stroke and poor outcome. The aim was to evaluate whether AF is associated with poor outcome in acute ischemic stroke (IS) patients treated with intravenous thrombolysis (IVT). In a retrospective study, 157 consecutive IS patients (98 males, mean age 67.3 +/- 10.2 years), treated with IVT within 3 hours from stroke onset, were divided into two groups according to presence/absence of AF. Neurological deficit was evaluated using the NIHSS on admission, 24 hours, and 7 days later, while the 90-day clinical outcome was assessed using the modified Rankin Scale (mRS). A total of 66 patients (38 males) presented with AF. The baseline NIHSS was 13.3 +/- 5.4 in AF and 11.0 +/- 5.1 points in non-AF patients (P = 0.006). AF patients had arterial occlusions more frequently in the baseline MRA (54.5% in AF versus 25.3% in non-AF, P = 0.0002). No differences were found between groups in clinical improvement after 24 hours and 7 days or in rate of achieved recanalizations. AF patients had significantly poorer 90-day clinical outcome than non-AF patients (median mRS 2.5 vs. 1.0). Patients with AF had significantly worse 90-day clinical outcome after IVT compared to those without AF, probably due to more severe baseline neurological deficits and the greater number of arterial occlusions in the MRA before IVT.
  Journal of Neurology 06/2010; 257(6):999-1003. · 3.47 Impact Factor
• Article: Assessment of the cerebral vasomotor reactivity in internal carotid artery occlusion using a transcranial Doppler sonography and functional MRI.

  Roman Herzig, Petr Hlustík, David Skoloudík, Daniel Sanák, Ivanka Vlachová, Miroslav Herman, Petr Kanovský
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  ABSTRACT: Several methods are being used to assess cerebral vasomotor reactivity (CVR), including transcranial Doppler (TCD) sonography and blood oxygenation level-dependent functional magnetic resonance imaging (fMRI). The aim was to assess the correlation of TCD and fMRI in the CVR assessment. Study group consisted of 28 patients (24 males, 4 females; aged 30-82, mean 63.1 +/- 10.0 years), presenting with 29 occluded internal carotid arteries. The TCD examination, including breath-holding/hyperventilation test (BH/HV) and breath-holding index (BHI), and fMRI examination were used for the assessment of CVR. fMRI employed a bimanual motor task within both a block paradigm and an event-related paradigm. Cohen's kappa was applied when statistically assessing correlation of the methods. The following correlations were found--between BH/HV and BHI 58.6%, kappa= .205; BH/HV and fMRI 65.5%, kappa= .322; BHI and fMRI 58.6%, kappa= .151; TCD (consistent result of both BH/HV and BHI test) and fMRI 70.6%, kappa= .414. In the evaluation of CVR, there is only a minimal correlation between the particular TCD tests (both BH/HV and BHI), and fMRI examination. However, there is a moderate correlation between TCD and fMRI in the case of congruity of both TCD tests.
  Journal of Neuroimaging 02/2008; 18(1):38-45. · 1.51 Impact Factor
• Article: Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis.

  Daniel Sanák, Vladimír Nosál, David Horák, Andrea Bártková, Kamil Zelenák, Roman Herzig, Jirí Bucil, David Skoloudík, Stanislav Burval, Viera Cisariková, Ivanka Vlachová, Martin Köcher, Jana Zapletalová, Egon Kurca, Petr Kanovský
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  ABSTRACT: Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M(1-2) segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis. Initial infarct volume (V(DWI-I) ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum V(DWI-I) still associated with a good clinical outcome, the patients were divided into two groups (V(DWI-I) < or =70 ml and >70 ml). V(DWI-I) ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a V(DWI-I) < or =70 ml (group 1) and deteriorated significantly (P=0.0018) in all patients with a V(DWI-I) >70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026). Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a V(DWI-I) < or =70 ml had a significantly better outcome.
  Neuroradiology 09/2006; 48(9):632-9. · 2.82 Impact Factor
• Source

  Available from: Miroslav Vaverka

  Article: Can we identify patients with carotid occlusion who would benefit from EC/IC bypass? Review.

  Roman Herzig, Petr Hlustík, Karel Urbánek, Miroslav Vaverka, Stanislav Burval, Josef Machác, Ivanka Vlachová, Bohdan Krupka, Andrea Bártková, Daniel Sanák, Jan Mares, Petr Kanovský
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  ABSTRACT: Occlusion of the internal carotid artery (CAO) is associated with a high mortality rate and frequent disability in survivors. Even in patients with good clinical recovery there is a high risk of recurrent stroke, mainly in those with impaired cerebral vasomotor reactivity (CVR). Current evidence based therapeutic options for patients with symptomatic CAO include antithrombotic medication and control of vascular risk factors. For stenosis of the contralateral internal or ipsilateral external carotid artery, endarterectomy or percutaneous transluminal angioplasty may be considered. Ongoing symptoms may cease after tapering antihypertensive medications. Extracranial to intracranial (EC/IC) arterial bypass surgery has been used since 1967 in patients with CAO. However, the international randomized EC/IC Bypass Study (1985) failed to confirm the effectiveness of EC/IC bypass for preventing cerebral ischemia in patients with symptomatic CAO when compared to those assigned to the best medical care. Nevertheless, the conclusion of the EC/IC Bypass Study has several objections and downfalls. Since then, there has been a revival of interest in cerebral revascularization procedures owing to the substantial progression of surgical techniques and the use of more advanced diagnostic methods. Thus, it has recently been reported that EC/IC bypass surgery can be useful in preventing stroke in patients with hemodynamic compromise. The main problem is to identify the small subgroup of surgical candidates. Presently, single photon emission computed tomography (SPECT), positron emission tomography (PET), transcranial Doppler sonography (TCD), computed tomography (CT) with administration of (133)Xe, perfusion CT, near infrared spectroscopy (NIRS), and functional magnetic resonance imaging (fMRI) are being used for this purpose.
  Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 01/2005; 148(2):119-22.
• Source

  Available from: Stanislav Burval

  Article: Association of Multiple Cerebral Aneurysms and Cerebral Arteriovenous Malformation: Case Report and Review of the Literature

  Bohdan Krupka, Miroslav Vaverka, Stanislav Burval, Roman Herzig, Ivanka Vlachová
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  ABSTRACT: The incidence of aneurysmal subarachnoid hemorrhage is about 10-11 cases per 100,000 inhabitants. The true incidence of multiple aneurysms is not known, however, according to previous studies it may vary between 20% and 30%. The association of arteriovenous malformation and cerebral aneurysm is well documented and varies between 20% and 30%. A case is described of a 47-year-old female presenting with massive acute subarachnoid hemorrhage. Computed tomography and cerebral panangiography revealed seven saccular aneurysms (five along the left anterior cerebral artery and its branches, one at the left M1/2 junction, and one in the anterior communicating artery), and an arteriovenous malformation involving the left frontal and parietal lobe fed mostly by the left anterior cerebral artery. Neurosurgeons clipped all seven aneurysms and then the arteriovenous malformation was extirpated.
  Acta Clinica Croatica; Vol.41 No.1.