Milan R Vosko

• MD, PhD
• Managing Director at Kepler University Hospital Linz

Background Chalos et al recently developed the MR PREDICTS@24H model to predict 90 days functional outcomes in ischaemic stroke patients following endovascular treatment (EVT). We aimed to validate this model in the real-world situation of endovascular stroke patients admitted to a tertiary care hospital. Methods We conducted a retrospective cohor...

Transcranial color Doppler (TCD) is currently the only noninvasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of this study was to...

Introduction: Transcranial Color Doppler (TCD) is currently the only non-invasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of thi...

Importance Whether infarct size modifies the treatment effect of early vs late direct oral anticoagulant (DOAC) initiation in people with ischemic stroke and atrial fibrillation is unknown. Objective To assess whether infarct size modifies the safety and efficacy of early vs late DOAC initiation. Design, Setting, and Participants Post hoc analysi...

Background Stroke resulting from occlusion of the middle cerebral artery (MCA) can have devastating consequences, potentially leading to a loss of independence. This study aimed to investigate the relationship between the distance to the thrombus (DT) and both ischemic lesion volume (ILV) and clinical outcomes. Methods We retrospectively evaluated...

Background and purpose Cerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in d...

Introduction Endovascular thrombectomy (EVT) and concomitant usage of intravenous alteplase (alteplase) in large vessel occlusion stroke may produce unwanted excess intracerebral hemorrhage (ICH). Whether this applies specifically to isolated occlusion of the M1 segment of the middle cerebral artery (MCA) is unknown. Methods A retrospective study...

Introduction To date, risk assessment of suffering ischemic and hemorrhagic stroke in individuals under oral anticoagulation (OAC) is limited to hospital-based cohorts and patients with atrial fibrillation. Patients and methods Through the combination of three individual datasets, (1) the population-based Tyrolean Stroke Pathway database, prospect...

Background and Purpose: Cerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in...

Zusammenfassung Die systemische Thrombolyse ist eine effektive und häufige Rekanalisationstherapie des akuten ischämischen Schlaganfalles. Eine Antikoagulation ist traditionell eine der typischen Kontraindikationen für die Anwendung der Lysetherapie. Die orale Antikoagulation (OAK) ist die effektivste Form der Prophylaxe von systemischen Thrombosen...

Background Endovascular therapy (EVT) has been established as a major component in the acute treatment of large vessel occlusion stroke. However, it is unclear whether outcome and other treatment-related factors differ if patients are treated within or outside core working hours. Methods We analyzed data from the prospective nationwide Austrian St...

Background Intravenous thrombolysis improves functional outcome in patients with acute stroke and frequencies of r-tPA (recombinant tissue-type plasminogen activator) treatment have been increasing over time. We aimed to assess whether functional outcome in r-tPA–treated patients improved over time and to investigate the influence of clinical varia...

Background and Purpose: Thrombophilic gene alterations are a major risk factor for cerebral sinus vein thrombosis (CSVT). Up to 30% of all patients with cerebral sinus vein thrombosis (CSVT) are found to have thrombophilic defects such as prothrombin mutation (PTM) or factor V Leiden (FVL). Their repercussions on the plasma levels of dabigatran ete...

Background: Transcranial sonography is beside magnetic resonance imaging (MRI) and computed tomography, a well-established imaging method for evaluation of brain parenchyma and already implicated in various neurological disorders as bed-side investigation possibility in clinical routine. The aim of this study was the qualitative assessment detecti...

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke. It is a critical condition that often leads to severe visual loss or blindness and can be a harbinger of further cerebrovascular events. Due to the lack of scientific data, there are no effective evidence-based forms of therapy for this condition. None of the conservative t...

Introduction Epidemiological studies show that increased physical activity is linked to a lower risk of breast cancer and mortality. As a result, physical activity can significantly improve patients' quality of life (QOL) both during and after therapy. Many breast cancer patients demonstrate a decrease in cognitive capacity, referred to as the symp...

Background and purpose: With aging population, there is an increase of atrial fibrillation (AF) and other vascular risk factors. We investigated trends in stroke severity at hospital admission with respect to AF and other risk factors in a prospective national stroke registry from 2005 to 2020. Methods: Data from the prospective Austrian Stroke...

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke. It is a critical condition that often leads to severe visual loss or blindness and can be a harbinger of further cerebrovascular events. Due to the lack of scientific data, there are no effective evidence-based forms of therapy for this condition. None of the conservative t...

Visually evoked potentials (VEPs) are widely used for diagnoses of different neurological diseases. Interestingly, there is limited research about the impact of the stimulus color onto the evoked response. Therefore, in our study we investigated the possibility of automatically classifying the stimulus color. The visual stimuli were selected to be...

Studies on caregiver burden in patients with frontotemporal lobar degeneration are rare, differ methodologically and show variable results. Single center longitudinal pilot study on caregiver burden and potential risk factors in patients with behavioural variant frontotemporal dementia (bvFTD) and semantic (svPPA) and non-fluent variants (nfvPPA) p...

The main aim of this study is to systematically record Cerebrolysin treatment modalities and concomitant medication, according to local standards, in patients with moderate to severe neurological deficits after acute ischemic stroke and to assess the impact of these parameters on therapy outcome during early rehabilitation (day 21) and on day 90. A...

Background: We hypothesized that autotitrating bilevel positive airway pressure (auto-BPAP) favorably affects short-term clinical outcomes in hyperacute ischemic stroke. Methods: In a multicenter, randomized, controlled trial patients with large vessel steno-occlusive stroke and clinically suspected sleep apnea were allocated to auto-BPAP or standa...

Background Neurogenic dysphagia is common and has no definitive treatment. We assessed whether pharyngeal electrical stimulation (PES) is associated with reduced dysphagia. Methods The PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) was a prospective single-arm observational cohort study. Particip...

Objective: To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). Methods: We performed a post hoc anal...

Background Pupil examination represents a diagnostic and prognostic test in the management of several neurological diseases. Infrared video pupillometry (IVP) is the gold standard, since it is not routinely available, a noninvasive bedside ultrasound assessment has been proposed as an alternative. The aim of this study was to assess the feasibility...

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 u...

Background and purpose Blood pressure (BP) variability has been associated with worse neurologic outcomes in acute ischemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as...

Aim: The aim of our study was to determine the occurrence of unprovoked epileptic seizures in ischaemic stroke (IS) patients and compare their association with SeLECT score risk factors (IS severity, large-artery atherosclerosis, acute symptomatic epileptic seizures in association with the initial IS, cortical localization of the lesion, the involv...

Introduction: Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern E...

Background Results of our recently published phase III randomized clinical trial of ultrasound-enhanced thrombolysis (sonothrombolysis) using an operator-independent, high frequency ultrasound device revealed heterogeneity of patient recruitment among centers. Methods We performed a post hoc analysis after excluding subjects that were recruited at...

BACKGROUND: Pulsed-wave ultrasound increases the exposure of an intracranial thrombus to alteplase (recombinant tissue plasminogen activator), potentially facilitating early reperfusion. We aimed to ascertain if a novel operator-independent transcranial ultrasound device delivering low-power high-frequency ultrasound could improve functional outcom...

Background and Purpose— Posterior circulation stroke (PCS) account for 20% of all ischemic strokes. There is limited evidence whether functional outcome of PCS is comparable to that of anterior circulation stroke (ACS). We aimed to analyze whether 3-month functional outcome is different in PCS and ACS. Methods— Patients with acute ischemic stroke...

Background: Dysphagia after stroke is common, especially in severely affected patients who have had a tracheotomy. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this group of patients. We aimed to replicate and extend this single-centre experience. Methods: We did a prospective, single-blind, randomise...

Background Comprehensive studies on caregiver burden (CB) of persons caring for dementia patients differ methodologically and show variable results. Objective Analysis of known and hypothesized factors of CB in home care of dementia patients. Methods Multicenter longitudinal study comprising 585 persons caring mostly for Alzheimer’s disease patie...

Transcranial Doppler (TCD) and cervical duplex ultrasound (CDU) offer insights into acute stroke mechanisms and provide real-time information for clinical decision making in acute stroke patients, selection for, and monitoring effects of therapeutic interventions. Both tests can be repeatedly performed at bedside. Main limitations include operator...

Mit Edoxaban ist der nun neueste Vertreter der Nicht-Vitamin K Antagonisten Oralen Antikoagulanzien (NOAK) verfügbar. Die Zulassung erfolgte auf Basis der zwei bisher größten Phase III Studien in der Indikation Schlaganfallprophylaxe bei nicht-valvulärem Vorhofflimmern (VHF, ENGAGE-AF) als auch bei der Behandlung von venösen Thromboembolien (VTE, H...

Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idaruc...

Introduction: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer's disease (AD) and behavioral variant of frontotemporal dementia (bvFTD). Methods: Patients were recruited in a prospective pilot study. A structured history w...

Background Patients with autonomic failure may experience postural dizziness, syncope, and falls. Identifying symptomatic dysautonomia in dementia is of importance to ensure appropriate management and reduce risk of falls. Objective The aim of this prospective study is to identify cardiovascular autonomic dysfunction in patients suffering from beh...

Reflex syncope is classified based on the efferent autonomic system as vasodepressant type, cardioinhibitory type and mixed type. We employed quantitative sweat testing to assess differences in sudomotor sympathetic activity in relation to the type of reflex syncope. In cardioinhibitory type sweating started in 7/9 patients after and in vasodepress...

Purpose: The mismatch concept in stroke magnetic resonance (MR) is based on the assumption that diffusion weighted imaging (DWI) indicates infarct core representing irreversibly damaged tissue. However, this thesis has not been proven yet in a large patient cohort. On the other hand, some publications report cases with possible remission of lesions...

Although the negative impact of sleep apnea on the clinical course of acute ischemic stroke (AIS) is well known, data regarding non-invasive ventilation in acute patients are scarce. Several studies have shown its tolerability and safety, yet no controlled randomized sequential phase studies exist that aim to establish the efficacy of early non-inv...

Background. Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. Methods. We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lo...

In a very limited number of cases, acute migrainous aura may mimic acute brain infarction. The aim of this study was to recognize patterns of MR perfusion abnormalities in this presentation. One thousand eight hundred fifty MR imaging studies performed for the suspicion of acute brain infarction were analyzed retrospectively to detect patients with...

Various techniques have been developed to estimate spontaneous baroreflex sensitivity noninvasively. However, in the EuroBaVar study it has been shown that they yield differing results. To investigate the reliability of these methods further we compared the results of the most common sequence techniques. We used the paradigm of brain death with the...

Recombinant tissue plasminogen activator (rt-PA) is successfully used in human stroke, but often shows serious drawbacks. To find an alternative, we hypothesised that the novel thrombolytic microplasmin would have fewer adverse effects on haemoglobin extravasation and microvascular damage compared with the effects of rt-PA and tenecteplase (TNK). A...

Microplasmin is a recombinant truncated form of human plasmin. It has demonstrated efficacy in experimental animal models of stroke and tolerability in healthy volunteers. We tested the tolerability of microplasmin in patients with acute ischemic stroke. In a multicenter, double-blind, randomized, placebo-controlled Phase II trial, 40 patients with...

Im österreichischen Stroke Unit Register wurden seit Januar 2003 bis Februar 2007 Schlüsseldaten von Patienten mit ischämischen Schlaganfall gesammelt. Es wurden insgesamt 13.440 Patienten ausgewertet. 9.509 unter 80 Jahre alt, 3.931 über 80 Jahre alt. Zahlreiche Patientendaten wurden auf Unterschiedliches Auftreten in den beiden Altersgruppen unte...

Clinical studies have shown that the treatment of ischemic stroke with hypothermia is promising. In this animal study, we investigated the fate of the microvasculature following focal cerebral ischemia in mice with and without hypothermia. Focal cerebral ischemia was induced by occlusion of the middle cerebral artery (MCAO) (3 h) with an intralumin...

Epidemiological and benchmarking parameters of patients with ischemic stroke were collected in the Austrian Stroke Unit Registry from January 2003 till February 2007. 13,440 patient-data were analysed. 9509 were under 80 years old, 3931 were older than 80. Old patients showed worse clinical symptoms upon admission (NIHSS 9 vs. 6) and doubled mortal...

Structural alterations of the cellular prion protein (PrP(C)) seem to be the core of the pathogenesis of prion diseases. However, the physiological function of PrP(C )remains an enigma. Cell culture experiments have indicated that PrP(C) and in particular its N-terminal octarepeat region together with the phosphatidylinositol 3-kinase (PI3K)/Akt si...

There are broad areas of tide planes across the Persian Gulf covered with tarball. Sedimentation of tarball can be abundantly found in the tide Coast of Khark Island located in the north half of Persian Gulf waters due to several oil platforms as well as oil extraction and locating operations threatening the life of coastal residents, tourism and m...

Transient ischemia has been shown to damage the basal lamina of the cerebral microvasculature. Other studies proved statins to be beneficial to non-cerebral microvessels. The aim of this study was to determine whether pravastatin pretreatment ameliorates microvascular basal lamina damage following transient ischemia. Using the suture model, we subj...

Focal cerebral ischemia is responsible for alterations of vascular permeability, and the loss of microvascular integrity is a primary source of subsequent hemorrhages. We evaluated the influence of different durations of ischemia and reperfusion on infarction size and microvascular damage after focal cerebral ischemia in the mouse. C57BL/6 mice (n=...

The authors have presented a literary survey dealing with a role of plasminogen-plasmin system, system of matrixmetalloproteinases and other proteolytic systems in the pathogenesis of ischemic cerebral infarction. The activation of endogenous plasminogen activators (particularly urokinase activator of plasminogen) and system of MMPs in early phases...

The authors have presented a literary survey dealing with a role of plasminogenplasmin system, system of matrixmetalloproteinases and other proteolytic systems in the pathogenesis of ischemic cerebral infarction. The activation of endogenous plasminogen activators (particularly urokinase activator of plasminogen) and system of matrixmetalloproteina...

Despite the presence of neural stem cells and ongoing neurogenesis in some regions of the adult mammalian brain, neurons are not replaced in most brain regions after injury. With the aim to unravel factors contributing to the failure of neurogenesis in the injured cerebral cortex, we examined the expression of cell fate determinants after acute bra...

We describe a novel experimental set-up that allows biochemical, immunohistochemical and morphometric recording of multiple parameters from a single rat brain. The whole brain was cut (coronal sectioning) in a volumetric manner, and 100 cryo-sections (10 microm) were collected from the region of infarction. By use of a scalpel to dissect the cryose...

In Slovak genetic Creutzfeldt-Jakob disease patients with E200K mutation in the prion protein gene the mean duration of clinical stage is significantly shorter in methionine homozygous then in methionine / valine heterozygous patients (3.70±2.00 vs. 7.84±7.30 months). An atypical prolonged course (13 months) of Creutzfeldt-Jakob disease complicated...

We investigated microvascular damage in areas with magnetic resonance imaging (MRI)-defined apparent diffusion coefficient reduction (ADC-R) in a rat model of thromboembolic occlusion of the middle cerebral artery. Rats received either intracarotid recombinant tissue plasminogen activator (rt-PA) or saline. Microvascular basal lamina damage was qua...

We evaluated effects of thrombosis of the superior sagittal sinus, its bridging and cortical veins (SVT) on the cerebral microvasculature in rats. Cryosections of brains ( n=7) were examined for venous infarction and microvascular basal lamina damage 3 h after SVT by immunohistochemical staining of microtubule-associated protein 2 and collagen type...

The authors present a case history of a female patient with the adult form of metachromatic leukodystrophy. Metachromatic leukodystrophy is a rare hereditary disease with an autosomal recessive heredity, caused by deficiency of the lysosome enzyme arylsulphatase A. The patient´s disease was clinicaly manifested in early adult age (22 y) by change o...

Ninty-five inhabitants of the gold mining area of Mt. Diwata (on Mindanao, Philippines), who were diagnosed to be mercury (Hg) intoxicated, were orally treated with 2 x 200 mg of the chelating agent DMPS (Dimaval, Co. Heyl, Germany) for 14 days in the course of a UNIDO project focusing on mercury pollution abatement. Blood and urine samples before...

The authors present the case-history of a female patient with the adult form of metachromatic leukodystrophy. Metachromatic leukodystrophy is a rare hereditary disease with an autosomal recessive heredity, its cause being deficiency of the lysozome enzyme arylsulphatase A. The patient's disease was clinically manifested in early adult age (22 years...

Bell's palsy (BP) is a peripheral facial nerve paralysis of unknown etiology. It is not a life-threatening condition; however, incomplete recovery may leave an individual stigmatized functionally, occupationally as well as socially. Recurrent paralyses are seldom, noted in 7-8% of all BP cases. More than two BP relapses are even less frequent. Adou...

Previous experimental work using in situ zymography has shown very early increased plasminogen activation in ischemic regions after 3 h of ischemia with and without reperfusion. The objective of the present study was to evaluate the time course and extent of plasminogen activation in long-term permanent focal cerebral ischemia. The middle cerebral...

In focal cerebral ischemia the plasminogen-plasmin system plays a role in the fibrinolysis of vessel-occluding clots and also in the proteolysis of extracellular matrix components, which potentially contributes to brain edema and bleeding complications. The authors investigated the plasminogen activation after middle cerebral artery occlusion with...

In 1996 in the Turiec region 32 patients suffered from paralysis of the VIIth nerve which means in a population of 113 000 an incidence of 28.31/100 000/year. In 1997 there were 76 peripheral facial paralyses, i.e. in a population of 114 843 in Turiec an incidence of Bell's palsy of 66.66/100 000/year. In 1997 the authors treated from the total num...

The authors present a case report of 26 years old man with bilateral optic nerve neuropathy. Detection of heteroplasmic mutation of mitochondrial DNA at G3460A site confirmed the suspicion on Lebers hereditary optic nerve neuropathy (LHON). Genetic and environmental factors of the disease and various accompanying neurologic and other symptoms, whic...

Multifocal motor neuropathy is a specific type of immune mediated neuropathy characterized by selective motor fibre damage and by typical persistent multifocal conduction blocks in the electrone-urographie picture. The interest in that relatively new clinical entity increased during the last decade especially because of its potential curability and...