Cerebrovascular Diseases Extra最新文献

{"title":"Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis.","authors":"Hediyeh Baradaran,&nbsp;Alen Delic,&nbsp;Ka-Ho Wong,&nbsp;Nazanin Sheibani,&nbsp;Matthew Alexander,&nbsp;J Scott McNally,&nbsp;Jennifer J Majersik,&nbsp;Adam De Havenon","doi":"10.1159/000514373","DOIUrl":"https://doi.org/10.1159/000514373","url":null,"abstract":"<p><strong>Introduction: </strong>Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk.</p><p><strong>Methods: </strong>In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model.</p><p><strong>Results: </strong>We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics.</p><p><strong>Conclusions: </strong>In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 1","pages":"37-43"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort.","authors":"Stavros Matsoukas,&nbsp;Brian Giovanni,&nbsp;Liorah Rubinstein,&nbsp;Shahram Majidi,&nbsp;Laura K Stein,&nbsp;Johanna T Fifi","doi":"10.1159/000520078","DOIUrl":"https://doi.org/10.1159/000520078","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system.</p><p><strong>Methods: </strong>We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) (\"actual\" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times (\"actual\" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort.</p><p><strong>Results: </strong>Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively.</p><p><strong>Conclusions: </strong>Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"137-144"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/30/cee-0011-0137.PMC8740215.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39771116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Burden and Stroke Services in Bangladesh.","authors":"Narayanaswamy Venketasubramanian,&nbsp;Muzharul Mannan","doi":"10.1159/000517234","DOIUrl":"https://doi.org/10.1159/000517234","url":null,"abstract":"Bangladesh, with a population of 165.6 million people, is located in the northwest region of South Asia, bordered on the west, north, and east by India, southeast by Myanmar, and south by the Bay of Bengal [1]. The per-capita income is USD 1,909, poverty rate is 20.5%, literacy (7+ years) is 73.2%, and life expectancy is 72.3 years; 74% live in rural areas. Stroke is a major cause of death and disability in the region, with an ageand sex-standardized mortality rate of 54.8 per 100,000 and disability-adjusted life years lost of 888.1 per 100,000 in Bangladesh [2]. The prevalence of stroke at approximately 1–2% of those aged over 20 years [3] is similar in males and females, and urban and rural areas [4], but increases with age such that the ratio of infarction to hemorrhage is 2.91 in the community [5]. Stroke incidence has not been studied in adequate epidemiological studies. In a large multicenter hospital study, 72% had ischemic stroke, and the frequency of hypertension, smoking, diabetes mellitus, ischemic heart disease, and dyslipidemia was 58%, 45%, 23%, 17%, and 5%, respectively [6]; these are not from population-based studies. Small-vessel “lacunar” disease was the most common type of ischemic stroke, and there is a clear seasonal variation in the frequency of hemorrhagic stroke [7, 8]. The high stroke mortality among Bangladeshi populations may be due to the high frequency of the conventional atherosclerotic risk factors, especially of hypertension and diabetes mellitus [9]; there is a strong belief over the importance of betel nut chewing, squatting and straining during defecation, chronic infection, vitamin D deficiency, and the combined effect of smoking and tobacco chewing [10]. Stroke mortality might be related to stroke severity, delayed diagnosis, and stroke care gaps discussed further below. Medical services are free in the community [11]. Community clinics are available at villages at ward levels, while small hospital services are located at the union and upazila levels. Secondary level care is provided at district hospitals; tertiary level care is provided at medical college hospitals and super-specialty hospitals. There are 2,213 hospitals with 45,723 registered physicians, but only 160 trained neurologists through training programs only provided at Dhaka Medical College (DMC) and Bangabandhu Sheikh Mujib Medical University (BSMMU). There are 2,300 technologists operating 250 CT scans and 80 MRIs in Bangladesh. Acute care for stroke patients is available in 2 government and 5 private hospitals, all situated in Dhaka, the capital city, while subacute care provided by neurologists is available in 23 government hospitals located in most parts of the country and 7 private hospitals. Stroke is the most common condition among neurology in-patients (48%) [12] and out-patients (24%) [13]. The Bangladesh Rehabilitation Assistance Committee (BRAC), a nongovernmental organization (NGO), provides stroke rehabilitation services to patients ","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"69-71"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000517234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39173802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Cognitive Changes after Revascularization Surgery in Adult Patients with Ischemic Moyamoya Disease.","authors":"Shun Uchida,&nbsp;Yoshitaka Kubo,&nbsp;Daisuke Oomori,&nbsp;Masahiro Yabuki,&nbsp;Kei Kitakami,&nbsp;Shunrou Fujiwara,&nbsp;Kenji Yoshida,&nbsp;Masakazu Kobayashi,&nbsp;Kazunori Terasaki,&nbsp;Kuniaki Ogasawara","doi":"10.1159/000521028","DOIUrl":"https://doi.org/10.1159/000521028","url":null,"abstract":"<p><strong>Introduction: </strong>Revascularization surgery for adult moyamoya disease (MMD) with ischemic presentation changes cognitive function and prevents further cerebral ischemic events. Most studies however repeated neuropsychological evaluation within 1 year after surgery. Our previous prospective cohort study of adult patients with MMD with misery perfusion who underwent direct revascularization surgery showed cognitive improvement and decline in 31% and 44%, respectively, of the patients 2 months after surgery. The present prospective study aimed to elucidate the 5-year cognitive changes after direct revascularization surgery in adult patients with cerebral misery perfusion due to ischemic MMD by following the same patients.</p><p><strong>Methods: </strong>In total, 31 patients were prospectively followed up for 5 years after direct revascularization surgery. Five types of neuropsychological tests were performed preoperatively, 2 months after surgery, and at the end of the 5-year follow-up. Cerebral blood flow (CBF) in the symptomatic cerebral hemisphere relative to that in the ipsilateral cerebellar hemisphere (hemispheric relative CBF [RCBF]) was measured using brain perfusion single-photon emission computed tomography preoperatively and at the end of the 5-year follow-up.</p><p><strong>Results: </strong>Based on results of pre- and postoperative neuropsychological tests, 11, 10, and 10 patients showed cognitive improvement, no change in cognitive function, and cognitive decline, respectively, at the end of the 5-year follow-up. These ratios were not significantly different compared with those 2 months after surgery (cognitive improvement, no change in cognitive function, and cognitive decline in 10, 8, and 13 patients, respectively). Although hemispheric RCBF was significantly greater at the end of the 5-year follow-up than before surgery in patients with cognitive improvement (80.7 ± 6.1% vs. 92.9 ± 5.5%; p = 0.0033) and in those showing no change in cognitive function (85.6 ± 3.5 vs. 91.5 ± 5.2%; p = 0.0093), this value was significantly lower at the end of the 5-year follow-up than before surgery in patients with cognitive decline (83.8 ± 3.7 vs. 81.0 ± 5.8%; p = 0.0367).</p><p><strong>Conclusion: </strong>One-third of adult patients with cerebral misery perfusion due to ischemic MMD who underwent direct revascularization surgery exhibited cognitive improvement, and one-third exhibited decline at the end of the 5-year follow-up. The former and latter patients had increased and decreased CBF, respectively, in the affected cerebral hemisphere at the end of the 5-year follow-up compared with preoperative brain perfusion.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"145-154"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/21/cee-0011-0145.PMC8787508.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39758898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accession Site Does Not Influence the Risk of Stroke after Diagnostic Coronary Angiography or Intervention: Results from a Large Prospective Registry.","authors":"Jan Matějka,&nbsp;Ivo Varvařovský,&nbsp;Jan Tužil,&nbsp;Tomáš Doležal,&nbsp;Martin Bobak,&nbsp;Jan Pospíchal,&nbsp;Petr Geier,&nbsp;Jiří Vondrák,&nbsp;Karel Bláha,&nbsp;Jan Málek,&nbsp;Alena Staňková,&nbsp;Juraj Bujdák,&nbsp;Vladimír Rozsíval,&nbsp;Vojtěch Novotný,&nbsp;Tomáš Lazarák,&nbsp;Milan Plíva,&nbsp;Jan Večeřa,&nbsp;Petr Vojtíšek","doi":"10.1159/000519539","DOIUrl":"https://doi.org/10.1159/000519539","url":null,"abstract":"<p><strong>Introduction: </strong>Periprocedural stroke represents a rare but serious complication of cardiac catheterization. Pooled data from randomized trials evaluating the risk of stroke following cardiac catheterization via transradial versus transfemoral access showed no difference. On the other hand, a significant difference in stroke rates favoring transradial access was found in a recent meta-analysis of observational studies. Our aim was to determine if there is a difference in stroke risk after transradial versus transfemoral catheterization within a contemporary real-world registry.</p><p><strong>Methods: </strong>Data from 14,139 patients included in a single-center prospective registry between 2009 and 2016 were used to determine the odds of periprocedural transient ischemic attack (TIA) and stroke for radial versus femoral catheterization via multivariate logistic regression with Firth's correction.</p><p><strong>Results: </strong>A total of 10,931 patients underwent transradial and 3,208 underwent transfemoral catheterization. Periprocedural TIA/stroke occurred in 41 (0.29%) patients. Age was the only significant predictor of TIA/stroke in multivariate analysis, with each additional year representing an odds ratio (OR) = 1.09 (CI 1.05-1.13, p < 0.000). The choice of accession site had no impact on the risk of periprocedural TIA/stroke (OR = 0.81; CI 0.38-1.72, p = 0.577).</p><p><strong>Conclusion: </strong>Observational data from a large prospective registry indicate that accession site has no influence on the risk of periprocedural TIA/stroke after cardiac catheterization.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"122-130"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/5d/cee-0011-0122.PMC8647137.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39823881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracerebral Hemorrhage Recurrence in Patients with and without Cerebral Amyloid Angiopathy.","authors":"João Pinho,&nbsp;José Manuel Araújo,&nbsp;Ana Sofia Costa,&nbsp;Fátima Silva,&nbsp;Alexandra Francisco,&nbsp;Miguel Quintas-Neves,&nbsp;João Soares-Fernandes,&nbsp;Carla Ferreira,&nbsp;Tiago Gil Oliveira","doi":"10.1159/000513503","DOIUrl":"https://doi.org/10.1159/000513503","url":null,"abstract":"<p><strong>Background: </strong>Intracerebral hemorrhage (ICH) recurrence risk is known to be higher in patients with cerebral amyloid angiopathy (CAA) as compared to other causes of ICH. Risk factors for ICH recurrence are not completely understood, and our goal was to study specific imaging microangiopathy markers.</p><p><strong>Methods: </strong>Retrospective case-control study of patients with non-traumatic ICH admitted to a single center between 2014 and 2017 who underwent magnetic resonance imaging (MRI). Clinical characteristics of the index event and occurrence of death and ICH recurrence were collected from clinical records. MRI images were independently reviewed by 2 neuroradiologists. Groups of patients with CAA-related and CAA-unrelated ICH defined were compared. Presence of CAA was defined according to the Boston modified criteria. Survival analysis with Kaplan-Meier curves and Cox-regression analyses was performed to analyze ICH recurrence-free survival.</p><p><strong>Results: </strong>Among 448 consecutive patients with non-traumatic ICH admitted during the study period, 104 were included in the study, mean age 64 years (±13.5), median follow-up of 27 months (interquartile range, IQR 16-43), corresponding to 272 person-years of total follow-up. CAA-related ICH patients presented higher burden of lobar microbleeds (p < 0.001), higher burden of enlarged perivascular spaces (EPVS) in centrum semiovale (p < 0.001) and more frequently presented cortical superficial siderosis (cSS; p < 0.001). ICH recurrence in patients with CAA was 12.7 per 100 person-years, and no recurrence was observed in patients without CAA. Variables associated with ICH recurrence in the whole population were age (hazard ratio [HR] per 1-year increment = 1.05, 95% CI 1.00-1.11, p = 0.046), presence of disseminated cSS (HR 3.32, 95% CI 1.09-10.15, p = 0.035) and burden of EPVS in the centrum semiovale (HR per 1-point increment = 1.80, 95% CI 1.04-3.12, p = 0.035).</p><p><strong>Conclusions: </strong>This study confirms a higher ICH recurrence risk in patients with CAA-related ICH and suggests that age, disseminated cSS, and burden of EPVS in the centrum semiovale are associated with ICH recurrence.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"15-21"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000513503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38868151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Major Cardioembolic Sources in Real-World Patients with Ischemic Stroke or Transient Ischemic Attack of Undetermined Cause.","authors":"Gerlinde van der Maten,&nbsp;Jorieke M B Reimer,&nbsp;Matthijs F L Meijs,&nbsp;Clemens von Birgelen,&nbsp;Marjolein G J Brusse-Keizer,&nbsp;Heleen M den Hertog","doi":"10.1159/000512743","DOIUrl":"https://doi.org/10.1159/000512743","url":null,"abstract":"<p><strong>Background/aim: </strong>Current guidelines recommend transthoracic echocardiography (TTE) and ambulatory rhythm monitoring following ischemic stroke or transient ischemic attack (TIA) of undetermined cause for identifying cardioembolic sources (CES). Due to ongoing controversies about this routine strategy, we evaluated its yield in a real-world setting.</p><p><strong>Methods: </strong>In a tertiary medical center, we retrospectively evaluated consecutive patients with ischemic stroke or TIA of undetermined cause, who (after standard work-up) underwent TTE, ambulatory rhythm monitoring, or both. CES were classified as major if probably related to ischemic events and warranting a change of therapy.</p><p><strong>Results: </strong>Between January 2014 and December 2017, 674 patients had ischemic stroke or TIA of undetermined cause. Of all 484 patients (71.8%) who underwent TTE, 9 (1.9%) had a major CES. However, 7 of them had already been identified for cardiac evaluation due to new major electrocardiographic abnormalities or cardiac symptoms. Thus, only 2 patients (0.4%) truly benefitted from unselected TTE screening. Ambulatory rhythm monitoring was performed in 411 patients (61.0%) and revealed AF in 10 patients (2.4%).</p><p><strong>Conclusion: </strong>Detecting a major CES is essential because appropriate treatment lowers the risk of recurrent stroke. Nonetheless, in this real-world study that aimed at routine use of TTE and ambulatory rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause, the prevalence of major CES was low. Most patients with major CES on TTE already had an indication for referral to a cardiologist, suggesting that major CES might also have been identified with a much more selective use of TTE.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"22-28"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000512743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25319817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing the Landscape of Stroke in Egypt.","authors":"Hany Aref,&nbsp;Magd Zakaria,&nbsp;Hossam Shokri,&nbsp;Tamer Roushdy,&nbsp;Ahmed El Basiouny,&nbsp;Nevine El Nahas","doi":"10.1159/000521271","DOIUrl":"https://doi.org/10.1159/000521271","url":null,"abstract":"<p><p>Egypt, a low-middle-income country, is the most populated nation in the Middle East with a high overall crude prevalence rate of stroke (963/100,000 inhabitants), accounting for 6.4% of all deaths. In this article, we discuss how, through a corrective plan, we could change the landscape of stroke services in Egypt, in a relatively short time, raising thrombolysis rate from <1% to 12.3%, with shortening of door-to-needle time. We could build a database that now exceeds 5,000 patients, our centers received international accreditation and several awards, and we developed tele-stroke service.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"155-159"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/4b/cee-0011-0155.PMC8787609.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39804880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Venous Thrombosis Associated with COVID-19 Infection: An Observational, Multicenter Study.","authors":"Sajid Hameed,&nbsp;Mohammad Wasay,&nbsp;Bashir A Soomro,&nbsp;Ossama Mansour,&nbsp;Foad Abd-Allah,&nbsp;Tianming Tu,&nbsp;Raja Farhat,&nbsp;Naila Shahbaz,&nbsp;Husnain Hashim,&nbsp;Wasim Alamgir,&nbsp;Athar Iqbal,&nbsp;Maria Khan","doi":"10.1159/000516641","DOIUrl":"https://doi.org/10.1159/000516641","url":null,"abstract":"<p><strong>Background and purpose: </strong>Coronavirus disease 2019 (CO-VID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients.</p><p><strong>Methods: </strong>This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged >18 years) with symptomatic CVT and recent COVID-19 infection.</p><p><strong>Results: </strong>Twenty patients (70% men) were included. Their mean age was 42.4 years, with a male-to-female ratio of 2.3:1. Headache (85%) and seizures (65%) were the common presenting symptoms, with a mean admission Glasgow Coma Scale (GCS) score of 13. CVT was the presenting feature in 13 cases (65%), while 7 patients (35%) developed CVT while being treated for COVID-19 infection. Respiratory symptoms were absent in 45% of the patients. The most common imaging finding was infarction (65%), followed by hemorrhage (20%). The superior sagittal sinus (65%) was the most common site of thrombosis. Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels. Homocysteine was elevated in half of the tested cases. The mortality rate was 20% (4 patients). A good functional outcome was seen in the surviving patients, with a mean modified Rankin Scale score at discharge of 1.3. Nine patients (45%) had a modified Rankin Scale score of 0-1 at discharge.</p><p><strong>Conclusion: </strong>COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19-related CVT cases. CVT should be suspected in COVID-19 patients presenting with headache or seizures. Mortality is high, but functional neurological outcome is good among survivors.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"55-60"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000516641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38971126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Enlargement on Non-Gated CT Is Associated with Large Vessel Occlusion in Acute Ischaemic Stroke.","authors":"Waleed Butt,&nbsp;Permesh Singh Dhillon,&nbsp;Robert Lenthall,&nbsp;Luqman Malik,&nbsp;Wazim Izzath,&nbsp;Kailash Krishnan,&nbsp;Bindu George,&nbsp;Kate Pointon","doi":"10.1159/000519121","DOIUrl":"https://doi.org/10.1159/000519121","url":null,"abstract":"<p><strong>Background: </strong>Recent reports have suggested that atrial fibrillation (AF) is more prevalent in the large vessel occlusion (LVO) subgroup of acute ischaemic stroke patients. Given the association between left atrial enlargement (LAE) and AF, we sought to evaluate the feasibility of assessing LAE on non-gated CT and its association with LVO in the hyperacute stroke setting.</p><p><strong>Methods: </strong>We analysed our prospectively collected database that included all stroke patients referred for consideration of endovascular treatment between April 14, 2020, and May 21, 2020. During this period, a CT chest was included in our regional stroke protocol to aid triage of patients suspected for COVID-19 from which cardiac measurements were obtained. Patients were dichotomized into LVO and no-LVO groups, and LA measurements were trichotomized into normal, borderline, and enlarged. Univariate analyses were performed between groups.</p><p><strong>Results: </strong>Of the included 38 patients, 21 were categorized as LVO and 17 as no LVO. There was a statistically significant association between LAE and LVO (p = 0.028). No significant difference was demonstrated between groups for the baseline AF and other clinical characteristics, except for baseline NIHSS (p = 0.0005). There was excellent inter- and intra-rater reliability (ICC = 0.969) for LA measurements.</p><p><strong>Conclusion: </strong>Our study provides preliminary data to suggest LAE is more prevalent in the LVO stroke subgroup at presentation and can be reliably assessed on non-gated CT in the hyperacute setting. These findings have potential implications for stratifying secondary management and may prompt a more rigorous pursuit of occult AF or other cardiac causes of stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"87-91"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/73/cee-0011-0087.PMC8543283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39440332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}