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* The left side of the patient's brain is on the right side of the figure Brain CT (computed tomography) was arranged and showed a large hypodense region with tubular hyperdensities at the left frontal lobe. The brain areas associated with dystypia and dystextia may involve the left frontal subcortical area, left frontal middle and inferior gyrus, as well as left frontal operculum according to the previous literature [[1]]. Typewriting and handwriting share a similar neuropsychological model and involve common brain regions, including the left superior parietal lobe, left supramarginal gyrus, and left premotor cortex close to Exner's area [[3]]. Brain MRI (Magnetic Resonance Imaging) revealed subacute infarction with hemorrhagic transformation at the left frontal operculum, left middle, and inferior frontal gyrus, as well as the subcortical white matter of left frontal cortices (Fig. [Extracted from the article]

Background and purpose: The clinical spectrum of different neuroradiological features of cerebral sinus-venous thrombosis (CSVT) varies considerably. We sought the relationship between different neuroradiological aspects and clinical presentations in these patients. Methods: The diagnosis of cerebral sinus-venous thrombosis has been confirmed by conventional angiography, MRI combined with MR venography following established diagnostic criteria. We analyzed clinical data, symptoms and signs, imaging findings, location and extent of the thrombus, and parenchymal lesions, retrospectively. Results: There were 220 consecutive patients with cerebral sinus-venous thrombosis; 98 (45%) had non-lesional sinus-venous thrombosis (NL CSVT), 51 (23%) had non-hemorrhagic infarct (NHI), 45 (20%) had hemorrhagic infarct (HI), and 26 (12%) had intracerebral hemorrhage (ICH). In patients with hemorrhagic lesion (HI+ICH), advanced age, headache (99%), behavioral disturbances (55%), consciousness disturbances (35%), seizures (41%), and language deficits (42%) were significantly higher than the other patients (NL+NHI) ( P < 0.001). High blood pressure at admission, puerperium, sigmoid and straight sinus thrombosis, multiple sinus and vein involvement were more frequent in patients with hemorrhagic lesion than those with non-hemorrhagic lesion. Patients with hemorrhagic lesion were more dependent or died (32%) than the other patients (12%) ( P < 0.001), and most of the patients with NL and NHI had no disability compared with the other patients at the 3 month of follow-up (96% and 65%; P < 0.001). Conclusion: Headache, convulsion, behavioral disorder, seizures, and speech disorders were the most frequent clinical symptoms of patients with hemorrhagic CSVT. Specific risk factors, including pregnancy/puerberium, early and extended thrombosis of large sinus, and presence of high blood pressure at admission, are associated with hemorrhagic lesion and unfavorable outcome. [ABSTRACT FROM AUTHOR]

Differentiating hemorrhagic infarct from parenchymal intracerebral hemorrhage can be difficult. The immediate and long-term management of the two conditions are different and hence the importance of accurate diagnosis. Using a series of intracerebral hemorrhage cases presented to our stroke unit, we aim to highlight the clues that may be helpful in distinguishing the two entities. The main clue to the presence of hemorrhagic infarct on computed tomography scan is the topographic distribution of the stroke. Additional imaging modalities such as computed tomography angiogram, perfusion, and magnetic resonance imaging may provide additional information in differentiating hemorrhagic infarct from primary hemorrhages. [ABSTRACT FROM AUTHOR]

Objective: Inflammation is increasingly viewed as a new therapeutic target in subacute stages of brain infarction. However, apart from causing secondary damage, inflammation could equally promote beneficial lesion remodeling and repair. Distinct subpopulations of monocytes/macrophages (MOs/MPs) may critically determine the outcome of lesion-associated inflammation. Methods: We addressed the role of bone marrow-derived MOs/MPs in 2 different mouse models of ischemic stroke using a combined cell-specific depletion, chemokine receptor knockout, bone marrow chimeric, and pharmacological approach. Results: Starting within 24 hours of stroke onset, immature Ly6chi monocytes infiltrated into the infarct border zone and differentiated into mature Ly6clo phagocytes within the lesion compartment. MO/MP infiltration was CCR2-dependent, whereas we did not obtain evidence for additional recruitment via CX3CR1. Depletion of circulating MOs/MPs or selective targeting of CCR2 in bone marrow-derived cells caused delayed clinical deterioration and hemorrhagic conversion of the infarctions. Bleeding frequently occurred around thin-walled, dilated neovessels in the infarct border zone and was accompanied by decreased expression of transforming growth factor (TGF)-β1 and collagen-4, along with diminished activation of Smad2. Injection of TGF-β1 into the lesion border zone greatly reduced infarct bleeding in MO/MP-depleted mice. Interpretation: Bone marrow-derived MOs/MPs recruited via CCR2 and acting via TGF-β1 are essential for maintaining integrity of the neurovascular unit following brain ischemia. Future therapies should be aimed at enhancing physiological repair functions of CCR2+ MOs/MPs rather than blocking their hematogenous recruitment. ANN NEUROL 2012;71:743-752 [ABSTRACT FROM AUTHOR]

Abstract: Isolated facio-lingual hypoesthesia and weakness is rare. We describe a case of isolated facio-lingual hypoesthesia and weakness after a hemorrhagic infarct localized at the contralateral operculum. A 66-year-old woman developed acute onset of facio-lingual hypoalgesia, hypoesthesia, and weakness, with no such symptoms being observed in other parts of the body. Brain magnetic resonance imaging showed a subacute hemorrhagic infarct in the right frontal operculum, which spread slightly to the right temporo-parietal operculum. 123IMP-SPECT showed hypoperfusion in the right fronto-temporo-parietal operculum, as detected by MRI, without apparent diaschisis within the brain. Neuroimaging findings for our patient suggested the involvement of the primary somatosensory-motor cortices (S1 and M1) and the secondary somatosensory cortex (S2), which receive trigemino-thalamo-cortical pathways. [Copyright &y& Elsevier]

Background: Seizures are a common complication of cerebral venous thrombosis. In this study, we intended to define clinical and neuroradiological factors associated with early and late seizures and predictors for seizure recurrence. Methods: The database of our high-volume tertiary stroke center was screened for patients diagnosed with cerebral venous thrombosis between April 2006 and July 2021. Demographics, clinical, imaging, and instrumental data were collected. Results: Out of a total of 80 patients, 30 had seizures, either within the first week after onset (22 patients) or after (8 patients). Speech impairment and intracerebral bleeding were statistically associated with seizures in univariate analysis, but in a logistic regression model, only brain damage with hemorrhagic infarct and/or presence of brain hematoma [OR 6.051; 95% CI 1.881–19.468] (p = 0.003) were predicting factors for seizures. Late seizures were significantly more frequent in younger age [OR 0.864; 95% CI 0.763–0.978] (p = 0.020). Early seizures resulted as protective factors for recurrence; an altered state of consciousness at baseline and late seizures resulted as predictive factors for relapses (0.0% vs. 81.0%, p = 0.005, and 100.0% vs. 19.0%, p < 0.005, respectively). Conclusions: Our study confirms brain bleeding as the strongest risk factor for seizures after cerebral venous thrombosis. Recurrence is unusual after early seizures, while the presence of late seizures seems to raise the risk of recurrence. [ABSTRACT FROM AUTHOR]

There is growing evidence in support of ischemic stroke as a manifestation of COVID-19 infection. However, hemorrhagic transformation of ischemic stroke is rare. We present two cases of hemorrhagic infarction as presenting features in COVID-19 patients who did not have traditional cardiovascular risk factors for ischemic or hemorrhagic stroke. While the hemorrhagic infarct was from a large artery in one of the patients, the other patient had a small artery related hemorrhagic infarct. We highlighted the possible underlining mechanisms from the literature and the implication of hemorrhagic infarct for routine anticoagulant therapy in patients with COVID −19 related ischemic stroke. [ABSTRACT FROM AUTHOR]

Posthemorrhagic ventricular dilatation (PHVD) is a major complication of intraventricular hemorrhage (IVH); it is associated with high risks of cerebral palsy and cognitive deficits compared with infants without PHVD. This study aims to explore the early perinatal risk factors-associated with the risk of progressive PHVD. Neonates ≤29 weeks gestational age (GA) with Grade II-III IVH and periventricular hemorrhagic infarct (PVHI) between 2015 and 2021 were retrospectively reviewed. All cranial ultrasounds done within 14 days postnatal age (PNA) were assessed for grade of IVH, anterior horn width (AHW), ventricular index (VI), and thalamo-occipital index (TOD). The outcome was defined as death of any cause or VI and/or AHW and/or TOD ≥ moderate-risk zone based on an ultrasound done beyond two weeks PNA. A total of 146 infants with a mean GA of 26 ± 1.8 weeks, birth weight 900 ± 234 g were included, 46% were females. The primary outcome occurred in 56 (39%) infants; among them 17 (30%) and 11 (20%) needed ventricular reservoir and shunt insertion, respectively. The risk factors present within 14 days PNA that significantly increased the odds of developing PHVD were hemodynamically significant patent ductus arteriosus (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.9 to 22), culture-proven sepsis (OR 5.4, 95% CI 1.8 to 18), Grade III IVH (OR 4.6, 95% CI 1.1 to 22), PVHI (OR 3.0, 95% CI 0.9 to 10), and VI (OR 2.1, 95% CI 1.6 to 2.9). Clinical predictors such as significant ductus arteriosus and bacterial septicemia, along with risk levels of AHW and VI measured with early cranial ultrasounds, are potential predictors of subsequent onset of PHVD. [ABSTRACT FROM AUTHOR]

Context.--: Extracorporeal membrane oxygenation (ECMO) is increasingly used in the treatment of respiratory and cardiac failure, but data describing lung histopathology in ECMO recipients are limited. Objective.--: To examine pulmonary histopathologic findings in patients who underwent venovenous (VV) ECMO for pulmonary reasons or venoarterial (VA) ECMO for cardiac indications shortly before death, and to determine if the pulmonary changes provided insights into therapy that may prevent complications and improve outcome. Design.--: We conducted a retrospective study of lung autopsies, from VV and VA ECMO recipients and patients with acute respiratory distress syndrome (ARDS) and non-ECMO treatment, between 2008 and 2020 in Silesia Center for Heart Diseases in Zabrze, Poland. Results.--: Among 83 ECMO patients (42-64 years; men, 57 [68.7%]), the most common histopathologic findings were bronchopneumonia (44 [53.0%]), interstitial edema (40 [48.2%]), diffuse alveolar damage (DAD; 32 [38.6%]), hemorrhagic infarct (28 [33.7%]), and pulmonary hemorrhage (25 [30.1%]). DAD was associated with longer ECMO treatment and longer hospital stay. The use of VV ECMO was a predictor of DAD in patients with ARDS and undergoing ECMO, but it also occurred in 21 of 65 patients (32.3%) in the VA ECMO group, even though VA ECMO was used for heart failure. Conclusions.--: Although DAD was significantly more common in lung autopsies of VV ECMO patients, one-third of VA ECMO patients had histopathologic changes characteristic of ARDS. The presence of DAD in lung autopsies of patients treated with VA ECMO indicates that in these patients, protective lung ventilation should be considered. [ABSTRACT FROM AUTHOR]

Herniation of the temporal lobe uncus typically leads to the compression of the ipsilateral oculomotor nerve, resulting in ipsilateral mydriasis, as well as compression of the ipsilateral posterior cerebral artery, leading to infarction in the posterior inferior temporal lobe and medial occipital cortex. In this report, we present the case of a 45‐year‐old man with a large left subdural hematoma. At autopsy, we observed left cingulate and uncal herniations, along with the characteristic lesions of Kernohan notch phenomenon due to compression of the contralateral cerebral peduncle. Additionally, a hemorrhagic infarct was identified in the right cerebellar hemisphere in the distribution of the superior cerebellar artery (SCA). This case provides the first autopsy report of uncal herniation with contralateral SCA infarct, an extremely rare condition. Importantly, this vascular complication may often go unnoticed in patients with Kernohan notch phenomenon although it may carry a grave clinical prognosis. [ABSTRACT FROM AUTHOR]

Cerebral venous sinus thromboses (CVSTs) are rare complications of neurosurgical interventions and their management remains controversial as most of cases appear clinically silent. Here, we analyzed our institutional series of patients with CVSTs evaluating clinical and neuroradiological characteristics, risk factors, and outcome. From the analysis of our institutional PACS, we collected a total of 59 patients showing postoperative CVSTs after supratentorial or infratentorial craniotomies. For every patient, we collected demographics and relevant clinical and laboratory data. Details on thrombosis trend were retrieved and compared along the serial radiological assessment. A supratentorial craniotomy was performed in 57.6% of cases, an infratentorial in 37.3%, while the remaining were a single cases of trans-sphenoidal and neck surgery (1.7%, respectively). A sinus infiltration was present in almost a quarter of patients, and in 52.5% of cases the thrombosed sinus was exposed during the craniotomy. Radiological signs of CVST were evident in 32.2% of patients, but only 8.5% of them developed a hemorrhagic infarct. CVST-related symptoms were complained by 13 patients (22%), but these were minor symptoms in about 90%, and only 10% experienced hemiparesis or impaired consciousness. The majority of patients (78%) remained completely asymptomatic along the follow-up. Risk factors for symptoms occurrence were interruption of preoperative anticoagulants, infratentorial sinuses involvement and evidence of vasogenic edema and venous infarction. Overall, a good outcome defined mRS 0–2 was observed in about 88% of patients at follow-up. CVST is a complication of surgical approaches in proximity of dural venous sinuses. CVST usually does not show progression and courses uneventfully in the vast majority of cases. The systematic use of post-operative anticoagulants seems to not significantly influence its clinical and radiological outcome. [ABSTRACT FROM AUTHOR]

Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST), a condition which nowadays is treated non-operatively. Decompressive craniectomy is reserved only for emergency settings. We present a 22-year-old pregnant lady, who was transferred at the emergency department with a reduced level of consciousness, headache, and nuchal rigidity. Her MRI study showed CVST, causing hemorrhagic infarct and midline shift. She underwent decompressive craniectomy with partial removal of the hemorrhagic parenchyma. Remarkably, she recovered without any neurological deficits regardless of the substantial temporal lobe damage, while the thrombus nearly resolved using anticoagulation. Decompressive craniectomy can be life-saving in selected CVST patients, followed by anticoagulantion to augment the recanalization process. [ABSTRACT FROM AUTHOR]

Recently, weeks after the COVID-19 prevalence, there were reports of brain involvement and neurologic presentations in the COVID-19. We present five cases of COVID-19 and cerebrovascular events. A 34-year-old woman with IVH and ischemic stroke. A 60-year-old man with multiple small hemorrhagic foci and mild IVH in the occipital horn. A 63-year-old woman with large left parietooccipital intracerebral hemorrhage (ICH) and IVH. A 56-year-old man with left hemispheric and midbrain ICH, lateral ventricular IVH, and hydrocephalus. A 85-year-old woman with right parietal hemorrhagic infarct. The coagulation profile was normal in all of them. The chest CT scan showed the typical ground-glass appearance of COVID-19. Recently, there were reports of brain involvement and neurologic presentations in the COVID-19. These reports and the present study necessitate the aimed and designed studies with emphasis on neurologic presentations in COVID-19 patients to illustrate the exact effects of coronavirus-2 on the central nervous system. [ABSTRACT FROM AUTHOR]

Introduction: Dengue counts among the most common arboviral illnesses, representing the fastest spreading tropical disease in the world. It is considered the second leading cause of acute febrile disease in travelers. Four different serotypes (DENV-1,-2,-3, and-4) cause dengue fever, with various infectious outcomes (asymptomatic to severe hemorrhagic fever). Dengue is prevalent in 128 countries, and more than 2.5 billion individuals are in danger each year of contracting dengue virus worldwide. Material & Methods: This is prospective study conducted at Department of Radio diagnosis, Kalinga Institute of Medical Sciences from November 2016 to April 2017 among 48 serologically proven dengue patients presenting with neurological symptoms and undergoing brain MRI over a period of 6-months were included. The diagnosis of dengue encephalopathy or encephalitis was established by presence of signs/symptoms of acute encephalitic syndrome with the presence of IgM antibody against dengue antibody in the serum and/or presence of dengue antigen (NS1) in serum. Any patients found to have positive serological test for malaria, leptospirosis, scrub typhus, Chikungunya, JE virus, and Herpes simplex virus (HSV) encephalitis were excluded from the study. Results: A total of 48 patients (29 men, 19 women; mean age of 29.84 years and age range of 2-70 years) were included in this study. Twelve patients (25%) were in the pediatric age group (<18 years of age) whereas the rest were in the adult age group. Of 48 cases, 15 cases were found to have no significant abnormality on MRI. Varying degrees of abnormality were found in rest of the 33 patients. The imaging findings are described based on a pattern recognition approach. Conclusion: MRI is an important tool for demonstrating the degree of brain involvement in dengue infection. Although the findings are not entirely unique to dengue, it can help to narrow down the list of differential diagnosis particularly when coupled with serological tests and CSF analysis. A pattern-based approach to evaluating the brain MRI in combination with patient's clinical details in the setting of dengue can help the radiologist to identify the definitive underlying pathologic process. This is of particular significance in differentiating between dengue encephalitis and post-dengue ADEM because of their different treatment strategies. [ABSTRACT FROM AUTHOR]

Takayasu arteritis is a well-known yet rare form of large vessel vasculitis. Takayasu arteritis affects mainly women, and is most commonly seen in Japan, South East Asia, India, and Mexico, where it usually presents in the 2nd or 3rd decade of life. It is seen usually as pulseless disorder often with bruit at the stenosed arteries. Manifestations range from asymptomatic disease, to catastrophic strokes. Angiography remains the gold standard for diagnosis. Approximately half of those patients treated with steroids will respond, and half of the remaining patients respond to methotrexate; mycophenolatemofetil may be useful. Fertility is not adversely affected and pregnancy does not appear to exacerbate the disease, although management of hypertension is essential. We herewith report a rare case of an11 year old girl, who presented with left-sided hemiparesis, dysarthria, left UMN facial palsy, feeble pulses on right side, high Blood Pressure recordings and positive anticardiolipin antibodies. Imaging studies revealed Occluded right Common carotid artery, occluded right subclavian artery and stenotic right renal artery and MRI showed Acute Infarcts in Right Basal Ganglia and Right High Parietal Region, Hemorrhagic infarct in right MCA subcortical area.The diagnosis of Takayasu arteritis with recent cerebrovascular accident (left hemiparesis) with hypertension was made and the patient was started on steroids, anti-platelets, anti-hypertensives and physiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate the prevalence of Labbé vein thrombosis (LVT) and its liability for the lesions observed in the case of associated ipsilateral transverse sinus thrombosis (TST). Methods: MRI findings of 58 consecutive patients (≥ 18 years) with acute LVT and TST (group 1) were compared with those of 149 patients with acute TST-no LVT (group 2) observed during the same period. Results: The prevalence of LVT was 15.2%. Group 1: TST extended to sigmoid sinus in 94.8%, resulting in complete sinuses occlusion. Any lesion was observed in 81% within LV territory: swelling (n = 5, 8.6%), edema (n = 9; 15.5%), non-hemorrhagic Infarct (n = 1; 1.7%), multiple temporal lobe hemorrhages (n = 31; 53.5%), temporal lobe hematoma (n = 13; 22.4%), and pericerebral hemorrhages (n = 28; 50%). The hemorrhagic lesions were not related to dominant TST or to extensive venous thrombosis. There was a prevalence of left TST- LVT (n = 32; 55.2%) and a higher prevalence of hemorrhagic lesions in this subset (59.4%). Risk factors were also associated (p = 0.03). Group 2: the TST resulted in an occlusion of the TS: (i) complete (n = 16; 10.7%); (ii) incomplete (n = 97; 82.8%); and (iii) segmental, involving the TS before (n = 32; 21.5%) or after (n = 10; 6.7%) LV ending within the TS. No parenchymal/pericerebral lesions were associated. Conclusion: This study shows a strong association between the following: (i) the extent of thrombosis in the TS and the presence of LVT (p < 0.0001), (ii) the concomitance of LVT-TST and the presence of lesions in the LV territory and at the temporo-frontal convexity, (iii) risk factors and group 1 (p = 0.03). [ABSTRACT FROM AUTHOR]

Objectives  The aim of the study is to assess the role of ultrafast (UF) magnetic resonance (MR) sequences in stroke imaging. Material and Methods  We prospectively studied 85 patients having clinical suspicion of stroke referred for MR imaging (MRI) during August 2016 to July 2018. These patients were subjected to both conventional and UF MRI sequences. The patients were divided into six categories based on the pathologies encountered. Further subclassification was done based on the size of the lesions as ≤10 mm and >10 mm as seen separately in both UF and conventional MR sequences. The number and visibility of these lesions on conventional and UF MRI were compared. The image quality of all the subjects was also compared based on a scale categorized into excellent, satisfactory, and poor. The findings on conventional and UF imaging sequences were correlated with the final clinical diagnosis arrived at the time of discharge. Results  In our study comprising 85 patients, 57 showed pathologies. The patients showing pathologies were assigned into the six categories as acute infarct (34 cases), acute hemorrhagic infarct (six cases), chronic infarct (17 cases), chronic hemorrhagic infarct (four cases), subacute infarct (three cases), and chronic hemorrhage (one case). The number of lesions seen on conventional and UF sequences were the same although there was a slight decrease in the size of the lesions on UF sequences as compared with conventional counterparts. The image quality using UF sequences was better in motion prone patients while conventional imaging showed better image quality in cooperative patients. Conclusion  In motion prone patients, UF sequences are a suitable alternative for conventional sequences as they help in arriving at the diagnosis in lesser time, with reasonably good image quality, and without motion artifacts. In cooperative stroke patients, it is better to use conventional MR sequences as the image quality is better. [ABSTRACT FROM AUTHOR]

SMTP-7 (Stachybotrys microspora triprenyl phenol-7) is a small molecule that promotes thrombolysis and suppresses inflammation possibly through plasminogen modulation and soluble epoxide hydrolase (sEH) inhibition, respectively. Here, we demonstrate an efficacy of SMTP-7 in a severe embolic stroke model in monkeys. The middle cerebral artery was embolized by an autologous blood clot. Saline, SMTP-7, or tissue-type plasminogen activator (t-PA) (n = 5 in each group) was given after 3 hours, and neurologic deficit scoring and infarct characterization were performed after 24 hours. Hemorrhagic infarct-accompanied premature death was observed for two animals in t-PA group. SMTP-7 treatment significantly reduced the sizes of infarct by 65%, edema by 37%, and clot by 55% compared to saline treatment. Plasma levels of the products of plasminogen activation (plasmin-α2-antiplasmin complex) and sEH reaction (dihydroxyeicosatrienoic acid) in SMTP-7 group were 794% (P < 0.05) and 60% (P = 0.085) compared to saline group, respectively. No significant changes in the plasma levels of MMP-9, CRP, MCP-1, and S100B were found. There was an inverse correlation between plasmin-α2-antiplasmin complex level and infarct volume (r = 0.93, P < 0.05), suggesting a role of thrombolysis in the SMTP-7 action to limit infarct development. In conclusion, SMTP-7 is effective in treating severe embolic stroke in monkeys under conditions where t-PA treatment tends to cause hemorrhagic infarct-associated premature death. [ABSTRACT FROM AUTHOR]

Background: The outcome of extracorporeal membrane oxygenation (ECMO) might be influenced by its complications. Only limited information is available regarding the pathologic consequences of ECMO, especially in the era of modern ECMO technology.Methods: We studied the histopathologic findings in autopsy lungs of patients treated with ECMO compared with those without ECMO. Autopsy files were queried for cases with ECMO. An age- and sex-matched control group comprised of patients who died in the ICU without acute respiratory distress syndrome, pneumonia, or ECMO was compared with patients with ECMO for cardiac reason. Histopathology and medical records were reviewed.Results: Seventy-six patients treated with ECMO (38 men; median age, 40 years) and 47 control patients (23 men; median age, 45 years) were included. Common histologic pulmonary findings in the ECMO group were pulmonary hemorrhage (63.2%), acute lung injury (60.5%), thromboembolic disease (47.4%), calcifications (28.9%), vascular changes (21.1%), and hemorrhagic infarct (21.1%). Pulmonary hemorrhage was associated with longer ECMO duration (median, 7.0 vs 3.5 months; P = .014), acute lung injury with venovenous ECMO (91.7% vs 54.7%; P = .039) and longer ECMO (6.0 vs 4.0 months; P = .044), and pulmonary calcifications with infants (50.0% vs 22.4%; P = .024). Patients with ECMO for cardiac reasons (n = 60) more frequently showed pulmonary hemorrhage (P < .001), diffuse alveolar damage (P = .044), thromboembolic disease (P = .004), hemorrhagic infarct (P = .002), pulmonary calcifications (P = .002), and vascular changes (P = .001) than patients in the non-ECMO group.Conclusions: Some findings are suspected to be associated with the patient's underlying disease, whereas others might be related to ECMO. Our results provide a better understanding of ECMO-related lung disease and might help to prevent it. [ABSTRACT FROM AUTHOR]

Background: Neonatal cerebral sinus venous thrombosis (CSVT) causes high morbidity and mortality. Factors associated with either favorable or unfavorable long-term outcomes have not been clearly established. This study aimed to determine the factors involved in long-term neurological outcomes in patients with neonatal CSVT.Methods: This was a retrospective cohort study of patients with neonatal CSVT at a single institution. Clinical factors associated with long-term neurological outcomes were examined.Results: A total of 67 patients met study inclusion criteria for radiologically confirmed neonatal CSVT. The mean patient follow-up duration was four years (range one week to 16 years, median six years). We observed a favorable neurological outcome defined by a pediatric stroke outcome measures (PSOM) score of 0 to 0.5 in 26 (53%) of osurviving patients at follow-up. An unfavorable neurological outcome as defined by PSOM score >0.5 was observed in 23 survivors (47%). Death was reported in 18 (27%) patients, of which 10 patients died due to direct complications of CSVT. Congential heart disease and genetic disease were associated with significantly increased odds for all-cause death. Cardiorespiratory failure and altered mental status during the initial neurological examination were significantly associated with increased odds of death due to CSVT. Among surviving patients, higher PSOM scores were associated with premature birth (i.e., gestational age < 37 weeks), traumatic birth, site of thrombosis in the straight sinus, site of thrombosis in the internal cerebral veins, and hemorrhagic infarct. In contrast, lower PSOM scores were associated with a normal neurological examination at presentation, thrombosis in only superficial sinuses, and hemorrhage without infarct. There was no statistically significant association between the type and duration of CSVT treatment.Conclusions: The major factors influencing outcome of neonates following CSVT included comorbid medical conditions, abnormal neurological examination at presentation, location of venous thrombosis, and type of cerebral injury. These results can help guide further studies in neonatal CSVT aiming to decrease morbidity and mortality with the goal of improving long-term neurological outcomes. [ABSTRACT FROM AUTHOR]

Uterine torsion is a rare condition. Even more so in cases of non-gravid torsion. We present the case of a post-menopausal woman in her 70s who arrived to our emergency department acutely unwell with abdominal pain and vomiting on a background of a large leiomyomatous uterus, complicated by aspiration pneumonia, acute anaemia, and acute kidney injury. Computed tomography demonstrated a small bowel obstruction secondary to a large heterogeneous calcified pelvic mass. Laparotomy performed demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A short segment of healthy jejunum was adhered to the uterine fundus, which was easily mobilized. Total hysterectomy and bilateral oophorectomy was performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall. [ABSTRACT FROM AUTHOR]

Background Seizures are the presenting feature of cerebral venous sinus thrombosis (CVST) in 12–31.9% of patients. 44.3% of patients have seizures in the early stage of the disease. Acute seizures (AS), refers to seizures which take place before the diagnosis or during the first 2 weeks afterward. Objective To report the predictors of acute seizures in cerebral venous sinus thrombosis (CVST). Methods 100 patients with CVST were included in the study. The occurrence of acute seizures was noted. The predictors of acute seizure were evaluated by univariate analysis including the demographic (gender, age), clinical (headache, focal neurological deficit, papilloedema, GCS score), type and number of risk factors, MRI findings (Type of lesion: hemorrhagic infarction or hematoma, location of lesion) and MRV findings (superficial or deep sinus, cortical veins). Results A total of 46 patients had acute seizures. On univariate analysis, altered mental status ( p < 0.001), paresis ( p = 0.03), GCS score <8 ( p = 0.009), hemorrhagic infarct on imaging ( p = 0.04), involvement of frontal lobe ( p = 0.02), superior sagittal sinus ( p = 0.008), and high D-dimer levels ( p = 0.03) were significantly associated with acute seizure. On multivariate analysis, the hemorrhagic infarct on MRI and high D-dimer was independently predictive for early seizure. Conclusion The predictive factors for the acute seizures are altered mental status (GCS < 8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels. [ABSTRACT FROM AUTHOR]

• Individuals with Fanconi anemia have a higher incidence of posterior reversible encephalopathy syndrome (PRES). • Cyclosporine level is not correlated with PRES occurrence. • PRES can present with a nonposterior distribution. • PRES is nonreversible in all cases. Posterior reversible encephalopathy syndrome (PRES) is one of the most common neurologic complications following hematopoietic stem cell transplantation (HSCT). We aimed to evaluate the incidence, clinical, and imaging features of PRES in pediatric patients with Fanconi anemia (FA) following HSCT. This prospective study included all post-HSCT patients with underlying FA disease between 2014 and 2017. Brain computed tomography scan and magnetic resonance imaging (MRI) were performed in all individuals who developed neurologic symptoms. PRES was diagnosed based on clinic-radiological evidence. Follow-up MRI was performed in all patients with PRES within two months. Forty-one patients with FA (28 males; mean age, 8.19 ± 3.25 years) were enrolled. Out of 15 patients with acute neurologic symptoms, PRES was diagnosed in 9 individuals (21.95% of the total cohort). The occurrence of PRES was significantly higher in patients who had a donor with a 1-locus mismatch (P =.02). Donor relation, stem cell source, and graft-versus-host disease grade did not have any significant association with the development of PRES. MRI showed asymmetric vasogenic edema in 5 patients, an overt infarct in 1 patient, and foci of microhemorrhages in 3 patients, 1 of whom developed a hemorrhagic infarct. This patient died shortly, and persistent microhemorrhages were noted in the other 2 patients. Our findings demonstrate a greater risk of developing PRES after HSCT in patients with FA compared with those with other diseases (21.95% versus 1% to 10%), and in contrast to its term, it might be irreversible and has adverse effects on HSCT outcomes. The increased vascular and endothelial fragility in FA may contribute to the higher frequency of PRES in these individuals. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke (AIS). Red blood cell distribution width (RDW) is a cost-effective parameter associated with incidence and prognosis of cerebrovascular diseases. The purpose of this study was to assess whether RDW is associated with HT in AIS patients. Methods: AIS patients within 24 h from stroke onset between January 1, 2014, and December 31, 2018, were consecutively enrolled. Blood samples were collected. The primary outcome was HT, which was diagnosed by follow-up brain image and classified into hemorrhagic infarct (HI) and parenchymal hematoma (PH). Multivariate logistic regression analysis was performed to determine the relationship between RDW and HT as well as its subtypes. Potential effect modifier was identified by stratified logistic regression analysis. Results: Among the included 1383 patients, 220 (15.9%) developed HT (HI in 103 and PH in 117). Elevated RDW levels were associated with an increased risk of HT when 2 extreme tertiles were compared (OR 1.60, 95% CI 1.04–2.44, p = 0.031). The risk of HT increased stepwise across RDW tertiles (p for trend = 0.042). RDW significantly correlated with HI rather than PH. The association between RDW and HT could be modified by reperfusion therapy (p for interaction = 0.010), with no significant association between RDW and HT among patients underwent reperfusion therapy. Conclusions: Elevated RDW level was related to increased risk of HT among AIS patients without reperfusion therapy. [ABSTRACT FROM AUTHOR]

Hyperintensities on T1-weighted magnetic resonance imaging (MRI) in the setting of brain ischemia are usually considered hemorrhagic transformations. Such changes can also be seen due to "incomplete infarction" with selective neuronal loss. Arguments regarding the cause of these T1 hyperintensities have shuttled between gemistocytic astrocyte accumulation, tissue calcification and paramagnetic substance deposition. Susceptibility weighted imaging (SWI), a sensitive modality for detecting paramagnetic agents and blood products, has never been used to resolve this issue. The study was aimed to evaluate the SWI signal changes of T1 hyperintense lesion in stroke patients and understand its usefulness in differentiating a hemorrhagic infarct and an incomplete infarct. All the seven patients with infarct, having hyperintensities on T1 weighted MR imaging seen over the last one year were subjected to SWI. In none of the patients SWI failed to show any blooming. By doing SWI for T1-weighted hyperintensities, we can differentiate hemorrhagic infarct and a non-hemorrhagic "incomplete infarct". This differentiation will immensely help in planning management strategy and prognostication. [ABSTRACT FROM AUTHOR]

Hyperintensities on T1-weighted magnetic resonance imaging (MRI) in the setting of brain ischemia are usually considered hemorrhagic transformations. Such changes can also be seen due to "incomplete infarction" with selective neuronal loss. Arguments regarding the cause of these T1 hyperintensities have shuttled between gemistocytic astrocyte accumulation, tissue calcification and paramagnetic substance deposition. Susceptibility weighted imaging (SWI), a sensitive modality for detecting paramagnetic agents and blood products, has never been used to resolve this issue. The study was aimed to evaluate the SWI signal changes of T1 hyperintense lesion in stroke patients and understand its usefulness in differentiating a hemorrhagic infarct and an incomplete infarct. All the seven patients with infarct, having hyperintensities on T1 weighted MRI seen over the last one year were subjected to SWI. In none of the patients SWI failed to show any blooming. By doing SWI for T1-weighted hyperintensities, we can differentiate hemorrhagic infarct and a non-hemorrhagic "incomplete infarct". This differentiation will immensely help in planning management strategy and prognostication. [ABSTRACT FROM AUTHOR]

A case of fibromuscular dysplasia (FMD), presenting with a non-hemorrhagic infarct is reported. Positivity of anticardiolipin antibodies suggested an immune response. A 40-year-old man presented with sudden onset of stroke, preceded by similar ischemic attacks. Computed tomography (CT) of the brain showed a recent non-hemorrhagic infarct in the left middle cerebral artery (MCA) territory and an old right MCA territory infarct. Serum was positive for anticardiolipin antibodies. These above findings were confirmed at autopsy. A portion of the internal carotid artery and the middle cerebral arteries on both sides revealed features of FMD, with thrombosis. This case suggests an immune mechanism for FMD, hitherto unobserved in the cerebral circulation. [ABSTRACT FROM AUTHOR]

Background: Case presentation of acute onset bilateral painless vision loss caused by bilateral infarction of the lateral geniculate bodies (LGB) and a systematic review of the literature. Methods: A descriptive case report is presented on a 17-year-old female diagnosed with acute pancreatitis who developed acute onset bilateral painless vision loss. A systematic literature review of cases with bilateral LGB lesions was conducted across three electronic databases (PubMed/PubMed Central/MEDLINE, Scopus, and ScienceDirect). The review was conducted in concordance with PRISMA guidelines and prospectively registered on PROSPERO (CRD42022362491). Results: The reported 17-year-old female was found to have MRI findings consistent with bilateral hemorrhagic infarction of the LGB and Purtscher-like retinopathy. A systematic literature review of bilateral LGB infarction yielded 23 records for analysis. 19/23 (82.6%) of reported cases occurred in women. Bilateral vision loss was noted in all cases. The average reported age was 27 years old with a range from 2–50. Gastrointestinal pathology (e.g., pancreatitis, gastroenteritis) was present in 8/23 (34.7%) of cases. 8/23 (34.7%) cases had neuroimaging or pathological evidence of hemorrhagic transformation of the infarct. Most cases experienced partial recovery of visual loss; only one case (4.7%) had complete visual recovery. 9/23 (39.1%) cases were reported from the United States and 4/23 (17.3%) from India. Conclusions: Bilateral LGB lesion is a rare cause of vision loss, typically caused by systemic diseases and with female preponderance. Purported pathophysiology relates to increased vulnerability of the LGB to ischemic and metabolic stress. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the clinical effect of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) (TACE+RFA) versus RFA or TACE alone in the treatment of rabbit VX2 hepatic tumors and related pathological changes. MethodsThe rabbits were sacrificed at 7 days after surgery, and the maximal diameter of coagulative necrotic zone or hemorrhagic infarct zone was compared, as well as typical pathological sections. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsOne rabbit in the RFA group died of pneumothorax and one in the TACE+RFA group died of extensive liver necrosis at 2 days after surgery. The other 16 rabbits survived to the end of observation, resulting in a success rate of 88.9% (16/18). There were significant differences between the TACE+RFA group and the other two groups in the maximal long and short diameters of coagulative necrotic zone and tumor cell necrosis rate (all P<0.05). The pathological analysis revealed greater vascular thrombosis, larger necrotic zone, and fewer clusters of viable tumor cells in the TACE+RFA group, compared with the other groups. ConclusionTACE+RFA has a better effect in tumor destruction than RFA or TACE alone. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acute neurological diseases requiring hospitalization are rare in young women. Many are unique to pregnancy and the postpartum period, contribute to approximately 20% of maternal deaths which is significant. MRI is safe in pregnancy and is the investigation of choice for most of these diseases. OBJECTIVE: To study the role of MRI in diagnosis of acute neurologic emergencies in pregnant and postpartum women. METHODS: This was a retrospective study carried in the Department of Radiology, JPMC hospital over one 1 year from November 2015 to November 2016, after approval by ethical review committee of the hospital. Patients referred to our department for MRI brain with complaints of neurological symptoms and signs during pregnancy, in peripartum period (up to 6 weeks) were included in the study. RESULT: Total of 31 patients with signs and symptoms of acute neurological diseases were evaluated using MRI brain. Age range was between 18 to 40 years with mean average of 25.9 year. The commonest radiological diagnosis was PRES in 13 patients. Other patients had CVST 9 patients (with hemorrhagic infarct), acute infarction in 5 patients and pituitary apoplexy 1 patient. 1 patient had tuberculoma. 2 patients had unremarkable brain imaging. CONCLUSION: Radiologists must be well aware of the imaging findings of acute neurological emergencies and their complications, occurring in pregnancy and the puerperium. With early and accurate diagnosis, radiologists may make important contributions to the care of this patient population. [ABSTRACT FROM AUTHOR]

Dengue virus, a RNA virus of family Flaviviradae is considered non-neurotropic. Increasing studies and case reports reveal neurological manifestations of dengue virus. In our case series, we have evaluated magnetic resonance imaging (MRI) findings of 3 patients with dengue fever diagnosed by positive dengue NS1 antigen with neurological symptoms, which revealed nonspecific imaging features of dengue encephalitis in two cases and dengue meningoencephalitis in one case. Autopsy findings are also correlated in 2 patients who succumbed to their disease. This case series underlines the consideration of dengue encephalitis in patients of dengue fever with neurological symptoms and relevant imaging findings. [ABSTRACT FROM AUTHOR]

Background: The cost of hospitalization for stroke accounts for a large proportion of the total cost of stroke in the first 12 months. Factors that affect hospital length of stay (LOS) among patients with acute stroke should be understood in order to develop appropriate rehabilitation targets and plan discharge times. The aim of this study was to determine factors that influenced LOS among patients with acute stroke. Methods: The records of 1507 patients' who were hospitalized due to acute stroke between September 2011 and September 2013 were investigated retrospectively; 909 patients were eligible for the study. Age, sex, stroke types (ischemic or hemorrhagic), muscle strength of upper and lower extremities, number of co-morbidities, presence of infection, physiotherapy information, history of smoking, and LOS were recorded. Results: The mean length of stay was 7 days (interquartile range: 5-13 days). Patients with hemorrhagic infarct, aphasia, infection, atrial fibrillation, and history of smoking had significantly longer LOS. LOS was also longer when patients received physiotherapy. The presence of infection and functional disability level (assessed using the modified Rankin Scale) emerged as significant predictors for LOS. Conclusions: Functional disability level and presence of infection may be used to predict the LOS in patients with stroke. In the acute term, realization of infection and detailed assessment of functional disability are fundamental issues. [ABSTRACT FROM AUTHOR]

Introduction: Labbe vein, inferior anastomotic vein, thrombosis is rare and accompanied with major vein thrombosis. Risk factors; malignancy, infections, pregnancy, oral contraceptivesand trauma. We would like to present the case with Labbe vein thrombosis 1 month after COVID-19. Case: Twenty one years male admitted to hospital with headache, vomiting, behavioral changes. He had no chronic illness except anemia. He had flu with other friends 1 month ago COVID PCR negative. At physical examination GCS:11, pupils isocoric, LR +/+. Right sided hemiparesis. BP: 130/70, HR: 70/mn. At brain CT; hematoma at left temporal pole, peripheral edema, shift on middle line. He had emergency surgery. Craniotomy, evacuation of hematoma and duraplasty were performed. Than he followed in ICU as intubated. Anitedema and antiepileptic treatment were arranged. COVID-19 antibody IgG and IgM positive. His CT and MR images are evaluated by neurology and radiology. Presence of giriform thickness and swelling at a certain area of brain cortex which suggest hemorrhagic venous infarction made diagnose him with Labbe vein thrombosis. Anticoagulation therapy started. He was extubated after 12 days and discharged from ICU after 18 days. Discussion: Labbe vein drains lateral temporal lobe and is running into transverse sinus. Its thrombosis is seen mostly with other vein thrombosis. Headache, seizure, focal neurological deficits can be present. It is difficult to detect radiologically since people have serebral venous system differences and variations. Hemorrhagic infarct in temporal lobe should suggest Labbe vein thrombosis. MR venography is used. Cerebral vein thrombosis rate was considerable in COVID-19 patients. Also in anemic patients it is more likely to be seen. Classical treatment includes anticoagulation and treatment with anti epileptic and anti edema drugs. Thrombectomy, thrombolytics and decompression surgery can be applied. Our case has risk factors like covid and anemia. He was difficultly diagnosed. But after the treatment he discharged from ICU as a healthy person. [ABSTRACT FROM AUTHOR]

Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2). Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions. [ABSTRACT FROM AUTHOR]

Introduction: The main objectives of the present study are to assess the incidence of cerebral venous thrombosis (CVT) presenting as isolated subarachnoid hemorrhage (SAH) and to determine the occurrence of cortical venous thrombosis (CoVT). Methods: Among 332 patients with CVT, investigated with the same CT and MR standardized protocol, 33 (10 %) presented with SAH, associated in 11 cases with hemorrhagic infarct or intracerebral hemorrhage. This study is based on 22 cases of CVT presenting as SAH in the absence of hemorrhagic brain lesion. Diagnosis of sinus thrombosis was established on T2* and magnetic resonance venography and that of CoVT on T2* sequence. Diagnostic of SAH was based on fluid-attenuated inversion recovery (FLAIR) sequence. Results: CVT involved lateral sinus in 18 patients, superior sagittal sinus in 16, and straight sinus in 1. Cortical veins were involved in all patients, in continuity with dural sinus thrombosis when present. SAH was circumscribed to few sulci in all cases and mainly localized at the convexity (21 cases). CoVT implied different areas on the same side in four patients and was bilateral in seven. There was no perimesencephalic or basal cisterns hemorrhage. Cortical swelling was present in 12 cases, associated with localized edema. All patients except one had a favorable outcome. Conclusion: This report shows that the incidence of CVT presenting as isolated SAH is evaluated to 6.4 % and that SAH is, in all cases, in the vicinity of CoVT and when dural thrombosis is present in continuity with it. [ABSTRACT FROM AUTHOR]

Clinical signs and symptoms of posterior cerebral artery (PCA) stroke are varied and can be challenging to diagnose at early stage. A case of bilateral PCA infarct presenting with marked behavioral symptoms and minimal neurological symptoms is presented here. A 34 years old female had presented with marked behavioral symptoms, blurring of vision and tingling sensation in left half of body. Though the latter complaints resolved following day, her behavioral complaints persisted. Magnetic Resonance Imaging (MRI) of brain revealed acute non-hemorrhagic infarct in bilateral PCA territory. Psychotropics were beneficial for her behavioral symptoms. Isolated behavioral symptoms in PCA stroke led to speculate anatomical substrate for those symptoms. We discussed possible anatomical substrates for behavioral symptoms. Our case adds to the existing literature on a range of disguising presentations in PCA stroke and also emphasizes those distinctions between 'neurological' or 'psychological' or 'psychiatric' disorders are often sketchy. [ABSTRACT FROM AUTHOR]

Background: Chemical thrombolysis in cerebral venous thrombosis (CVT) is one of the treatment options and the data is limited. Settings and Design: Prospective observational nonrandomized study . Subjects and Methods: This is a prospective study of 10 patients (six females and four males) admitted between May 2007 and June 2013. Grading system proposed by Department of Interventional Neuroradiology (INR), King Edward Memorial Hospital (KEM), Mumbai was used to grade the clinical status at admission. There were six patients with clinical Grade 3, two with Grade 4, and two with Grade 5. Patients with either Grade less than 3 or more than Grade 5 were excluded. Those patients, who were diagnosed with Cerebral venoussinous thrombosis (CSVT) but without hemorrhagic venous infarct and treated according to INR KEM criteria, were excluded from the study . Average duration of thrombolysis was 13 hours (range 10-18 hours). Average dose of urokinase was 12.2 lakh units (range 9.2-16.8 lakh units). Results: Six patients presented with clinical Grade 3 had modified Rankin Scale (mRS) sore of 1 at 30-day follow-up. Of the two patients with Grade 4, one had mRS 1 and the other had mRS 2 at 30-day follow-up. Of the two patients with Grade 5, one had mRS 2 at 30-day follow-up and the other did not respond to local thrombolysis and succumb to intracranial hemorrhagic infarct within 48 hours. Conclusion: This small prospective single-center study showed local dural venous thrombolysis significantly improves clinical and radiological outcome in patients with CVT. A randomized control trial with large sample size is needed to substantiate our findings. [ABSTRACT FROM AUTHOR]

Background and purpose After first-ever ischaemic stroke, to assess the risk and baseline factors associated with acute symptomatic seizure ( ASS) (occurring within 7 days) and late post-stroke seizure ( LPS) (>7 days). Methods All consecutive patients aged 15-49 with first-ever ischaemic stroke between 1994 and 2007 treated at the Helsinki University Central Hospital were included, using Cox proportional hazard models to identify factors associated with seizures. Adjustment was for age, gender, vascular risk factors, admission hyperglycemia (>6.1 mm) and hyponatremia (<137 mm), use of psychiatric medication, stroke severity ( NIH Stroke Scale) and anatomical (Bamford criteria) and etiological (Trial of Org in Acute Stroke Treatment) stroke subtype. Results ASSs emerged in 35 (3.5%) patients. LPSs ( n = 102) occurred at a cumulative rate of 6.1% at 1 year, 9.5% at 5 years and 11.5% at 10 years. In multivariate analysis, anxiolytic use at time of index stroke (hazard ratio 13.43, 95% confidence interval 3.91-46.14), moderate stroke severity (3.95, 1.86-8.41), cortical involvement (3.69, 1.66-8.18) and hyponatremia (3.26, 1.41-7.57) were independently associated with ASSs. Risk factors for LPSs were total anterior circulation infarct (15.94, 7.62-33.33), partial anterior circulation infarct (3.48, 1.52-7.93), history of ASS (3.94, 2.07-7.48), antidepressant use at the time of LPS (3.88, 2.46-6.11), hemorrhagic infarct (1.94, 1.19-3.15), male gender (1.79, 1.10-2.92) and hyperglycemia (1.62, 1.05-2.51). Conclusions In young ischaemic stroke patients, the magnitude of seizure risk and the major risk factors were similar to older ischaemic stroke patients but risk factors for ASSs and LPSs differed. [ABSTRACT FROM AUTHOR]

We report a 71 years old male who consulted in the emergency room for abdominal pain lasting 12 hours. On physical examination there was pain on abdominal palpation and signs of peritoneal irritation. An abdominal CT scan showed a thickening of the medial and distal ileum, multiple adjacent collections and signs of peritonitis. The patient was operated, observing multiple white tumors in the mesentery and serosa of small bowel, one of these lesions, adhered to the bowel wall, had a hemorrhagic infarct. One of the lesions was punctured, obtaining a milky fluid. Biopsies were obtained and the infarcted lesion was excised. The pathological study reported a Mesenteric Multilocular Lymphangioma. The patient had an uneventful postoperative evolution. [ABSTRACT FROM AUTHOR]

Introduction: The Penumbra system is a newly approved mechanical device for the treatment of acute stroke designed for better and faster recanalization. We describe our initial experience with the use of this device. Methods: We studied 27 consecutive patients with acute ischemic strokes due to arterial occlusions presenting at our center from January to October 2009. The primary outcome was the degree of recanalization measured by thrombolysis in myocardial infarction (TIMI grade 2/3) at the end of the procedure. Secondary end points were the proportion of patients who achieved a modified Rankin scale (mRS) ≤2 at 3 months, all-cause mortality and intracerebral hemorrhage (ICH) on non contrast computed tomography at 24 h. Procedural complications were also recorded. Results: Of 27 patients (13 male, mean age 61 years) in the study, 22 (81%) patients had anterior circulation strokes and five (18%) had posterior circulation strokes. Twenty-three (85%) patients achieved TIMI grade 2/3 recanalization at completion of the procedure. Excluding five patients who needed use of a second device, the Penumbra system achieved TIMI grade 2/3 recanalization in 67% of patients. Thirteen (48%) patients had mRS ≤2 at 3-month follow-up. Procedural and post-procedural complications included vasospasm (3.7%), distal emboli (48.1%), and ICH (33.3%). The distribution of ICH is as follows: hemorrhagic infarct type 1 (25.9%), parenchymal hemorrhage type 1 (3.7%), and parenchymal hemorrhage type 2 (3.7%). All-cause mortality was 19%. Conclusions: High recanalization rates and good clinical outcomes are achievable with the Penumbra system. Complication rates are comparable to a previously published literature. [ABSTRACT FROM AUTHOR]

Abstract: Background: Self-retaining brain retractors are commonly used during intracranial surgery, and they are indispensable during microneurosurgery. There is a common severe complication due to the use of self-held retractors, that is, formation of a hemorrhagic infarct area in the brain region exposed to traction. All the more, present retractor systems are fixed and rigid and obstruct surgeons during surgery. Sometimes these retractors create glare in the microscope that distracts the surgeon. We hereby propose a simple and easy method of retraction of brain especially the temporal lobe using the transsylvian approach and vermis using the transvermian approach. Methods: This is retrospective analysis of 47 patients in 4 years in which we have used our stitch retractor. We have analyzed their outcome, postoperative scan, and ease of performing surgery. Results: In 47 patients, there was only 1 postoperative contusion, and the longest period it was kept for is 6 hours. The other advantage was that it does not obstruct in any way while doing dissections and surgery. There was no glare while operating under a microscope. Conclusion: We hereby propose a simple and easy method of retraction of brain especially the temporal lobe using the transsylvian approach and vermis using the transvermian approach. It is minimally traumatic, reducing insult to the brain. It allows the surgeon to dissect without any obstruction and glare in the way. The biggest advantage of the present stitch retractor is that it is very cheap and simple to use. [Copyright &y& Elsevier]

Consequences of neonatal cerebral venous infarct can be severe. However, we have identified a series of neonates with unilateral temporal lobe infarcts, suspected to be secondary to superficial cortical venous thrombosis, who have had relatively normal outcomes. Medical records were reviewed retrospectively. History, relevant studies, and outcomes for 7 patients are described. Most patients presented with neonatal seizures. Neuroimaging showed unilateral temporal lobe hemorrhage and surrounding ischemic change, which was initially attributed to thrombosis of the vein of Labbe; however, magnetic resonance venogram findings suggest that thrombosis of other superficial temporal lobe veins may also be involved. Seizure control was achieved in all cases. Development and neurologic examination at follow-up were usually normal. We conclude that neonatal temporal lobe hemorrhagic infarct secondary to suspected superficial temporal venous thrombosis appears to have a good clinical outcome. This is surprising, given the dramatic imaging and clinical presentations. [ABSTRACT FROM AUTHOR]

OBJECTS: The aim of this study was to explore the pathogenesis of typical pituitary apoplexy in different periods, to help to formulate a reasonable treatment program and to select the correct operation time. METHODS: Forty-four cases with pituitary apoplexy were diagnosed by the clinical presentation, pathological examination and surgical findings. Clinical manifestation, imaging features, surgical and pathological findings, as well as their relationships with the courses of this disease were analyzed retrospectively. RESULTS: The course of typical pituitary apoplexy was divided into two stages (the early hemorrhagic infarct stage and the late necrosis stage). The total removal rates in the early and late stage were 87.5% (14/16) and 100% (28/28), respectively. CONCLUSIONS: Typical pituitary apoplexy is mainly caused by hemorrhage secondary to necrosis after infarction. The staging of this disease provides an important guidance value to diagnosis and treatment. The surgical outcomes in the late stage were significantly better than those in the early stage. The patients without significant symptoms can be conservatively treated by hormone substitution therapy. [ABSTRACT FROM AUTHOR]

Although the utility of magnetic resonance imaging (MRI) as a universal screening tool in preterminfants has been contested, it is increasingly used to investigate neonatal seizures. The authors evaluated 236 infants <34 weeks' gestationat birth. Seizures were documented according to the clinical standard of care. Infants underwent MRI and head ultrasound during the neonatal period, and a neuroradiologist and ultrasonologist performed detailed reviews of the images. During the hospital course, 9 infants (3.8%) had clinical suspicion of seizures. Magnetic resonance imaging was abnormal in each case. Periventricular hemorrhagic infarct was more common in infants with seizures. Infants with seizures were more likely to have white matter injury, though the difference was not significant. Head ultrasound failed to detect the extent of brain abnormality in 8 (89%) of the infants. In this large cohort, infants with clinical suspicion of seizures had a high rate of MRI abnormalities that were not as well characterized by head ultrasound. Magnetic resonance imaging may be the study of choice for evaluating preterm infants with seizures. [ABSTRACT FROM AUTHOR]

Severe neonatal hypernatremia is an important electrolyte disorder that has serious effects on the central nervous system, including brain edema, intracranial hemorrhage, hemorrhagic infarct, and thrombosis. Cerebral venous thrombosis is relatively rare in severe neonatal hypernatremic dehydration. The English literature contains only a few reports of the cranial radiological findings in severe neonatal hypernatremia. The authors report cranial MR venography findings of a newborn infant with severe hypernatremic dehydration. To the best of their knowledge, this is the first such report in the English literature. [ABSTRACT FROM AUTHOR]

Neuroimaging in seizures associated with nonketotic hyperglycemia (NKH) is considered normal. We report magnetic resonance imaging (MRI) abnormalities in four patients with NKH and seizures. We prospectively evaluated clinical and radiological abnormalities in four patients with NKH during the period March 2004 to December 2005. All patients presented with seizures, either simple or complex partial seizures or epilepsia partialis continua. Two of them had transient hemianopia. MRI showed subcortical T2 hypointensity in the occipital white matter and in or around the central sulcus (two patients each), T2 hyperintensity of the overlying cortex (two patients), focal overlying cortical enhancement (three patients) and bilateral striatal hyperintensity (one patient). Diffusion-weighted imaging (DWI) performed in three patients showed restricted diffusion. The ictal semiology and electroencephalographic (EEG) findings correlated with the MRI abnormalities. On clinical recovery, the subcortical T2 hypointensity and striatal hyperintensity reversed in all patients. The initial cortical change evolved to FLAIR hyperintensity suggestive of focal cortical gliosis. The radiological differential diagnosis considered initially included encephalitis, malignancy and hemorrhagic infarct rendering a diagnostic dilemma. We identified subcortical T2 hypointensity rather than hyperintensity as a characteristic feature of seizures associated with NKH. Only very few similar reports exist in literature. Reversible bilateral striatal T2 hyperintensity in NKH has not been reported to the best of our knowledge. [ABSTRACT FROM AUTHOR]