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Introduction: The diagnosis of giant cell arteritis (GCA) by ultrasonography including large vessels, apart from the temporal artery increases the sensibility of the study and informs about the risk of specific complications. However, there is less information about the study of these arteries, whose affection carries higher proportion of severe complications., Objectives: To describe and analyze the value of the diameter of the cervical vertebral canal of the vertebral artery (VA) as a sign of vertebral vasculitis (VV) related to GCA and estimate the risk of stroke complications., Materials and Methods: Observational study of a population that includes patients with GCA with and without VA vasculitis as well as healthy subjects. We evaluated whether there were differences in VA diameter in the groups and, if so, we estimated the diagnostic capacity of the variable that best defines VA diameter using a ROC curve. Cut-off points with their associated reliability chosen thereafter., Results: There were 347 subjects included:107 with GCA of whom 37 had vertebral vasculitis, 240 healthy controls. In patients with GCA and VV, the VA diameter was increased (No GCA 3.4 mm, GCA without VV 3.6 mm, GCA with VV 5.2 mm p  < 0.01). According to the ROC curves, the variable defining vertebral diameter with best diagnostic accuracy is the sum of both sides (area under the curve of 0.98). With a cut-off point of 8.45 mm, the reliability values are: sensitivity 94.1%, specificity 94.5%, PPV 82.1% and NPV 98.4%. With a cut-off point of 9.95 mm, the sensitivity is 52.9% and the specificity is 100%. Likewise, VA diameter is independently associated with the presence of stroke in the vertebrobasilar territory (OR 1.6, range 1.2-2.2)., Conclusion: The VA diameter, measured as the sum of both sides, is an objectively measurable sign with very high reliability for detect vertebral vasculitis in patients with GCA. It is proposed here as a novel echographic sign, which can aid the detection of the involvement of an artery where the complications are especially serious., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ayo-Martin, Garcia-Garcia, Hernandez-Fernandez, Palao, Poyatos-Herraiz, Barahona-Espinal, Gonzalez-Romero, Marin-Conesa, Serrano-Serrano, Paya and Segura.)

Background and Purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year., Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020)., Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths., Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Overweight and obesity are well-known independent risk factors for stroke in the general population although uncertain in the case of the elderly, according to the obesity paradox. Little is known about underlying mechanisms. Our study aims to assess whether there is a relationship between excess body weight (measured as waist circumference) and poor cerebral hemodynamics (measured by transcranial Doppler parameters: basal, mean flow velocity (MFV), and dynamic, cerebrovascular reserve (CvR) in the right middle cerebral artery (RMCA)). A possible underlying molecular mechanism was analyzed via plasma leptin, adiponectin, TNF-α, IL-6, VCAM, and CRP levels. One hundred sixty-five subjects were included. Bivariate and multivariate regression showed a linear correlation between waist circumference and hemodynamics in RMCA, with clear gender effects: MFV (global NS, men β - 0.26 p < 0.01; women NS), CvR (global: β - 0.15 p < 0.01; men: β - 0.29 p < 0.01, women: β - 0.19 p < 0.09). For subjects above 65 years, there is no significant relationship between AbP and cerebral hemodynamics. In multivariate regression models, only leptin correlated independently with MFV in RMCA (β 7.24, p < 0.01) and CvR (β - 0.30, p < 0.01). In both cases, waist circumference remains significantly related to both parameters. There is an inverse linear correlation between excess body weight and cerebral hemodynamics, independent of other vascular risk factors and clearly influenced by gender. This relation disappears in the elderly population. Leptin might play a role in this relationship. Nevertheless, there must be another associated mechanism, not identified in this study.

Introduction: The histological composition of the clot influences its mechanical properties, affects the efficacy of endovascular treatment (EVT), and could determine the clinical outcome of patients with acute ischemic stroke (AIS). Insights into clot composition may guide therapeutic decision-making prior to EVT and facilitate revascularization therapies. Material and Methods: Consecutive patients with AIS recorded in a prospective single-center reperfusion registry from December 2015 to December 2019 and treated with EVT were included. Baseline, laboratory [including post-procedural C-reactive protein (CRP)], radiological, and angiographic variables were analyzed. We aimed to study the relationship between histological composition of the clot with basal neuroimaging, laboratory markers, and recanalization technique. The secondary outcome was to analyze the correlation between clot composition and functional outcome at 3 months assessed by the modified Rankin scale (mRS). Results: From the study period, 360 AIS patients treated with EVT were included, of whom 189 (53%) fulfilled the inclusion criteria. One hundred (53%) cases of fibrin-predominant clot (FPC) were recorded. Full recanalization in FPC cases was achieved with higher probability when stent retrievers (SR) were selected as the first-line device (68.2%, p = 0.039). Patients with FPC had higher levels of CRP ( p = 0.02), lower frequency of the hyperdense middle cerebral artery (HMCA) in baseline imaging ( p = 0.039), and higher rates of mortality ( p = 0.012). The multivariate analysis showed that the absence of HMCA (OR = 0.420; 95% CI 0.197-0.898; p = 0.025) and higher levels of CRP (OR = 1.01; 95% CI 1.003-1.019; p = 0.008) were predictors of FPC. Leukocytes and platelet counts were not associated with clot histology. Conclusions: The absence of HMCA and higher levels of CRP were markers of FPC. In patients with FPC, complete recanalization was most likely to be achieved when a SR was selected as first line of treatment. Mortality was higher in patients within this histologic group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hernández-Fernández, Ramos-Araque, Barbella-Aponte, Molina-Nuevo, García-García, Ayo-Martin, Pedrosa-Jiménez, López-Martinez, Serrano-Heras, Julia-Molla and Segura.)

Introduction: An arterial gas embolism is defined as the presence of air in the arterial circulation. This is an extremely rare cause of stroke that has been described in a multitude of clinical scenarios, generally related to iatrogenic processes. A clinical case is reported in which the arterial gas embolism occurred after a traumatic brain injury, and the most relevant aspects of diagnosis and aetiopathogenesis are reviewed., Case Report: We report the case of a 52-year-old woman with an open craniofacial wound resulting from an attack with an axe. The initial CT scan found fractures in the left zygomatic, sphenoidal and maxillary arches, as well as pneumocephalus in the cavernous sinuses and the right carotid canal. One hour later, the patient showed a neurological deficit in the right hemisphere, and so a new cranial computed tomography scan with multimodal vascular study was urgently requested, which revealed the mobilisation of the pneumocephalus and ruled out a large vessel arterial occlusion. A shunt study using transcranial Doppler and echocardiography showed the presence of a patent foramen ovale to be the cause of arteriovenous communication that justified an arterial gas embolism. The follow-up CT scan at 48 hours confirmed the appearance of a right parietal ischaemic lesion., Conclusion: This case reflects the simultaneous presence of air in the arterial and venous circulation of the brain, as well as the peripheral communication through a patent foramen ovale. This production mechanism is poorly documented in the literature.

INTRODUCTION. Atherosclerotic occlusion of the brachiocephalic trunk (CBT) is a rare clinical entity and its presentation in the form of arterio-arterial embolism is uncommon. Early identification of patients with CBT occlusion may have important therapeutic implications. CASE REPORT. A man aged 49 presents with sudden onset symptoms involving the territory of the right middle cerebral artery. Emergent transcranial doppler evaluation showed a flow pattern of proximal right M1 occlusion. After intravenous recombinant tissue plasminogen activator administration, partial recanalization of the vessel was found and the patient improved clinically. Cervical and transcranial duplex sonography demonstrated an occlusion in CBT, which was later confirmed on CT angiography and digital angiography of supraaortic vessels. After aorto-innominate bypass, pathological analysis confirmed the atherosclerotic origin. CONCLUSIONS. The most common clinical presentation of CBT occlusion are transient ischemic symptoms related to steal phenomenon in the vertebro-basilar territory. Symptoms of carotid circulation stroke usually result from arterio-arterial embolic mechanism. Early recognition is important for its therapeutic implications, therefore thrombolytic therapy should be indicated. Neurosonologic study allows rapid and reliable examination on hemodynamic status and the presence of distal embolic phenomena.

A 72-year-old male presented to the emergency department with gait instability and unclear speech. Computed tomography of the brain showed old lacunar infarcts in basal ganglia. Transcranial Doppler (TCD) sonography was normal. Extracranial Duplex sonography showed indirect hemodynamic signs of bilateral subclavian artery stenosis and both vertebral arteries also showed delayed systolic flow increase. A bilateral subclavian steal phenomenon was suspected, and arm compression tests was performed. The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde. Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms. So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.