12 research outputs found
Primary appendiceal mucinous adenocarcinoma in two first-degree relatives: case report and review
Carcinomas of the appendix are exceedingly rare tumors and have an annual age-adjusted incidence of around 0.4 cases per 100,000. Appendiceal adenocarcinoma accounts for < 0.5% of all gastrointestinal neoplasms and, of these, mucinous adenocarcinomas account for the majority. Published accounts of familial instances of primary appendiceal tumors are strikingly rare. We report two siblings who both developed primary mucinous adenocarcinomas. A genetics evaluation was conducted to determine if there was a recognizable underlying single gene disorder; no DNA mismatch repair defect was evident, and no other diagnosis was apparent. A review of appendiceal cancers seen at Mayo Clinic from l997 to the present was conducted to search for additional familial cases. Among 316 cases of primary appendiceal cancer of any histologic type, this sib pair was the only family reporting a second affected family member. The occurrence of appendiceal cancer in siblings may represent a random occurrence. An exceedingly rare predisposition syndrome cannot be ruled out
Expanding indications for endovascular thrombectomy-how to leave no patient behind.
Endovascular thrombectomy (EVT) has become standard of care for large vessel occlusion strokes but current guidelines exclude a large proportion of patients from this highly effective treatment. This review therefore focuses on expanding indications for EVT in several borderline indications such as patients in the extended time window, patients with extensive signs of infarction on admission imaging, elderly patients and patients with pre-existing deficits. It also discusses the current knowledge on intravenous thrombolysis as an adjunct to EVT and EVT as primary therapy for distal vessel occlusions, for tandem occlusions, for basilar artery occlusions and in pediatric patients. We provide clear recommendations based on current guidelines and further literature
Letter to the Editor for the article “Flat-head positioning increases cerebral blood flow in anterior circulation acute ischemic stroke: A cluster randomized phase IIb trial”
Ultrasound Assessment of Extracranial Carotids and Vertebral Arteries in Acute Cerebral Ischemia
Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation of extracranial vasculature. CDU has the advantages of a low cost, easily applicable, bed side examination with high temporal and spatial resolution and without exposing the patients to any significant complications. It represents an easily repeatable test that can be performed in the emergency room as a first-line examination of cervical artery pathology. CDU provides well validated estimates of the type of the atherosclerotic plaque, the degree of stenosis, as well as structural and hemodynamic information directly about extracranial vessels (e.g., subclavian steal syndrome) and indirectly about intracranial circulation. CDU may also aid the diagnosis of non-atherosclerotic lesions of vessel walls including dissections, arteritis, carotid-jugular fistulas and fibromuscular dysplasias. The present narrative review outlines all potential applications of CDU in acute stroke management and also highlights its potential therapeutic implications
HSV-Encephalitis Resembling Acute Cerebral Infarction in a Patient With Atrial Fibrillation Beware of Stroke Mimics
Introduction: Herpes simplex virus-1 (HSV-1) encephalitis, the most
common and potentially life-threatening type of encephalitis, may rarely
present as a stroke mimic. Prompt diagnosis is of paramount importance
for the timely initiation of antiviral treatment and to avert
intravenous thrombolysis. Case Report: A 60-year-old man with a history
of lone paroxysmal atrial fibrillation without prior antithrombotic
treatment was admitted due to mild gait unsteadiness and intermittent
dysarthria of acute onset. On admission, the patient was afebrile,
whereas neurological examination revealed only a mild pronator drift on
the left. Brain magnetic resonance imaging (MRI) showed an extensive
right temporo-occipital and thalamic lesion with restricted diffusion
and 3 small-sized hemorrhagic foci. Brain MR-angiography did not show
large vessel stenosis or occlusion. On the basis of careful observation
and the depiction of several imaging discrepancies, such as early
vasogenic edema and hemorrhagic transformation, as well as uncus
involvement, but also the lack of significant neurological deficits
despite the size of the brain lesion we suspected viral encephalitis
which was confirmed by the detection of HSV-1 DNA in the cerebrospinal
fluid. Conclusion: HSV-encephalitis might occasionally result in the
development of unilateral brain MRI lesions with extensive cytotoxic
edema, resembling an acute ischemic stroke. Therefore, HSV-encephalitis
must be considered in the differential diagnosis of acute ischemic
stroke with atypical presentation. The presence of a significant
dissociation between the brain MRI lesion volume and the neurological
deficits, as well as certain brain MRI imaging discrepancies might serve
as “red flags” to extend the diagnostic workup
Ultra-Early Remote Intracranial Hemorrhage Complicating Intravenous Thrombolysis with Tenecteplase for Acute Ischemic Stroke
Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective
Advanced neuroimaging is one of the most important means that we have in the attempt to overcome time constraints and expand the use of intravenous thrombolysis (IVT). We assessed whether, and how, the prior use of advanced neuroimaging (AN), and more specifically CT/MR perfusion post-processed with RAPID software, regardless of time from symptoms onset, affected the outcomes of acute ischemic stroke (AIS) patients who received IVT. Methods. We retrospectively evaluated consecutive AIS patients who received intravenous thrombolysis monotherapy (without endovascular reperfusion) during a six-year period. The study population was divided into two groups according to the neuroimaging protocol used prior to IVT administration in AIS patients (AN+ vs. AN−). Safety outcomes included any intracranial hemorrhage (ICH) and 3-month mortality. Effectiveness outcomes included door-to-needle time, neurological status (NIHSS-score) on discharge, and functional status at three months assessed by the modified Rankin Scale (mRS). Results. The rate of IVT monotherapy increased from ten patients per year (n = 29) in the AN− to fifteen patients per year (n = 47) in the AN+ group. Although the onset-to-treatment time was longer in the AN+ cohort, the two groups did not differ in door-to-needle time, discharge NIHSS-score, symptomatic ICH, any ICH, 3-month favorable functional outcome (mRS-scores of 0–1), 3-month functional independence (mRS-scores of 0–2), distribution of 3-month mRS-scores, or 3-month mortality. Conclusion. Our pilot observational study showed that the incorporation of advanced neuroimaging in the acute stroke chain pathway in AIS patients increases the yield of IVT administration without affecting the effectiveness and safety of the treatment
Recommendations for Mechanical Thrombectomy in Patients with Acute Ischemic Stroke A Clinical Guide by the Hellenic Stroke Organization
This document presents the consensus recommendations of the Hellenic Stroke Organization which can be of assistance to the treating stroke physicians
Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective
Advanced neuroimaging is one of the most important means that we have in
the attempt to overcome time constraints and expand the use of
intravenous thrombolysis (IVT). We assessed whether, and how, the prior
use of advanced neuroimaging (AN), and more specifically CT/MR perfusion
post-processed with RAPID software, regardless of time from symptoms
onset, affected the outcomes of acute ischemic stroke (AIS) patients who
received IVT. Methods. We retrospectively evaluated consecutive AIS
patients who received intravenous thrombolysis monotherapy (without
endovascular reperfusion) during a six-year period. The study population
was divided into two groups according to the neuroimaging protocol used
prior to IVT administration in AIS patients (AN+ vs. AN-). Safety
outcomes included any intracranial hemorrhage (ICH) and 3-month
mortality. Effectiveness outcomes included door-to-needle time,
neurological status (NIHSS-score) on discharge, and functional status at
three months assessed by the modified Rankin Scale (mRS). Results. The
rate of IVT monotherapy increased from ten patients per year (n = 29) in
the AN- to fifteen patients per year (n = 47) in the AN+ group. Although
the onset-to-treatment time was longer in the AN+ cohort, the two groups
did not differ in door-to-needle time, discharge NIHSS-score,
symptomatic ICH, any ICH, 3-month favorable functional outcome
(mRS-scores of 0-1), 3-month functional independence (mRS-scores of
0-2), distribution of 3-month mRS-scores, or 3-month mortality.
Conclusion. Our pilot observational study showed that the incorporation
of advanced neuroimaging in the acute stroke chain pathway in AIS
patients increases the yield of IVT administration without affecting the
effectiveness and safety of the treatment
Cerebral Amyloid Angiopathy—Related Inflammation: A Single-Center Experience and a Literature Review
Background: Limited data exist regarding the prevalence of clinical, neuroimaging, and genetic markers among patients diagnosed with Cerebral Amyloid Angiopathy–related inflammation (CAA-ri). We sought to determine these characteristics in patients diagnosed in our center and to summarize available literature published either as single-case reports or small case series (<5 patients). Methods: We reported our single-center experience of patients diagnosed with CAA-ri according to international criteria during a seven-year period (2015–2022), and we abstracted data from 90 previously published cases. Results: Seven patients (43% women, mean age 70 ± 13 years) were diagnosed with CAA-ri in our center. The most common symptom at presentation was focal neurological dysfunction (71%), and the most prevalent radiological finding was the presence of T2/FLAIR white matter hyperintensities (100%). All patients were treated with corticosteroids and had a favorable functional outcome. Among 90 previously published CAA-ri cases (51% women, mean age 70 ± 9 years), focal neurological dysfunction was the most common symptom (76%), followed by a cognitive decline (46%) and headache (34%). The most prevalent neuroimaging findings were cerebral microbleeds (85%), asymmetric T2/FLAIR white matter hyperintensities (81%), and gadolinium-enhancing T1-lesions (37%). Genetic testing for the Apolipoprotein-E gene was available in 27 cases; 59% carried the APOE ε4/ε4 genotype. The majority of the published CAA-ri cases (78%) received corticosteroid monotherapy, while 17 patients (19%) were treated with additional immunosuppressive treatment. Favorable functional outcome following treatment was documented in 70% of patients. Conclusion: Improving the vigilance of clinicians regarding the early recognition and accurate diagnosis of CAA-ri is crucial for swift therapy initiation, which may result in improved functional outcomes