The Role of Patent Foramen Ovale in Cryptogenic Stroke Kriptojenik İnmede Patent Foramen Ovalenin Rolü

INTRODUCTION Approximately 40% of ischemic strokes with no clearly definable etiology are classified as cryptogenic stroke (1). The etiology of some cryptogenic strokes may be an embolus from the venous system traversing from the right to left atrium into the systemic circulation through a patent foramen ovale (PFO), a phenomenon known as paradoxical embolism (2). The first description regarding the association of PFO with stroke was in a young woman with cerebral arterial embolism by Cohnheim et al. (3) in 1877. At autopsy series of general population, the prevalence of PFO is 20−26% (4). However, PFO prevalence in cryptogenic strokes changes between 40% and 55.7% (5). A PFO located between the septum primum and septum secundum leads to the passage of fetal blood from the right atrium to the left atrium. In 75% of PFO cases, thi

The clinical efficiency of acupuncture in preventing migraine attacks and its effect on serotonin levels

Objectives: This study aims to investigate the efficacy of acupuncture in preventing migraine attacks

Leptomeningeal enhancement as a sole magnetic resonance imaging finding of secondary central nervous system vasculitis: A case report

The main radiological findings of central nervous system (CNS) consist of multiple subcortical infarcts, parenchymal and leptomeningeal enhancement, petechial hemorrhages on MRI and multifocal caliber changes of the vessels on MRA and DSA. Solely or prominent leptomeningeal enhancement is rarely seen as an isolated manifestation of CNS. We report a case of intracerebral vasculitis secondary to inflammatory bowel disease (IBD) showing leptomeningeal enhancement as a unique finding in routine contrast-enhanced cranial MRI and aimed to emphasize the importance of these finding in diagnosing CNS

Bilateral hypertrophic olivary degeneration secondary to ischemia following endovascular treatment of cerebral aneurysm: A case report

Hypertrophic olivary degeneration (HOD) is a degenerative disorder of the inferior olivary nucleus (ION) that occurs after damage to the dentatorubroolivary pathway (DROP). Damage to the DROP causes hypertrophy and enlargement of the inferior olivary nuclei (ION) contrary to the atrophy observed in the other parts of central nervous system. Focal lesions that may lead to HOD include ischemia, hemorrhage, trauma, and cavernous hemangioma and it also may mimic diseases including tumors and demyelinating processes. We here in present our experience with a case of bilateral HOD, which was a result of a thromboembolic complication during endovascular aneurysm embolization

LDL Subclasses in Ischemic Stroke: A Risk Factor?

Introduction: Seven low-density lipoprotein (LDL) subclasses are identified, and smaller LDL particles are associated with an increased risk for cardiovascular events. However, there is limited data about the relationship between the acute ischemic stroke (AIS) subtypes and LDL subclasses. The aim of our study is to investigate the relationship between AIS subtypes and LDL subclasses

Abstract Number ‐ 175: First Pass Results of Mechanical Thrombectomy with two‐drop zone NeVaTM Device

Introduction Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy.The NeVaTM(Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTMdevice for mechanical thrombectomy. Methods Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria.The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post‐intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded. Results There was female pre‐dominance (54.5%). Median presenting NIHSS was 16 (IQR, 3–32). 88 MCA‐m1 (60,6%), 43 ICA‐tip (29,6%), 11 MCA‐m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7–136). First‐pass reperfusion scores were mTICI 0–2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% andmTICI 3 35.9%.Mean number of pass was1,84±1,14.Final mTICI 2b‐3 score was 97.9% and TICI2c‐3 score was 87.6%. No device related adverse event occurred. The mean 24‐hour NIHS score was 6 (IQR 0–33). Conclusions In conclusion, the NeVa thrombectomy device offers a high rate of first‐pass success along with favorable safety profile. Larger series and multi‐center studies are needed for further investigatio

Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Background: Prior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (-6.4% (95% CI -7.0% to -5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: -5% (95% CI -5.9% to -4.3%), p=0.06; moderate: -8.3% (95% CI -10.2% to -6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION This study is registered under NCT04934020