Cerebral blood volume ASPECTS is the best predictor of clinical outcome in acute ischemic stroke: A retrospective, combined semi-quantitative and quantitative assessment

INTRODUCTION:The capability of CT perfusion (CTP) Alberta Stroke Program Early CT Score (ASPECTS) to predict outcome and identify ischemia severity in acute ischemic stroke (AIS) patients is still questioned. METHODS:62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT), recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS) at 3 months after onset were recorded. RESULTS:Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001). CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS ≤ 2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001). CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02) only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome. CONCLUSIONS:Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size

Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

BACKGROUND: The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. METHODS: A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). RESULTS: During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02-1.06, p&nbsp;&lt; 0.001), severe hepatic failure (OR 3.25, 95% 1.31-8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04-1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24-3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. CONCLUSIONS: The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions

Stroke admissions during the COVID-19 pandemic: a single-center retrospective analysis

The SARS-CoV-2 pandemic affected the organization of the healthcare system, and several studies analyzed the impact on hospitalization for non-COVID diseases, in particular during the first wave period. We sought to analyze the impact of the pandemic on stroke care in the province of Ferrara during a longer pandemic period and its different phases

Early Combined Percutaneous Aortic Valvuloplasty and Carotid Endarterectomy In A Patient With Minor Ischemic Stroke and High Perioperative Risk

Objectives: Here, we present the case of L.B., a 68-year-old Caucasian male patient who reported a sudden onset of right upper limb weakness and transient visual disturbance. Materials and methods: Therefore, he was referred to ER of S. Anna University Hospital of Ferrara. His medical history included moderate aortic valve stenosis due to previous rheumatic heart disease at early age, dyslipid- emia, hypertension and not significant epi-aortic trunks atherosclerosis. Arrived at the Hospital on May 24th 2020, neurological evaluation document- ed just a slight weakness of right upper limb (NIHSS 1); accordingly, he performed urgent brain CT, showing no acute lesions, and he was admitted to the Stroke Unit. A Carotid US was carried out, which showed an iso- hypoechogenic ulcerated plaque with hemodynamic stenosis of 70% at the origin of the left internal carotid artery; patient also underwent echocardiog- raphy, which documented an evolution of the previously known aortic valve stenosis in severe degree stenosis (left ventricular outflow tract diameter 2.3 cm, Aortic valve area 0,87 cm2 ). Results: Considered neurological and instrumental findings, an indi- cation was given for very early carotid TEA, but this was contraindicated for the high operative risk linked to the cardiac condition. Hence, on May 26th 2020, the patient underwent a coronary angiography + balloon percutaneous aortic valvuloplasty (inflation of a 20 ml balloon), as a bridge procedure in order to perform early carotid TEA intervention dur- ing the same day (after a few hours). Discussion and Conclusion: These procedures were carried out with- out complications and the patient had full neurological recovery at dis- charge, one week later. Furthermore, coronary angiography showed a critical stenosis of the middle tract of the LAD with a subcritical stenosis of common trunk. Thus, the patient was listed for a CABG and definitive surgical aortic valve replacement

Transorbital Ultrasound for Morphological and Haemodynamical Assessment of Optic Nerve in Multiple Sclerosis

Background and aims: Changes of the optic nerve (ON) reflect the overall pathology in multiple sclerosis (MS). Transorbital ultrasonography (TOUS) is a promising tool for detecting ON changes after exposure to optic neuritis. We aimed to explore ON haemodynamic in addition to morphological changes in a sample of MS patients. Methods: Sixty-seven MS patients (Thompson diagnostic criteria) were included in this preliminary study: 53 women and 14 men aged 41.6 (11.3) and 40.1 (11.0) (p=ns) years. EDSS score was 0-2.5 in 47 (70.1%) and &gt;2.5 in 20 (14.9%) subjects. ANCOVA was used to investigate the association between US morphological (ON diameter (OND) at 3 and 5 mm from papilla, ON sheath diameter (ONSD) at 3 mm from papilla and myelination index (MI) ratio), a history of optic neuritis, controlling for sex and EDSS. Results: Out of 134 eyes no history of optic neuritis was recorded in 89 (66.4%), while at least 1 episode was recorded for 45 (33.6%). A higher proportion of affected eyes among women (86.4%) than men (13.6%) was observed (p=ns). OND – at 5 mm from papilla especially - and ONSD at 3 mm were significantly reduced in ONs with optic neuritis. MI ratios were higher in affected vs unaffected eyes. Mean ON diameters were lower in patients with higher EDSS score, irrespective of history optic neuritis. Mean flow velocity was reduced in affected eyes for all principal arteries explored. Conclusion: TOUS and Doppler US examination can detect ON changes in MS, showing potential for prognostic marker

Brain unidentified bright objects ("UBO") in systemic lupus erythematosus: sometimes they come back. A study of microembolism by cMRI and Transcranial Doppler ultrasound

The objectives of this report are to assess the occurrence of microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) in systemic lupus erythematosus (SLE) patients with (NPSLE) and without (SLE) neuropsychiatric involvement, and to verify the correlation between MES, clinical characteristics, especially the patent foramen ovale (PFO), and the presence of punctuate T2-hyperintense white matter lesions (WMHLs) detected by conventional magnetic resonance imaging (cMRI).Objectives The objectives of this report are to assess the occurrence of microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) in systemic lupus erythematosus (SLE) patients with (NPSLE) and without (SLE) neuropsychiatric involvement, and to verify the correlation between MES, clinical characteristics, especially the patent foramen ovale (PFO), and the presence of punctuate T2-hyperintense white matter lesions (WMHLs) detected by conventional magnetic resonance imaging (cMRI).Methods A TCD registration to detect MES from the middle cerebral artery was carried out in SLE and NPSLE patients after exclusion of aortic and/or carotid atheromatous disease. In all patients conventional brain magnetic resonance imaging (cMRI) and transesophageal echocardiography were performed. Patients were stratified in two groups, with and without WMHLs, and compared.Results Twenty-three SLE patients (16 NPSLE and seven SLE) were enrolled in the study. Overall MES were detected in 12 patients (52.1%), WHMLs were detectable in 15 patients (13 NPSLE and two SLE) while eight patients had normal cMRI (three NPSLE and five SLE). Matching TCD ultrasound and neuroimaging data, MES were detected in 10 (nine NPSLE and one SLE) out of 15 patients with WHMLs and in only two out of eight patients (two NPSLE and six SLE) with normal cMRI, both with NP involvement. A PFO was confirmed in all cases of MES detection.Conclusion MES are frequent findings in SLE patients, especially in those with focal WMHLs detected by cMRI and correlating with PFO. These findings should be taken into account and suggest caution in the interpretation of cMRI pictures along with a careful evaluation of MES in patients with cMRI abnormalities that should be included in the workup of SLE patients

Impact of Glomerular Filtration Rate on Intravenous Thrombolytic Therapy in Acute Ischemic Stroke: A Retrospective Study from a Single Italian Center

Aim: Chronic kidney disease (CKD) is a risk factor for stroke and in-hospital mortality due to stroke. Stroke is highly prevalent in CKD patients. Our aim was to evaluate the impact of glomerular filtration rate in acute ischemic stroke (IS) patients after thrombolytic therapy.&nbsp;&nbsp;Methods: All patients who underwent thrombolytic therapy for acute IS in our Department between 2009 and 2012 were studied retrospectively. Age, co-morbidities, blood pressure, glycaemia, National Institutes of health Stroke Scale score were evaluated. Renal function was estimated by CKD-EPI equation. Three-month outcome (death, residual disability, intracranial hemorrhage) in patients with glomerular filtration rate (GFR) &lt;60 ml/min/1.73m2 was compared to that of patients with GFR ≥ 60 ml/min/1.73 m2. Logistic regression analysis was used to determine which factor was independently associated with outcome. Results: Among 191 patients treated for acute IS, 74 had GFR&lt;60 ml/min/1.73m2. They were older and had higher prevalence of hypertension than patients with normal filtration rate. We found no differences in 3-month death or poor outcome between the two groups. However, patients with impaired renal function had a significantly higher risk of hemorrhagic complication (OR = 2.5; 95% CI = 1.1-6.2, p&lt;0.01).Conclusion: GFR&lt;60 ml/min/1.73m2 significantly affects the risk of intracranial hemorrhage in stroke patients treated with thrombolytic therapy. Hence, subjects with reduced renal function eligible for intravenous thrombolysis could be informed about the increased ICH risk.</p