Subacute Infarction Research Articles

Andrographolide protects against isoproterenol-induced myocardial infarction in rats through inhibition of L-type Ca2+ and increase of cardiac transient outward K+ currents

Myocardial infarction (MI) is the irreversible injury of the myocardium caused by prolonged myocardial ischemia and is a major cause of heart failure and eventual death among ischemic patients. The present study assessed the protective potentials of andrographolide against isoproterenol-induced myocardial infarction in rats. Animals were randomly divided into four groups: Control (Ctr) group received 0.9% saline solution once daily for 21 days, Isoproterenol (Iso) group received 0.9% saline solution once daily for 19 days followed by 80 mg/kg/day of isoproterenol hydrochloride solution on day 20 and 21, Andrographolide (Andro) group received 20 mg/kg/day of andrographolide for 21 days, and Andrographolide plus Isoproterenol (Andro + Iso) group received 20 mg/kg/day of andrographolide for 21 days with co-administration of 80 mg/kg/day of isoproterenol hydrochloride solution on day 20 and 21. After all treatments, cardiac-specific parameters that define cardiac health and early subacute MI were measured in all groups using both biophysical and pharmacological assay methods. Isoproterenol administration significantly (P < 0.05) increased cardiac mass indexes, systemic cardiac biomarkers, infarct size and caused cardiac histological alterations; significantly (P < 0.05) increased heart rate, QRS & QTc intervals and caused ST-segment elevation; significantly (P < 0.05) increased myocytes shortening, action potential duration (APD), L-type Ca2+ current (ICa,L) density and significantly (P < 0.05) decreased transient outward K+ current (Ito) density typical of the early subacute MI. Interestingly, pretreatment with andrographolide prevented and or minimized these anomalies, notably, by reducing ICa,L density and increasing Ito density significantly. Therefore, andrographolide could be seen as a promising therapeutic agent capable of making the heart resistant to early subacute infarction and it could be used as template for the development of semisynthetic drug(s) for cardiac protection against MI.

The Long-Term Functional Effect of Thrombectomy on Patients with Middle Cerebral Artery Occlusion Who Exhibit Moderate to Severe Disability.

Background and Objectives: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We investigated the effects of EVT on the activities of daily living (ADL), handicap, gait, and eating in patients with middle cerebral artery (MCA) occlusion who exhibited moderate to severe disability (score of 3–5 on the modified Rankin scale (mRS)) due to stroke, up to six months after onset. Materials and Methods: This retrospective longitudinal case–control study assessed 45 patients with MCA occlusion who exhibited moderate to severe disability (mRS score ≥ 3): 15 underwent EVT and 30 served as controls. Clinical assessments were conducted at two weeks (12–16 days), four weeks (26–30 days), and six months (180–210 days) after stroke onset. Functional assessments comprised the Korean version of the modified Barthel index (MBI), mRS, functional ambulation category (FAC), and dysphagia outcome severity scale (DOSS) to assess disability, handicap, gait, and eating. Results: The MBI, mRS, FAC, and DOSS scores all improved significantly (all p < 0.05) in the EVT group, compared to the controls. Conclusions: EVT has favorable effects on performing routine ADL, the handicap itself, walking, and eating. Therefore, EVT is recommended for patients with acute MCA occlusion, including those with severe disability at the initial assessment.

An Exceedingly Rare Case of Antithrombin III Deficiency and Catastrophic Antiphospholipid-Like Disease

Antithrombin III (AT III) is a critical component of the coagulation cascade that functions primarily to inhibit activated coagulation factors IIa and Xa. AT III deficiency is a disorder that predisposes patients to thromboemboli. Antiphospholipid syndrome (APS) is an autoimmune disorder that predisposes patients to vascular and microvascular thrombosis, which can often be devastating and lead to multiorgan involvement. The mainstay of treatment for both conditions involves the use of lifetime vitamin K antagonists. Recent studies suggest that patients with APS refractory to warfarin therapy may benefit from the addition of aspirin, statin, or hydroxychloroquine; low weight molecular heparin; or a combination regimen. Studies have also suggested that patients with AT III deficiency refractory to warfarin therapy may see improvement with use of a novel oral anticoagulant. This case report describes the recurrent hospitalizations of a 45-year-old patient who presented with multiorgan thrombosis involving the descending aorta, deep lower extremity veins, superior mesenteric artery and artery of the brain. This led to mesenteric ischemia, limb necrosis and a subacute frontal cortex infarct. Initial anticoagulation therapy was refractory to the use of warfarin. Enoxaparin therapy was initiated, resulting in no further thrombotic events. Clinicians should consider poor gastrointestinal absorption of warfarin in patients who fail to reach therapeutic anticoagulation goals. In addition, a thorough workup for hereditary and acquired thrombophilias should be performed in patients who present with recurrent thromboemboli, as these disorders increase the risk of poor patient outcomes if left untreated. J Med Cases. 2021;12(7):262-266 doi: https://doi.org/10.14740/jmc3689

Sequential pontine and bilateral cerebral peduncle infarction with resultant early Wallerian degeneration of the ponto‐cerebellar fibers

AbstractBilateral cerebral peduncular infarction (BCPI) is an extremely rare neurological disorder reportedly associated with locked‐in syndrome. A 60‐year‐old man represented with reduction in conscious level three weeks following a paramedian pontine infarction due to basilar artery thrombosis. Repeated MRI revealed subacute pontine infarction with new infarct involving bilateral cerebral peduncle. MRA showed absent flow‐related signal along the basilar artery consistent with occlusion. Additionally, Wallerian degeneration characterized by symmetrical hyperintense signal on MRI involving the ponto‐cerebellar fibers and both the middle cerebellar peduncles (MCPs) were seen. BCPI is an exceedingly rare type of stroke with characteristic symmetrical signal change involving the cerebral peduncles called “Mickey Mouse Ear” sign. Early Wallerian degeneration of the bilateral MCPs ensuing pontine infarction is also uncommon and is often detected incidentally and exhibits regular and symmetrical signal changes on MRI. Here, a rare encounter of early Wallerian degeneration following sequential pontine and BCPI is described.

Intrapericardial regenerative therapies in experimental subacute myocardial infarction. comparative study of microencapsulated versus free cdcs administration

Intrapericardial regenerative therapies in experimental subacute myocardial infarction. comparative study of microencapsulated versus free cdcs administration

Impact of COVID-19 Pandemic on Presentation and Outcome of Consecutive Patients Admitted to Hospital Due to ST-Elevation Myocardial Infarction

Impact of COVID-19 pandemic and pandemic-related social restrictions on clinical course of patients treated for acute ST-elevation myocardial infarction (STEMI) is unclear. In the present study presentation and outcome of patients with STEMI in the year 2020 were compared with the years before in a German registry that includes all patients hospitalized for acute STEMI in a region with approximately 1 million inhabitants. In the year 2020 726 patients with STEMI were registered compared with 10.226 patients in the years 2006 to 2019 (730 ± 57 patients per year). No significant differences were observed between the groups regarding age, gender and medical history of patients. However, in the year 2020 a significantly higher rate of patients admitted with cardiogenic shock (21.9% vs 14.2%, p <0.01) and out-of-hospital cardiac arrest (OHCA) (14.3% vs 11.1%, p <0.01) was observed. The rate of patients with subacute myocardial infarction (14.3% vs 11.6%, p <0.05) was elevated in 2020. Hospital mortality increased by 52% from the years 2006 to 2019 (8.4%) to the year 2020 (12.8%, p <0.01). Only 4 patients (0.6%) with STEMI in the year 2020 had SARS-CoV-2 infection, none of those died in-hospital. In conclusion, in the year 2020 a highly significant increase of STEMI-patients admitted to hospital with advanced infarction and poor prognosis was observed. As the structure of the emergency network to treat patients with STEMI was unchanged during the study period, the most obvious reason for these changes was COVID-19 pandemic-related lockdown and the fear of many people to contact medical staff during the pandemic.

Improved Detectability of Brain Stem Ischemia by Combining Axial and Coronal Diffusion-Weighted Imaging.

To evaluate the benefit of a coronal diffusion-weighted imaging (DWI) in addition to standard axial DWI for the detection of brain stem infarctions. A retrospective analysis of patients with symptoms consistent with acute and subacute brain stem infarction who received magnetic resonance imaging, including axial and coronal DWI. Diffusion restrictions were identified by 2 independent raters blinded for the final clinical diagnosis in 3 separate reading steps: axial DWI, coronal DWI, and combined axial and coronal DWI. Lesion location and certainty level were both documented for each reading step. In cases of reader disagreement, an additional consensus reading was performed. Two hundred thirty-nine patients were included. Of these, 124 patients (51.9%) were clinically diagnosed with brain stem infarction. Sensitivity, specificity, positive, and negative predictive values were best for combined DWI assessment (90.3%, 99.1%, 99.1%, and 90.5%) compared with axial (85.5%, 94.9%, 94.6%, and 85.8%) and coronal DWI alone (87.9%, 96.5%, 96.5%, and 88.1%). Diffusion restriction on combined DWI was diagnosed in 112/124 patients compared with 106/124 on axial DWI and 109/124 on coronal DWI. Interobserver agreement for the detection of brain stem lesions was the highest in the combined rating step (Cohen κ coefficient=0.94). Coronal DWI sequences might improve the detection rate of brain stem infarction compared with standard axial DWI. The combined coronal and axial DWI provides the best detection rate while minimally increasing scan times.

Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient

Cerebral venous sinus thrombosis (CVST) is an uncommon manifestation in patients with the human immunodeficiency virus (HIV) due to the virus’s prothrombotic state. Our case involves a 41-year-old Hispanic male with a past medical history of HIV on bictegravir/emtricitabine/tenofovir/alafenamide (Biktarvy), hyperlipidemia, post-traumatic stress disorder, hypogonadism with the cessation of testosterone injections one month prior, and generalized anxiety disorder who presented with retro-orbital headache, intermittent bilateral blurry vision, and flashing lights in the lower lateral left eye for one week. Vitals signs and laboratory studies were within normal limits aside from new iron deficiency anemia. Neurological exam was unremarkable. Computed tomography (CT) of the head showed evidence of a subacute cerebral infarct with hemorrhagic transformation in the right superior parietal lobe. Magnetic resonance imaging (MRI) of the brain with contrast revealed a small thrombosed cortical vein with surrounding hemorrhage and edema in the same location, in addition to a partial thrombosis of the adjacent superior sagittal sinus, which was confirmed by magnetic resonance venogram (MRV). Although cerebral angiography was performed, no intervention was attempted for the partially occluded sagittal sinus. HIV viral load was undetectable with a robust cluster of differentiation (CD) 4 count on therapy. The patient was treated with strict blood pressure control, a statin, and a heparin drip. He remained stable and was discharged on enoxaparin injections with bridging to warfarin. In summary, appropriate lab testing, imaging, and high clinical suspicion are required for proper diagnosis and treatment of venous thromboembolism (VTE) or CVST in an HIV-positive patient.

Surgical management of cavernous sinus mucormycosis through minipterional approach

Rhino-cerebral mucormycosis is a rare fulminant fungal infection, that mostly occurs in individuals with committed immunity. The delay caused by late occurrence of cerebral manifestations led to poor prognosis. The treatment involves aggressive surgical therapy, with repeated debridement, in combination with intravenous anti-fungic therapy. We describe a case of microsurgical resection of rhino-cerebral mucormycosis with cavernous sinus extension and internal carotid thrombosis. Informed written consent was obtained from the patient. A 41-year-old patient, with diabetes mellitus was admitted at a nearby hospital for frontal headache and nasal congestion.Computed tomography scan showed diffuse sinusitis. Endoscopic endonasal debridement of the paranasal sinuses was performed. Patient was then transferred to our institution. After one day of treatment, patient developed left sided hemiplegia and worsening of periorbital swelling. Magnetic resonance image depicted hyperintense signal changes in the right orbit, ethmoidal and maxillary sinus, partial thrombosis of the right cavernous sinus and internal carotid artery, and right fronto-parietal ischemia.Debridement of the ethmoidal, maxilla and sphenoidal sinus, associated with right eye enucleation were performed. Histopathological examination revealed the presence of mucormycosis. Serial MRI imaging studies after day 40 showed increased extension of inflammatory changes in the right cavernous sinus and increased mass in the right trigeminal nerve, thrombosis of the right internal carotid artery and subacute cerebral infarcts. Because of the persistence of the infection the patient underwent extradural and subdural microsurgery resection of mucormycosis collection in the right cavernous sinus. During the follow-up she gradually improved and was discharged on an ambulatorial regimen.

ROLE OF COMPUTED TOMOGRAPHY SCAN IN EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN COVID 19 POSITIVE PATIENTS AND ITS CORRELATION WITH D-DIMER VALUE AND GCS: A RETROSPECTIVE COHORT STUDY IN A TERTIARY CARE HOSPITAL IN CENTRAL INDIA

Objective: To investigate the incidence and spectrum of neuroimaging ndings and their prognostic role in hospitalized COVID-19 patients in Government Medical College Nagpur along with their correlation with D-Dimer Values and GCS . Methods: This is a retrospective cohort study of 774 COVID-19 conrmed patients admitted to Government Medical College st st Nagpur between 1 April 2020 and 31 October 2020. Clinical data were extracted from electronic medical records, and particularly data of all neurological symptoms were extracted from the imaging reports. Four neuro-radiologists evaluated all neuroimaging studies for acute neuroimaging ndings related to COVID-19. Plasma D-dimer levels were measured using a particle-enhanced, immunoturbidimetric assay on admission in the 116 patients who came for evaluation of neurological symptoms. Moreover ,the patients were classied into different groups as mild, moderate and severe based on their GCS scores and was assessed with respect to their neuro-imaging ndings. Results: 15 % of the admitted patients suffered from neurological symptoms. Acute stroke was the most common nding in the patients with positive neuroimaging ndings resulting in 34.4% of the patients with positive neuroimaging ndings. Other ndings were subacute infarcts (13.8%), Chronic lacunar infarcts (20.6%) , Intraparenchymal hemorrhage in 10.4 %, hypertensive encephalopathy in 7 % and subarachanoid hemorrhage in 3.4 %. Plasma median D-dimer levels were signicantly (P฀ =฀ 0.000) higher in Acute stroke patients as compared to COVID 19 positive patients who had negative CT scan imaging features(0.88; interquartile range [IQR], 0.28–2.11 mg/L and 0.31; IQR, 0.17–0.74 mg/L). Patients who have positive neuroimaging ndings presented with a lower GCS whereas patients who had negative neuroimaging ndings presented with a higher GCS. Conclusions: Our study demonstrates acute stroke is the most common neuroloimaging nding in hospitalized COVID 19 Patients. Moreover D-Dimer values are highly predictive of acute ischemic stroke. Patients with positive neuro-imaging ndings have poor GCS scores.

57-Year-Old Woman With Weakness and Word-Finding Difficulties

57-Year-Old Woman With Weakness and Word-Finding Difficulties

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction.

OBJECTIVEObstructive sleep apnea (OSA) is a potential cardiovascular risk. We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction (AMI).METHODSWe prospectively enrolled 252 AMI elderly patients (mean age, 68.5 ± 6.9 years) who were undergoing revascularization and completed a sleep study during their hospitalization. All subjects were categorized into non-OSA (apnea–hypopnea index (AHI) < 15, n = 130) and OSA (AHI ≥ 15, n = 122) groups based on the AHI. The changes in the autonomic nervous system, incidence of arrhythmia during nocturnal sleep, and major adverse cardiovascular and cerebrovascular events (MACCEs) were compared between the groups. RESULTSThe mean AHI value in all AMI patients was 22.8 ± 10.9. OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation (MinSaO2), as well as greater proportion of multivessel coronary artery disease (all P < 0.05). The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset (both P < 0.05) and higher incidence of arrhythmia (including sinus, atrial, and ventricular in origin). At a median follow-up of 6 months (mean 0.8–1.6 years), OSA (AHI ≥ 15) combined with hypoxia (MinSaO 2 ≤ 80%) was independently associated with the incidence of MACCEs (hazard ratio [HR]: 4.536; 95% confidence interval [CI]: 1.461−14.084,P = 0.009) after adjusting for traditional risk factors. CONCLUSIONSOSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction, increase the occurrence of heart rhythm disorders in elderly subacute MI patients, and worsen their short-term poor outcomes.

Charles Bonnet Syndrome as Another Cause of Visual Hallucinations

Charles Bonnet syndrome (CBS) presents as gradual vision loss and associated visual hallucinations in a patient who is otherwise neurologically and psychiatrically intact. This syndrome presents primarily as ophthalmologic disease, however, may be secondary to an ischemic stroke or tumor in the occipital lobe. Patients present with a complaint of vivid visual hallucinations ranging from spots and geometric shapes to seeing people, distorted figures and landscapes.First noted in the 1760s, CBS did not reach the western scientific community until the early 1980s.Our patient reported seeing her dog and deceased mother only when looking left. She was having an experience of phantom images in addition to a visual field impairment but was otherwise of sound mind with no gross neurological deficits. Computer topography of the brain revealed a subacute infarct in the right posterior occipital lobe. The patient was ultimately diagnosed with CBS following magnetic resonance imaging and ophthalmology consultation at tertiary center.Diagnosis may be delayed by lack of symptom reporting as patients do not want to carry a stigma as ‘crazy.’ Further, physician awareness of this etiology is low and a better understanding of the disease will prevent missed diagnosis as well as lack of appropriate consultation and follow-up. Treatment includes close outpatient ophthalmology care, maximizing existing vision and lifestyle changes including adjustments in lighting, decreasing stress and increasing socialization. Trials of prescription treatment (i.e., antipsychotics, serotonin reuptake inhibitors, antiepileptics) have shown only anecdotal evidence at efficacy. CBS is an uncommon presentation of cerebral vascular disease that warrants the attention of emergency department physicians.

A Fibromuscular Dysplasia Clinical Tetrad of Coronary Artery Dissection, Cardiogenic Shock, Carotid Dissection, and Stroke

Spontaneous coronary artery dissection is a serious and underreported clinical entity strongly associated with fibromuscular dysplasia (FMD). The female predominance of FMD may predispose many women to coronary artery dissection or other similar vascular pathologies. We present a case of a young woman who presented with a clinical tetrad of spontaneous coronary artery dissection, cardiogenic shock requiring extracorporeal membrane oxygenation, internal carotid dissections, and subacute cerebellar infarct secondary to underlying FMD. The patient’s clinical course and vascular pathology are discussed. A review of the relevant literature of previously published similar cases, the incidence of spontaneous coronary artery dissection, and issues in the clinical management of spontaneous coronary artery dissection are also included.

Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction.

[Purpose] To compare the sensitivity to change and responsiveness of the Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance Evaluation Systems Test in patients with subacute cerebral infarction. [Participants and Methods] Thirty patients with subacute cerebral infarction participated in this study. The Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, Brief-Balance Evaluation Systems Test, Berg Balance Scale, and ambulatory ability were assessed on admission and discharge. Sensitivity to change was calculated using the effect size, standardized response mean, and relative efficiency. Responsiveness was analyzed by comparing the ability of the difference between the scores of the balance assessments at admission and discharge in classifying the participants’ ambulatory independence. [Results] All assessments showed significant improvement from admission to discharge. The effect size of the three versions of the Balance Evaluation Systems Test ranged from 0.41 to 0.69. The standardized response mean ranged from 0.75 to 1.28. The cutoff score was 16.7% for the Balance Evaluation Systems Test, 5.5 points for the Mini-Balance Evaluation Systems Test, 1.5 points for the Brief-Balance Evaluation Systems Test, and 3.5 points for the Berg Balance Scale. [Conclusion] The sensitivity to change of the three versions of the Balance Evaluation Systems Test was high or moderate. However, the Mini-Balance Evaluation Systems Test had the highest responsiveness, as determined with the extent of ambulatory independence.

Palinopsia as a Rare Presenting Symptom of Occipital Stroke “Case Report”

Palinopsia is the recurrence or persistence of visual images after cessation of the stimulus. Palinopsia has been associated with a wide variety of etiologies and mechanisms such as drug induced, seizures, migraine, psychiatric conditions, head trauma and structural lesions in the brain. We report a case of occipital stroke who presented with oscillating palinopsia. Sudden-onset palinopsia is a very rare symptom of stroke, but it must be recognized early as it is a highly time dependent, and potentially treatable condition. A 57-year-old woman with a history of poorly controlled type 2 diabetes, hyperlipidemia, and hypertension presented with sudden onset right sided palinopsia with images of her face and right forearm with hand, occurring several times in a day, lasting for a few minutes each time, and appearing in the same location each time. There are few case reports in literature secondary to stroke and what makes it interesting also is that she reported persistence of image even when her eyes are closed. Moreover, the sudden onset is not common in literature. The Magnetic Resonance Imaging (MRI) of the brain showed evidence of left Posterior Cerebral Artery (PCA) territorial (Fusiform gyrus) subacute ischemic infarction. Visual field assessment showed a right homonymous hemianopia. She was treated with aspirin and clopidogrel. The frequency and intensity of palinopsia reduced subsequently. The face image disappeared in the first week while the forearm image disintegrated gradually over the next few weeks. Palinopsia may be a rare presenting symptom of stroke. It is important for the clinician or emergency room doctors to be alert to the possibility of undiagnosed structural neurological lesions like occipital stroke and differentiate it from non-organic causes, as prompt management may reduce the risk of visual or motor disability.

Metabolically Active Subacute Infarct Masquerading as Metastasis: A Finding not to be overlooked in Asymptomatic Oncology Patients.

A 50-year-old man with carcinoma of the right buccal mucosa underwent staging whole-body 18F-fluorodeoxyglucose positron emission tomography–computed tomography, which revealed a hypermetabolic heterogeneously enhancing lobulated primary lesion in the right buccal region and an incidental finding of subacute stroke. The case highlights the importance of discriminating brain neoplasms mimicking stroke from true ischemic stroke, which is crucial for appropriate management of patients in an oncology setting.

Stroke presenting as a rare complication of neurosarcoidosis in a young adult male: A case report

A 29-year-old Filipino-Chinese man with pathologically diagnosed neurosarcoidosis experienced right-sided weakness and slurring of speech. Neuroimaging showed a subacute infarction at the left paramedian pons. Pharmacotherapy included steroids, immunosuppressants, and anticoagulants. Three-month follow-up showed no progression of focal neurologic deficits. Stroke is rare in neurosarcoidosis and typically relates to granulomatous inflammation with a predilection for the perforator arteries. Neurosarcoidosis generally responds well to corticosteroids; however, combination therapy with additional immunosuppression is recommended to reduce the risk of relapse on steroid weaning. This report aims to highlight the occurrence of stroke as a rare complication of an equally rare disease entity in neurosarcoidosis.

Yield of Head Imaging in Ambulatory and Hospitalized Patients With SARS-CoV-2: A Multi-Center Study of 8675 Patients.

Background and Purpose:To describe the neurological and cerebrovascular findings in patients who tested positive for SARS-CoV-2 and underwent head imaging in ambulatory and inpatient settings.Methods:Consecutive patients aged ≥18 years with SARS-CoV-2 infection diagnosed or treated at Mayo Clinic sites from 3/11/2020 to 7/23/2020 with head CT or brain MRI within 30 days of SARS-CoV-2 diagnosis were included. Demographics, medical history, indication for SARS-CoV-2 testing, neurologic symptoms, indication for brain imaging, neuroimaging findings, etiology of cerebrovascular events, and hospital course were abstracted from medical records.Results:Of 8,675 patients with SARS-CoV-2, 180 (2.07%) had head imaging. Mean age of the entire cohort was 42 ± 18 years, whereas mean age of those with head imaging was 62 ± 19 years. Common indications for imaging were headache (34.4%), encephalopathy (33.4%), focal neurologic symptom (16.7%), and trauma (13.9%). While 86.1% of patients who underwent head imaging had normal exams, cerebrovascular events occurred in 18 patients (0.21% of the total cohort). Of patients with cerebrovascular events, 8 (44.5%) had acute infarct; 6 (33.3%), acute intracranial hemorrhage; 5 (2.8%), subacute infarct; and 1 (0.6%) posterior reversible encephalopathy syndrome. In the thirteen patients with ischemic stroke, 6 (46.2%) had cryptogenic stroke; 3 (23.1%), other defined causes; 2 (15.4%), small vessel stroke; 1 (7.7%), large vessel stroke; and 1 (7.7%) cardioembolic stroke.Conclusion:In ambulatory and hospitalized patients with SARS-CoV-2 infection, the rate of head imaging is low, with common indications of encephalopathy and headache. Cerebrovascular events occurred rarely, and cryptogenic stroke was the most common stroke mechanism.

Cortical Laminar necrosis in a patient with chronic cerebral infarction; Case report

Cortical laminar necrosis (CLN) is a persistent ischemic injury attributed to a particular pan necrosis of the cerebral cortex (comprising neurons, glia, and blood vessels although underline white matter is totally or partially spared). CLN is represented radiologically by the typical curvilinear gyriform distribution high signal intensity cortical lesions on T1 weighted MRI images in the affected cerebral convolutions. This is a case of cortical laminar necrosis following old left temporo-parietal ischemic infarction. A 67-year male patient with a prior history of old left temporo-parietal ischemic infarction came for follow up MRI for old right-sided hemiplegia and aphasia. He was diabetic and hypertensive. MRI Brain images showed large old left temporo-parietal ischemic infarction in the territory of Lt. MCA. There is associated subacute ischemic infarct at the left occipital cortex. There is laminar linear cortical hyperintensity in T1WI following gyral distribution, accompanied by loss of the volume of the underlying cortex at the left temporo-parieto-occipital region suggesting cortical laminar necrosis and this picture appeared two months following old cerebral infarction and shortly the patient died.