Cerebral Artery Thrombosis Research Articles

Results of assessing cerebral vasospasm following subarachnoid hemorrhage using transcranial doppler ultrasound

SUMMARY Objective: Review the results of assessing cerebral vasospasm after subarachnoid hemorrhage using transcranial doppler ultrasound. Subjects and methods: A retrospective, cross-sectional descriptive study was performed on 39 patients with subarachnoid hemorrhage treated at the Neurology Center, Bach Mai Hospital from January 2020 to September 2023. Results: The mean age of the study group was 55.12 ± 14.33. The age group distribution with the highest incidence is 41-50 years old with a rate of 35.9%. The male/female ratio is 20/19. The most common symptoms were headache (97.4%), nausea and vomiting (92.3%), The least common symptoms were convulsions and hemiplegia in 5.1% of subjects. The most common clinical severity assessed by the Hunt and Hess scale is level 2 (59%), followed by level 3 (23.1%), level 4 (10.2%), and level 1 (5.1%). Evaluation of Fisher scale found that the most common fisher level is level 4 with a rate of 33.6%, followed by level 3 (28.2%), level 1 (25.6%), the least common is grade 2 with 2.6%. The results of the second transcranial Doppler ultrasound performed on the sixth to eighth day of the disease is the time with the highest rate of vasospasm, showing the most vasospasm cerebral artery is the middle cerebral artery: right middle cerebral artery. 35.9%, left middle cerebral artery 12.8%. Next is anterior cerebral artery spasm: right anterior cerebral artery 23.1%, left anterior cerebral artery 2.6%. Right posterior cerebral artery 10.3%, left posterior cerebral artery 5.1%. Compared to the gold standard for diagnosing vasospasm, which is 128-slices MSCT, transcranial Doppler ultrasound has a sensitivity of 0.91, a specificity of 0.88, a positive predictive value of 0.91, and a negative predictive value of 0.88. The appropriateness of transcranial Doppler ultrasound and 128-slices computed tomography scan in diagnosing cerebral vasospasm after subarachnoid hemorrhage is very high, Kappa coefficient = 0.791, statistically significant with p < 0.05. Conclusion: Clinical symptoms of the disease are very diverse and non-specific, the most common symptom being headache is 97.4%. The most common Hunt and Hess scale to assess clinical severity is 2, however the most common Fisher scale is 4. Middle cerebral artery thrombosis has the highest rate of spasm, followed by the anterior cerebral artery. Compared to the gold standard for diagnosing vasospasm, which is 128-slices MSCT, transcranial Doppler ultrasound has a sensitivity of 0.91, a specificity of 0.88, a positive predictive value of 0.91, and a negative predictive value of 0.88

Inhibition of sodium-glucose cotransporter-2 improves anaemia in mice and humans with sickle cell disease, and reduces infarct size in a murine stroke model.

Sodium-glucose cotransporter-2 (SGLT-2) is expressed in the kidney and may contribute to anaemia and cardiovascular diseases. The effect of SGLT-2 inhibition on anaemia and vascular endpoints in sickle cell disease (SCD) is unknown. A murine model of SCD was studied to determine the effects of the SGLT-2 inhibitor, empagliflozin, on anaemia and stroke size. The University of Michigan's Precision Health Database was used to evaluate the effect of SGLT-2 inhibitors on anaemia in humans with SCD. SCD mice treated with daily empagliflozin for 8 weeks demonstrated increases in haemoglobin, haematocrit, erythrocyte counts, reticulocyte percentage and erythropoietin compared to vehicle-treated mice. Following photochemical-induced thrombosis of the middle cerebral artery, mice treated with empagliflozin demonstrated reduced stroke size compared to vehicle treated mice. In the electronic health records analysis, haemoglobin, haematocrit and erythrocyte counts increased in human SCD subjects treated with an SGLT-2 inhibitor. SGLT-2 inhibitor treatment of humans and mice with SCD is associated with improvement in anaemic parameters. Empagliflozin treatment is also associated with reduced stroke size in SCD mice suggesting SGLT-2 inhibitor treatment may be beneficial with regard to both anaemia and vascular complications in SCD patients.

Glycine Receptor Beta Subunit (GlyR-β) Promotes Potential Angiogenesis and Neurological Regeneration during Early-Stage Recovery after Cerebral Ischemia Stroke/Reperfusion in Mice.

Ischemic stroke is mainly caused by cerebral artery thrombosis. This study investigated the role of glycine receptor beta subunit (GlyR-β) in the recovery from cerebral ischemia stroke/reperfusion. The oxygen glucose deprivation and recovery (OGD/R) bEnd3 cell model and the middle cerebral artery occlusion/reperfusion (MCAO/R) mouse model were used in this study. Expression of both the GlyR-β gene and vascular endothelial growth factor (Vegf), cell proliferation, and tube formation ability was decreased in bEnd3 cells after OGD/R, and was reversed by overexpression of GlyR-β. Neurological function, asindicated by Zea Longa scores, area of cerebral ischemia, and pathological changes were increased in mice after MCAO/R, and were ameliorated by overexpression of the glycine receptor beta (Glrb) gene at 24 h and 7 d after MCAO/R. Expression of GlyR-β and Gap-43 was decreased, and the expression of CD34, Vegf, and Bdnf, and cell growth as determined by a bromodeoxyuridine (BrdU) assay, increased in the affected brain tissue of MCAO/R mice in a time-dependent manner. GlyR-β overexpression resulted in enhanced expression of CD34, Vegf, Growth association protein 43 (Gap-43), and brain-derived neurotrophic factor (Bdnf) and cell growth in affected brain tissue of MCAO/R mice in a time-dependent manner. GlyR-β promoted potential angiogenesis and neurological regeneration in affected brain tissue, thus promoting recovery from cerebral ischemia stroke/reperfusion.

Central Retinal Artery Occlusion in Young Adults at High Altitude: Thin Air, High Stakes.

Rana, Vipin, Pradeep Kumar, Sandeepan Bandopadhyay, Vijay K. Sharma, Meenu Dangi, Dattakiran Joshi, Sanjay Kumar Mishra, Satyabrat Srikumar, and V.A. Arun. Central retinal artery occlusion in young adults at high altitude: thin air, high stakes. High Alt Med Biol. 00:000-000, 2024.-We present five cases of young security personnel who were posted at high altitude (HA) for a duration of at least 6 months and presented with a sudden decrease of vision in one eye. The diagnosis of central retinal artery occlusion (CRAO) was made in all patients. Fundus fluorescein angiography and optical coherence tomography of the macula supported the diagnosis. None of these cases had any preexisting comorbidities. Erythrocytosis was noticed in all patients, and two of them had hyperhomocysteinemia. Four out of five patients showed either middle cerebral artery or internal carotid artery (ICA) thrombosis on computed tomography angiography. The patients were managed by a team of ophthalmologist, hematologist, vascular surgeon, and neurologist. In cases of incomplete ICA occlusion, patients were managed surgically. However, in the case of complete ICA occlusion, management was conservative with antiplatelet drugs. This case series highlights HA-associated erythrocytosis and hyperhomocysteinemia as important risk factors for CRAO in young individuals stationed at HA.

Thrombus extraction in acute ischemic stroke: three years of experience at the regional vascular center

From a modern perspective, the key to successful treatment of ischemic stroke is early reperfusion with systemic thrombolytic therapy and thrombus extraction. Thrombectomy is the only reliable method of recanalization in patients with thrombosis of a large cerebral artery. Despite the fact that thrombus extraction has proven its effectiveness in the treatment of acute ischemic stroke in a number of large randomized trials, there are still issues that have not been fully studied, on which there are controversial opinions among specialists. For instance, there is different information about whether direct thrombectomy or thrombus extraction after systemic thrombolysis is more effective and safer. Moreover, in accordance with modern procedures for providing care to patients with acute cerebral circulatory disorders, patients admitted in the «therapeutic window» should receive intravenous thrombolytic therapy even if thrombectomy is planned. Based on the analysis of 164 thrombus extractions in patients with acute ischemic stroke admitted to the regional vascular center in 2020–2023, the results of direct thrombus extraction and staged reperfusion (systemic thrombolytic therapy + thrombectomy) were compared. It has been found that compared to direct thrombus extraction, staged reperfusion provides more frequent achievement of 2b-3 recanalization (71.83 % and 78.49 %, respectively), accompanied by lower mortality (45 % and 23.66 %, respectively) and more frequent achievement of Rankin 0–2 functional status at the time of discharge (48.72 % and 61.96 %, respectively). The worst results were observed among patients with vascular occlusion in the vertebrobasilar basin, at TICI 0-2a and the age of patients over 80 years.

Left middle cerebral artery and sigmoid sinuses thrombosis in a female patient with Crohn's disease

Introduction: Neurologic manifestations in patients with inflammatory bowel disease (IBD) appear to be more common than in the past. However, vascular events in IBD are still a rare presentation and were reported in few cases. Case presentation: A 48-year-old female patient known case of Crohn’s disease presented with sudden onset aphasia, headache, blurring of vision, and decreased level of consciousness for 2 hours. The patient looked ill, confused, agitated, and aphasic. Neurologic examination shows dysarthria and 0/5 power of the right upper and lower extremity. A brain CT without contrast was ordered and showed acute ischemic stroke. The patient received tPA (alteplase) immediately in the intensive care unit and was under observation. On admission, brain CT angiography, MRI, and MRV were performed, which showed middle cerebral artery and sigmoid sinuses thrombosis. The patient has undergone cerebral catheterization, and an MCA stent was inserted. Post catheterization, the patient’s right-sided extremity power was improved to 3/5. She was discharged from the hospital after 13 days in good general condition except for her expressive aphasia. Conclusion: To the best of our knowledge, here we report the first case presented with both; cerebral venous sinus thrombosis and cerebral arteries thrombosis in a patient with IBD. Clinicians must be considered ischemic stroke in any patients with IBD presented with acute neurological manifestation, and an urgent interventional approach must be performed.

Impact of the COVID-19 pandemic on acute ischemic stroke medical care: a prospective study

INTRODUCTION: Acute ischemic stroke (AIS) is not uncommon in patients with novel coronavirus infection. During the COVID-19 pandemic, an increase of the frequency of adverse clinical and functional outcomes of AIS was noted.OBJECTIVE: The recent study was to evaluate the impact of the COVID-19 pandemic on the clinical and diagnostic characteristics of patients with AIS, as well as on the results of various types of treatment.MATERIALS AND METHODS: The prospective study included 460 patients with AIS after systemic or selective thrombolysis, thromboextraction and combination of thromboextraction with thrombolysis and stenting, hospitalized in 2019–2022: 55 patients in 2019, and in 2020–2022 — 405 patients. All patients were clinically evaluated using NIHSS and Rankin scales. Instrumental data included: assessment of computed tomography (CT) lesion size, extracranial and transcranial Duplex ultrasound (DUS) and computed angiography. Patients who received invasive treatment (thromboextraction, including in combination with thrombolysis or stenting) underwent cerebral angiography (CA). The characteristics of cerebral hemodynamics before and after the use of various types of treatment, clinical and functional outcomes were subject for comparison.Statistics: The statistical software Statistica 12.0, SPSS Statistics 17.0 were used. Normality of distribution was assessed using the Shapiro–Wilks test. Comparison of groups based on quantitative parameters was carried out using the Mann–Whitney U test. When testing statistical hypotheses, the acceptable level of error of the first type was considered to be a value not exceeding 0.05. To assess the correlation between parameters, the Spearman method was used.RESULTS: During the pandemic of COVID-19, patients with AIS were younger, had lower percentage of comorbidities and a higher NIHSS score. A significantly lower rate of favorable clinical and functional outcomes was obtained during the pandemic compared to the period before the pandemic, including after the use of invasive treatment methods: only 47% of patients had clinical improvement during the pandemic, while in 2019 the proportion of favorable outcomes was 64% (p=0.003). There was an increase in the share of pulmonary embolism and pneumonia in the structure of mortality from AIS during the pandemic (25% in the period before the pandemic vs 38% during the pandemic). Duplex ultrasound of cerebral arteries demonstrated high comparability with angiography data (correlation coefficient with invasive methods 0.84).DISCUSSION: According to the literature data, strokes are not uncommon in patients with COVID-19, especially in those with severe disease and risk factors. The authors consider thrombosis and/or thromboembolism of cerebral arteries to be possible ways of cerebral ischemia. According to Russian scientists, from the beginning of the pandemic, a significant increase in the incidence of ischemic stroke of varying severity was noted. The statistical pattern we identified confirms the data from literature sources that when infected with the SARS-CoV-2 virus, the brain and cerebral arteries are target organs. It is significant for clinical practice that we have evaluated the clinical and instrumental characteristics of these lesions in relatively homogeneous gender, age and clinical groups.CONCLUSION: The incidence of favorable clinical and functional outcomes during the pandemic was significantly lower compared to the pre-pandemic period. Complete and partial restoration of blood flow, as well as a decrease in the ischemic focus, were significantly more common before the pandemic. The effectiveness of invasive methods of cerebral revascularization during the pandemic were also lower. Duplex ultrasound serves as a reliable method not only for primary diagnosis, but also for dynamic monitoring. Initial changes in hemodynamics in patients with AIS before and during the pandemic did not differ significantly and were represented by hypoperfusion with a decrease in peripheral resistance. In 2020–2022 after treatment, hypoperfusion was observed significantly more often, which can be considered as one of the reasons for the less favorable clinical and functional outcomes obtained during the pandemic.

Stroke without cerebral arteriopathy in sickle cell disease children: causes and treatment.

Cerebral arteriopathy (CA) in children with sickle cell disease (SCD) is classically described as chronic stenosis of arteries in the anterior brain circulation, leading to ischemic stroke. Some studies have, however, reported strokes in children with SCD but without CA. In order to better understand the etiology and risk factors of these strokes, we retrospectively analyzed ischemic strokes occurring in a large cohort of children over a 13-year period. Between 2007 and 2020, 25 of 1,500 children with SCD had an ischemic stroke in our center. Among them, 13 (52%) had CA, described as anatomical arterial stenosis, while 12 (48%) did not. Patients with stroke without CA were older than patients with stroke attributed to SCD-CA (9.0 years old vs. 3.6 years old; P=0.008), and more frequently had SC genotype (25% vs. 0%, respectively). Their strokes more frequently involved the posterior circulation, with cerebellar involvement in 42%. Retained stroke etiologies in patients without typical SCD-related CA were reversible cerebral vasoconstriction syndrome, cerebral fat embolism, arterial thrombosis or thromboembolism, hyperviscosity, vasculitis in a context of infectious meningo-encephalitis, and severe hemodynamic failure. No recurrence was observed in the 24 months following stroke, even though 67% of the patients in this group were no longer receiving exchange transfusions. In conclusion, in a cohort of pediatric SCD patients with an efficient stroke screening strategy, half of the ischemic strokes that occurred were related to causes other than CA. They affected a different population of SCD children and systematic long-term transfusion programs may not be necessary in these cases.

Protective Impact of Combined Perindopril and Coenzyme Q10 Treatment Against Cerebral Ischemia/Reperfusion Injury in Male Rats

Background: Cerebral ischemia is reason of death and disability worldwide with 11.6\% of all death and 5.7\% of the total disability. Thrombosis and embolism of a major cerebral artery, mainly the middle cerebral artery, account for over 70\% of stroke cases. The other major type of stroke is cerebral hemorrhage either intracerebral or subarachnoid hemorrhage. The oxygen requirements of the nervous tissue are excessively high bringing the brain highly susceptible to ischemia. The subsequent reperfusion after brain ischemia can precipitate more brain injury. Objectives: Assess the neuroprotective effects of perindopril and coenzyme Q10 in combination, as well as to speculate on their mechanism. Method: A total of forty-nine adult male Sprauge-dawley rats weighing between 200 and 300 g were randomly assigned to 7 groups: sham (no Bilateral common carotid artery occlusion (BCCAO)), control group (BCCAO for 30 minutes followed by reperfusion for an hour), vehicle-1 group (rat were pretreatment with oral 1% carboxymethylcellulose for seven days followed by control group), vehicle-2 group (seven days of oral distilled water pretreatment then as control group), perindopril group (rat were pretreatment with perindopril for then as control group), coenzyme Q10 group (rat were pretreatment with coenzyme Q10 for seven days then as control group), and combination group (rat were pretreatment with perindopril plus coenzyme Q10 for seven days then as control group). The brain tissues were separated in order to measure the size of the brain infarction, assess the histology, and measure the levels of cerebral IL-6, IL-10, TNF-\(\alpha\), ICAM-1, NF-\(\kappa\)B p65, and total antioxidant capacity. Results: The brain levels of IL-6, IL-10, ICAM-1, TNF-\(\alpha\), NF-\(\kappa\)B p65, and the cerebral infarct size were substantially increased in control and vehicle in relation to sham groups, while the total anti-oxidant capacity was considerably reduced. Perindopril and coenzyme Q10 treatment alone and in combination resulted in marked elevation in IL-10 and the total antioxidant capacity, with significant decrement in IL-6, ICAM-1, TNF-\(\alpha\), and NF-\(\kappa\)B p65 in respect to vehicle and control group. There was severe histopathological ischemic damage in control and vehicle groups which was remarkedly decreased by perindopril and coenzyme Q10 treatment alone and in combination pretreatment. Conclusions: Due to their anti-inflammatory and anti-oxidative characteristics, perindopril and coenzyme Q10, either separately or in combination, exhibit neuroprotective benefits in male rats that have been treated to cerebral ischemia/reperfusion injury.

Prevalence, Epidemiology, Mortality and Morbidity of Thrombotic Events in SLE: A Nationwide Study in the United States

CONCLUSION Thrombotic events (TE) are a major cause of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). Data is scant, however, on the prevalence, epidemiological characteristics, in hospital morbidity and mortality of TEs in this population. To perform a comprehensive epidemiological study on patients with SLE and DVT, PE or atypical thrombosis and their variation by gender, geographic region and hospital status. We also aimed to explore the associated morbidity and mortality for each TE and potential associations with other risk factors such as obesity and smoking. We conducted a retrospective cohort study, using the 2003-2018 Nationwide Inpatient Sample (NIS) database. All adult patients with a diagnosis of SLE using ICD-9 and 10 codes were included. The ICD 9 and 10 codes were also used to find other TE variables including DVT, PE, Cerebral venous sinus thrombosis (CVST), Splanchnic thrombosis (ST)and Arterial thrombosis (AT). Of the 513,904 SLE patients included, PE, DVT, ST, CVST and AT were identified in 1.38%, 3.07%, 1.34%, 0.04% and 0.35% patients respectively. Each TE (except CVST) had a statistically significant increase in length of hospital stay, cost of hospitalization and all-cause in-hospital mortality. Higher prevalence of PE, DVT, ST and AT were reported in males with SLE, and higher prevalence of obesity was seen in SLE patients with TEs, except AT, which interestingly was associated with a lower prevalence of obesity. Despite comprising only one third of the cohort, African Americans (AAs) faced the highest burden of PEs and DVTs. No significant differences were seen between geographic regions. This study is limited by administrative claims data, lack of antiphospholipid antibody status, and only includes inpatient encounters. Additionally, this is an observational retrospective study, and the assessment is limited to association of these thrombotic events in the SLE population. Arterial, venous and atypical thrombosis exert significant morbidity and mortality in patients with SLE. Racial and gender variations exist in each category of thrombosis, and identifying these differences is crucial while taking management decisions for patients with SLE. Particular attention should be directed to AAs with SLE, who appear to be particularly vulnerable.

Ischemic stroke secondary to radiation-induced carotid artery stenosis

Large vessel vasculopathy, such as carotid stenosis, has been shown to be a side effect of radiotherapy (RT) and has received increasing attention especially in recent decades with the improvement of RT technology. These injuries can lead to a higher risk of cerebrovascular events such as ischemic stroke. The management of these lesions may be performed with surgical repair but also with endovascular technique. A 61-year-old man was admitted to the emergency department for an acute ischemic stroke. He was treated 16years prior for laryngeal tumor for which he had received 23 sessions of radiation therapy at the dose of 60Gy per session. The CT scan showed a radiation-induced stenosis of the right internal carotid artery with thrombosis of the right anterior cerebral artery and the right middle cerebral artery. The patient was treated with angioplasty of the right internal carotid artery with good outcome. Radiation-induced vasculopathy of the carotid artery has gained relevance in patients with head and neck neoplasms. These vascular lesions are associated with the risk of late cerebrovascular events.

Interventions in cerebrovascular emergencies among patients with Paroxysmal nocturnal haemoglobinuria - A word of caution

IntroductionParoxysmal nocturnal haemoglobinuria (PNH) is a clonal hematopoietic disorder, where there is deficiency of glycosylphosphatidylinositol (GPI) anchored proteins in the cell membrane, leading to increased complement sensitivity of red blood cells, intravascular hemolysis and vascular inflammation. Arterial and venous strokes in patients with PNH are a rarity posing significant diagnostic and therapeutic challenges. We report our experience with management of PNH patients with cerebrovascular emergencies. MethodsWe report 2 patients with PNH, one who was previously diagnosed with PNH and had arterial stroke, the other had an index presentation of cerebral venous sinus thrombosis (CVT) and was subsequently diagnosed with PNH. We also present the systematic review of literature reporting similar cases, highlighting the challenges in management. ResultsBoth patients presented to our centre with cerebrovascular emergency. The first patient was a diagnosed with PNH, and presented with left hemispheric infarction caused by thrombosis of middle cerebral artery. He was thrombolysed and underwent mechanical thrombectomy, which was unsuccessful in view of repeated re – thrombosis of the vessel. The patient survived with significant disability. The second patient had severe cerebral venous sinus thrombosis with large right hemispheric hemorrhagic venous infarction. She underwent emergency decompressive hemicraniectomy complicated by massive blood loss and disseminated intravascular coagulation. She subsequently had recurrent life threatening intracranial bleed secondary to platelet transfusions, thrombocytopenia, and use of contrast agents. She progressed to develop Budd Chiari syndrome and was initiated on Eculuzimab. She became transfusion independent, however remained in minimally conscious state and succumbed to sepsis. ConclusionsManagement of arterial and venous strokes is complex in patients with PNH. Invasive procedures and platelet transfusions are to be avoided in acute thrombosis, till robust evidence is available establishing the safety of the same in patients with PNH. Eculuzimab is a promising option, but far from reach for patients in developing countries.

Unilateral Oculomotor Nerve Palsy as a Rare Manifestation of Isolated Pre-Communicating Segment of Posterior Cerebral Artery Thrombosis.

Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits.

Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature.

Background: The causative agent of the new coronavirus infection SARS-CoV-2 has unique properties causing hyperinflammatory syndrome and cytokine storm, as well as widespread endotheliitis and thrombotic microangiopathy, initially detected in the lungs of adult patients who died from a severe form of the disease. Venous and arterial thrombosis in adults were identified as common causes of severe complications and deaths in new coronavirus infections. There are very few reports of thrombotic events in children with COVID-19 in the literature. Methods: We conducted a retrospective analysis of the histories of 60 patients in the Irkutsk Regional Children's Clinical Hospital from November 2020 to November 2022 with a MIS-C diagnosis established according to WHO criteria, of which 8 (13.3%) were diagnosed with venous and/or arterial thrombosis, confirmed by laboratory and ultrasound and/or X-ray methods. Results: The average age of children with thrombosis (Me) was 7.5 years (min 4 months, max 17 years), with a M:F ratio of 3.0. Venous thrombosis was detected in six of the eight patients, including in the deep veins of the lower extremities in four. Pulmonary embolism occurred in two (one of them was fatal), and cerebral venous sinus thrombosis and thrombosis of the branches of the upper and lower vena cava were found in one patient. Extensive bilateral stroke due to thrombosis of the large cerebral arteries occurred in two patients, including one in combination with distal gangrene. Secondary thrombotic renal microangiopathy took place in three of the eight patients. Among these three, atypical HUS was diagnosed in one case. Multiple thrombosis involving the venous and arterial bed was detected in four of the eight patients. High levels of D-dimer, thrombocytopenia, increased NT-proBNP, cerebral coma, and aseptic meningitis were the events most often associated with thrombosis. All patients received immunomodulatory therapy (immunoglobulin, dexamethasone/methylprednisolone), pathogenetic therapy for multiorgan failure, anticoagulant therapy with heparin/LMWH, and acetylsalicylic acid. Biologics were used in two patients. Conclusions: The main predictors of thrombosis in children with MIS-C were increased D-dimer, thrombocytopenia, hospitalization in the ICU, and noncardiogenic pulmonary edema. Thrombosis of the deep veins of the lower extremities, large cerebral arteries, and secondary thrombotic microangiopathy was common. There was a single death (12.5% of the eight patients), associated with PE.

SUSCEPTIBILITY WEIGHTED IMAGING TECHNIQUE UTILITY IN DIVERSE NEUROLOGICAL ENTITIES

Background: Susceptibility Weighted Imaging (SWI) is a novel modality based upon GE (Gradient Echo) sequences that employ differences in susceptibility of various paramagnetic as well as diamagnetic substances that aid in the better diagnosis of various neurological entities such as intracranial tumors, vascular malformations, arterial stroke, venous hemorrhagic infarcts. Objective:To assess utility of SWI in various neurological diseases. Methods: The retrospective observational study was held in a tertiary care medical center in India in 2021. Multiple neurological diseases on SWI were analyzed in 100 patients with neurological complaints. The inclusion criteria included patient of all age group who presented with neurological signs and symptoms. The exclusion criteria included presence of post-operative non-compatible orthopedic hardware and patients with cardiac pacemakers, cochlear implants in situ. Results: The majority were males and > 60 years (23%) in age. Among 100 patients, most had tumors (18%), followed by trauma (16%), arterial stroke (15%), and hemorrhage (14%). Most of 14 patients with hemorrhage have intraparenchymal hemorrhage 9 (64.29%). There were10 patients with venous sinuses thrombosis and 15 cases with arterial stroke amongst whom most had middle cerebral artery thrombosis (46.66%). Most 13 patients with vascular pathologies had amyloid angiopathy 4 (30.77%). The majority of tumors were primary 15 (83.33%) with 10 (66.67%) newly diagnosed tumors, 11 (61.11%) tumors had a hemorrhage, 3 (16.67%) presented with calcification, and 4 (22.22%) had both hemorrhage and calcification. According to SWI grading of the tumor by intratumoral susceptibility score (ITSS), the majority were in grade III. On the correlation of SWI grading with MR Spectroscopy (MRS) and MR perfusion (MRP) study, 6 (100%) grade III patients showed hyperperfusion on MRP with raised choline/Creatinine ratio. SWI was better than CT (P<0.05) in detecting trauma, hemorrhage, cerebral venous sinus thrombosis, vascular pathologies, and tumors. Conclusion: SWI is a helpful imaging tool in neuroradiological practice and should be incorporated into standard procedures. It is beneficial in identifying hemorrhages, low-flow vascular abnormalities, diffuse axonal injury, and neurodegenerative illnesses. In addition, it is a supplementary sequence in the stroke by distinguishing calcium from hemorrhage in the brain and categorizing brain tumors.

Secondary polycythaemia from chronic hypoxia is a risk for cerebral thrombosis: a case report

BackgroundSecondary polycythemia is considered the usual complication of chronic hypoxia. It can theoretically increase the oxygen-carrying capacity, but this adaptive trait has a deleterious effect because the blood viscosity increases, which can induce significant morbidity and mortality, such as stroke and myocardial infarction.Case presentationA 55-year-old man with a history of a congenitally small main pulmonary artery presented to the emergency department with sustained unsteady walking, dizziness and vertigo. Evaluation revealed elevated hemoglobin and superior posterior circulation cerebral artery thrombosis. The patient was treated with high flux inhalation of oxygen and anti-platelet aggregation.ConclusionsThe involvement of cerebral vessels has rarely been reported in chronic hypoxia cases. The present case is the first case of superior posterior circulation cerebral artery thrombosis due to chronic hypoxia in a patient with a congenitally small main pulmonary artery. This case demonstrates the importance of recognizing some chronic diseases that can lead to hypoxia and secondary polycythemia thereby leading to hypercoagulable state and subsequent thrombosis.

Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study.

In patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increases due to hemostatic changes secondary to the primary disease and due to treatment-related factors. In this multicenter study, we aimed to research the frequency of central nervous system (CNS) thrombosis occurring during treatment, hereditary and acquired risk factors, clinical and laboratory features of patients with thrombosis, treatment approaches, and thrombosis-related mortality and morbidity rates in pediatric ALL patients. Pediatric patients who developed CNS thrombosis during ALL treatment from 2010 to 2021 were analyzed retrospectively in 25 different Pediatric Hematology Oncology centers in Türkiye. The demographic characteristics of the patients, symptoms associated with thrombosis, the stage of the leukemia treatment during thrombosis, the anticoagulant therapy applied for thrombosis, and the final status of the patients recorded through electronic medical records were determined. Data from 70 patients with CNS thrombosis during treatment, out of 3968 pediatric patients with ALL, were reviewed. The incidence of CNS thrombosis was 1.8% (venous: 1.5 %; arterial: 0.03%). Among patients with CNS thrombosis, 47 had the event in the first 2months. Low molecular weight heparin (LMWH) was the most commonly used treatment with a median of 6months (min-max: 3-28months). No treatment-related complications occurred. Chronic thrombosis findings occurred in four patients (6%). In five (7%) patients who developed cerebral vein thrombosis, neurological sequelae (epilepsy and neurological deficit) remained. One patient died related to thrombosis, and the mortality rate was 1.4%. Cerebral venous thrombosis and, less frequently, cerebral arterial thrombosis may develop in patients with ALL. The incidence of CNS thrombosis is higher during induction therapy than during other courses of treatment. Therefore, patients receiving induction therapy should be monitored carefully for clinical findings suggestive of CNS thrombosis.

P205 Pulmonary artery aneurysms in Behçet's syndrome: a case series of 51 patients

Abstract Background/Aims Behçet’s syndrome (BS) is a multi-systemic vasculitis highly prevalent in a broad range stretching from the Mediterranean region to eastern Asia. The vascular involvement, present in up to 40% of the cases, is characterised by a high tendency towards the venous system and thrombosis. Although pulmonary artery aneurysms (PAA) are considered to be rare (less than 5% in cohorts), they are a quasi-pathognomonic sign of BS and play a major role in patient’s morbidity and long-term mortality. Our work aims to depict the clinical profile, imaging features, therapeutic management, and outcomes of BS patients presenting with PAA. Methods We conducted a retrospective, descriptive and monocentric study including 531 BS patients admitted to the internal medicine department between 2000 and 2021. All patients fulfilled the International Study Group Criteria for Behçet’s disease. We enrolled all cases with documented PAA on CT angiography of the chest (CTA chest). Results Among 531 BS patients, 51 had PAA (10%). The mean age was 36 ± 11 [20-69] and the sex ratio (M:F) was 4:1. Cardiovascular risk factors comprised chronic tobacco consumption (13.5%) and high blood pressure (9.6%). PAA occurred after a median of 5.5 years following the disease onset. Patients were either asymptomatic (78%) or presented with hemoptysis (6%), dry cough (6%), chest pain (4%), and dyspnea (2%). On CTA chest, PAA were commonly multiple (78%), proximal (46%), and bilateral (29%). Concomitant arterial manifestations were observed in 25% of the patients, consisting of peripheral arteries aneurysms (17%), pulmonary artery thrombosis (7.7%), cerebral artery thrombosis (4%), and aortic aneurysms (2%). Venous thrombosis was also simultaneously found in 21% of the cases, observed in the superior (9.6%) and inferior vena cava (9.6%), cerebral veins (7.7%), and lower extremity veins (6%). On echocardiography, right intracardiac thrombosis was visualised (17%). The other extravascular involvements were mainly mucocutaneous (73%), ocular (46%), articular (29%), and neurological (10%). Our patients were treated with colchicine (100%) and an initial pulse of methylprednisolone (15mg/kg/day for three days), followed by oral prednisolone (1 mg/kg/day), gradually tapered (94%). The immunosuppressive therapy administered consisted of cyclophosphamide (38.5%), azathioprine (31%), and infliximab, a TNF alpha inhibitor (2%). Curative anticoagulation was prescribed in 21% of the cases. Only one patient underwent surgery. Relapse and death were recorded in respectively 15% and 6% of the cases. Conclusion PAA are a very unique feature of BS, with specific characteristics related to their inflammatory pathogenesis. We highly recommend evoking the diagnosis of BD in presence of PAA, especially in young male patients presenting with other vascular lesions and intracardiac thrombosis. The prompt initiation of anti-inflammatory and immunosuppressive therapy is of paramount importance to reduce the risk of massive hemorrhage from PAA rupture. Disclosure S. Chadli: None. H. Khibri: None. S. Fari Firdaous: None. N. Moatassim: None. W. Ammouri: None. M. Maamar: None. H. Harmouche: None. M. Adnaoui: None. Z. Tazi Mezalek: None.

Epidemiology of Stroke and Survival Rate of Patients after Admission to Hospitals in Kazakhstan

BACKGROUND: According to the official statistics of the Ministry of Health, 40 thousand cases of stroke are registered annually in Kazakhstan. Meanwhile, the study of issues of organization of medical care in the admission of patients with stroke to hospitals in Kazakhstan remains relevant and requires a number of decisions to improve care. AIM: The aim of the study was to study the prevalence of stroke among the population of Kazakhstan and the organization of medical care in hospitals for the years 2018–2020. METHODS: The data were obtained from the Information System “Electronic Register of Dispensary Patients.” More than 60.0% of patients diagnosed with cerebral infarction caused by cerebral artery thrombosis were admitted to the hospital. RESULTS: The availability of medical care for stroke is of great importance. As the analysis of survival rate showed, the average survival time directly depends on the patient’s condition at admission to hospitals. The survival rate of patients with various nosologies of cerebral circulation in men and women differs significantly and reaches 80 years. CONCLUSION: The correct organization of the management of medical care for patients with acute circulatory disorders is of paramount importance. It is necessary to strengthen the integration and coordination of the systems of emergency care and primary health care.

Incidence of Thrombosis at Different Sites During the Follow-Up Period in Essential Thrombocythemia: A Systematic Review and Meta-Analysis.

Thrombotic events are the most frequent manifestations of essential thrombocythemia (ET). The objective of this study is to determine the incidence of thrombosis at different sites on follow-up in patients with ET. We searched PubMed, Web of Science, and The Cochrane Library databases and calculated the incidence of thrombosis by pooling and analyzing the extracted data using a random-effects model. A total of 70 studies (N = 25,805) were included in the analysis. The total and annual incidences of arterial thrombosis on follow-up were 13.4% and 2.0%, respectively. The total and annual incidences of the different manifestations of arterial thrombosis were as follows: stroke (5.3% and 0.8%), transient ischemic attack (5.1% and 1.2%), myocardial infarction (2.4% and 0.5%), unstable angina (0.9% and 0.2%), and peripheral arterial thrombosis (2.0% and 0.2%), respectively. In contrast, the total and annual incidences of arterial thrombosis in JAK2-positive patients were 18.4% and 2.7%, respectively. The total and annual incidences of arterial thrombosis in JAK2-negative patients were 5.9% and 0.8%, respectively. The total and annual incidences of venous thrombosis were 5.5% and 0.7%, respectively, and the incidences of the different manifestations of venous thrombosis at different sites were as follows: peripheral venous thrombosis (2.9% and 0.5%), superficial venous thrombosis (1.8% and 0.7%), deep venous thrombosis (1.6% and 0.3%), abdominal venous thrombosis (0.8% and 0.1%), pulmonary embolism (0.3% and 0.1%), and cerebral venous thrombosis (0.2% and 0%), respectively. The total and annual incidences of venous thrombosis in JAK2-positive patients were 7.4% and 1.2%, respectively. The total and annual incidences of venous thrombosis in JAK2-negative patients were 1.6% and 0.4%, respectively. The incidence of arterial thrombosis was higher than that of venous thrombosis in patients with ET. Arterial thrombosis manifested with cerebral arterial thrombosis, followed by cardiac thrombosis. Venous thrombosis events were mainly peripheral and superficial venous thrombosis. JAK2-positive patients have a higher incidence of arterial and venous thromboses than JAK2-negative patients, the sequence of thrombsis sites was similar to that of the overall patients.