Seizures and Epilepsy in Patients With a Posterior Circulation Infarct

Background and Purpose: Hyperintense vessel sign on FLAIR (HVS) has been described in hyperacute stroke patients with arterial occlusion. It’s a surrogate marker for stroke severity in patients with acute ischemic stroke of the anterior circulation. We aimed to reveal the clinical significance of HVS in patients with acute posterior circulation infarction. Methods: This observational study is based on a single-center prospective registry study. Inclusion criteria were: symptomatic ischemic stroke patients who have lesions only in posterior circulation; and taken initial MRI within 14 days from onset.An unfavorable outcome was defined as mRS score of 2 to 6 at 3 months from the onset. First investigation is to estimate whether HVS could be related to the subtype of acute ischemic stroke (cohort A). Second, the correlation between HVS and mRS at 3 months was evaluated (cohort B). Results: From October 2012 to May 2019, consecutive 1,079 ischemic stroke subjects were screened, including 277 in cohort A (191 male, median age 64 years) and 240 in cohort B (165 male, median age 66 years, Figure A). In cohort A, HVS was independently associated with intracranial artery dissection (OR 5.228; 95% CI 2.270-12.039; p = 0.001) and large-artery atherosclerosis (OR 3.582; 95% CI 1.244-10.317; p = 0.018, Figure B). In cohort B, HVS was not a factor independently associated with unfavorable outcome (OR 2.925; 95% CI 0.881-9.714; p = 0.080). Conclusions: HVS in patients with posterior circulation infarct suggests intracranial artery dissection or large-artery atherosclerosis, but does not have impact on their clinical courses.

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The Effect of the 2019 Novel Coronavirus Pandemic on Stroke and TIA Patient Admissions: Perspectives and Risk Factors

Journal of Clinical Medicine ◽

10.3390/jcm10071357 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1357

Author(s):

Luke Carson ◽

Christopher Kui ◽

Gemma Smith ◽

Anand K. Dixit

Keyword(s):

Risk Factors ◽

Transient Ischaemic Attack ◽

Posterior Circulation ◽

Modifiable Risk Factors ◽

Presentation Time ◽

Ischaemic Attack ◽

Stroke Mimic ◽

Novel Coronavirus ◽

The Impact ◽

Posterior Circulation Infarct

Background: The 2019 novel coronavirus pandemic has generated concern from stroke specialist centres across the globe. Reductions in stroke admissions have been reported, despite many expecting an increase due to the pro-thrombotic nature of 2019 novel coronavirus. Aims: To assess the impact of the pandemic and subsequent lockdown on stroke admissions and transient ischaemic attack referrals at the Royal Victoria Infirmary, Newcastle-Upon-Tyne, and additionally on patient behaviours affecting modifiable risk factors or perspectives related to accessing healthcare. Methods: A single-centre retrospective data analysis was carried out on a “lockdown” cohort of suspected stroke patients admitted between 11 March to 26 May 2020 and a “pre-lockdown” cohort admitted in 2019. Differences in weekly admissions, weekly referrals, onset-to-presentation time and weekly thrombolysis cases were examined. Further analysis interrogated these cohorts separated by Bamford classification and stroke mimics (such as seizure/hemiplegic migraine/functional neurology). A binary-format questionnaire was separately administered to admitted patients from 15 April to 5 June 2020. Results: Significant reductions in weekly posterior circulation infarct (−43%, p = 0.017) and stroke-mimic (−47%, p < 0.001) admissions and weekly referrals diagnosed as non-transient ischaemic attack (−55%, p = 0.002) were observed in the lockdown cohort, with no differences in onset-to-presentation time. Over 25% of questionnaire respondents reported less physical activity, increased isolation and delaying their presentation due to the pandemic. Conclusions: This study provides evidence of reduced stroke-mimic and posterior circulation infarct admissions. Questionnaire findings suggest that patients need to be informed to ensure they appropriately seek medical advice. Significant communication at the stroke-primary care interface is needed to support referral pathways and management of modifiable risk factors.

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