Abstract WMP107: Neuroimaging Characteristics of Intracranial Hemorrhages and Microhemorrhages in Infective Endocarditis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Robert Marquardt ◽  
Lucy Zhang ◽  
Prateek Thatikunta ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage ◽  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Cerebral Angiogram ◽  
Tertiary Referral Center ◽  
Imaging Characteristics ◽  
Median Volume ◽  
Mycotic Aneurysms ◽  
And Staphylococcus Aureus

Introduction: Intracranial hemorrhage (ICH) is common in infective endocarditis (IE). We explored the imaging characteristics, predictors, and clinical implications of ICHs including intraparenchymal hemorrhage (IPH), and subarachnoid hemorrhage (SAH) and, subdural hematoma (SDH). Methods: We reviewed records of 116 consecutive acute IE patients by Duke’s criteria with neurological consultation or admission to stroke neurology service in a single tertiary referral center from January 2015 to July 2016. ICHs were defined as IPH, SAH, or SDH seen on CT. Microhemorrhages were identified on susceptibility weighted imaging (SWI) on MRI. Patient’s radiographic characteristics and complications were collected. Results: Of 116 patients, 25 persons (21.6%, median age 58) had ICHs, 14 with IPHs, 7 with SAHs, 3 with both IPH and SAH, and 1 SDH. Of 17 (14.7%) IPHs (median NIH Stroke Scale 6 and median volume 38.6cc), 10 (8.6%) IPHs were symptomatic and 7 IPHs were silent. Eleven persons (65%) with IPH also had ischemic strokes. Mycotic aneurysms were identified only in 1 (4.8%) in 21 persons with ICH who underwent cerebral angiogram. MRIs identified 66 persons with microhemorrhages (56.9%, median age 58.5) among 85 who underwent MRI. Eighteen (72%) of 25 persons with ICHs had microhemorrhages in SWI. In multivariate logistic regression analysis, ICH was associated with the presence of >5 microhemorrhages (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.04-1.50) and staphylococcus aureus (OR: 1.25, 95% CI: 1.03-1.51). Ten persons (40%) with ICH died (7 with IPH and 4 with SAH) in the same hospitalization. Thirteen persons (52%) with ICH (median 21.4cc in 9 IPHs) underwent valve replacement at median of 13.5 days and 2 persons had new non-fatal strokes (1 IPH and 1 ischemic stroke). Conclusions: Intracranial macro- or micro-hemorrhages are seen in 73 (63%) persons with IE. The mortality of intracranial hemorrhage is high but the perioperative stroke risk appears low.

Abstract WMP35: The Characteristics of Infectious Intracranial Aneurysm and Indication of Cerebral Angiogram in Infective Endocarditis (IE)

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Robert Marquardt ◽  
Lucy Zhang ◽  
Prateek Thatikunta ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Aneurysm ◽  
Intracerebral Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Cerebral Angiogram ◽  
Tertiary Referral Center ◽  
Valvular Surgery ◽  
Imaging Characteristics ◽  
Perioperative Complication ◽  
Glue Embolization

Introduction: Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aim to describe the characteristics of IIA and to assess indications for cerebral angiography. Methods: We reviewed IIAs among 116 consecutive active IE by Duke’s criteria with neurological consultation or admission to stroke neurology service in a single tertiary referral center from January 2015 to July 2016. Susceptibility weighted imaging (SWI) hemorrhage was defined as low signal on SWI in sulci or parenchyma that was not apparent on CT. Results: Of 116 patients, 74 persons (63.8%, mean age of 54) underwent digital subtraction angiography (DSA). IIAs were identified in 13 (17.6%). All of 13 IIAs were unruptured and only one IIA had unrelated intracranial hemorrhage on CT. None of the IIA was seen with CTA or MRA. Eleven (85%) IIAs had clinical strokes (10 ischemic strokes, 1 intracerebral hemorrhage, median NIH stroke scale 3), and 2 neurologically asymptomatic with abnormal MRI. Six of 9 IIAs had SWI hemorrhage in sulci or parenchyma (5 in sulci, 5 in parenchyma, and 1 in both) and all of the lesions were in the vicinity of IIA. Contrast MRI was performed in 7 IIAs, and 4 IIAs had enhancements, all of which were present near the location of IIAs. Ischemic stroke, intracranial hemorrhage, intravenous drug abuse, and type of valve were not associated with the presence of IIA. Of 13 IIAs, 3 remained on antibiotic alone, 5 had antibiotic with coil embolization, and, 5 had antibiotic with glue embolization. Ten patients with IIAs had valvular surgery, including one person with untreated IIA. Out of all patients with IIA, only one intracerebral hemorrhage occurred as perioperative complication unrelated to treated IIA. Conclusions: IIAs were found in approximately one fifth of IE persons who underwent DSA. Imaging characteristics such as SWI hemorrhage in sulci or parenchyma and contrast enhancement appear to correlate with the presence of IIA. DSA should be performed when they are present.

Magnetic Resonance Imaging Susceptibility-Weighted Imaging Lesion and Contrast Enhancement May Represent Infectious Intracranial Aneurysm in Infective Endocarditis

2017 ◽  
Vol 44 (3-4) ◽  
pp. 210-216 ◽  
Author(s):  
Sung-Min Cho ◽  
Cory Rice ◽  
Robert J. Marquardt ◽  
Lucy Q. Zhang ◽  
Jean Khoury ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Infective Endocarditis ◽  
Magnetic Resonance ◽  
Intracranial Aneurysm ◽  
Contrast Enhancement ◽  
Multivariate Logistic Regression Analysis ◽  
Susceptibility Weighted Imaging ◽  
Resonance Imaging ◽  
Tertiary Referral Center ◽  
Mri Characteristics

Background: Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aimed to describe the magnetic resonance imaging (MRI) characteristics of IIA. Methods: We reviewed IIAs among 116 consecutive patients with active IE by conducting a neurological evaluation at a single tertiary referral center from January 2015 to July 2016. MRIs and digital cerebral angiograms (DSA) were reviewed to identify MRI characteristics of IIAs. MRI susceptibility weighted imaging (SWI) was performed to collect data on cerebral microbleeds (CMBs) and sulcal SWI lesions. Results: Out of 116 persons, 74 (63.8%) underwent DSA. IIAs were identified in 13 (17.6% of DSA, 11.2% of entire cohort) and 10 patients with aneurysms underwent MRI with SWI sequence. Nine (90%) out of 10 persons with IIAs had CMB >5 mm or sulcal lesions in SWI (9 in sulci, 6 in parenchyma, and 5 in both). Five out of 8 persons who underwent MRI brain with contrast had enhancement within the SWI lesions. In a multivariate logistic regression analysis, both sulcal SWI lesions (p < 0.001, OR 69, 95% CI 7.8-610) and contrast enhancement (p = 0.007, OR 16.5, 95% CI 2.3-121) were found to be significant predictors of the presence of IIAs. Conclusions: In the individuals with IE who underwent DSA and MRI, we found that neuroimaging characteristics, such as sulcal SWI lesion with or without contrast enhancement, are associated with the presence of IIA

scholarly journals The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Gökhan Ceyhun
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Stroke Risk ◽  
Low Density Lipoprotein ◽  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Relationship Of ◽  
The Relationship

Abstract Background In this study considering the relationship between serum endocan and CHA2DS2-VASc score, we assumed that endocan level could be a new biomarker for stroke risk in patients with paroxysmal atrial fibrillation (PAF). It was examined that endocan could be an alternative to determine the risk of stroke and anticoagulation strategy in patients with PAF. The CHA2DS2-VASc scores were calculated for 192 patients with PAF, and their serum endocan levels were measured. The patients were divided into two groups as those with low to moderate (0-1) and those with high (≥ 2) CHA2DS2-VASc scores, and the endocan levels were compared between these two groups. Results The serum endocan level was significantly higher in the high CHA2DS2-VASc score group (p < 0.001). In the multivariate logistic regression analysis, endocan, C-reactive protein, and low-density lipoprotein were found to be independent determinants of the CHA2DS2-VASc score. The predictive value of endocan was analyzed using the ROC curve analysis, which revealed that endocan predicted a high stroke risk (CHA2DS2-VASc ≥ 2) at 82.5% sensitivity and 71.2% specificity at the cutoff value of 1.342. Conclusion This study indicates that endocan is significantly associated with CHA2DS2-VASc score. We demonstrated that endocan could be a new biomarker for the prediction of a high stroke risk among patients diagnosed with PAF.

scholarly journals Intracranial Hemorrhage Following Thrombolytic Use for Stroke Caused by Infective Endocarditis

2009 ◽  
Vol 12 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Parita Bhuva ◽  
Sheng-Han Kuo ◽  
J. Claude Hemphill ◽  
George A. Lopez
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage

Abstract WP335: Intracranial Mycotic Aneurysms in Infective Endocarditis: Incidence, Predictors and Outcome

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mehmet A Topcuoglu ◽  
Oguzhan Kursun ◽  
Ferdinando S Buonanno ◽  
Aneesh B Singhal
Keyword(s):  
Infective Endocarditis ◽  
Mitral Regurgitation ◽  
Multivariable Analysis ◽  
Native Valve ◽  
Duke Criteria ◽  
Mycotic Aneurysms ◽  
Mean Size ◽  
Pre Treatment ◽  
Cardiac Valve Disease

Introduction: Intracranial mycotic aneurysms (IMA) are rare but serious complications of infective endocarditis (IE). Methods and Results: In this retrospective study (1980-2011) we used original Duke criteria to diagnose IE in 1149 episodes (1081 patients; 81% definite, 80% native valve). Neuro complications occurred in 28%, stroke in 22% (202 infarcts, 53 hemorrhages) and 1% had TIA/TMB. N=33 IMA were detected in 23 (2%) patients. IMA were detected in 8% with focal neuro deficits, 13% with seizures, and 3% with encephalopathy. IMA-related symptoms were present in 22 of 23 cases: headache 48%, seizure 13%, altered sensorium 35% and focal deficits 61%. IMA were detected in 0/885 without stroke, 5.4% with infarcts and 22.6% with hemorrhages (p<0.001); the latter included 9/36 (25%) with ICH, 3/13 (23%) with SAH, and 0/4 with SDH. Of the 23 IMA patients 61% had hemorrhage, 30% had SAH and 57% had infarcts. IMAs were detected by DSA in 21/166 (12.7%). The mean size was 3.6±2.4 mm; 30% multiple; 61% located in distal segments; and 67% in MCA branches. On MRI, 31 had any SAH and 45 had any ICH; IMA detected in 6/9 with diffuse SAH, 2/22 with convexal SAH, 11/45 with ICH, and 11/202 with infarcts. Patients with IMA had higher rates of women, hypertension, known cardiac valve disease, mitral regurgitation, mitral vegetation and S.viridians infection (all p<0.05). On multivariable analysis, mitral regurgitation with vegetation (OR 5.9, 95% CI 2.5-14.0, p<0.001) was the only independent predictor of IMA. Clipping was performed in 8 (all pre-2000); endovascular treatment in 7 (all post-1997); 2 died pre- treatment; 1 detected on autopsy; 1 no follow-up available, and 4 regressed/disappeared with antibiotics. Patients with and without IMA showed no difference in rates of in-hospital mortality (22% v. 19%, p=0.93), and length of stay (32d v. 24d, p=0.28). IMA rates did not decrease during the study period (2.2% in 784 episodes 1980-2000 vs. 1.6% of 365 episodes 2001-2011, p=0.653). Conclusion: IMA are invariably heralded by neurological symptoms and stroke (especially hemorrhages) on brain imaging. Mitral IE has the highest risk for IMA. IMAs can resolve with antibiotics however studies are needed to determine the efficacy of different treatment approaches.

Abstract W MP66: Rates of Ischemic Stroke after Intracranial Hemorrhage in a Population-Based Sample of Patients with Atrial Fibrillation

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Michael P Lerario ◽  
Gino Gialdini ◽  
Daniel Lapidus ◽  
Mesha Shaw ◽  
Babak Navi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Anticoagulant Therapy ◽  
Stroke Risk ◽  
Hazard Analysis ◽  
Large Population ◽  
Population Based ◽  
Administrative Claims ◽  
Index Visit

Introduction: Patients with atrial fibrillation (AF) who experience intracranial hemorrhage (ICH) often cannot tolerate anticoagulant therapy and presumably face a higher risk of thromboembolism. However, there are little population-based data on long-term rates of stroke after ICH in patients with AF. Methods: Using validated diagnosis codes and administrative claims data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at their first encounter with a recorded diagnosis of AF. We excluded patients with diagnoses of stroke or ICH prior to their index visit or a diagnosis of stroke at the index visit. A time-varying covariate was used to account for ICH (intracerebral or subarachnoid hemorrhage) at the index visit or during follow-up. Kaplan-Meier survival statistics were used to calculate cumulative rates of stroke, and Cox proportional hazard analysis was used to evaluate the relationship between incident ICH and stroke while adjusting for the CHA 2 DS 2 VASc score. Results: During a mean 3.2 years of follow-up among 2,376,207 patients with AF, 25,243 (1.06%) developed ICH and 93,183 (3.92%) developed stroke. The cumulative 1-year rate of stroke was 6.50% (95% CI, 6.06-6.96%) after ICH versus 2.22% (95% CI, 2.20-2.24) in those without ICH. ICH remained associated with higher stroke risk after adjusting for the CHA 2 DS 2 VASc score (HR, 2.29; 95% CI, 2.18-2.40). Among patients with ICH, stroke risk rose in step with the CHA 2 DS 2 VASc score. Conclusions: In a large population-based cohort, patients with AF faced a substantially higher risk of stroke after ICH. This risk rose proportionally with increasing CHA 2 DS 2 VASc score. These findings point to patients with AF and ICH as a vulnerable population who may especially benefit from therapeutic alternatives to anticoagulant therapy for preventing thromboembolism in AF.

Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher Lu ◽  
Jack Chan ◽  
Zejia Yu ◽  
Paula Anzenberg ◽  
Mikhail Torosoff
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atrial Flutter ◽  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
History Of ◽  
Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

Association between cardiometabolic index and stroke: A population-based cross-sectional study

2021 ◽  
Vol 18 ◽  
Author(s):  
Feng-E Li ◽  
Yi Yang ◽  
Zhen-Ni Guo ◽  
Yun Luo ◽  
Fu-Liang Zhang ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Sectional Study ◽  
Cross Sectional ◽  
Discrimination Ability ◽  
Cardiometabolic Index

Background: Cardiometabolic index (CMI) is associated with several risk factors for stroke; however, few studies have assessed the role of CMI in stroke risk. Objective: This study aimed to assess the association between CMI and stroke in a population-based cross-sectional study. Methods: This study included 4445 general residents aged ≥40 years selected by multistage stratified random cluster sampling. CMI was calculated as the product of the ratio of waist circumference to height (WHtR) and the ratio of triglyceride levels to high-density lipoprotein cholesterol levels (TG/HDL-C). Participants were categorized according to CMI quartiles: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4). Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the association between CMI and stroke. Results: A total of 4052 participants were included in the study, with an overall stroke prevalence of 7.2%. The prevalence of stroke increased with CMI quartiles, ranging from 4.4% to 9.2% (p for trend <0.001). Compared with Q1, stroke risk for Q2, Q3, and Q4 were 1.550-, 1.693-, and 1.704- fold, respectively. The area under the ROC curve (AUC) [95% CI] was (0.574 [0.558−0.589]) for CMI, 0.627 [0.612−0.642]) (p=0.0024) for WHtR, 0.556 [0.540−0.571]) (p<0.0001) for TG/HDL-C. CMI was inferior to WHtR, but CMI had marginal advantage over TG/HDL-C in terms of its stroke discrimination ability. Conclusion: Although there was a strong and independent association between CMI and stroke in the general population, CMI had limited discriminating ability for stroke. Thus, new parameters should be developed.

Differentiation between endometriosis-associated ovarian cancers and non- endometriosis-associated ovarian cancers based on magnetic resonance imaging

2021 ◽  
pp. 20201441
Author(s):  
Ximing Zhang ◽  
Min Li ◽  
Zhuopeng Tang ◽  
Xinyi Li ◽  
Ting Song
Keyword(s):  
Regression Analysis ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Maximum Diameter ◽  
Mri Findings ◽  
Ovarian Cancers ◽  
Imaging Characteristics ◽  
Mri Characteristics ◽  
Mural Nodules

Objectives: Endometriosis-associated ovarian cancer (EAOC) patients show different clinical characteristics compared with non-EAOC patients. However, a few studies are focused on the imaging characteristics of EAOC until now. We assessed MRI characteristics in differentiating EAOC and non-EAOC. Methods: We retrospectively analyzed clinical and MRI characteristics from 54 patients with 67 lesions diagnosed with primary epithelial ovarian carcinoma at the Third Affiliated Hospital of Guangzhou Medical University between January 2012 and October 2020. We studied MRI findings such as maximum diameter, morphology, configuration, locularity, features of mural nodules, lymphadenopathy, peritoneal implants, the presence of hyperintensity on T1WI, and hypointensity on T2WI. We also studied the clinical characteristics. Significant MRI variables in univariate analysis were selected for subsequent multivariate regression analysis. This study evaluated the diagnostic performance of the significant MRI variables in univariate analysis. Results: We found that the patients with EAOC, compared with those with non-EAOC, were younger, more unilateral, and had earlier FIGO stage. Univariate analysis revealed that morphology, locularity, growth pattern of mural nodules, and hypointensity on T2WI were factors that significantly differed between EAOC and non-EAOC. In the multivariate logistic regression analysis, locularity and hypointensity on T2WI were independent predictors to distinguish EAOC from non-EAOC. Conclusions: EAOC typically presented as a unilocular mass with hypointensity on T2WI in cystic components. MRI could help distinguish EAOC from non-EAOC. Advances in knowledge: MRI is a promising tool for preoperative diagnosis of EAOC.

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