Cardiac CathLab-based stroke thrombectomy routine service by the BRAIN team in a recently established Thrombectomy-Capable Stroke Center in Poland

Introduction. Perimesencephalic subarachnoid hemorrhage (PMSAH) accounts for approximately half of all cases of non-aneurysmal hemorrhage, has a typical pattern on computed tomography (CT) of the brain, and favorable clinical course. Moreover, in the domestic literature there are no studies devoted to this problem.The purpose of the study: to study the frequency of occurrence, clinical and CT features of PMSAH in comparison with nonaneurismatic non-PMSAH according to the hospital register of the regional stroke center.Materials and methods. The data of 383 patients who underwent treatment with a diagnosis of spontaneous SAH in the regional stroke center of Perm Clinical Hospital №4 in 2014–2019 were analyzed. All patients underwent a standard examination, including CT of the brain and digital selective angiography (DSA). According to the pattern of SAH on CT, patients are divided into the groups PM-1 (isolated preptine), PM-2 (traditional) and PM-3 (diffuse). Evaluation of the long-term outcome was carried out using a telephone interview, as well as according to the regional electronic medical system.Results. Of 383 patients with SAH, aneurysms were identified in 350 patients (91,3%). Non-aneurysmal SAH was found in 20 patients (5,2%), in 8 patients (2,1%) − PMSAH. The age of patients averaged 48 years, women predominated. Intense headache in the onset of the disease was observed in the vast majority of patients. Nausea was significantly more often observed in patients with PMSAР (50%) compared with patients with non-PMSAР (8,3%). Loss of consciousness occurred in every fourth patient with PMSAР and only 8% of patients with non-PMSAH. The neurological status of the patients also did not differ and was characterized by a normal consciousness, meningeal syndrome (in 63% of patients with PMSAH) in the absence of focal symptoms. The level of neurological deficit according to NIHSS averaged 0 points, the severity of SAH on the Hunt-Hess scale averaged 2 points. At the time of completion of treatment, most patients did not have a neurological and functional deficit. According to CT, in 4 patients (50%), PM-2 was visualized, in 3 patients (38%) − PM-3, and in one patient − PM-1 (12%). On average, after 15 months, none of the treated patients developed repeated SAH, patients did not have functional limitations.Conclusions. This study for the first time made it possible to characterize the approximate frequency of occurrence, clinical and CT picture, as well as the long-term prognosis of PMSAH in a cohort of patients from a large regional stroke center in Russia.

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Abstract TP207: Clinicoradiologic Discordance in Methamphetamine Vasculopathy-Associated Rhombencephalitis: Three New Cases of Temporal and Geographical Similarity

Stroke ◽

10.1161/str.51.suppl_1.tp207 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michael P Flannery ◽

Alicia Bennett

Keyword(s):

Imaging Techniques ◽

Vasogenic Edema ◽

Case Series ◽

Methamphetamine Use ◽

Vertebral Arteries ◽

Csf Analysis ◽

Vessel Imaging ◽

T2 Hyperintensity ◽

Stroke Center ◽

The Brain

Introduction: Structural and functional imaging techniques have demonstrated CNS abnormalities due to methamphetamine use, however there are no prior reports of rhombencephalon involvement. Furthermore, clinicoradiologic discordance is unique to this case series. Methods: We report a case series of patients with a diagnosis of vasculopathy-associated rhombencephalitis out of proportion to clinical examination in the setting of methamphetamine use at our tertiary stroke center. Results: Three patients were evaluated within 3 months of each other for focal neurologic deficits with normal mental status at our tertiary stroke center. All admitted to recent methamphetamine use. MRI of the brain with and without contrast demonstrated T2 hyperintensity without enhancement or diffusion restriction involving primarily the pons, consistent with vasogenic edema or demyelination (Figure 1). Workup for infectious and inflammatory etiologies including CSF analysis was unremarkable. All patients had vessel imaging demonstrating extracranial vasculopathy; all had dissections of the vertebral arteries, one of which had an associated pseudoaneurysm (Figure 1). All of the patients had GCS of 15 and minimal to no improvement with various treatment. Conclusion: Vasculopathy-associated rhombencephalitis in the setting of acute methamphetamine use has not been reported previously. The temporal and geographic relationship among these cases is key to the suspected diagnosis that a methamphetamine adulterant has a leukotoxinogenic predilection for the rhombencephalon. The cause of significant clinicoradiologic discordance remains unclear. Further investigation into this association is needed.

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