cerebral infarcts
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2021 ◽  
Vol 118 ◽  
pp. 102034
Author(s):  
Vibeke Bay ◽  
Nina K. Iversen ◽  
Seyedeh Marziyeh Jabbari Shiadeh ◽  
R. Andrew Tasker ◽  
Gregers Wegener ◽  
...  

Author(s):  
Peter Hsu ◽  
James C Gay ◽  
Chyongchiou J Lin ◽  
Mark Rodeghier ◽  
Michael R DeBaun ◽  
...  

In 2020, the American Society of Hematology published evidence-based guidelines for cerebrovascular disease in individuals with sickle cell anemia (SCA). While guidelines were based on NIH-sponsored randomized controlled trials, no cost-effectiveness analysis was completed for children with SCA and silent cerebral infarcts. We conducted a cost-effectiveness analysis comparing regular blood transfusion versus standard care using Silent Cerebral Infarct Transfusion (SIT) Trial participants. This analysis included a modified societal perspective with direct costs (hospitalization, emergency room visit, transfusion, outpatient care, iron chelation) and indirect costs (special education). Direct medical costs were estimated from hospitalizations from SIT hospitals and unlinked aggregated hospital and outpatient costs from SIT sites using the Pediatric Health Information System. Indirect costs were estimated from published literature. Effectiveness was prevention of infarct recurrence. Incremental cost-effectiveness ratio using a 3-year time horizon (mean SIT trial participant follow-up) compared transfusion versus standard care. A total of 196 participants received transfusions (N=90) or standard care (N=106), with a mean age of 10.0 years. Annual hospitalization costs were reduced by 54% for transfusions than standard care ($4,929 vs. $10,802), but transfusion group outpatient costs added $22,454 to $137,022 per year. Special education costs savings was $2,634 over three years for every infarct prevented. Transfusion therapy had an incremental cost-effectiveness ratio of $22,025 per infarct prevented. Children with pre-existing silent cerebral infarcts receiving blood transfusions have lower hospitalization but higher outpatient costs, primarily associated with oral iron chelator deferasirox. Regular blood transfusion therapy is cost-effective for infarct recurrence in children with SCA. This trial is registered at www.clinicaltrials.gov as NCT00072761.


Author(s):  
Thirumalai V. Srivatsan ◽  
Haroon M. Pillay ◽  
Lakshay Raheja

AbstractPituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together.We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.


2021 ◽  
Author(s):  
Vojtech Novotny ◽  
Sander Johan Aarli ◽  
Andrej Netland Khanevski ◽  
Anna Therese Bjerkreim ◽  
Christopher Elnan Kvistad ◽  
...  

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012404
Author(s):  
Yan Wang ◽  
Slim Fellah ◽  
Melanie E. Fields ◽  
Kristin P. Guilliams ◽  
Michael M. Binkley ◽  
...  

Objective:To determine the patient- and tissue-based relationships between cerebral hemodynamic and oxygen metabolic stress, microstructural injury, and infarct location in adults with sickle cell disease (SCD).Methods:Control and SCD participants underwent brain MRI to quantify cerebral blood flow (CBF), oxygen extraction fraction (OEF), mean diffusivity (MD), and fractional anisotropy (FA) within normal-appearing white matter (NAWM), and infarcts on FLAIR. Multivariable linear regression examined the patient- and voxel-based associations between hemodynamic and metabolic stress (defined as elevated CBF and OEF, respectively), white matter microstructure, and infarct location.Results:Of 83 control and SCD participants, adults with SCD demonstrated increased CBF (50.9 vs 38.8 mL/min/100g, p<0.001), increased OEF (0.35 vs 0.25, p<0.001), increased MD (0.76 vs 0.72 x 10-3mm2 s-1, p=0.005), and decreased FA (0.40 vs 0.42, p=0.021) within NAWM compared to controls. In multivariable analysis, increased OEF (β=0.19, p=0.035), but not CBF (β=0.00, p=0.340), independently predicted increased MD in the SCD cohort, while neither were predictors in controls. On voxel-wise regression, the SCD cohort demonstrated widespread OEF elevation, encompassing deep white matter regions of elevated MD and reduced FA, which spatially extended beyond high density infarct locations from the SCD cohort.Conclusion:Elevated OEF, a putative index of cerebral oxygen metabolic stress, may provide a metric of ischemic vulnerability which could enable individualization of therapeutic strategies in SCD. The patient- and tissue-based relationships between elevated OEF, elevated MD, and cerebral infarcts suggest that oxygen metabolic stress may underlie microstructural injury prior to the development of cerebral infarcts in SCD.


2021 ◽  
Author(s):  
Shino Magaki ◽  
Zesheng Chen ◽  
Mohammad Haeri ◽  
Christopher K. Williams ◽  
Negar Khanlou ◽  
...  

AbstractIntracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. Hypertension and cerebral amyloid angiopathy (CAA) are the most common causes of primary ICH, but the mechanism of hemorrhage in both conditions is unclear. Although fibrinoid necrosis and Charcot–Bouchard aneurysms (CBAs) have been postulated to underlie vessel rupture in ICH, the role and significance of CBAs in ICH has been controversial. First described as the source of bleeding in hypertensive hemorrhage, they are also one of the CAA-associated microangiopathies along with fibrinoid necrosis, fibrosis and “lumen within a lumen appearance.” We describe clinicopathologic findings of CBAs found in 12 patients out of over 2700 routine autopsies at a tertiary academic medical center. CBAs were rare and predominantly seen in elderly individuals, many of whom had multiple systemic and cerebrovascular comorbidities including hypertension, myocardial and cerebral infarcts, and CAA. Only one of the 12 subjects with CBAs had a large ICH, and the etiology underlying the hemorrhage was likely multifactorial. Two CBAs in the basal ganglia demonstrated associated microhemorrhages, while three demonstrated infarcts in the vicinity. CBAs may not be a significant cause of ICH but are a manifestation of severe cerebral small vessel disease including both hypertensive arteriopathy and CAA.


Author(s):  
Federica Benvenuti ◽  
◽  
Francesco Meucci ◽  
Luisa Vuolo ◽  
Rita Nistri ◽  
...  

Abstract Background Patent foramen ovale (PFO) closure is superior to medical therapy alone to prevent stroke recurrence in selected patients. Small cortical infarcts and large right to left shunts seem to identify patients who will benefit most from closure. We aimed to study the correlation between the size of the PFO and the volume of cerebral ischemic lesions in young patients with cryptogenic ischemic stroke. Methods PFO dimensions and acute ischemic lesion volume of 20 patients, aged<55 years, were analyzed with transesophageal echocardiography and brain magnetic resonance imaging, respectively. The association between the volume of ischemic lesions with the length of PFO, maximum separation between septum primum and septum secundum, and the combination of the twos was explored. Results A direct statistically significant correlation was found between cerebral lesion volume and maximum separation of septum primum and septum secundum (p=0.047). Length of PFO showed a non-significant trend towards an inverse correlation with lesion volume (p=0.603). Multiple linear regression analysis showed that cerebral lesion volume was dependent directly on maximum separation and inversely on length of PFO (regression coeff. −0,837; p= 0.057; 2,536, p=0.006, respectively). Conclusions These data suggest that even small PFO might be pathogenetic in case of small cerebral infarcts and that large cerebral infarcts might be PFO related if the shunt is large. If confirmed, the combination of detailed characteristics of PFO with the volume of cerebral infarct could be integrated in a new score to select patients who would take real advantage from a percutaneous closure.


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