LARGE VESSEL OCCLUSION STROKE IN A 17 YEAR OLD MALE WITH PAEDIATRIC INFLAMMATORY MULTI-SYSTEM SYNDROME ASSOCIATED WITH SARS-COV-2

Background: Paediatric Cov-2 infections have been less severe than in adults, however some have developed a newly defined syndrome, Paediatric Inflammatory Multisystem Syndrome associated with CoV-2 (PIMS -TS). Its presentation is variable and can cause multi-system involvement. It belongs to the common spectrum of pathogen-triggered hyperinflammatory states, including atypical Kawasaki disease. Case summary: 17 year old male of Ghanaian origin, with no significant past medical history, presented with a one-week history of general malaise, fevers and sore throat. He developed severe chest pain and cardiogenic shock, with a CRP of 200, raised troponin and global hypokinesia on echocardiogram with an ejection fraction of 20%. He was positive for SARS-CoV-2 antibodies (though PCR-antigen negative at admission) and fit the criteria for myocarditis secondary to PIMS-TS. He was treated for sepsis, commenced on IV methylprednisolone and needed intubation, sedation and cardiothoracic ICU level care. On weaning sedation after 3 days, he was found to have left middle cerebral artery syndrome with NIHSS 16. CT head and CT angiogram showed a left MCA ischaemic stroke, and a thrombus in the Sylvian MCA branch. This was treated with antiplatelets. His disease markers and motor deficits improved significantly, however he has cognitive impairment and low mood. Conclusion: PIMS-TS related LVO anterior circulation infarct is rare. It necessitates urgent recognition and multi-specialty involvement as currently management is not standardised. Axial DWI (A), ADC (B) MRI demonstrate large left MCA territory infarct. Axial MRA (C) shows occlusion of the left M2 branches, signal drop-out on SWI (D).

A QUALITATIVE STUDY OF PATIENT PERCEPTIONS OF IMMUNOGLOBULIN TREATMENT REGIMENS FOR INFLAMMATORY NEUROPATHY

Introduction With RCT evidence of equivalency between intravenous (IVIg) and subcutaneous (SCIg) immunoglobulin in the management of CIDP, we sought to optimise uptake of homecare SCIg in our inflammatory neuropathy cohort. This is of particular importance in the context of the COVID pandemic. Aim To explore patient perception of IVIg and SCIg and understand treatment preferences. Methods We performed a non-hypothesis driven qualitative study of patient perception. Data was collected from adult patients with CIDP via an open-ended telephone interview and a focus group facilitated by medics independent members of the treating team. The data was coded using Braun and Clarke's reflexive thematic analysis. Results 11 patients were interviewed (mean age=51.55;S.D. 8.70, mean time on immunoglobulin treatment 61 months, S. D. 35.64). Patients found the treatment effective but highlighted perceived side-effects. The hospital environment (IVIg treatment) was reassuring but brought with it a range of difficulties, both logisti-cal and financial. Knowledge and direct experience of SCIg was lacking. Conclusion We will develop a structured questionnaire based on these themes for broader application across the cohort. From this qualitative data we will continue to adapt our service in a patient focused manner and identify measures of quality improvement.

KEEPING TIME: WARD-BASED INTERVENTIONS IMPROVE LEVODOPA ADMINISTRATION AT THE NATIONAL HOSPITAL OF NEUROLOGY AND NEUROSURGERY

Background The National Hospital for Neurology and Neurosurgery admits Parkinson's disease (PD) patients for medical management and deep brain stimulation, as well as non-PD inpatients on levodopa with dystonia or atypical Parkinsonism. Previous work showed 24.5% of administrations were outside of the recommended 30-minute time window. Methods We introduced interventions based on the Leeds Quality Improvement Project 'Get it Right on Time', adapted for local protocols and focused questionnaires. Due to cancellation of elective PD admissions during the SARS-CoV-2 crisis, we included all inpatients on levodopa. We tested differences between pre-intervention and post-intervention groups using Chi-squared (c2), with post hoc comparisons to examine individual time categories. Results We compared 177 post-intervention administration episodes to 404 in the pre-intervention group. Across all time categories, we found a significant change in administration timings between groups (c2=35.9, p<0.001). This was driven by an increase in levodopa given on time, from 11.4% to 23.2% (p<0.001) and a decrease in levodopa given up to 15 minutes late, from 31.2% to 17.5% (p<0.001). Conclusion Ward-based interventions improve timely levodopa administration. Including non-PD patients altered the study population and may have impacted results. Further work includes surveying staff to identify additional interventions and investigating a PD-only cohort.