Embolic strokes in a patient with a large floating thrombus in the ascending aorta.

BACKGROUND: A floating thrombus in the ascending aorta is a rare finding that may cause multiple ischemic strokes with catastrophic consequences. The treatment algorithm for such lesions is yet to be defined. CASE REPORT: We report the case of a 50-year-old patient with multiple cerebral ischemic strokes due to a sizeable floating thrombus (25 x 15 x 13 mm) in the ascending aorta. Conservative management utilizing anticoagulants was chosen due to the patient's high estimated perioperative risk. CONCLUSION: An anticoagulation treatment strategy may be feasible, safe, and effective in patients with large mobile thrombus in the aorta who are not eligible for thrombectomy. HIPPOKRATIA 2021, 25 (3):172-174.

The impact of the Covid-19 pandemic on a Greek cohort of patients with epilepsy.

BACKGROUND: The Covid-19 pandemic, the subsequent lockdown, and the measures of social distancing may have had adverse effects on patients with epilepsy (PWE). This study was designed to assess the pandemic's psychological impact on the Greek non-infected PWE and possible changes in their seizure control. METHOD: The patients were evaluated utilizing a semi-structured interview consisting of open questions regarding their demographic, social, and clinical characteristics, followed by five questions (on a scale of 0-10) related to the Covid-19 pandemic, lockdown, and social distancing measures. Anxiety and depression of PWE were screened using the Hospital Anxiety and Depression Scale (HADS), which consists of HADS-Anxiety and HADS-Depression subscales. RESULTS: We evaluated 65 PWE in the outpatient clinic (60 %) or via telephone interview (40 %). None of these patients experienced changes in seizure control. The mean scores of the Covid-19-related questions were 6.1 ± 2.7 (fear of getting infected), 4.7 ± 3.3 (fear of death), 7.1 ± 2.7 (fear of sickness for their relatives), 6.4 ± 3.1 (stress during lockdown), and 3.0 ± 2.9 (fear of antiepileptic drugs unavailability). Thirty-nine (60 %) patients screened positive for anxiety and thirty-three (50.8 %) for depression. CONCLUSION: The psychological impact of the Covid-19 pandemic, lockdown, and social distancing measures on non-infected PWE was moderate without changes in their seizure control. HIPPOKRATIA 2021, 25 (4):145-150.

The evaluation of blood flow Xe133 in different degrees experimentally induced carotid stenosis.

The present study was conducted in order to detect the possible relationship between the degree of carotid artery stenosis and the morphology, width of Xe133 curves and the absolute value of blood flow volume, obtained by the intra-carotid injection of Xe133 in 21 dogs (Groups A,B,C, n = 7 in each). In Group B the morphology of Xe133 curves revealed a double peak on the vertical part and the width a 57% decrease on the same part as compared to the control (Group A), while the per min blood flow value decreased by 47%. In Group C an elevation of the horizontal part was observed in all animals, the width of the vertical part could not be measured and the horizontal part showed a 10% increase as compared to the control Group A. Finally, the per minute blood flow value decreased by 75% compared to the controls.

Preoperative evaluation of patients with extracranial carotid disease. Plethysmographic criteria for the use of a shunt, and for avoidance of surgery.

Eighty five angiographically studied patients (mean age 52) with carotid artery disease were preoperatively evaluated for the type and adequacy of their collateral circulation by the use of supraorbital photo-electric plethysmography (SPP). According to certain criteria we identified the candidates for surgery with or without shunt or for conservative treatment. Sixty patients presented evidence of extracranial collateral mainly from the ipsilateral superficial temporal artery (49 of 60), 11 patients revealed evidence of intracranial collateral mainly from the contralateral internal carotid artery (9 of 11), while in the rest, 14 patients, the source of the collateral circulation was undeterminable. Furthermore, an adequate circle of Willis was found in 67 patients and an inadequate one in the rest 7 (4 of 60, and 3 of 14). The majority of the surgically treated patients (74 of 81) were subjected to surgery without shunt (91%) while only 7 necessitated the use of a shunt (9%). No neurological complication was encountered and the single death (1.3%) was not directly related to the surgery itself. According to the present study, the careful preoperative determination of the collateral circulation, with the simple technique of SPP and the identification of patients at high risk under certain criteria could help the surgeon to decide about the advisability of a shunt or not and about the avoidance of surgery as well. This technique may be valuable where other more sophisticated forms of monitoring, such as EEG, evoked potentials or blood flow, are not readily available.