Multimodal CT imaging and recanalizing therapy in acute ischemic stroke: retrospective analysis of a one-year single-center experience.

BACKGROUND: Recanalizing therapy in ischemic stroke is restricted to thrombolysis within 3 h. Multimodal imaging of vessel and parenchymal perfusion status may allow the extension of this time window. AIM: To retrospectively analyze treatment results of any recanalizing therapy in clinical practice. METHODS: Patients comprised three groups: 'standard' intravenous thrombolysis within 3 h; 'off-label' intravenous thrombolysis, and off-label interventional therapy. Recanalizing therapy was applied dependent on multimodal CT according to standardized pathways. Short-term clinical courses were analyzed. RESULTS: Of 543 patients (ischemic stroke, TIA), 68 (12.5%) received some type of recanalizing therapy. Of these, 47 (mean age 73.4, 24 female, mean symptom onset and hospital admission 62 min) received standard and 10 off-label thrombolysis (70.8, 6 female, 332 min), and 11 interventional therapy, mostly mechanical thrombectomy (mean age 62.5, 7 female, 186 min). Mean Δ short-term National Institutes of Health Stroke Scale (2-5 days) in these three groups were 3.7 ± 4.7, 3.9 ± 4.4, and 4.1 ± 5.8, respectively. The short-term clinical benefit was similar in the three groups. CONCLUSION: Off-label therapy is considered to have a higher risk of complications. However, if multimodal CT imaging of acute ischemic stroke is incorporated in everyday clinical decision-making, the rate of effective recanalizing procedures may be increased without an apparent negative effect on short-term outcome.

Diagnosis of leptomeningeal disease in diffuse large B-cell lymphomas of the central nervous system by flow cytometry and cytopathology.

Reliable detection of leptomeningeal disease has the potential of facilitating the diagnosis of central nervous system (CNS) lymphoma and is important for therapeutic considerations. Currently, the standard diagnostic procedure for the detection of lymphoma in the cerebrospinal fluid is cytopathology. To improve the limited specificity and sensitivity of cytopathology, flow cytometry has been suggested as an alternative. Here, we evaluated multi-parameter flow cytometry in combination with conventional cytopathology in cerebrospinal fluid (CSF) samples from 30 patients with primary CNS lymphoma and seven patients with secondary CNS lymphoma. Overall, in 11 of 37 (29.7%) patients with CNS lymphoma, lymphoma cells were detected in CSF by flow cytometry, while cytopathology was less sensitive displaying unequivocally malignant CSF cells in only seven of all 37 (18.9%) patients. Six (16.2%) patients showed cytopathological results suspicious of lymphoma; however, in only one of these patients, the diagnosis of CSF lymphoma cells could be confirmed by flow cytometry. In primary CNS lymphomas (PCNSL), seven of 30 (23.3%) patients were positive for CSF lymphoma cells in flow cytometry, in contrast to four (13.3%) patients with PCNSL with definitely positive cytopathology. In summary, our results suggest that multi-parameter flow cytometry increases the sensitivity and specificity of leptomeningeal disease detection in CNS lymphomas. Both methods should be applied concurrently for complementary diagnostic assessment in patients with CNS lymphoma.

Detection of free immunoglobulin light chains in cerebrospinal fluids of patients with central nervous system lymphomas.

Diagnosis of central nervous system (CNS) lymphoma depends on histopathology of brain biopsies, because no reliable disease marker in the cerebrospinal fluid (CSF) has been identified yet. B-cell lymphomas such as CNS lymphomas are clonally restricted and express either kappa or lambda immunoglobulin light chains. The aim of this study was to find out a potential diagnostic value of free immunoglobulin light chains released into the CSF of CNS lymphoma patients. Kappa (kappa) and lambda (lambda) free immunoglobulin light chains (FLC) were measured in CSF and serum samples collected from 21 patients with primary and secondary CNS lymphomas and 14 control patients with different neurologic disorders. FLC concentrations and ratios were compared between patient groups and were further analyzed in correlation with clinical, cytopathological, and radiological findings. FLC concentrations for all patients were lower in CSF when compared to serum. In patients with CNS lymphoma, the FLC ratios in CSF were higher (range 392-0.3) compared to control patients (range 3.0-0.3). Irrespective of cytopathological proven lymphomatous meningitis, in 11/21 lymphoma CSF samples the FLC ratios were markedly above 3.0 indicating a clonally restricted B-cell population. Increased FLC ratios in CSF were found in those patients showing subependymal lymphoma contact as detected in magnetic resonance imaging. In summary, this is the first report demonstrating that a significant proportion of patients with CNS lymphomas display a markedly increased FLC ratio in the CSF.