Practice recommendations for neurovascular ultrasound investigations of acute stroke patients in the setting of the COVID-19 pandemic: an expert consensus from the European Society of Neurosonology and Cerebral Hemodynamics.

BACKGROUND AND PURPOSE: Patients with acute ischemic stroke are at high-risk for contracting COVID-19 infection. Additionally, healthcare professionals including neurovascular ultrasound providers are also at risk of being infected by SARS-CoV-2 virus. Yet, preparedness to continue to guarantee hyperacute treatment is vital for patients outcome. In light of this situation, the European Society of Neurosonology and Cerebral Hemodynamic (ESNCH) appointed a task force to provide consensus recommendations for the performance of neurovascular ultrasound investigations in acute ischemic stroke during the COVID-19 pandemic with the aim of protecting both patients and ultrasound providers. METHODS: The "ultrasound in acute stroke working group" of the ESNCH examined literature articles and reviews using the following key words: "corona virus" or "COVID-19" or "SARS-CoV-2 virus", and "acute stroke" or "cerebrovascular disease", and "ultrasound". Thereafter, a thorough discussion was conducted with the "education and guidelines working group" of the ESNCH. RESULTS: We propose rapid up-to-date recommendations for healthcare personnel involved in the pre-hospital and intra-hospital assessment of stroke patients, with a particular attention to neurovascular ultrasound performance. CONCLUSION: The ESNCH provides a guidance summary for the performance of neurovascular ultrasound investigations in acute ischemic stroke in the time of COVID-19.

Computed tomographic angiography criteria in the diagnosis of brain death-comparison of sensitivity and interobserver reliability of different evaluation scales.

INTRODUCTION: The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD. METHODS: Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales. RESULTS: Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p<0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p=0.37). CONCLUSIONS: In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.

Changes in cerebral hemodynamics after carotid stenting: evaluation with CT perfusion studies.

PURPOSE: To determine changes in cerebral perfusion parameters, based on CT perfusion imaging, in patients after unilateral transluminal angioplasty and stent placement. MATERIAL AND METHODS: 74 patients with symptomatic high - grade internal carotid artery stenosis (>70%) were studied with CT perfusion imaging before and - on average - 70 hours and 172 days after carotid stent placement. There were 50 patients with unilateral carotid artery stenosis and 24 with stenosis and accompanying contralateral internal carotid artery occlusion. CT examination was performed using a multidetector helical CT scanner (Light Speed Ultra Advantage, GE Healthcare, USA). Maps showing the absolute values of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were generated. RESULTS: In a group with unilateral carotid artery stenosis perfusion deficits were present in 84% of patients, ipsilaterally to stenosis. MTT elongation was noted (6.2-6.8s) together with decreased values of CBF (40-46ml/100g/min) and slightly increased CBV (3.2ml/100g). In this group, 3 days after stenting, 30% of patients had perfusion deficits, and after 6 months only 6%. In a group with carotid artery stenosis and contralateral artery occlusion severe perfusion deficits were noted in both hemispheres and they were present in 100% of patients. 6 months after stenting hypoperfusion was observed only in 17% of patients. CONCLUSIONS: Brain perfusion deficits, observed in a majority of patients with carotid artery stenosis tend to improve considerably after carotid artery stenting, in long - term follow up.

[Role thrombocytes in etiopathogenesis of ischemic stroke]. / Udzial plytek krwi w etiopatogenezie udaru niedokrwiennego mózgu.

This paper presents the most essential problems concerning the role of platelets in the genesis of ischaemic brain disease and their role in spreading of ischaemic focus. The role of platelets in atherogenesis and development of vascular abnormalities in arterial hypertension and diabetes mellitus was considered, and attention was paid to conditions concerned with the pathogenesis of ischaemic stroke such as presence of antiphospholipid antibodies and presence of large volume platelets, in which platelet activation plays essential role. Then it was shown that platelet hyperactivation occurs in acute phase of ischaemic stroke and mechanisms of destructive action of activated platelets on recent ischaemic focus in brain such as secretion of neurotoxins and blocking of microcirculation by platelet aggregates were discussed.

[The role of protein C in the pathogenesis of stroke]. / Rola bialka C w patogenezie udaru mózgu.

This paper presents the role of inhibitory protein C in the haemostatic processes, types of its deficiency and current opinions concerning the role of protein C deficiency in the pathogenesis of stroke. Deficiency of protein C (PC) or activated protein C resistance (both hereditary and acquired) play a role in pathogenesis of stroke, but not so great as it was thought until quite lately. Isolated protein C deficiency in old patients does not increase the risk of stroke. But in children hereditary deficiency of PC or activated PC resistance are of great importance in pathogenesis of ischaemic or venous stroke. In the presence of additional risk factors both in children and in adults deficiency of PC may be an important condition leading to stroke occurrence.

[Dialysis therapy and central nervous system disturbances]. / Dializoterapia a zmiany w osrodkowym ukladzie nerwowym.

Complications connected with chronic dialysis therapy and manifesting themselves as symptoms of central nervous system lesion, are presented. A special attention was paid to dialysis encephalopathy, to dialysis disequilibrium syndrome and to the vascular lesion of brain, that of the dialysis.

Pathogenesis and clinical aspects of malignant hyperpyrexia (MH).

Great progress in anaesthetic techniques has resulted in elimination or significant reduction of complications connected with the disease, operation technique or anaesthesia. However, sometimes a rapid increase in systemic metabolism occurs immediately after induction of anaesthesia and it may end in the patient's death. This syndrome defined as malignant hyperpyrexia (MH) was described for the first time by Denborough and Lovell (2). They reported 10 deaths of this type in one family. Later it was noticed that some patients may develop MH after inhalation anaesthetics or suxametonium. MH was observed more frequently in several groups of patients. It occurs rarely--1 to 15,000 cases after anaesthesia in children and 1 to 50,000 cases after anaesthesia in adults, but its sudden and rapid development becomes a great clinical problem.

Current opinions in etiopathogenesis of headaches caused by cervical spine pathology.

Headaches of occipital and nape region, which repeat paroxysmally and are concerned with cervical spine disorders cause many problems in everyday medical practice. This review article presents problems of classification, clinical features and current opinions in etiopathogenesis of headaches caused by cervical spine pathology.