Cerebellar hemorrhages in patients with cerebral amyloid angiopathy.

BACKGROUND: Cerebral amyloid angiopathy (CAA) typically involves the cerebral cortex but whether it affects the cerebellum remains uncertain. METHODS: Patients with intracerebral hemorrhage (ICH) who underwent magnetic resonance imaging were prospectively enrolled. Patients were diagnosed with CAA according to the Boston criteria and their hemorrhage types were categorized as macro-hematoma (MH) or microbleeds (MB). Patients with CAA and cerebellar involvement were compared with CAA patients without cerebellar involvement. RESULTS: Out of 614 patients with ICH, 85 (14%) had a post-ICH MRI. Of those, 41 (48%) were diagnosed with possible (n = 19), probable (n = 21) or definite (n = 1) CAA. Cerebellar involvement was seen in 14/41 (34%) patients with CAA. Most cerebellar lesions were of the MB type (35%) and most patients had several cerebellar MB typically involving the cerebellar cortex (85%). Patients with cerebellar involvement had larger numbers of lobar MB but clinical variables including age, gender, risk factor profile, mRS scores at 90 days or survival did not differ between those with and without cerebellar involvement. CONCLUSIONS: Cerebellar involvement may be common in CAA. Most patients have multiple superficial cerebellar MB. Clinical characteristics do not differ between CAA patients with or without cerebellar involvement. Patients presenting with cerebellar ICH should be screened for CAA with MRI.

Clot length does not impact outcome following thrombectomy.

BACKGROUND AND AIMS: Clot length was associated with outcome after treatment with intravenous tissue plasminogen activator (tPA) in patients with stroke secondary to emergent large vessel occlusions (ELVO) but data regarding the influence of clot length on outcome after thrombectomy is lacking. PATIENTS AND METHODS: Prospectively accrued data on consecutive patients with ELVO treated with thrombectomy was analyzed. Data on demographics, risk factors, stroke severity, survival and occurrence of symptomatic intracranial hemorrhage (sICH) was collected. Procedural details including clot length measured on the pre-thrombectomy digital subtraction angiograms in multiple projections were collected. Functional outcome was determined with the modified Rankin Scale (mRS) 90 days post stroke and mRS ≤ 2 was considered as favorable outcome. RESULTS: Data was collected for 94 patients that fulfilled entry criteria. On univariate analysis clot length did not differ between patients with favorable or unfavorable outcomes. Clot length also did not influence the rates of sICH or mortality. On multivariate logistic regression age and stroke severity remained significant modifiers for favorable outcome. In a second regression model age, poor collaterals, the number of passes needed for recanalization and the magnitude of change in neurological deficits between presentation and discharge remained significant modifiers of outcomes. However, clot length had no effect on outcome in both models. CONCLUSIONS: In patients undergoing thrombectomy for ELVO, clot length has no effect on functional outcomes, mortality or sICH. Therefore, patients with ELVO should not be excluded from thrombectomy based on lot length.