Ultra-early improvement after endovascular thrombectomy and long-term outcome in anterior circulation acute ischemic stroke.

BACKGROUND: The use of post-treatment measures after acute ischemic stroke is important to predict good functional outcome. The most studied is 24 h National Institutes of Health Stroke Scale (NIHSS) score and existing literature is scarce regarding the use of earlier indicators, namely NIHSS immediately after endovascular thrombectomy (EVT). We hypothesized that an immediate neurological improvement after EVT, that we called ultra-early neurological improvement (UENI), would be a reliable functional independence predictor in anterior circulation acute ischemic stroke patients. METHODS: We included 296 anterior circulation stroke patients who received EVT at our institution between January 2015 and December 2017. We obtained post-EVT NIHSS score in the angiography room. UUENI was defined as a ≥ 4 point decrease in post-EVT NIHSS score relatively to baseline or post-EVT NIHSS score of 0-1. Patients' functional outcome was assessed using the modified Rankin Scale at 3 months. The ability of UENI to predict good functional outcome was assessed using logistic regression analysis. RESULTS: A total of 155 (52.4%) patients presented UENI. This group of patients achieved a statistically significant higher rate of functional independence (70.3% vs 46.8%, OR crude 2.69, 95% CI 1.67-4.34). After adjusting for potential confounders, the UENI showed to be an independent predictor of good outcome, with UENI patients having 4.61 times the probability of obtaining good outcome compared to patients without UENI. CONCLUSIONS: UENI is useful in outcome prediction in patients with anterior circulation stroke treated with EVT, with the advantage that it can be assessed at an ultra-early stage.

Ictal kissing in a patient with right frontal lobe epilepsy.

When performing pre-surgical evaluation of patients with refractory epilepsy, the analysis of seizure semiology is one of the key elements used to generate a hypothesis about the location of the epileptogenic zone. Ictal kissing is a very rarely observed ictal automatism described in patients with temporal lobe epilepsy. We present a 62-year-old man who was referred to our epilepsy centre for comprehensive evaluation. During prolonged video-EEG monitoring, six focal-onset hyperkinetic seizures were registered. In five seizures, the patient repeatedly produced sonorous kisses "into the air". Initial ictal EEG pattern consisted of rhythmic theta or alpha activity at the right fronto-polar and fronto-medial electrodes. MRI depicted focal cortical dysplasia located in the right prefrontal medial cortex. This case suggests that ictal kissing can also occur in the setting of right frontal lobe epilepsy; we therefore believe that this observation expands the anatomo-clinical correlation for this rare ictal automatism. [Published with video sequences].