The prognosis prediction significance of Hounsfield unit value for stroke patients treated by intravenous thrombolysis.

BACKGROUND: Intravenous thrombolysis (IVT) is a rapid and effective treatment in the early stage of ischemic stroke patients and the purpose of this work is to explore the significance of Hounsfield unit (HU) value in Alberta Stroke Program Early CT Score (ASPECTS) for predicting the clinical prognosis of stroke patients with middle cerebral artery occlusion (MCAO) treated by IVT. METHODS: The 84 stroke patients with MCAO treated by IVT were divided into good prognosis group (48 cases) and poor prognosis group (36 cases). HU ratio and HU difference calculated from non-contrast computed tomography between groups were analyzed. RESULTS: The HU ratio of good prognosis group was higher than that in poor prognosis group and the HU difference of good prognosis group was lower than that in poor prognosis group (P < 0.05). The HU ratio and ASPECTS were negatively correlated with the infarct volume, and the HU difference was positively correlated with the infarct volume (P < 0.05). HU difference was an independent risk factor for prognosis of patients with MCAO treated by IVT. The area under the receiver operating characteristic curve of HU ratio and HU difference for prognosis was 0.743 and 0.833 respectively. CONCLUSION: The HU value changes are related to the clinical prognosis of stroke patients with MCAO treated by IVT, HU value may be a prognostic indicator for stroke patients with MCAO treated by IVT.

Arteritis and Large Vessel Occlusive Strokes in Children After COVID-19 Infection.

We describe 2 previously healthy children who suffered disabling arterial ischemic strokes because of acute intracranial large vessel occlusion within 3 to 4 weeks of coronavirus disease 2019 (COVID-19) infection. Both children presented from communities with high COVID-19 case rates in the Southwest United States. An 8-year-old American Indian girl experienced severe iron deficiency anemia requiring blood transfusion and presented with bilateral middle cerebral artery (MCA) distribution strokes 3 weeks later. She underwent emergent mechanical thrombectomy of the left MCA with successful clot retrieval but experienced reocclusion of that artery 5 hours after intervention. She also had evidence of cerebral arteritis on catheter angiography and vessel wall imaging, and clot pathology revealed recently formed, unorganized platelet- and fibrin-rich thrombus with sparse clusters of erythrocytes, degenerated histiocytes, few eosinophils, and rare neutrophils. A 16-year old African American boy demonstrated evidence of arteritis on brain magnetic resonance angiography and serological markers of cardiac and renal injury accompanied by positive lupus anticoagulant antibodies. The children described in this report express clinical features inconsistent with focal cerebral arteriopathy, including elevated markers of systemic inflammation in both bilateral MCA strokes in one case and multiple organ system dysfunction in the other case. Neither patient fulfilled criteria for multisystem inflammatory syndrome in children, given absence of fever. These cases illustrate that systemic postinfectious arteritis with cerebrovascular involvement may complicate COVID-19 infection in previously healthy school-aged children, and their presentations may overlap but not fulfill criteria for multisystem inflammatory syndrome in children or focal cerebral arteriopathy.

The Extra Mile: Special Consideration of Atrial Fibrillation in Older Adults with Endurance Athletic History.

BACKGROUND Aerobic exercise is uniformly accepted as one of the most important modifiable factors to improve cardiovascular health, but endurance athletic training poses a significant risk factor for development of atrial fibrillation (AFib) in middle-aged and older adults. Ubiquitous risk assessment tools (CHADS2 and CHA2DS2-VASc) and US Preventive Services Task Force guidelines do not presently account for this association. A case is presented which illustrates a dire outcome of undiagnosed AFib in an elderly male patient who had run many marathons. CASE REPORT An 80-year-old male with well-controlled hypertension and hypercholesterolemia and a history significant for running many marathons throughout his life was brought in via ambulance after being found down with head trauma by his wife at home. A short run of AFib was recorded on telemetry and electrocardiogram (ECG) and a review of previous ECGs revealed evidence of interatrial block (Bayes Syndrome), though the patient had no history of AFib or anticoagulation. This coupled with imaging indicated thromboembolic stroke to the left middle cerebral artery leading to right-sided hemiplegia and a subsequent fall to the right, causing right-sided head trauma and intracranial hemorrhage. His clinical course did not improve, and on his fifth day of admission he was transferred to comfort care, extubated, and succumbed to his injuries. CONCLUSIONS This case and the accompanying summary of evidence strongly encourage further investigation and a higher index of suspicion for AFib in asymptomatic older adults with a history of endurance athletic training.