Introduction. Atrial fibrillation is associated with an increased risk of ischemic stroke. The benefit of intravenous thrombolysis in patients with acute ischemic stroke and atrial fibrillation is still unclear. The aim of the study was to assess and compare the effects of intravenous thrombolysis in stroke patients with and without atrial fibrillation. Material and Methods. We analyzed stroke patients who were treated with intravenous thrombolysis. Patients were divided into two groups according to the presence of atrial fibrillation. Demographic, clinical and radiological characteristics of patients were compared between the two groups. The treatment efficacy was evaluated in relation to the improvement of neurological status after 24 hours, and functional recovery after three months. Binary logistic regression was used to evaluate predictors of outcome. Results. From a total of 188 patients, 39.4% presented with atrial fibrillation. Patients with atrial fibrillation were older (69.4 vs. 62.6 years; p <0.0001), with female predominance (43.2% vs. 28.9%, p = 0.04) and had clinically more severe stroke (National Institutes of Health Stroke Scale, score on admission 15.4 vs. 12.1; p = 0.0001). Significantly more patients without atrial fibrillation (61.4% vs. 43.2%, p = 0.01) had a favorable clinical outcome at three months after stroke. Nevertheless, atrial fibrillation was not an independent predictor of poor outcome at three months after stroke (p=0.66). Conclusion. Acute ischemic stroke patients, with atrial fibrillation, treated with intravenous thrombolysis, had worse outcomes than patients without atrial fibrillation did. However, it is mainly due to older age and a more severe stroke in patients with atrial fibrillation.
A 32-year-old white woman presented with acute onset of right limb weakness, 3 days before hospitalization. She had non-regulated hyperthyreoidism and a history of smoking. Brain computed tomography (CT) showed a several occipital and high parietal ischemic lesions of the left hemisphere [ Figure 1a and b]. Duplex ultrasonography scan (DUS) showed the existence of fibrolipid plaque located on the back wall of the common carotid artery, that extended to the external as well as internal carotid artery making an uneven plaque, a part of which moved up and down with the heart beat, creating stenosis of 80-90% [ Figure 1c and d]. CT angiography revealed unstable plaque in left internal carotid artery that protrudes into the lumen as well as moderate stenosis in the proximal segment of the external carotid artery [ Figure 2]. She underwent total carotid endarterecotomy of symptomatic left internal carotid artery, 25 days after being admitted. Histopathological finding indicated that the plaque was atherosclerotic. In the prevention of stroke recurrence, the patient was given 75 mg of clopidogrel and 100 mg of aspirin daily. The patient did well, with residual discrete right-sided weakness and no recurrent strokes. Follow-up DUS was done and it showed no signs of plaque or restenosis.Mobile carotid plaques are unstable and associated with recurrent stroke, [1] with the estimated prevalence of 1 in 2000. [2] They bear high risk of embolic cerebrovascular incidents, as was the case in our patient. This type of plaque usually represents degenerated atherosclerotic flap, ruptured plaque with mobile thrombus or intimal dissection plaque. The only method that can show the mobility of the plaque is ultrasonography. [1] Mobile floating carotid plaques can be treated with urgent carotid endarterectomy, delayed carotid endarterectomy and carotid angioplasty and stenting. [2,3] Beside surgery, patients are treated with antiplatelet therapy. [2] Neuroimage Figure 1: Brain computed tomography showed several occipital and high parietal ischaemic leasions of the left hemisphere (a, b). Duplex ultrasonography scan revealed fibrolipid plaque located on the back wall of the common carotid artery, that extended to the external as well as internal carotid artery making an uneven plaque (c, d) d c b a Figure 2: Computed tomographic angiography of the neck showed unstable plaque in left internal carotid artery that protrudes into the lumen as well as moderate stenosis in the proximal segment of external carotid artery. Axial source imaging (a, b) and 3D reconstruction imaging (c, d) d c b a
Intravenous Thrombolysis in Acute Ischemic Stroke. Acute ischemic stroke is a major cause of mortality and morbidity in the world. Intravenous thrombolysis with recombinant tissue plasminogen activator remains the standard treatment for acute ischemic stroke for any patient presenting within 4.5 hours from symptom onset. However, it is more effective and safe when treatment starts early. This therapy for acute ischemic stroke has been administered in Vojvodina since 2008. Various factors influence the outcome after intravenous thrombolysis. Timely recanalization and reperfusion is associated with better clinical outcomes. Mechanical Thrombectomy - a New Therapeutic Modality for the Treatment of Acute Ischemic Stroke. Nevertheless, the rate of recanalization and favorable outcomes for patients with acute ischemic stroke due to large vessel occlusion are low after intravenous thrombolysis. In such patients mechanical thrombectomy has demonstrated significantly higher rates of recanalization and improved outcomes compared with intravenous thrombolysis alone. This endovascular reperfusion therapy began to be implemented in Vojvodina in 2016. Conclusion. Intravenous thrombolysis continues to play a key role in the treatment of all acute ischemic stroke patients, but mechanical thrombectomy should be the ?gold standard? in the cases with large vessel occlusion.
A wide range of disorders can cause LETM, but usually the first line diagnosis is neuromyelitis optica (NMO). Based on the detection of NMO immunoglobulin G in the serum of affected patients, a variety of allied disorders were grouped under the name of NMO spectrum disorders, including recurrent myelitis associated with LETM and myelitis associated with autoimmune disorders such as SS. There have been only a few cases reported in the literature with recurrent LETM associated with non-organ specific autoimmune disorder.
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