Tortuosity in anterior circulation has been associated with the outcomes of mechanical thrombectomy (MT). We classified vertebral artery (VA) tortuosity and investigated the effect of VA tortuosity on the outcomes of basilar artery occlusion (BAO) after MT. We enrolled patients who underwent MT for BAO. VA tortuosity was classified into three-types; Type-I: non-tortuous, Type-II: S-shape or VA with acute angulation (<90°), and Type-III: coiled, kinked, or VA with multiple acute angulations. The 3-month modified Rankin Scale (mRS), successful recanalization, and post-MT hemorrhagic transformation (HT) were assessed. A total of 106 patients were included. Age, baseline stroke severity, and the 3-month mRS score were significantly different according to the VA tortuosity (P=0.003, P=0.002, and P<0.001, respectively). A multivariable analysis demonstrated that VA tortuosity was a predictor for mRS score 0-3 (Type-I: reference; Type- II: 0.26 [0.07–0.95], P=0.041; Type-III: 0.12 [0.02–0.82], P=0.031). Moreover, Type-III was associated with less successful recanalization (Type-I: reference; Type-III: 0.12 [0.02–0.84], P=0.032) and was a potential factor for post-MT HT (Type-I: reference; Type-III: 3.09 [0.83– 11.56], P=0.094). VA tortuosity was significantly associated with the stroke outcome after MT for BAO. Initial stroke severity and successful recanalization might affect the stroke outcome.

Brivaracetam (BRV) is a new antiepileptic drug (AED) approved for adjunctive treatment of focal (partial-onset) seizures in adults. It is a selective, high-affinity ligand for synaptic vesicle 2A (SV2A) with much higher affinity than Levetiracetam (LEV). It has a high lipid solubility and rapid brain penetration, and has been shown to have potent broad-spectrum antiepileptic activity in animal models. The aim of the study was to evaluate the efficacy and tolerability of BRV in everyday clinical practice. This observational study included 35 participants, suffering from different types of epilepsy. Patients were observed over a period of 1 year and data was collected using an interview design model. After the initial interview, a final interview took place after 1 year. Various parameters studied included demographic parameters, seizure frequency and duration, any side effects such as behavioral issues. This study included total 35 patients. The mean age of the participants was 33 years (range 3 – 90 years). Approximately 63% patients demonstrated a decrease in seizure frequency after switching to Brivacetam. Out of these patients, 76% patients were those patients, who were earlier treated with Levetiracetam, and it was discontinued either due to inadequate control of seizures or prominent side-effects. Brivaracetam also improved emotional balance in the treated patients (treatment naïve or Levetiracteam associated behavioral issues).Brivaracetam seems to be an effective and safe antiepileptic drug in the routine clinical setting.

Transient ischemic attack and minor ischemic stroke are associated with early recurrence and deterioration respectively. There is a high risk of stroke after TIA ranging between 10-20% in the ensuing 90 days in the various studies. There are various clinical and imaging factors which predict the early risk of stroke after a TIA. To evaluate the short term and long term risk of ischemic stroke following early treatment of TIA and minor stroke. TIA is defined as sudden focal neurologic deficit of presumed vascular origin lasting less than 24 hours. Minor ischemic stroke is defined as National institute of Health Stroke scale score of ≤5. TIA mimics were excluded from the study. The patients were followed up till 1 year. In patients with minor ischemic stroke, a 2-point worsening in the NIHSS was considered as an event. Modified Rankin score at 3 months was assessed. Total 320 patients were analysed with a mean age of 60.6 ± 13.6 years. Out of the them 20.7% were females, 78% of patients had minor stroke. There is significant association of lacunar stroke in minor stroke patients (p<0.01), whereas most TIA patients, etiology remained undetermined. In multiple regression analysis, both diabetes [p<0.05] and significant vessel stenosis (>50%) [p<0.05] were found to be an independent predictor of recurrent stroke in TIA and minor stroke patients. Urgent treatment after TIA and minor ischemic stroke is associated with reduced risk of ischemic stroke recurrence. Both diabetes mellitus and significant vessel stenosis are independent predictor of stroke recurrence.