Background: Multimodal stroke imaging (Non-contrast CT, CT perfusion and CT angiogram) is essential to acute stroke assessment, there is currently no benchmark for this key process from real world data. Methods: Retrospective review of the turnaround time of consecutive multimodal imaging performed for acute stroke assessment at two high volume stroke centers in Australasia from July to September 2019.Results: 252 imaging studies were included from both sites. The overall median time from acquisition to imaging availability was 13 minutes (IQR 11- 16). The median for Christchurch and Box Hill were 11 minutes (IQR 10 – 12) and 15 minutes (IQR 13 – 19) respectively. Conclusions: Multimodal stroke imaging turnaround time of 11 minutes is a reasonable benchmark.
Background Autoimmune encephalitis is an increasingly recognised disease that presents with seizures, neuropsychiatric symptoms, dystonic movements, and autonomic dysfunction 1 . As the mainstay of treatment immunosuppressive therapies are most effective when subject to early initiation and timely escalation, both of which are recognised to affect outcomes 2 . Nevertheless approximately half of patients with NMDA-R antibody encephalitis do not respond adequately to first-line therapy, and a significant proportion (12-30%) relapse 2 . Cases A 19 year old lady presented with new-onset seizures and psychosis. EEG showed focal spike-and-wave discharges and MRI brain a focal area of restricted diffusion consistent with recent seizure activity. NMDA-R antibodies were present in both CSF and serum. Following early treatment with corticosteroid, plasma exchange, IVIG and rituximab the patient recovered, returning to college after 6 months.A 50 year old gentleman presented with a two day history of myalgias and confusion. EEG showed spike-and-wave discharges and MRI brain increased T2 signal in the mesial temporal lobes. NMDA-R antibodies were present in both CSF and serum. He was treated with corticosteroid, plasma exchange, IVIG and rituximab, and continued on oral prednisone and mycophenolate. Response to treatment was poor with persistent ongoing physical and cognitive impairment at 6 months. Serial MRI showed substantial (~30%) loss of parenchymal brain volume. Discussion These cases illustrate that timely and aggressive management of NMDA-R antibody encephalitis with favourable prognostic markers is no guarantee of recovery. Several novel clinical and immunological predictors of response to therapy have been postulated, and currently await broader validation. 3
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