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  • ISSN: 2334-2307
    Early Online
    Volume 7, Issue 2
    Case Report
    Masaomi Yamamoto*, Tomohisa Dembo, Tetsuo Yamaga, Masato Suzuki, Hikoaki Fukaura, Yumiko Kobayashi, Wataru Masuda, and Kyoichi Nomura
    The patient was a 77-year-old man who initially presented with blue toe syndrome (BTS) and multiple cerebral emboli. He was diagnosed as having Trousseau syndrome due to lung adenocarcinoma. BTS is a rare presenting symptom in Trousseau syndrome, which is caused by blood hypercoagulability and is mainly associated with mucin-producing adenocarcinoma. Serum CA125 levels, a mucin production marker, increased together with plasma D-dimer level because of lung adenocarcinoma, which is rare. Anticoagulant therapy with heparin temporarily improved the D-dimer level and skin discoloration of BTS. Therefore, we believe that the BTS in this case was consistent with Trousseau syndrome.
    Jochanan E. Naschitz* and Bait Balev Nesher
    A 72-year-old man with basilar artery stroke was underwent successful angioplasty. Bilateral infarctions in the cerebellum, basal ganglia and capsula interna left the patient with central ataxia. His longstanding arterial hypertension (HT) had deteriorated. Orthostatic hypotension (OH) along with supine HT evolved, being indicators of efferent baroreflex failure. Managing the patients blood pressure (BP) became challenging, more so under repeated changes of the clinical scenario during a 6 weeks period. There was a reminder to the numerous faces of syndrome of supine HT associated with OH: 1. longstanding HT phenotype had acutely changed under a cerebrovascular involving the midbrain; 2. new-onset OH, supine HT and highly variable BP not influenced by mental challenge were consistent with efferent baroreflex failure; 3. BP management under efferent baroreflex failure was difficult and there was a need to compromise, giving priority for avoiding orthostatic symptoms; 4. intercurrent sepsis caused an persistent alteration of the patients BP status requiring discontinuation of antihypertensive medications.
    Research Article
    Cora EA, Birdi N, Ramaswamy R, Minks DP, DuPlessis J, Mitra D, Gholkar A, Flynn D, Ford GA, and White P*
    Aim: Multiple recent trials have proven the efficacy of thrombectomy in large vessel occlusive stroke and earlier reperfusion correlates with improved outcomes. We developed a thrombectomy technical difficulty index (TTDI) to predict the expected procedural difficulty as an aid to operator decision making for the achievement of a fast and successful recanalization.
    Materials and Methods: Key thrombectomy factors were used to grade predicted difficulty of thrombectomy on a 3-point scale, from minimal, mild to moderate to severe. Thirty patients that underwent thrombectomy had their computed tomography angiograms scans analysed by seven neurointerventionists using the TTDI to predict level of difficulty to establish its reliability (intra-class correlation, ICC) and validity.
    Results: An almost perfect level of agreement on TTDI scores between the 7 neurointerventionists was reported (ICC = 0.89, 95% CI = 0.81 to 0.94), and an expert INR opinion of case difficulty using the TTDI (ICC = 0.861, 95% CI = 0.77 to 0.93). Validity analysis showed that that length of procedure was shorter for minimal compared to mild to moderate difficultly cases as assessed with TTDI.
    Conclusion: The TTDI is a promising tool to assess predicted thrombectomy case difficulty, allowing operator to consider potential problems and inform decisions about whether a modification to technique, including access, equipment and anaesthesia, should be considered. Larger prospective studies evaluating the TTDI are warranted.
    Domenico Bosco*, Antonietta Fava, Maria Ettore, Gaetano Gorgone, Maria Pantusa, Dario Cristiano, Antonio Vaccaro, Demetrio Messina, Pasquale Mungari and Massimiliano Plastino
    Stroke rapid response (stroke code) teams facilitate the evaluation and treatment of patients with potential stroke. We investigated the accuracy of the pre-hospital diagnosis in triggering the stroke path of an acute cerebrovascular disease (CVA) by emergency medical services. During a period of 12-months we prospectively recorded all consecutive patients for whom a stroke code (SC) has been activated. Discharge diagnosis was classified into CVA and NO-CVA. The protocol is activated by triage nurses or emergency department is identified within 4,5-hours from onset. SC has been activated in 126 cases by "emergency department staff", in 157 cases by emergency ambulance physicians and only in 2 cases by non-neurological unit cares. Stroke was correctly diagnosed in 57% patients. The remaining 43% had a diagnosis classified as "stroke mimics". Stroke patients were significantly more likely diabetics, hypertensive and coronary heart disease affected. The rate of incorrect CVA referrals was higher in emergency ambulance physicians (49%) vs physicians from other emergency department (35,7%). Constant educational programs could be effective for improving diagnostic accuracy of CVA into the emergency care system.
    Short Communication
    Paulo Eduardo Lahoz Fernandez* and Guilherme Diogo Silva
    Background: Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease that presents from mild cases to severe forms. Comorbidities, especially cardiovascular diseases, were associated with poor outcome. The virus uses angiotensin converting enzyme 2 (ACE-2) receptor to invade cells. Cerebrovascular diseases have a more conflicting relationship with ACE-2 regulation. The objective of this study was to evaluate the impact of Cerebrovascular and Cardiovascular diseases to Non-cardiovascular diseases (Chronic pulmonary obstructive diseases, chronic kidney diseases, cancer, liver diseases, etc) and compare Cerebrovascular diseases to Other cardiovascular diseases (Cardiac diseases, hypertension and diabetes) in COVID-19 poor outcomes.
    Methods: We searched PubMed, EMBASE and Scopus including english language studies from 2020. We selected studies considering COVID-19 patients with poor outcome (severe form and non-survivors patients). Then we compared the prevalence of cerebrovascular diseases x Non-cardiovascular diseases; all cardiovascular diseases x Non-cardiovascular diseases and cerebrovascular diseases x other cardiovascular diseases. The Cerebrovascular diseases were included in all cardiovascular and excluded in other cardiovascular diseases groups.
    Results: We found 1155 studies, including 18 studies in the quantitative analysis (meta-analysis). Cerebrovascular diseases and All Cardiovascular diseases were more frequent than Non-cardiovascular diseases in COVID-19 poor outcome. [RR 1.39 CI 95% (1.20-1.63), p < 0.0001, I2 = 15%, fixed effects; RR 1.10 CI 95% (1.01-1.21), p = 0.04, I2 11%, fixed effects]. The prevalence of cerebrovascular diseases was disproportionately increased even when compared to other cardiovascular diseases. [RR 1.34 CI 95% (1.13-1.60), p = 0.001, I2 57%, random effects].
    Conclusion: Cerebrovascular and cardiovascular diseases were more frequent in COVID-19 patients with poor outcomes than Non-cardiovascular diseases. Also, cerebrovascular diseases were disproportionately represented in poor outcome than other cardiovascular diseases. We consider that Clinicians should be aware that a cerebrovascular disease is an important risk factor for severe disease and deaths in COVID-19 pandemic.
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