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Neurological deterioration and its risk score in total anterior circulation infarct

Poh KW, Er CK, Hoh WH, Abd Wahab ZW, Kok CY

Clin Neurol Neurosurg, 2020 04;191:105684.
PMID: 31981997 DOI: 10.1016/j.clineuro.2020.105684

OBJECTIVES: Specific factors and its predictive parameters for neurological deterioration in total anterior circulation infarct (TACI) were not known. Our objective was to determine the risk factors and risk scores for neurological deterioration in TACI. The secondary objective was to determine the effect of antiplatelet therapy in TACI.
PATIENTS AND METHODS: This was a single-center cohort study. 46 patients with TACI were enrolled and followed up for 30 days, discharged, or death; whichever earlier. The National Institutes of Health Stroke Scale (NIHSS) was performed daily by investigators who are NIHSS certified and radiological findings were confirmed by a certified radiologist. Neurological deterioration was defined by a drop in NIHSS by 2 points or Glasgow Coma Scale (GCS) by 1 point. Clinical, laboratory and radiological variables were evaluated. Significant predictive variables were given a score based on its co-efficient values in multivariate analysis.
RESULTS: Lower Alberta stroke program early CT score (ASPECTS) and higher numbers of early computed tomography (CT) sign of middle cerebral artery (MCA) infarct were significant risk factor for neurological deterioration with p 

Matched MeSH terms: Infarction, Anterior Cerebral Artery/physiopathology
Fulltext Acute ophthalmic artery occlusion in decompression illness with underlying anterior cerebral artery A1 segment hypoplasia

Omar AR, Ibrahim M, Hussein A

Diving Hyperb Med, 2018 Jun 30;48(2):112-113.
PMID: 29888385 DOI: 10.28920/dhm48.2.112-113

A diver presented with total loss of vision in the left eye and right hemiparesis following a routine no-stop scuba dive to 20 metres' depth. A diagnosis of decompression illness (DCI) with acute ophthalmic artery air embolism and left carotid artery insult causing acute anterior circulatory ischaemia was made. He underwent seven hyperbaric treatments leading to a full recovery. Magnetic resonance angiography revealed an underlying left anterior cerebral artery A1 segment hypoplasia. Making a prompt diagnosis and early hyperbaric oxygen treatment are crucial to halt further tissue damage from ischaemia in central nervous system DCI. In this case, the finding of a left A1 anterior cerebral artery segment hypoplasia variant may have increased the severity of DCI due to deficient collateral circulation.

Matched MeSH terms: Anterior Cerebral Artery
Fulltext Angioinvasive cerebral aspergillosis presenting as acute ischaemic stroke in a patient with diabetes mellitus

Norlinah MI, Ngow HA, Hamidon BB

Singapore Med J, 2007 Jan;48(1):e1-4.
PMID: 17245496

Cerebral angioinvasive aspergillosis is a rare manifestation of disseminated aspergillosis which may result in stroke in immunocompromised individuals. Reports of such disease in patients with diabetes mellitus are rare. We describe a 45-year-old man with diabetes mellitus who presented with a three-day history of right-sided limb weakness and aphasia. Cerebral computed tomography showed features of an acute infarct involving the left anterior and middle cerebral arteries. He was initially treated for an acute ischaemic stroke. Further history revealed that he was investigated for a growth in the sphenoid sinus two months earlier. Culture of the biopsied material from the sphenoid sinus grew Aspergillus fumigatus. Magnetic resonance imaging showed an extension of the growth to the brain, causing the acute ischaemic stroke. He was subsequently diagnosed with angioinvasive cerebral aspergillosis and was commenced on intravenous amphotericin B. Unfortunately, he succumbed to his illness despite treatment.

Matched MeSH terms: Infarction, Anterior Cerebral Artery/diagnosis*

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