Vascular and Vasogenic Manifestations of Systemic ANCA-Associated Vasculitis with Renal Involvement in Non-Contrast Brain MRI in Patients with Acute Disease Onset.

Background. Data concerning central nervous system (CNS) alterations in ANCA-associated vasculitis with renal involvement (AAVR) are sparse. The study aimed to assess vascular and vasogenic brain alterations in patients with acute onset of AAVR and the applicability of non-contrast magnetic resonance imaging (MRI) techniques in this diagnosis. Methods. Thirty-eight patients with acute onset of AAVR were included in the study. BVAS/WG, c-ANCA, p-ANCA, renal function and perfusion, neurological assessment, and brain MRI were performed. Results. Cerebral vascular alternating narrowing and dilatation (VAND) was detected in 42.1% of patients, and the black-blood was significantly more diagnostic than the TOF technique (p < 0.001). VAND occurrence was independently associated with the concentration of p-ANCA. The vasogenic white matter lesions (VWML) were found in 94.4% of patients, and in their detection, SWAN was significantly better than the FLAIR technique (p = 0.002). The number of VWML correlated with age and cranial nerve damage. Hemosiderin deposits were found in 21.6% of patients and were associated with a gait impairment and paresthesia. Conclusions. Vascular and vasogenic alterations in the CNS are frequent in patients with acute onset of systemic ANCA-associated vasculitis with renal involvement. Non-contrast MRI is useful in the diagnosis of brain vasculitis.

[Treatment of ischemic stroke with mechanical trombectomy systems]. / Leczenie udaru niedokrwiennego mózgu z zastosowaniem systemów do trombektomii mechanicznej.

The implementation of ischemic stroke therapy has created new opportunities for clinical improvement and the reversal of adverse prognosis in patients with ischemic stroke. Mechanical thrombectomy has become the recommended treatment for acute stroke in a select group of patients and in highly specialized centres with experience in endovascular therapy. AIM: The aim of the study was to evaluate of the efficacy and safety of mechanical thrombectomy in patients with acute ischemic stroke within the first six hours of illness was reported. MATERIALS AND METHODS: 34 patients previously hospitalized in the Department of Neurology due to ischemic stroke were included in the study during the first six hours of illness. Short-term efficacy and safety (1 month after surgery) and long-term (3 months) were evaluated based on the assessment of early mortality, functional status and neurological status. Factors that increase the risk of death were also analyzed. RESULTS: In the study group, the recanalization of the vessel was obtained in 52% of patients, which was associated with a significant improvement of functional status. Improvements in functional and neurological status were obtained in most of the patients (63%), including very good functional status (mRS 0-1) in 7 (20%) patients upon discharge from the hospital. CONCLUSIONS: In the study group, the recanalization of the vessel was obtained in 52% of patients, which was associated with a significant improvement of functional status. Improvements in functional and neurological status were obtained in most of the patients (63%), including very good functional status (mRS 0-1) in 7 (20%) patients upon discharge from the hospital.

RISK FACTORS OF rt-PA THERAPY IN PATIENTS WITH ISCHEMIC STROKE.

The stroke mortality rate in Poland is one of the highest in Europe with particularly large percentage of deaths in early phase of stroke. The aim of the study was to analyze the causes and risk factors for treatment failure and early death in patient with ischemic stoke treated with thrombolysis in the Department of Neurology, Military Institute of Medicine. The study included 295 patients treated with thrombolysis over the period 2005-2015. The study protocol defined for each patient include demographic data, time of recombinant tissue plasminogen activator (rt-PA) administration from the onset of symptoms, the presence of stroke risk factors. The incidence of in-hospital deaths was 8.1% within the first week and 15.6% in the first month. In the final model, relevant death predictors were: baseline National Institutes of Health Stroke Score (NIHSS), hemorrhagic transformation type 2, hyperglycemia at admission and increased blood pressure above 180/110 mmHg during or in the first day after thrombolysis. The most common cause of death was a massive stroke with increased intracranial pressure, (36.4%), intracerebral hemorrhage (15.3%), concomitant edema and hemorrhage (27%), pneumonia (15.3%), cardiac disorders (13.4%). The important risk factors of death directly associated with thrombolytic therapy were hemorrhagic transformation and hemisphere stroke with malignant edema increasing the risk of bleeding.