Intra-arterial thrombolysis for acute ischemic stroke in octogenarians.

BACKGROUND: It is unclear whether octogenarians benefit from intra-arterial thrombolysis (IAT) for the treatment of acute ischemic stroke (AIS). The aim of the present study was to compare baseline characteristics, clinical outcome and complications of patients aged ≥80 with those of patients aged <80 years. METHODS: Forty-three octogenarians and 524 younger patients with AIS were treated with IAT. The modified Rankin scale (mRS) score was used to assess 3-month outcome. RESULTS: There was a female preponderance among octogenarians (63 vs. 37%, p = 0.015). Stroke severity, occlusion site, and time from stroke onset to IAT did not differ between the groups. Good recanalization (TIMI 2-3) was achieved in 65% of older and in 71% of younger patients (p = 0.449). Rates of symptomatic intracranial hemorrhage (ICH) were 6% in patients <80 years and 2% in octogenarians (p = 0.292). Favorable outcome (mRS 0-2) was less frequent among octogenarians (28 vs. 46%, p = 0.019), while mortality was higher (40 vs. 22%, p = 0.008). Octogenarians died more often from extracerebral complications than younger patients (59 vs. 27%, p = 0.008). CONCLUSIONS: Compared with younger patients, octogenarians did not have a significantly increased risk of symptomatic ICH after IAT. Although favorable outcome was less frequent and mortality rates were higher, IAT appeared to be safe in octogenarians. It seems reasonable to include octogenarians in randomized clinical trials to assess the balance of risk and benefit of IAT in this patient group.

Comprehensive Laboratory Diagnostic Workup for Patients with Suspected Intraocular Lymphoma including Flow Cytometry, Molecular Genetics and Cytopathology.

BACKGROUND: Intraocular lymphoma (IOL) presents a real challenge in daily diagnostics. Cyto- and/or histopathology of vitreous body represent the diagnostic cornerstones. Yet, false negative results remain common. Therefore, we analyzed the diagnostic significance of flow cytometry (FC) within the workup algorithm of IOL and compared its sensitivity with the results obtained from routine cytopathology and molecular genetics; Methods: Seven patients undergoing vitrectomy due to suspected IOL were investigated by FC and parallel cytopathology and, if available, digital droplet PCR (ddPCR) for MYD88 L265P; Results: Four out of seven patients were finally diagnosed with IOL. Among the IOL patients, cytopathology confirmed the presence of lymphoma cells in only two cases. In contrast, FC was positive for IOL in all four cases, and FC additionally confirmed the lack of IOL in the remaining patients. In IOL patients diagnosed by FC and with available ddPCR, the diagnosis of IOL was confirmed by the presence of the MYD88 L265P mutation in all three patients; Conclusions: The combination with FC was superior to cytopathology alone in the diagnostic work-up of IOL, and it showed an excellent correlation with ddPCR results. A comprehensive diagnostic panel consisting of cytopathology, FC and molecular genetics should be considered for the work-up of suspected IOL.