Central retinal artery occlusion in a patient with sickle cell disease treated with recombinant tissue plasminogen activator.

Central retinal artery occlusion is a rare ophthalmological complication of sickle cell disease, usually provoked by additional contributing risk factors and its treatment remains controversial. We describe a patient with sickle cell disease and a spontaneous central retinal artery occlusion of his left eye that probably has good result from intravenous thrombolysis. We want to add sickle cell disease as rare etiological cause of central retinal artery occlusion and perpetuate evidence of intravenous recombinant tissue plasminogen activator administration in this condition.

Neurologist-Led Management of Implantable Loop-Recorders After Embolic Stroke of Undetermined Source.

INTRODUCTION: Upon completion of the workup for stroke, etiology cannot be identified in approximately one-third of the patients, with an embolic stroke of undetermined source (ESUS) accounting for around 50% of these cryptogenic etiologies. Whether management of complex long-term monitoring in order to detect suspected atrial fibrillation (AFib) could be initiated and managed through a neurologist is not sufficiently investigated. PATIENTS AND METHODS: We recruited all consecutive patients with ESUS who received implantation after neurological adjudication of Reveal LINQ® loop recorder between January 2016 and July 2020. We collected demographic, clinical, heart- and neuroimaging, laboratory, and electrocardiographic data assessed on prolonged baseline ECG monitoring, number of supraventricular (SVEs) and ventricular (VEs) extrasystolic complexes, and from preimplantation ECG-PQ interval. AFib detection was manually supervised and determined positive when the duration was over 120 s. RESULTS: We followed a total of 131 patients for a median of 504 days. There were 45 (34%) manually verified AFib diagnoses. In univariate analysis, earlier implantation after ESUS was associated with AFib detection (13 vs. 31 days, p = 0.011). In multivariate analysis, increased rate of AFib was associated with a more prolonged PQ interval (per 50-ms increase) (HR 1.99, 95% CI 1.39-2.85) and number of SVEs (HR 1.29, 95% CI 1.05-1.57) measured on pre-implantation ECG. CONCLUSION: We observed similar predictors for Afib after ESUS, albeit with higher frequency than previously reported. This study suggests that the neurologist-led decision, management, and evaluation of ILR after ESUS is feasible.