Intraluminal Thrombus of the Extracranial Cerebral Arteries in Acute Ischemic Stroke: Manifestations, Treatment Strategies, and Outcome.

Background: Intraluminal thrombus (ILT) of the cervical arteries is an uncommon finding that can lead to acute or recurrent ischemic stroke. Currently, antithrombotic therapy in the form of antiplatelet and/or anticoagulation is considered the mainstay of treatment, but evidence of which one has a better outcome is lacking. Methods: A retrospective cohort study included 28 patients diagnosed with acute stroke or transient ischemic attack with ILT of the extracranial arteries from 2013 to 2022. The primary efficacy outcome was assessed as recurrent stroke, and the primary safety outcome was assessed as hemorrhagic complications. Secondary outcomes were assessed as the resolution of thrombi by CT angiography (CTA) and clinical improvement by the Modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS). Results: Out of 28 patients, more than half (57.1%; n = 16) were males with a mean age of 57.8 ± 9.5 years and an average BMI of 26.9 ± 4.5 kg/m2. As initial treatment, twenty-four patients received anticoagulation and four received antiplatelet agents. Recurrent strokes were found in four patients (14.29%), and all were initially treated with anticoagulation. One patient in the anticoagulation group had a significant retroperitoneal hemorrhage. None of the patients in the antiplatelets group had a recurrent stroke or bleeding event. Initial treatment with antiplatelet agents significantly improved the NIHSS on day 7 (P = 0.017). A significant improvement in NIHSS on day 90 was observed in the anticoagulant group (P = 0.011). In the follow-up CTA performed on 24 patients, 18 (75%) showed complete resolution (3 out of 3 (100%) in the antiplatelet group and 15 out of 21 (71.43%) in the anticoagulant group). Conclusion: Initial treatment with anticoagulants improves neurologic outcomes in patients with ILT-induced acute ischemic stroke but carries the risk of recurrent stroke and bleeding. However, initial treatment with dual antiplatelet agents appears to have comparable efficacy without sequelae, particularly in atherosclerosis-induced ILT.

Patterns and Outcomes of Complementary and Alternative Medicine Use Among Adult Patients With Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease that causes demyelination of the central nervous system. No treatment has been shown to be curative; thus, we assume that the tendency for patients with MS to use unconventional therapies, such as complementary and alternative medicine (CAM), might increase. The aim of this study was to explore the pattern of CAM use among patients with MS at a tertiary health care center in Saudi Arabia (SA). This was a questionnaire-based observational cross-sectional study that targeted adult patients diagnosed with MS at King Abdulaziz Medical City in Riyadh, SA, from 2018 to 2019. The sample size included 176 patients, and a consecutive non-probability sampling technique was used to engage them during their appointments. An Arabic questionnaire was used to evaluate patients' use of CAM. The mean age of participants was 34.6 ± 10.9 years, females represented the majority 125 (71%) of participants, and 89% of the participants reported using CAM at least once, with one or more modalities being used. Prayer, Salat, was the most frequent modality (60%) followed by supplication, Dua'a (59%), Ruqia, reciting Holy Quran (52%), and vitamins (44%). Symptomatic improvement was reported by 49 (27.8%) of dietary supplement users and 81 (46%) of non-dietary supplement medicine users. The study found a high prevalence of CAM utilization among Saudi adult patients with MS, which exceeded internationally reported rates. Although some patients described some improvement in their symptoms, further research is needed to evaluate the effectiveness of CAM.

Morbidity Patterns of Non-Traffic Unintentional Injuries Among the Pediatric Age Group Attending the Emergency Department at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia.

Objectives The aim of this study is to measure the magnitude and describe morbidity pattern, management, and outcome of non-traffic unintentional injuries among a pediatric age group at a tertiary hospital in Riyadh, Saudi Arabia. Materials and Methods This is a retrospective descriptive cross-sectional study conducted at Emergency Department (ED) of King Abdul-Aziz Medical City, Riyadh, Saudi Arabia, including all pediatric patients aged 0 to 14 years who had non-traffic unintentional injuries and admitted to the ED from January 1, 2016, to December 31, 2017. The number of children included for the specified period was 491 patients. Results A total of 491 patients were included over the study period; the majority were males (64%). The most common injury types were fractures, dislocations, and subluxations (47.3%) followed by penetration injuries (21%) and burn injuries (17.5%). The most involved body site was the upper limbs (45.2%) followed by head and neck (24.2%) and lower limbs (17.3%). Fall was the leading mechanism of injuries (47.7%) followed by hot liquids and chemical exposure (14.5%). Most of the cases resulted in no significant disabilities (40%), 21.6% resulted in short-term disability, 24.2% had long-term disability, and 12.8% had permanent disabilities. There were six cases (1.2%) of mortality. Conclusions Non-traffic unintentional pediatric injuries are common with significant morbidity and complications, and most of them are preventable. More efforts are needed to increase public awareness and to implement preventive measures at households and public places.