Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan.

BACKGROUND: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. METHODS: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies. RESULTS: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality. CONCLUSION: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.

Real-World Experience with Idarucizumab to Reverse Anticoagulant Effect in Dabigatran-Treated Patients: Report of 11 Cases from Taiwan.

BACKGROUND: This study aims to observe the effectiveness and safety of idarucizumab in dabigatran-treated patients with severe bleeding or requiring surgery in Taiwan. METHODS AND RESULTS: In Taiwan, 11 dabigatran-treated patients developed severe bleeding, fracture that needed surgery, and acute ischemic stroke requiring thrombolysis. These patients were treated with idarucizumab and obtained adequate hemostasis. Our experiences reconfirmed the efficacy and safety of idarucizumab in Asian patients. CONCLUSIONS: Idarucizumab improves safety in dabigatran-treated patients. Continued education about the availability and appropriate use of idarucizumab is necessary in Asia.

A gas filled intradural cyst with intradural disc herniation: a case report.

Intradural disc herniation is rare. In a colon cancer patient who suffered from low back pain for several years, MRI examination showed evidence of vacuum phenomenon and ring enhancement at the level of L3-4. Intradural herniation of an intervertebral disc was confirmed surgically. Pathological evidence of intradiscal gas is rarely reported in the literature, however, an association between intradural disc herniation and pneumocysts was demonstrated in this case. The implications of our sequential radiological and pathological findings for the pathogenesis of intradural pneumocysts are discussed.

Prognostic factors for mental retardation in patients with tuberous sclerosis complex.

PURPOSE: To analyze the prognostic factors for mental retardation in patients with tuberous sclerosis complex (TSC). METHODS: We retrospectively reviewed 35 in-patients with TSC in a medical center and analyzed the clinical features. 19 of 32 patients (59.4%) fulfilled the classical diagnosis of tuberous sclerosis. According to the diagnostic criteria of Roach et al., 30 patients had definite TSC and 5 patients possible TSC. RESULTS: Among the 35 patients, the mean age at diagnosis was 15.9 +/- 12.5 years, and the male-to-female ratio was 14:21. 11 of 30 patients (36.6%) had a family history of TSC. The most frequent CNS manifestations were seizures (32/35, 91.4%) and mental abnormality (12/32, 62.5%). The most common cutaneous manifestation was facial angiofibroma (27/35, 77.1%) and the most common seizure pattern was generalized tonic clonic seizures (22/32, 62.9%). Poor control of seizures (p=0.006) and the presence of cortical tubercles in imaging studies (p=0.03) were correlated statistically with mental abnormality. Poor control of seizures (15/32, 46%) was more common in generalized tonic clonic seizures than other seizure types (p=0.041). Twenty-six of 28 patients (92.8%) displayed the typical findings of cortical tubers and subependymal nodules on the brain CT or MRI. CONCLUSION: Mental retardation in TSC was correlated with poor control of seizures and the presence of CNS lesions.