Factors associated with the laterality of Cardio-Embolic stroke.

OBJECTIVE: Understanding the lateralization factors, including the anatomic and hemodynamic mechanisms, is essential for diagnosing cardio-embolic stroke. This study aims to investigate the elements, for the first time together, that could affect the laterality of stroke. METHODS: We performed a monocentric retrospective case-control study based on prospective registries of acute ischemic stroke patients in the comprehensive stroke center of the RWTH University hospital of Aachen for three years (June 2018-June 2021). We enrolled 222 patients with cardioembolic stroke (136 left stroke and 86 right stroke) admitted for first-ever acute ischemic stroke with unilateral large vessel occlusion of the anterior circulation. The peak systolic velocity (PSV) asymmetry of middle cerebral artery (MCA) was assessed by doppler as well as internal carotid artery (ICA) angle, aortic arch (AA) branching pattern and anatomy were assessed by CT-Angiography. RESULTS: We found that the increasing left ICA angle (p = 0.047), presence of bovine type AA anatomy (p = 0.041) as well as slow PSV of the right MCA with a value of >15% than left (p = 0.005) were the predictors for left stroke lateralization, while the latter was an independent predictor for the left stroke (OR=3.341 [1.415-7.887]). Inter-Rater Reliability ranged from moderate to perfect agreement. CONCLUSION: The predictors for left stroke lateralization include the higher values of left ICA angle, presence of the bovine type AA and the slow right MCA PSV.

Epidural Hematoma: The Outcome of Glucocorticoids' Complementary Use to Surgical Treatment.

BACKGROUND: The use of glucocorticoids in trauma patients with parenchymal damage is deemed unnecessary and is not advocated. Notwithstanding, acute epidural hematomas (aEH) are extra-parenchymal lesions, so the patients could benefit from the use of glucocorticoids. METHODOLOGY/RESULTS: 97 patients with acute epidural hematoma were separated into two groups, whether they received glucocorticoid treatment or not. Depending on the severity of the deficit and their clinical status, some of the patients were operated on and others not. The patients who received glucocorticoids had better neurological status upon discharge, while their hospitalization was shorter. CONCLUSIONS: The surgical management of the acute epidural hematomas in combination with glucocorticoid treatment had the best outcome in our protocol.