Free-floating thrombus in stroke patients with nonstenotic internal carotid artery-an ultrasonographic study.

BACKGROUND: There are multiple causes of free-floating thrombus (FFT) formation in carotid arteries. The purpose of this study was to evaluate the incidence and natural history of FFT in nonstenotic internal carotid arteries of patients with acute ischemic stroke. METHODS: During a 50-month period, 3,200 consecutive patients with acute ischemic stroke were evaluated for internal carotid artery stenosis and the presence of FFT by color-coded duplex ultrasonography. Diagnostic workup included brain CT, transthoracic echocardiography, Holter electrocardiogram, and hypercoagulability state evaluation. RESULTS: We found an FFT in 5 (0.18%) of 2,757 patients with acute stroke and nonstenotic internal carotid artery (mean age 44 years). The underlying pathology was hypercoagulable state in active pulmonary tuberculosis (n = 1), essential thrombocythemia (n = 1), thrombotic complications of nonstenotic plaques (n = 1), unknown (n = 2). All patients clinically improved under antiplatelet therapy. Follow-up color-coded duplex ultrasonography showed complete dissolution of FFT in all cases. There was no stroke recurrence. CONCLUSIONS: Internal carotid artery FFT could be found in young stroke patients without identifiable arterial disease and could be resolved with antithrombotic treatment.

Detection of basilar artery dissection by ultrasound.

We report a case of a 45-year-old woman with unusual headache 1 week before admission. After cerebrovascular ultrasound, a basilar artery dissection was supposed despite the normal neurologic, cerebrospinal fluid, and computed tomography findings. On a follow-up color-coded duplex sonography (1 month after the onset), reperfusion was detected in the vertebral and basilar arteries, but residual high-grade stenosis of the basilar artery was also present.

Unexpected arterial recanalization after decompressive hemicraniectomy.

We report a 43-year-old patient with malignant embolic ischemic stroke in the right middle cerebral artery (MCA), treated by decompressive hemicraniectomy. Cerebrovascular ultrasound detected a subtotally occluding thrombus in the right internal carotid artery and a partial occlusion of the ipsilateral MCA. After the surgery, complete recanalization of the affected vessels was observed.

Socio-Economic Burden of Myasthenia Gravis: A Cost-of-Illness Study in Bulgaria.

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder, which is characterized by fatigable muscle weakness with frequent ocular signs and/or generalized muscle fatigue, and occasionally associated with thymoma. MG patients and their families face a significant socio-economic burden. This population is often experiencing unemployment, unwilling job transfers and decreased income. Objective: This study aimed to estimate the annual costs from a societal perspective in a triple dimension of direct health care costs, direct non-health care costs (formal and informal care) and labor productivity losses in MG patients from Bulgaria, as well as to identify the main clinical and demographical cost drivers. Methods: A bottom-up, cross-sectional, cost-of-illness analysis of 54 adult MG patients was carried out in 2020. To collect data on demographic characteristics, health resource utilization, informal care and productivity losses, questionnaires were administered to and completed by patients. Results and Conclusion: Median annual costs of MG in Bulgaria were 4,047 EUR per patient. Direct costs slightly outweighed indirect costs, with drugs cost item having the biggest monetary impact. Despite the zero-inflated median, hospitalizations also influenced the direct costs by an estimated amount of 1,512 EUR in the 3rd quartile. Social services and professional caregiver costs were found to be almost missing, with the vast majority of patients reporting reliance on informal caregivers. Severe generalized disease, disease crises, and recurrent infections were confirmed as statistically significant cost driving factors. There were no severe generalized MG patients in the bottom quartile of the total costs distribution. It should be noted that in both cases of crises or infections, the overall increase in the total costs was mainly due to higher indirect costs observed. Reliance on family members as informal caregivers is routine among Bulgarian MG patients. This phenomenon is likely due to the lack of access to appropriate social services. Moreover, it is directly related with higher disease burden and significant inequalities. There is a need for further research on MG in Bulgaria in order to design targeted health policies that meet the needs and expectations of these patients.

Mesencephalic form of meningoencephalitis in a patient with HLA-B51 Behçet's disease: case report.

This case report is a detailed description of the clinical, laboratory, imaging and therapeutic characteristics of the sixth patient with neuro-Behçet's disease reported by Bulgarian authors. The diagnosis was made in accordance with the international diagnostic criteria for Behçet's disease and was verified by skin biopsy. Therapeutic response was followed up by clinical and magnetic resonance imaging data for 6 months. Discussed are differences in the classical Behçet's disease presentation and other neuro-Behçet's disease cases found in Bulgaria. The current case supports the wide clinical heterogeneity of the disorder and the variety of therapeutic options.