Intravenous thrombolysis for acute ischaemic stroke in patients not fully adhering to the European licence in Poland.

BACKGROUND AND PURPOSE: The European licence for alteplase excludes from thrombolysis large groups of acute stroke patients. The Polish licence was revised in 2010, but until then many patients could receive the treatment only off-label. Our aim was to evaluate the safety and effectiveness of intravenous alteplase in Polish patients not fully adhering to the original European drug licence compared to patients treated strictly on-label. MATERIAL AND METHODS: We analysed all patient data contributed to the Safe Implementation of Thrombolysis in Stroke registry from Polish centres between October 2003 and July 2009. RESULTS: Off-label thrombolysis was administered in 224/946 (23.7%) patients. The most frequent deviations were: use of intravenous antihypertensives (8.2%), age > 80 years (5.4%), time-to-treatment > 3 hours (4.5%), oral anticoagulation (4.2%), previous stroke with concomitant diabetes (2.1%), and previous stroke ≤ 3 months (1.5%). We found no differences in the ratio of symptomatic intracranial haemorrhage (sICH) according to SITS, ECASS and NINDS definitions. Adjusted odds for 3-month mortality were similar (OR 0.86, 95% CI: 0.51-2.41), excluding patients with previous stroke ≤ 3 months (OR 3.48, 95% CI: 0.96-12.7). Adjusted odds for death or dependency were slightly increased (OR 1.40, 95% CI: 0.92-2.13), especially in patients aged > 80 years (OR 2.80, 95% CI: 1.11-7.05), and with previous stroke ≤ 3 months (OR 4.07, 95% CI: 0.97-17.1). CONCLUSIONS: Polish stroke patients receiving off-label thrombolysis tended to achieve a less favourable outcome, but they were not at increased risk of sICH or death. Considering the current Polish license for alteplase, it may be reasonable to additionally stratify the risk in patients aged > 80 years or with previous stroke ≤ 3 months.

Planar measurements of foetal lateral ventricles.

To compare the linear dimensions (width) of the foetal atrium and occipital horns to their areas, 31 foetuses (15-24 weeks, C-R 12.5-23.5 mm) from spontaneous abortions were evaluated. Images of the axial sections of the brains were transferred to computer and Scion for Windows 98 software was used for image analysis. 11 brains appeared normal and 20 were abnormal (leukomalacia in 9 cases, periventricular and intraventricular haemorrhage in 6 cases, ventriculomegaly in 3 cases, colpocephaly in 1 case, vascular malformation in 1 case). High-range linear and planar asymmetries in the atrium and occipital horns were observed both in normal and abnormal brains. There was no close correlation between the width and the area of the structures under investigation, although it was stronger in case of the occipital horns. The wider occipital horns and atria often had a smaller area than the narrower ones. Some abnormal cerebral hemispheres had relatively narrow atria and occipital horns in comparison with their large areas. Further investigation should be carried out to assess the utility and potential superiority of planar measurements over linear in the image diagnosis of foetal ventricles.

Clinical anatomy of the human anterior cranial fossa during the prenatal period.

We examined the prenatal development of the human anterior cranial fossa and considered its clinical aspects. Our purpose was an evaluation of anterior cranial fossa geometry, its measurements and connections with the nasal cavity and middle cranial fossa. The study was performed on 29 foetuses from the first and second trimester of pregnancy. New methods of computer image analysis, Scion for Windows 98 and ELFv 4.2, were applied to examine this anatomical region. Different options used were binarisation, equalisation, filters, linear and non-linear transformations and mathematical operations of images. This enabled the dynamics of prenatal development to be accurately evaluated for parts of the base of the human skull. Measurements were taken of angles of the cranial base. The anterior cranial base angle (the apex in the middle of the sella turcica and the arms running through the zygomatic ossification points) decreased gradually between C-R 6 to 23.5 cm from 170 to 120 degrees and afterwards became constant. The contrary-medial cranial base angle (adjacent to the anterior cranial base angle and with a second arm running through the auricular cartilage) increased from 50 to 70 degrees. The anterior cranial fossa was first located on the same level as the middle and posterior fossae. The process of descent of the middle and posterior cranial fossa begins in the 4th gestational month. The geometry of the anterior cranial fossa changes rapidly, especially in the first trimester of pregnancy. The first trimester of pregnancy is crucial for the development of its defects. Preconception prophylaxis of inborn defects of the anterior cranial fossa is therefore extremely important.

Prenatal assessment of ventriculomegaly: an anatomical study.

BACKGROUND: The aim of the study was to analyze the development of the lateral ventricles during the 1st and 2nd trimester of fetal life using computerized image processing, and to compare the findings with the results obtained by ultrasound imaging and MRI. MATERIAL/METHODS: The material consisted of 32 fetuses from spontaneous abortions, 54-235 mm crown-rump length. After detached craniotomy, the brains were cut into axial sections; the sections were filmed with a video camera and then analyzed using specialized software RESULTS: In 12 analyzed brains, no significant pathological changes were observed in the cerebral hemispheres, whereas the remaining 20 (63%) demonstrated visible pathology. In 10 cases there were areas of leukomalacia, in 5 intra- and periventricular hemorrhages, and in 2 fetuses ventriculomegaly with lateral ventricular triangles over 10 mm wide (in cases of active hydrocephalus and colpocephaly). In 1 case of an 18-week-old fetus, lateral ventricular morphology typical of hydrocephalus (generalized distension) was observed with ventricular triangles 8.5 mm wide. The other 2 fetuses demonstrated developmental defects. The frontal horns were the most markedly enlarged in both cases of hydrocephalus (100%) and were semicircular, whereas after intra- and periventricular hemorrhages they were less enlarged and triangular, with the base of the triangle directed to the front and frequent significant asymmetry. CONCLUSIONS: The shape of the ventricular system, including that of the frontal horns, is important in the diagnostics of fetal CNS.