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Article: Recurrent Reversible Cerebral Vasoconstriction Syndrome: A Report of Two Cases.

Patel, Pooja A / Sanborn, Emma / Then, Ryna / Williams, Dena M

2023 Volume 15, Issue 8, Page(s) e42992

Abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological condition that classically presents with recurrent, thunderclap headaches and radiographic findings of multifocal narrowing of cerebral vasculature. Complications of RCVS may ... ...

Abstract	Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological condition that classically presents with recurrent, thunderclap headaches and radiographic findings of multifocal narrowing of cerebral vasculature. Complications of RCVS may include ischemic or hemorrhagic strokes. Sympathomimetic agents including cannabinoids have been associated as precipitants in many cases. RCVS is classically considered to be reversible, although cases of recurrent RCVS have been described in the literature. In this report, we describe two cases of recurrent RCVS, which were precipitated by recurrent exposures to inciting agents. The first patient was found to have a history of repeated exposure to tetrahydrocannabinol (THC) and suffered from recurrent multifocal ischemic strokes with evidence of persistent multifocal narrowing of cerebral vasculature by cerebral arteriography. The second case describes a patient with a history of use of ashwagandha, medical marijuana, and serotonin-norepinephrine reuptake inhibitors (SNRIs) who experienced multiple intracranial hemorrhages with radiographic evidence of multifocal narrowing of cerebral vessels as well.
Language	English
Publishing date	2023-08-05
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.42992
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Article ; Online: Neuroimaging mimics of anoxic brain injury: A review.

Mason Sharma, Alexandre / Birnhak, Alana / Sanborn, Emma / Bhana, Nikhil / Kazmi, Khuram / Thon, Jesse M / Thon, Olga R / Siegler, James E

Journal of neuroimaging : official journal of the American Society of Neuroimaging

2023 Volume 33, Issue 4, Page(s) 467–476

Abstract: Diffuse cortical diffusion changes on magnetic resonance imaging (MRI) are characteristically ascribed to global cerebral anoxia, typically after cardiac arrest. Far from being pathognomonic, however, this neuroimaging finding is relatively nonspecific, ... ...

Abstract	Diffuse cortical diffusion changes on magnetic resonance imaging (MRI) are characteristically ascribed to global cerebral anoxia, typically after cardiac arrest. Far from being pathognomonic, however, this neuroimaging finding is relatively nonspecific, and can manifest in a myriad of disease states including hypoxia, metabolic derangements, infections, seizure, toxic exposures, and neuroinflammation. While these various conditions can all produce a neuroimaging pattern of widespread cortical diffusion restriction, many of these underlying causes do have subtly unique imaging features that are appreciable on MRI and can be of clinical and diagnostic utility. Specific populations of neurons are variably sensitive to certain types of injury, whether due to differences in perfusion, receptor type density, or the unique tropisms of infectious organisms. In this narrative review, we discuss a number of distinct etiologies of diffuse cortical diffusion restriction on MRI, the unique pathophysiologies responsible for tissue injury, and the resulting neuroimaging characteristics that can be of assistance in differentiating them. As widespread cortical injury from any cause often presents with altered mental status or coma, the differential diagnosis can be enhanced with rapid acquisition of MRI when clinical history or detailed physical examination is limited. In such settings, the distinct imaging features discussed in this article are of interest to both the clinician and the radiologist.
MeSH term(s)	Humans ; Neuroimaging/methods ; Magnetic Resonance Imaging/methods ; Hypoxia, Brain/pathology ; Seizures ; Brain Injuries/pathology ; Brain/pathology
Language	English
Publishing date	2023-04-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.13106
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Zs.A 3211: Show issues

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Article ; Online: Nilotinib-Associated Atherosclerosis Presenting as Multifocal Intracranial Stenosis and Acute Stroke.

Kakadia, Bhavika / Thakkar, Richa / Sanborn, Emma / Suero-Abreu, Giselle Alexandra / Jovin, Tudor G / Then, Ryna

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2021 Volume 30, Issue 8, Page(s) 105883

Abstract: Nilotinib, a BCR-ABL tyrosine kinase inhibitor (TKI), has been associated with vascular events and accelerated arterial stenosis, presumably of atherosclerotic etiology. Studies of nilotinib-associated atherosclerosis are mainly associated with ... ...

Abstract	Nilotinib, a BCR-ABL tyrosine kinase inhibitor (TKI), has been associated with vascular events and accelerated arterial stenosis, presumably of atherosclerotic etiology. Studies of nilotinib-associated atherosclerosis are mainly associated with progressive peripheral artery occlusive disease (PAOD), and only a few cases of coronary artery disease (CAD), and cerebrovascular disease (CVD) have been reported. The mechanisms by which nilotinib promotes atherosclerosis are poorly understood but endothelial and perivascular factors, mast cell depletion, and metabolic factors such as promotion of dyslipidemia and impaired glucose metabolism are thought to play a role. We present a case of a patient with chronic myelogenous leukemia (CML) treated with nilotinib who developed intracranial atherosclerosis leading to acute onset of stroke. Our patient had no cardiovascular risk factors prior to treatment with nilotinib and developed accelerated atheromatous cerebrovascular disease with severe left middle cerebral artery (MCA) stenosis. These findings suggest that nilotinib may be associated with the development of intracranial atherosclerotic disease (ICAD) independently of any preexisting vascular risk factors leading to acute stroke. Clinicians should have increased awareness of the association between nilotinib and the development of progressive atheromatous disease and vascular adverse events including PAOD, CAD, and CVD. In certain patients, these events can be severe and life threatening. Thus, screening for vascular risk factors including CVD prior to starting nilotinib and close follow up during treatment is crucial.
MeSH term(s)	Antineoplastic Agents/adverse effects ; Functional Status ; Humans ; Infarction, Middle Cerebral Artery/diagnostic imaging ; Infarction, Middle Cerebral Artery/etiology ; Infarction, Middle Cerebral Artery/therapy ; Intracranial Arteriosclerosis/chemically induced ; Intracranial Arteriosclerosis/diagnostic imaging ; Intracranial Arteriosclerosis/therapy ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/etiology ; Ischemic Stroke/therapy ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy ; Male ; Middle Aged ; Protein Kinase Inhibitors/adverse effects ; Pyrimidines/adverse effects ; Recovery of Function ; Risk Factors ; Treatment Outcome
Chemical Substances	Antineoplastic Agents ; Protein Kinase Inhibitors ; Pyrimidines ; nilotinib (F41401512X)
Language	English
Publishing date	2021-06-02
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2021.105883
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Zs.A 3519: Show issues

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Article ; Online: Acute ischaemic stroke associated with SARS-CoV-2 infection in North America.

Dmytriw, Adam A / Dibas, Mahmoud / Phan, Kevin / Efendizade, Aslan / Ospel, Johanna / Schirmer, Clemens / Settecase, Fabio / Heran, Manraj K S / Kühn, Anna Luisa / Puri, Ajit S / Menon, Bijoy K / Sivakumar, Sanjeev / Mowla, Askan / Vela-Duarte, Daniel / Linfante, Italo / Dabus, Guilherme C / Regenhardt, Robert W / D'Amato, Salvatore / Rosenthal, Joseph A /

Zha, Alicia / Talukder, Nafee / Sheth, Sunil A / Hassan, Ameer E / Cooke, Daniel L / Leung, Lester Y / Malek, Adel M / Voetsch, Barbara / Sehgal, Siddharth / Wakhloo, Ajay K / Goyal, Mayank / Wu, Hannah / Cohen, Jake / Ghozy, Sherief / Turkel-Parella, David / Farooq, Zerwa / Vranic, Justin E / Rabinov, James D / Stapleton, Christopher J / Minhas, Ramandeep / Velayudhan, Vinodkumar / Chaudhry, Zeshan Ahmed / Xavier, Andrew / Bullrich, Maria Bres / Pandey, Sachin / Sposato, Luciano A / Johnson, Stephen A / Gupta, Gaurav / Khandelwal, Priyank / Ali, Latisha / Liebeskind, David S / Farooqui, Mudassir / Ortega-Gutierrez, Santiago / Nahab, Fadi / Jillella, Dinesh V / Chen, Karen / Aziz-Sultan, Mohammad Ali / Abdalkader, Mohamad / Kaliaev, Artem / Nguyen, Thanh N / Haussen, Diogo C / Nogueira, Raul G / Haq, Israr Ul / Zaidat, Osama O / Sanborn, Emma / Leslie-Mazwi, Thabele M / Patel, Aman B / Siegler, James E / Tiwari, Ambooj

Journal of neurology, neurosurgery, and psychiatry

2022 Volume 93, Issue 4, Page(s) 360–368

Abstract: Background: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome.: Methods: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 ... ...

Abstract	Background: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. Methods: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. Results: A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. Conclusion: There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.
MeSH term(s)	Brain Ischemia/epidemiology ; Brain Ischemia/etiology ; Brain Ischemia/virology ; COVID-19/complications ; Humans ; Ischemic Stroke/epidemiology ; Ischemic Stroke/etiology ; Ischemic Stroke/virology ; Middle Aged ; Retrospective Studies ; SARS-CoV-2 ; Stroke/epidemiology ; Stroke/etiology ; Stroke/virology ; Thrombectomy ; Treatment Outcome
Language	English
Publishing date	2022-01-25
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	3087-9
ISSN	1468-330X ; 0022-3050
ISSN (online)	1468-330X
ISSN	0022-3050
DOI	10.1136/jnnp-2021-328354
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Ui II Zs.93: Show issues

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Article ; Online: Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry.

Siegler, James E / Cardona, Pere / Arenillas, Juan F / Talavera, Blanca / Guillen, Ana N / Chavarría-Miranda, Alba / de Lera, Mercedes / Khandelwal, Priyank / Bach, Ivo / Patel, Pratit / Singla, Amit / Requena, Manuel / Ribo, Marc / Jillella, Dinesh V / Rangaraju, Srikant / Nogueira, Raul G / Haussen, Diogo C / Vazquez, Alejandro R / Urra, Xabier /

Chamorro, Ángel / Román, Luis S / Thon, Jesse M / Then, Ryna / Sanborn, Emma / de la Ossa, Natalia P / Millàn, Mònica / Ruiz, Isaac N / Mansour, Ossama Y / Megahed, Mohammed / Tiu, Cristina / Terecoasa, Elena O / Radu, Răzvan A / Nguyen, Thanh N / Curiale, Gioacchino / Kaliaev, Artem / Czap, Alexandra L / Sebaugh, Jacob / Zha, Alicia M / Liebeskind, David S / Ortega-Gutierrez, Santiago / Farooqui, Mudassir / Hassan, Ameer E / Preston, Laurie / Patterson, Mary S / Bushnaq, Saif / Zaidat, Osama / Jovin, Tudor G

International journal of stroke : official journal of the International Stroke Society

2020 Volume 16, Issue 4, Page(s) 437–447

Abstract: Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients.: Aim: To summarize the findings of a multinational observational cohort of patients ... ...

Abstract	Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020-16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130-280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; COVID-19/complications ; COVID-19/epidemiology ; COVID-19/therapy ; Cerebrovascular Disorders/epidemiology ; Cerebrovascular Disorders/etiology ; Cerebrovascular Disorders/therapy ; Cohort Studies ; Female ; Hospital Mortality ; Humans ; Intracranial Hemorrhages/epidemiology ; Ischemic Stroke/epidemiology ; Ischemic Stroke/etiology ; Ischemic Stroke/therapy ; Lymphocyte Count ; Male ; Middle Aged ; Prevalence ; Registries ; Retrospective Studies ; Risk Factors ; Sex Factors ; Thrombosis/etiology ; Tobacco Use ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-09-30
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	2303728-3
ISSN	1747-4949 ; 1747-4930
ISSN (online)	1747-4949
ISSN	1747-4930
DOI	10.1177/1747493020959216
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Article: Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

Chamorro, Ángel / Román, Luis S / Thon, Jesse M / Then, Ryna / Sanborn, Emma / de la Ossa, Natalia P / Millàn, Mònica / Ruiz, Isaac N / Mansour, Ossama Y / Megahed, Mohammed / Tiu, Cristina / Terecoasa, Elena O / Radu, Razvan A / Nguyen, Thanh N / Curiale, Gioacchino / Kaliaev, Artem / Czap, Alexandra L / Sebaugh, Jacob / Zha, Alicia M / Liebeskind, David S / Ortega-Gutierrez, Santiago / Farooqui, Mudassir / Hassan, Ameer E / Preston, Laurie / Patterson, Mary S / Bushnaq, Saif / Zaidat, Osama / Jovin, Tudor G

Int J Stroke

Abstract: BACKGROUND: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. AIM: To summarize the findings of a multinational observational cohort of patients with ... ...

Abstract	BACKGROUND: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. AIM: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. METHODS: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020-16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). RESULTS: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130-280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. CONCLUSIONS: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #806135
Database	COVID19

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Article ; Online: Cerebrovascular events and outcomes in hospitalized patients with COVID-19

International Journal of Stroke

The SVIN COVID-19 Multinational Registry

2020 , Page(s) 174749302095921

Abstract: Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with ... ...

Abstract	Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020–16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970–1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920–1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130–280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4–60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63–15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07–2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34–0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
Keywords	Neurology ; covid19
Language	English
Publisher	SAGE Publications
Publishing country	us
Document type	Article ; Online
ZDB-ID	2303728-3
ISSN	1747-4930
ISSN	1747-4930
DOI	10.1177/1747493020959216
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Recurrent Reversible Cerebral Vasoconstriction Syndrome: A Report of Two Cases.

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Article ; Online: Neuroimaging mimics of anoxic brain injury: A review.

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Article ; Online: Nilotinib-Associated Atherosclerosis Presenting as Multifocal Intracranial Stenosis and Acute Stroke.

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Article ; Online: Acute ischaemic stroke associated with SARS-CoV-2 infection in North America.

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Article ; Online: Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry.

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Article: Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

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