MIRVETUXIMAB-INDUCED PNEUMONITIS LEADING TO SEVERE ARDS

CHEST Journal · 2025-10-01

Lumbar artery pseudoaneurysm in traumatic spinal cord injury from a gunshot wound: A case report

Trauma · 2024-01-04

Lumbar artery pseudoaneurysms are a rare complication of penetrating trauma that can result in devastating retroperitoneal hemorrhage or embolic complications if left untreated. Prompt recognition in the trauma setting can lead to timely definitive diagnosis via spinal angiography and treatment via endovascular embolization. We present a case of lumbar artery pseudoaneurysm secondary to a gunshot wound to the spine treated via coil embolization.

Pembrolizumab-Related Secondary Adrenal Insufficiency Precipitating Electrolyte Derangements in a Patient With Malignant Melanoma

2024-04-30 · 1 citations

Abstract 001: Microvascular reperfusion during endovascular therapy: the balance of supply and demand

Stroke Vascular and Interventional Neurology · 2023-11-01

Introduction Endovascular therapy (EVT) has revolutionized acute stroke treatment, but large vessel recanalization does not always result in tissue‐level reperfusion. Cerebral blood flow (CBF) is not routinely monitored during EVT. Here we aimed to leverage diffuse correlation spectroscopy (DCS), a novel transcranial optical imaging technique, to assess the relationship between microvascular CBF and post‐EVT outcomes. Methods Frontal lobe CBF was monitored by DCS in 40 patients undergoing EVT. Baseline CBF deficit was calculated as the percentage of CBF impairment on pre‐EVT CT perfusion. Microvascular reperfusion was calculated as the percentage increase in DCS‐derived CBF that occurred with recanalization. The adequacy of reperfusion was defined by persistent CBF deficit, calculated as: baseline CBF deficit ‐ microvascular reperfusion. Good functional outcome was defined as 90‐day modified Rankin Scale ≤2. Results 36 (of 40) patients achieved successful recanalization, in whom microvascular reperfusion in itself was not associated with infarct volume or functional outcome. However, patients with good functional outcomes had a smaller persistent CBF deficit (median: 1%; IQR: ‐11%–16%) than patients with poor outcomes (median: 28%; IQR: 2%–50%), p=0.02. Smaller persistent CBF deficit was also associated with smaller infarct volume (p=0.004). Multivariate models confirmed that persistent CBF deficit was independently associated with infarct volume and functional outcome. Conclusion CBF augmentation alone does not predict post‐EVT outcomes, but when microvascular reperfusion closely matches the baseline CBF deficit, patients experience favorable clinical and radiographic outcomes. By recognizing inadequate reperfusion, bedside CBF monitoring may provide opportunities to personalize post‐EVT care aimed at CBF optimization.

Microvascular reperfusion during endovascular therapy: the balance of supply and demand

Journal of NeuroInterventional Surgery · 2023-10-28 · 5 citations

BACKGROUND: Endovascular therapy (EVT) has revolutionized the treatment of acute stroke, but large vessel recanalization does not always result in tissue-level reperfusion. Cerebral blood flow (CBF) is not routinely monitored during EVT. We aimed to leverage diffuse correlation spectroscopy (DCS), a novel transcranial optical imaging technique, to assess the relationship between microvascular CBF and post-EVT outcomes. METHODS: Frontal lobe CBF was monitored by DCS in 40 patients undergoing EVT. Baseline CBF deficit was calculated as the percentage of CBF impairment on pre-EVT CT perfusion. Microvascular reperfusion was calculated as the percentage increase in DCS-derived CBF that occurred with recanalization. The adequacy of reperfusion was defined by persistent CBF deficit, calculated as: baseline CBF deficit - microvascular reperfusion. A good functional outcome was defined as 90-day modified Rankin Scale score ≤2. RESULTS: Thirty-six of 40 patients achieved successful recanalization, in whom microvascular reperfusion in itself was not associated with infarct volume or functional outcome. However, patients with good functional outcomes had a smaller persistent CBF deficit (median 1% (IQR -11%-16%)) than patients with poor outcomes (median 28% (IQR 2-50%)) (p=0.02). Smaller persistent CBF deficit was also associated with smaller infarct volume (p=0.004). Multivariate models confirmed that persistent CBF deficit was independently associated with infarct volume and functional outcome. CONCLUSIONS: CBF augmentation alone does not predict post-EVT outcomes, but when microvascular reperfusion closely matches the baseline CBF deficit, patients experience favorable clinical and radiographic outcomes. By recognizing inadequate reperfusion, bedside CBF monitoring may provide opportunities to personalize post-EVT care aimed at CBF optimization.

Highly Visible Wall‐Timer to Reduce Endovascular Treatment Time for Stroke

Stroke Vascular and Interventional Neurology · 2022-09-08 · 3 citations

Background Endovascular therapy for acute ischemic stroke has revolutionized clinical care for patients with stroke and large vessel occlusion, but treatment remains time sensitive. At our stroke center, up to half of the door‐to‐groin time is accounted for after the patient arrives in the angio‐suite. Here, we apply the concept of a highly visible timer in the angio‐suite to quantify the impact on endovascular treatment time. Methods This was a single‐center prospective pseudorandomized study conducted over a 32‐week period. Pseudorandomization was achieved by turning the timer on and off in 2‐week intervals. The primary outcome was angio‐suite‐to‐groin time, and secondary outcomes were angio‐suite‐to‐intubation time, groin‐to‐recanalization time, and 90‐day modified Rankin scale. A stratified analysis was performed based on type of anesthesia (ie, endotracheal intubation versus not). Results During the 32‐week study period, 97 mechanical thrombectomies were performed. The timer was on and off for 38 and 59 cases, respectively. The timer resulted in faster angio‐suite‐to‐groin time (28 versus 33 minutes; P =0.02). The 5‐minute reduction in angio‐suite‐to‐groin was maintained after adjusting for intubation status in a multivariate regression ( P =0.02). There was no difference in the 90‐day modified Rankin scale between groups. The timer impact was consistent across the 32‐week study period. Conclusions A highly visible timer in the angio‐suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for patients with stroke. Given the lack of risk and low cost, it is reasonable for stroke centers to consider a highly visible timer in the angio‐suite to improve treatment times.

Intra-arterial Bevacizumab for Posterior Fossa Hemangioblastoma

Cureus · 2022-12-17 · 5 citations

Hemangioblastoma (HB) is a rare, highly vascularized, and benign central nervous system (CNS) tumor. This vascularity is due to a high degree of signaling by vascular endothelial growth factor (VEGF). Consequently, anti-VEGF agents, such as bevacizumab, have been postulated and shown in a few cases to be effective in treating these tumors when surgical therapy is not feasible. Additionally, selective intra-arterial (IA) administration of bevacizumab has shown promise in treating other cancers such as glioblastoma (GBM). Here, we present the case of a 60-year-old female with a symptomatic posterior fossa HB where embolization and surgery were not feasible due to tumor location. She underwent selective IA treatment with bevacizumab, which led to tumor stability and symptomatic improvement. Bevacizumab has been used intravenously (IV) as a treatment for HB, however, its efficacy has not been well-established. This case demonstrates the potential viability of selective bevacizumab in HB, as demonstrated by symptomatic improvement and decreased tumor size on MRI. Further research is needed to demonstrate the specific efficacy of IA bevacizumab for CNS HB when surgery or other treatment modalities are not viable options.

Paget-Schroetter Syndrome Causing a Rare Case of Venous Thoracic Outlet Syndrome

2022-05-01

Early Neurologic Deterioration with Symptomatic Isolated Internal Carotid Artery Occlusion: A Cohort Study, Systematic Review, and Meta‐Analysis

Stroke Vascular and Interventional Neurology · 2022-05-05 · 4 citations

Background: Acute endovascular revascularization for isolated internal carotid occlusion without tandem intracranial occlusion has been proposed to prevent early neurologic deterioration (END) and improve outcome, but has not been shown to be more effective than medical therapy. We aimed to evaluate prognosis with initial medical therapy alone, and also performed a systematic review to put these results in a broader context. Methods: We performed a retrospective cohort study of patients admitted over a 2-year period with acute stroke/TIA due to isolated internal carotid artery occlusion. Subjects with tandem intracranial occlusion or ASPECTS≤5 were excluded. The primary outcome was END within 48 hours (NIHSS increase ≥4 persisting for ≥24 hours). Secondary outcomes included discharge NIHSS and disposition. We also performed a systematic review and meta-analysis of published studies along with the data from our cohort. Results: Twenty-three patients met our inclusion criteria. Median age was 69 years, initial ASPECTS 10, and NIHSS score 3. END attributed to recurrent ischemia occurred in 5/23 patients (22%, 95%CI: 7-44%). At discharge, 78% had a favorable outcome with a median NIHSS of 2 (IQR 1-3). END appeared more frequent in those with higher baseline NIHSS. In our systematic review, 7 prior studies met our inclusion criteria. END occurred in 17% (95%CI:12-23%) of patients, 18% with medical therapy versus 13% with endovascular therapy, with substantial heterogeneity among studies. Conclusions: In patients with acute stroke or TIA due to isolated internal carotid occlusion, END is relatively common (occurring in about 1 out of 6 patients). Further research is needed to evaluate the roles of maximal medical management or acute endovascular thrombectomy in these patients.

A Case Report of Herpes Simplex-1 Viral Encephalitis Complicated by Hemorrhagic Conversion

Cureus · 2022-04-18 · 3 citations

Herpes simplex virus (HSV) encephalitis is the most common cause of nonendemic sporadic encephalitis in the United States. Treatment with acyclovir has been proven to reduce mortality by 50%. Antiviral therapy should be initiated immediately in patients with clinical suspicion of viral encephalitis and should not be delayed by serological confirmation of the diagnosis. The most common central nervous system complication of HSV encephalitis is seizures (38%), while intracranial hemorrhage is very rare (2.7%). We describe a case of a 59-year-old African American male who presented to the hospital after being found unresponsive for a day and was found to have HSV-1 encephalitis that was complicated by hemorrhagic conversion. Our patient's neurological status did not improve even with appropriate antiviral treatment with a 28-day course of intravenous (IV) acyclovir. Intracranial hemorrhage is a rare complication in patients with HSV encephalitis. Close monitoring of neurological status is recommended for signs of deterioration or lack of improvement, and further imagings are needed (as in our patient) to evaluate for neurological complications such as intracranial hemorrhage.