Citations

A 49-year-old woman presented with a dorsal column-predominant sensory myelopathy secondary to superficial siderosis. She had Marfan syndrome and was found to have dural ectasia. Superficial siderosis results from subpial haemosiderin deposition due to chronic subarachnoid space bleeding, often from a dural pathology, such as a tear. Dural ectasia is common in Marfan syndrome, but superficial siderosis is not. Gait ataxia, often with hearing impairment, is a common clinical presentation of superficial siderosis. Patients may develop myelopathy, here being a pure sensory myelopathy with predominant dorsal column deficit. Meningeal diverticulae and superficial siderosis are both associated with cerebrospinal fluid (CSF) leaks. This patient had dural ectasia and meningeal diverticulae, but the CT myelogram found no CSF leak. Superficial siderosis should be considered in patients with sensory myelopathy. Lumbosacral dural ectasia, or less likely CSF leak, can cause superficial siderosis in people with Marfan syndrome.

ABSTRACT Background and Purpose Neuroimaging of acute ischemic stroke (AIS) may provide clues to the underlying mechanism based on stroke location. Patients who experience stroke despite therapeutic anticoagulation provide a clinical challenge, and the subsequent preventive regimen may depend on the underlying stroke mechanism. We conducted a retrospective analysis of patients presenting with stroke despite anticoagulation (AC+) and compared their imaging findings to those of patients with stroke while not on anticoagulation (AC−). Methods Retrospectively, patients hospitalized with AIS were categorized as AC+ and AC− based on their prehospital anticoagulation use. A total of 119 patients met the inclusion criteria for AC+ strokes, which were compared to a random sample of 135 AC− patients during the same time frame. Imaging was dichotomized into embolic (ES) and nonembolic stroke (NES) groups. Descriptive analyses were used to compare imaging appearance between the two groups. Secondary analyses using multivariate logistic regression were used to identify risk factors for strokes in the AC+ group. Results ES were proportionally higher among the AC+ group compared to the AC− cohort. Atrial fibrillation was an independent predictor for breakthrough stroke among the entire cohort (adjusted OR 69.8 [21.1–291.8], p < 0.001), as well as a predictor for ES among those with AC+ stroke (adjusted OR 55.29 [14.4–286.2], p < 0.001). Conclusions AC+ patients have a higher proportion of embolic appearing strokes, suggesting incomplete response to anticoagulation rather than competing mechanisms as the cause of stroke in these patients. Further investigation into stroke mechanisms and management in this unique population is needed.

Abstract Endothelial dysfunction can be regarded as the earliest feature of vascular aging and may occur in individuals without traditional risk factors for cardiovascular disease. Once present, endothelial dysfunction is known to increase the risk for atherosclerosis, cardiovascular diseases and complications such as stroke or death. Identification of individuals with early features of vascular aging remains challenging and has fuelled investigative efforts to associated biologic, imaging, and digital markers with endothelial dysfunction. This review highlights emerging and traditional methods to identify patients with early endothelial dysfunction and summarizes available and experimental therapies aimed at mitigating the vascular aging process.

ABSTRACT Background and Purpose Corticospinal tract (CST) integrity is an imaging biomarker for predicting upper extremity motor recovery, but data are limited in acute ischemic stroke patients. Our study aimed to assess the impact of CST disruption on upper extremity motor recovery after acute ischemic stroke. Methods We enrolled patients with upper extremity motor deficits within 7 days of stroke onset. Patients’ clinical status was assessed for the upper extremity Fugl–Meyer assessment motor component (UE‐FM) within 7 days of stroke and at 15, 30, and 90 days. MRI with tractography was performed within 7 days of stroke. Diffusion tensor images (DTI) were processed to produce maps of fractional anisotropy (FA), apparent diffusion, axial, radial, and mean diffusivity. FA maps were used to assess CST asymmetry index (CST‐AI). Fisher's exact tests for categorical variables, two‐sample t ‐tests for normally distributed numerical data, and Wilcoxon rank sums for non‐normally distributed numeric data were used. Results A total of 21 patients were enrolled in the study with a mean age of 66 (±14) years and median baseline upper extremity motor component score (UE‐FM) of 42 (median) [range: 23, 53]. Baseline UE‐FM was not predictive of a 10‐point change at 90 days ( p = 0.4469). CST‐AI was predictive of recovery at 15 days ( p = 0.0373), and axial diffusivity was predictive of recovery at 90 days ( p = 0.0402). All other imaging variables did not predict recovery. Conclusion Our data suggest that upper extremity motor recovery after acute ischemic stroke is impacted by CST integrity. Further studies are needed to validate our findings.

Introduction: Accreditation of vascular laboratories has been shown to lead to overall improvements in quality patient care. However, there are still factors that needlessly delay the granting of full accreditation. We performed a retrospective analysis looking at factors associated with delays in accreditation in extracranial carotid artery ultrasound examinations by the Intersocietal Accreditation Commission - Vascular Testing (IAC-VT) division. Materials and Methods: We accessed an active database from the IAC-VT division between 2014 and 2020 and extracted data linked to vascular laboratory accreditation in extracranial carotid ultrasound studies. We used the ‘Delay” versus the “Grant” status as outcome and looked at the association with 18 metrics that are part of the application evaluation. We further used a modified Delphi method to determine the relative role played by either the technologist/sonographer or the interpreting physician for each metric. Statistical significance was evaluated by Chi-square. Results: A “Delay” status was assigned in 1638 (58.6%) out of 2794. Ten factors were noted to be significant univariate predictors of a “Delay” status. The three major factors were solely associated with the interpreting physician while adherence to technical factors showed mostly shared responsibility. Conclusion: This retrospective study indicated that the accreditation process is strongly dependent on interpreting physician performance. Targeted interventions may help decrease time and effort associated with the costs of the accreditation process.

OBJECTIVE In phototherapy for neonatal hyperbilirubinemia, the use of covers placed between the newborn and the phototherapy source is variable. Guidelines often recommend a cover for the phototherapy blanket pad. Because covers could affect illumination levels, we assessed phototherapy irradiance levels from an overhead phototherapy system and a phototherapy blanket, with and without commercial covers. METHODS In this nonclinical study, the overhead phototherapy system used calibrated radiometer measurements from 420 to 500 nm at 2 distances below the light source; the phototherapy blanket used measurements from 400 to 520 nm. We measured irradiance in 4 different variations using 2 types of covers (a mesh swaddle and a phototherapy blanket pad). RESULTS For the overhead system, at 30.5 cm below the light source and with a mesh swaddle covering the meter, the irradiance was 29.5 μW/cm2/nm, which was 14% lower than the value without covering (34.4 μW/cm2/nm). The mean irradiance at 15 cm from the light source with the mesh covering the meter (38.5 μW/cm2/nm) was 15% lower than without a cover (45.4 μW/cm2/nm). The irradiance under the zipper of the mesh swaddle was substantially lower at either distance. For the phototherapy blanket, the irradiance measured in all the posterior covering variations ranged from 61.1 (nest plus swaddle) to 98.5 μW/cm2/nm (no covering). CONCLUSIONS Clinicians should be aware that commercial phototherapy coverings affect irradiance; however, optimal irradiance can be achieved and may even exceed current American Academy of Pediatrics (AAP) recommendations of 25 to 35 μW/cm2/nm.