BACKGROUND AND OBJECTIVES:The major clinical implication of brain arteriovenous malformations (bAVMs) is spontaneous intracranial hemorrhage. There is a growing body of experimental evidence proving that inflammation and blood-brain barrier (BBB) dysfunction are involved in both the clinical course of the disease and the risk of bleeding. However, how bAVM treatment affects perilesional BBB disturbances is yet unclear. METHODS:We assessed the permeability changes of the BBB using dynamic contrast-enhanced MRI (DCE-MRI) in a series of bAVMs (n = 35), before and at a mean of 5 (±2) days after treatment. A set of cerebral cavernous malformations (CCMs) (n = 16) was used as a control group for the assessment of the surgical-related collateral changes. The extended Tofts pharmacokinetic model was used to extract permeability (K trans ) values in the lesional, perilesional, and normal brain tissues. RESULTS:In patients with bAVM, the permeability of BBB was higher in the perilesional of bAVM tissue compared with the rest of the brain parenchyma (mean K trans 0.145 ± 0.104 vs 0.084 ± 0.035, P = .004). Meanwhile, no significant changes were seen in the perilesional brain of CCM cases (mean K trans 0.055 ± 0.056 vs 0.061 ± 0.026, P = .96). A significant decrease in BBB permeability was evident in the perilesional area of bAVM after surgical resection (mean K trans 0.145 ± 0.104 vs 0.096 ± 0.059, P = .037). This benefit in BBB permeability reduction after surgery seemed to surpass the relative increase in permeability inherent to the surgical manipulation. CONCLUSION:In contrast to CCMs, BBB permeability in patients with bAVM is increased in the perilesional parenchyma, as assessed using DCE-MRI. However, bAVM surgical resection seems to reduce BBB permeability in the perilesional tissue. No evidence of the so-called breakthrough phenomenon was detected in our series. DCE-MRI could become a valuable tool to follow the longitudinal course of BBB damage throughout the natural history and clinical course of bAVMs.

Background The aim of this is to explore the histological basis of vessel wall enhancement (WE) on magnetic resonance imaging (MRI), which is a strong radiological biomarker of aneurysmal prone to rupture compared to other classical risk predictors (e.g., PHASES score, size, morphology). Methods A prospective observational study was performed including all consecutive patients presenting with a saccular intracranial aneurysm at Vall d’Hebron University Hospital between October 2017 and May 2019. The patients underwent high-resolution 3 T MRI, and their aneurysms were classified into asymptomatic, symptomatic, and ruptured. A histological and immunohistochemical study was performed in a subgroup of patients ( n = 20, of which 15 presented with WE). Multiple regression analyses were performed to identify predictors of rupture and aneurysm symptoms. Results A total of 132 patients were enrolled in the study. WE was present in 36.5% of aneurysms: 22.9% asymptomatic, 76.9% symptomatic, and 100% ruptured. Immunohistochemical markers associated with WE were CD3 T cell receptor ( p = 0.05) and CD45 leukocyte common antigen ( p = 0.05). Moreover, WE is an independent predictor of symptomatic and ruptured aneurysms ( p < 0.001). Conclusions Aneurysms with WE present multiple histopathological changes that may contribute to wall disruption and represent the pathophysiological basis of radiological WE. Moreover, WE is an independent diagnostic predictor of aneurysm symptoms and rupture.

Background and PurposeThe prognostic significance of postcontrast enhancement of intracranial atheromatous plaque is uncertain. Prospective, long-term follow-up studies in Caucasians, using a multicenter design, are lacking. We aimed to evaluate whether this radiological sign predicts long-term new stroke in symptomatic and asymptomatic intracranial atherosclerotic disease (ICAD) patients. MethodsThis was a prospective, observational, longitudinal, multicenter study. We included a symptomatic and an asymptomatic cohort of ICAD patients that underwent 3T MRI including high-resolution sequences focused on the atheromatous plaque. We evaluated grade of stenosis, plaque characteristics, and gadolinium enhancement ratio (postcontrast plaque signal/postcontrast corpus callosum signal). The occurrence of new events was evaluated at 3, 6, 9, and 12 months and annually thereafter. The association between plaque characteristics and new stroke was studied using Cox multiple regression survival analysis and Kaplan-Meier curves. ResultsForty-eight symptomatic and 13 asymptomatic patients were included. During 56.3 +/- 16.9 months, 11 patients (18%) suffered a new event (seven ischemic, two hemorrhagic, and two transient ischemic attacks). A receiver operating characteristic curve identified an enhancement ratio of >1.77 to predict a new event. In a multivariable Cox regression, postcontrast enhancement ratio >1.77 (hazard ratio [HR]= 3.632; 95% confidence interval [CI], 1.082-12.101) and cerebral microbleeds (HR = 5.244; 95% CI, 1.476-18.629) were independent predictors of future strokes. Patients with a plaque enhancement ratio >1.77 had a lower survival free of events (p < .05). ConclusionsHigh intracranial postcontrast enhancement is a long-term predictor of new stroke in ICAD patients. Further studies are needed to elucidate whether postcontrast enhancement reflects inflammatory activity of intracranial atheromatous plaque.

Introduction:Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid-β (Aβ) in brain vessels and is a main cause of lobar intracerebral hemorrhage (ICH) in the elderly. CAA is associated with magnetic resonance imaging (MRI) markers of small vessel disease (SVD). Since Aβ is also accumulated in Alzheimer's disease (AD) in the brain parenchyma, we aimed to study if several single nucleotide polymorphisms (SNPs) previously associated with AD were also associated with CAA pathology. Furthermore, we also studied the influence of APOE and CLU genetic variants in apolipoprotein E (ApoE) and clusterin/apolipoprotein J (ApoJ) circulating levels and their distribution among lipoproteins.Methods:The study was carried out in a multicentric cohort of 126 patients with lobar ICH and clinical suspicion of CAA.Results:We observed several SNPs associated with CAA neuroimaging MRI markers [cortical superficial siderosis (cSS), enlarged perivascular spaces in the centrum semiovale (CSO-EPVS), lobar cerebral microbleeds (CMB), white matter hyperintensities (WMH), corticosubcortical atrophy and CAA-SVD burden score]. Concretely, ABCA7 (rs3764650), CLU (rs9331896 and rs933188), EPHA1 (rs11767557), and TREML2 (rs3747742) were significantly associated with a CAA-SVD burden score. Regarding circulating levels of apolipoproteins, protective AD SNPs of CLU [rs11136000 (T) and rs9331896 (C)] were significantly associated with higher HDL ApoJ content in the lobar ICH cohort. APOEε2 carriers presented higher plasma and LDL-associated ApoE levels whereas APOEε4 carriers presented lower plasma ApoE levels. Additionally, we observed that lower circulating ApoJ and ApoE levels were significantly associated with CAA-related MRI markers. More specifically, lower LDL-associated ApoJ and plasma and HDL-associated ApoE levels were significantly associated with CSO-EPVS, lower ApoJ content in HDL with brain atrophy and lower ApoE content in LDL with the extent of cSS.Discussion:This study reinforces the relevance of lipid metabolism in CAA and cerebrovascular functionality. We propose that ApoJ and ApoE distribution among lipoproteins may be associated with pathological features related to CAA with higher ApoE and ApoJ levels in HDL possibly enhancing atheroprotective, antioxidative, and anti-inflammatory responses in cerebral β-amyloidosis.

Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in elderly patients. Growing evidence suggests a potential role of aquaporin 4 (AQP4) in amyloid-beta-associated diseases, including CAA pathology. Our aim was to investigate the circulating levels of AQP4 in a cohort of patients who had suffered a lobar ICH with a clinical diagnosis of CAA. AQP4 levels were analyzed in the serum of 60 CAA-related ICH patients and 19 non-stroke subjects by enzyme-linked immunosorbent assay (ELISA). The CAA–ICH cohort was divided according to the time point of the functional outcome evaluation: mid-term (12 ± 18.6 months) and long-term (38.5 ± 32.9 months) after the last ICH. Although no differences were found in AQP4 serum levels between cases and controls, lower levels were found in CAA patients presenting specific hemorrhagic features such as ≥2 lobar ICHs and ≥5 lobar microbleeds detected by magnetic resonance imaging (MRI). In addition, CAA-related ICH patients who presented a long-term good functional outcome had higher circulating AQP4 levels than subjects with a poor outcome or controls. Our data suggest that AQP4 could potentially predict a long-term functional outcome and may play a protective role after a lobar ICH.

Introduction. Thrombophlebitis of the cavernous sinus is a severe infectious disease with high mortality and morbidity. It is usually diagnosed at a late stage and requires a number of visits to the emergency department in most cases, and the prognosis is highly dependent on prompt treatment. Despite its severity, evidence regarding treatment with corticosteroids and anticoagulation therapy is scarce and controversial. One of its complications is arteritis, which can be mistaken for medium to large vessel vasculitis, as in this case. Case report. A 26-year-old female, who visited due to headache and left palpebral oedema. Imaging tests revealed thrombosis in the left cavernous sinus and significant narrowing of the internal carotid artery. The clinical picture was interpreted as secondary to an inflammatory vascular process and treatment with corticosteroids was initiated, with a good response. However, soon afterwards, fever and contralateral palpebral oedema developed. In the blood cultures a growth of Streptococcus intermedius was obtained and thrombophlebitis of the cavernous sinus was diagnosed. Despite initiating antibiotic and anticoagulation therapy, the patient suffered a right hemiplegia secondary to the formation of frontotemporal abscesses. Surgical drainage was performed and the patient progressed well. In the absence of other infectious foci, and due to the oral origin of the germ, a prophylactic multiple exodontia was performed. Conclusion. Thrombophlebitis should be considered as a diagnostic option both in headaches with ocular symptoms and in medium to large vessel arteritis so that they can be treated in a timely manner.

Thrombophlebitis of the cavernous sinus is a severe infectious disease with high mortality and morbidity. It is usually diagnosed at a late stage and requires a number of visits to the emergency department in most cases, and the prognosis is highly dependent on prompt treatment. Despite its severity, evidence regarding treatment with corticosteroids and anticoagulation therapy is scarce and controversial. One of its complications is arteritis, which can be mistaken for medium to large vessel vasculitis, as in this case.A 26-year-old female, who visited due to headache and left palpebral oedema. Imaging tests revealed thrombosis in the left cavernous sinus and significant narrowing of the internal carotid artery. The clinical picture was interpreted as secondary to an inflammatory vascular process and treatment with corticosteroids was initiated, with a good response. However, soon afterwards, fever and contralateral palpebral oedema developed. In the blood cultures a growth of Streptococcus intermedius was obtained and thrombophlebitis of the cavernous sinus was diagnosed. Despite initiating antibiotic and anticoagulation therapy, the patient suffered a right hemiplegia secondary to the formation of frontotemporal abscesses. Surgical drainage was performed and the patient progressed well. In the absence of other infectious foci, and due to the oral origin of the germ, a prophylactic multiple exodontia was performed.Thrombophlebitis should be considered as a diagnostic option both in headaches with ocular symptoms and in medium to large vessel arteritis so that they can be treated in a timely manner.Síndrome de seno cavernoso secundario a una tromboflebitis por Streptococcus intermedius complicada con vasculitis de la arteria carótida interna y abscesos cerebrales.Introducción. La tromboflebitis del seno cavernoso es una enfermedad infecciosa grave con alta mortalidad y morbilidad. Su diagnóstico suele ser tardío y requiere múltiples visitas a urgencias en la mayoría de casos, y el pronóstico es altamente dependiente de su rápido tratamiento. A pesar de su gravedad, la evidencia con respecto al tratamiento con corticoides y anticoagulación es escasa y controvertida. Entre sus complicaciones se encuentra la arteritis, la cual puede confundirse con una vasculitis de mediano-gran vaso, como en este caso. Caso clínico. Mujer de 26 años, que acude por una cefalea y un edema palpebral izquierdo. En las pruebas de imagen se evidencia trombosis del seno cavernoso izquierdo y una estrechez importante de la arteria carótida interna. Se interpreta el cuadro como secundario a un proceso vascular inflamatorio y se inician corticoides, con buena respuesta. Sin embargo, al poco tiempo se presenta fiebre y edema palpebral contralateral. En los hemocultivos se obtiene un crecimiento de Streptococcus intermedius y se diagnostica una tromboflebitis del seno cavernoso. A pesar del inicio de antibióticos y anticoagulación, sufre una hemiplejía derecha secundaria a la formación de abscesos frontotemporales. Se procede al drenaje quirúrgico y la paciente cursa con buena evolución. Ante la ausencia de otros focos infecciosos, y debido a la procedencia oral del germen, se realiza una exodoncia múltiple profiláctica. Conclusión. Se recomienda considerar la tromboflebitis como una opción diagnóstica tanto en las cefaleas con síntomas oculares como en la arteritis de mediano-gran vaso para su tratamiento oportuno.

Background and Purpose— Despite recanalization, almost 50% of patients undergoing endovascular treatment (EVT) experience poor outcome. We aim to evaluate the value of computed tomography perfusion as immediate outcome predictor postendovascular treatment. Methods— Consecutive patients receiving endovascular treatment who achieved recanalization (modified Thrombolysis in Cerebral Ischemia [mTICI] 2a-3) underwent computed tomography perfusion within 30 minutes from recanalization (CTPpost). Hypoperfusion was defined as the Tmax>6 second volume; hyperperfusion as visually increased cerebral blood flow/cerebral blood volume with reduced Tmax compared with unaffected hemisphere. Dramatic clinical recovery (DCR) was defined as 24-hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. Delayed recovery was defined as no-DCR with favorable outcome (modified Rankin Scale score 0–2) at 3 months. Results— We included 151 patients: median National Institutes of Health Stroke Scale score 16 (interquartile range, 10–21), median admission ASPECTS 9 (interquartile range, 8–10). Final recanalization was the following: mTICI2a 11 (7.3%), mTICI2b 46 (30.5%), and mTICI3 94 (62.3%). On CTPpost, 80 (52.9%) patients showed hypoperfusion (median Tmax>6 seconds: 4 cc [0–25]) and 32 (21.2%) hyperperfusion. There was an association between final TICI and CTPpost hypoperfusion(median Tmax>6: 91 [56–117], 15 [0–37.5], and 0 [0–7] cc, for mTICI 2a, 2b, and 3, respectively, P <0.01). Smaller hypoperfusion volumes on CTPpost were observed in patients with DCR (0 cc [0–13] versus non-DCR 8 cc [0–56]; P <0.01) or favorable outcome (modified Rankin Scale score 0–2: 0 cc [0–13] versus 7 [0–56] cc; P <0.01). No associations were detected with hyperperfusion pattern. An hypoperfusion volume <3.5 cc emerged as independent predictor of DCR (OR, 4.1 [95% CI, 2.0–8.3]; P <0.01) and 3 months favorable outcome (OR, 3.5 [95% CI, 1.6–7.8]; P <0.01). Conclusions— Hypoperfusion on CTPpost constitutes an immediate accurate surrogate marker of success after endovascular treatment and identifies those patients with delayed recovery and favorable outcome.

Background: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. Objective: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. Methods: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0-3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. Results: Forty-seven consecutive patients were included: mean age 70.9 +/- 12.1 years, median admission NIHSS score, 16 (IQR: 8-30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age < 70 years (odds ratio = 6.20, 95%CI 1.52-25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09-38.24, p = 0.04) were independently associated with a good outcome. Conclusions: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.

Background: Endovascular treatment (EVT) of extracranial internal carotid artery (ICA) lesions in the setting of tandem occlusions is a challenge, being angioplasty alone (AA) or angioplasty+stenting (AS) the two current approaches. Hemorrhagic transformation (HT) is a major problem when a conventional [self-expanding (SX)] stent is placed, regarding the need of early double antiplatelet therapy. Interestingly, balloon-expanding (BX) stents, due to their less thrombogenicity, may constitute an alternative, so they do not need early antiplatelets. We aimed to study differences in ICA restenosis, HT, clinical outcome and stroke recurrence between patients treated with AA or AS. Methods: Prospective study of consecutive patients with non-cardioembolic ischemic stroke and tandem occlusions, who underwent <6hours EVT from April 2013 to April 2017. We compared rate of ICA high-degree stenosis/occlusion at 24h, HT, clinical outcome (change in NIHSS at 24h and at discharge over NIHSS at admission, and mRS≥2 at 3 months) and stroke recurrence within 3 months between AA and AS (SX and BX stents) groups. Results: Ninety-two patients fulfilled inclusion criteria: mean age 64.6±12.6 years. Forty (43.5%) received AA and 52 (56.5%) AS (61.5% SX stents, 38.5% BX stents). Both groups were comparable in baseline characteristics. Fifty (54.3%) received IV rtPA. Patients who underwent AA presented ICA high-degree stenosis/occlusion at 24h more frequently than those who underwent AS (86.5% vs. 21.2%, p <0.001). No differences were found in HT, clinical outcome and stroke recurrence ( p >0.05 for all comparisons). In the AS group, all SX stents received antiplatelets after EVT, whereas in 75% of cases in the BX group no antiplatelets were started within 24h. However, no differences were found in ICA high-degree stenosis /occlusion at 24h, clinical outcome and stroke recurrence ( p >0.05). We neither found differences in HT. Nevertheless, all cases were asymptomatic in the BX stents group. Conclusions: Emergent ICA stenting seems to have a lower risk of restenosis compared to AA, without a significant increase of HT and stroke recurrence or a worse clinical outcome. BX stents, without early antiplatelet therapy, are a promising alternative to conventional carotid stents.

Background: Platelet function measured by Aggregometry tests (AT) are commonly used to measure the response to antiplatelets in patients undergoing intracranial and coronary stenting. However, its relevance in carotid and vertebral stents (CVS) is unsettled. We aimed to determine the yield of antiplatelet resistance (AR) in CVS patients, and its relationship with early restenosis and new ischemic lesions on magnetic resonance imaging (MRI). Methods: We studied consecutive patients undergoing CVS. Platelet function was assessed before stenting by means of VerifyNow-assay using Aspirin and P2Y12 cartridges. Antiplatelet reactivity was defined using the cut-off values ARU≥550 as Aspirin resistance (AASR) and PRU≥220 as Clopidogrel resistance (CR). Patients received baseline and 5-day MRI. Periprocedural complications, the new ischemic lesions at 5-day MRI and stent permeability by carotid ultrasound at 24 hours, 5 days and 3 months were analysed. Results: A total of 366 patients were screened. Of those, 246 patients were enrolled and tested for platelet function. A total of 135 patients (54.2%) showed AR, 48 AASR (19.5%) and 112 CR (45.5%). Aspirin dose after the test was increased in 21 patients (45.7%). In 22 patients (20%) with CR the daily dose was increased, in 40 patients (37.7%) an extra-loading dose was administrated and in 9 patients (8.4%) we increased both. At 24 hours, one patient showed restenosis >50% and another an occlusion (0.4 and 0.4% respectively). At 5 days, 8 patients had restenosis <50% (13.1%) and in 43 (17.5%) MRI showed new ischemic lesions. At 3 months 9 patients had stenosis >50% (4.5%) and stenting-related recurrence was observed in 3 (1.4%). A larger size lesions at 5-day MRI (OR 0.143; 95%CI 0.028-0.719) and a multi-territorial ischemic pattern (OR 0.143; 95%CI 0.075-0.893) were associated with lack of response to Clopidogrel therapy. No significant differences in AASR were observed across different groups. Conclusion: The yield of antiplatelet resistance in our series was 54.2%. Clopidogrel resistance was associated with a larger size and a multi-territorial stroke pattern at 5-day MRI. More studies are needed to elucidate the clinical impact of Aggregometry test and management recommendations.

Background: Up to 20% of acute intracranial occlusions have an associated extracranial internal carotid artery (ICA) severe stenosis or occlusion, and they often need specific treatment. However, it remains unclear which is the best option for extracranial revascularization. We aimed to study differences in restenosis, complications, and stroke recurrences between patients treated with stenting and those who underwent angioplasty without stenting. Methods: Prospective study of consecutive patients with non-cardioembolic ischemic stroke and occlusion or severe stenosis of the extracranial ICA, who underwent hyperacute endovascular procedure from April 2013 to December 2015. We divided patients depending on the extracranial treatment they received. We compared the rate of stenosis >50% or occlusion of the ICA at 24 hours (evaluated by carotid ultrasound or CTA). Besides, we analyzed differences in complications and stroke recurrences within 1 year of follow-up. Results: From 97 patients who underwent hyperacute revascularization of the extracranial ICA, 63 fulfilled the inclusion criteria: mean age 65.6±13.6 years, median time from symptoms onset to treatment 249 [161-330] minutes. Thirty-one (49.2%) were treated with angioplasty and 32 (50.8%) with stent. Both groups were comparable in demographic data, vascular risk factors, previous treatment (including antiplatelets), and ASPECTS score. Thirty-seven (58.7%) received intravenous rtPA and 58 (92.1%) intracranial thrombectomy. Patients who underwent angioplasty presented stenosis >50% or occlusion at 24h more frequently than those who underwent stenting (67.7% vs 21.9% , p =0.002), regardless the degree of residual stenosis after the angioplasty. Thirteen (38.1%) of the angioplasties were permeable at 24 hours, nevertheless 39.1% needed a deferred stenting. There were no differences in complications, including intracranial hemorrhage, despite intravenous rtPA or early double antiplatelet therapy, as well as in stroke recurrences within 1 year ( p >0.05 for all comparisons). Conclusions: Hyperacute extracranial ICA stenting seems to have a lower risk of restenosis compared to angioplasty, without a significant increase of complications and stroke recurrences

Brain and vascular imaging are required components of the emergency assessment of patients with suspected stroke. Either CT or MRI may be used as the initial imaging test. MRI is more sensitive to the presence of acute and chronic ischemic lesions, and chronic microbleeds, but CT remains the most practical and used initial brain imaging test. Although, a non-enhanced CT or T2* MRI sequence showing no haemorrhage is sufficient for deciding intravenous treatment eligibility within the first 4.5h after stroke onset, a non-invasive intracranial vascular study is strongly recommended during the initial imaging evaluation of the acute stroke patient, particularly if mechanical thrombectomy is contemplated. Advanced imaging with multimodal MRI may facilitate accurate ischemic stroke diagnosis and characterization, and should be considered as an alternative to CT, especially for the selection of patients for acute reperfusion therapy in extended time windows, and in patients in which time of stroke onset is unknown. However, MRI should only be considered in the acute stroke workflow if centres are able to achieve speed and triaging efficiency similar to that which is currently available with CT-based imaging.

Infarct volume is a strong predictor of outcome. Multiparametric imaging are meant to identify infarct core or non-reversible lesions, and therefore predict on admission the minimum volume of final infarct even if recanalization is rapidly achieved. We aimed to confirm this hypothesis and define the Maximal Admission Lesion volumes Compatible with favorable OutcoMe (MALCOM) in stroke patients receiving endovascular treatment. Methods: We studied consecutive patients with ICA/MCA occlusion and multiparametric CT/MRI, who underwent endovascular procedures. Indication for procedure was based on ASPECTS>6 and presence of mismatch (visually>20%). Admission infarct core was later measured on initial imaging (CBV-CTP or DWI-MRI) and infarct volume was measured on follow-up CT-scan. Lesion growth was calculated: final lesion–admission core. We defined MALCOM: cut-off admission core volume (CBV or DWI) above which probability of mRS0-2 is <10% Results: 57 patients were studied (29 MRI, 28 CT-perf). For all patients mean core volume was 28±22cc, recanalization TICI2b-3:77%. At 24h mean infarct volume was 64±97cc; mean lesion growth: 37±92cc and at 3 months favorable outcome 45% (mRS 0-2). Infarct growth was larger in non-recanalizers (118±182 Vs 29±77; p=0.04). In patients who recanalized admission core was 29±23cc and final lesion was 57±84cc. Overall the maximal lesion volume compatible with favorable outcome (MALCOM) was 39cc. When recanalization was achieved, up to 62% of patients within MALCOM (<39cc) achieved favorable outcome, whereas despite recanalization only 12% of patients beyond MALCOM (>39cc) achieved mRS0-2 (p=0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having an admission core lesion

We aim to investigate the clinical onset, computed tomography (CT) and magnetic resonance (MR) imaging findings, and follow-up of patients with cerebral amyloid angiopathy (CAA)-related inflammation, an uncommon but clinically striking presentation of CAA.

Objective: The finding of cerebral epileptogenic lesions in magnetic resonance (MR) has demonstrated to be a relevant prognostic factor for potential surgical candidates. In a series of consecutive adults with focal onset epilepsy, we investigated the yield of 3 T MR imaging for detecting epileptogenic cerebral lesions.Materials and methods: We prospectively recruited 161 adult patients with a diagnosis of focal epilepsy, all of whom underwent standardized MR imaging study performed with a 3 T magnet.Results: Lesion-related epilepsy was observed in 48% of patients, and 12% of cryptogenic patients showed subtle or non-specific lesions related to the epileptogenic source. The most common findings were focal cortical dysplasia and vascular lesions, followed by mesial temporal sclerosis, tumors, and scars from previous cerebral injuries. Patients older than 72 years were more likely to have vascular epilepsy.Conclusions: Diagnostic assessment using a standardized 3 T MR imaging protocol for focal-onset epilepsy detects lesions in nearly half the patients. Our results indicate that elders with focal epilepsy should be searched for vascular lesions. (C) 2013 Elsevier B.V. All rights reserved.