David Horák

Acute ischaemic stroke in pregnancy: a severe complication of ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of sterility treatment. It is characterised by ovarian enlargement, ascites, electrolyte disturbance, hypovolaemia and haemoconcentration. A case of ischaemic stroke due to right middle cerebral artery (MCA) occlusion in a young female with OHSS after pharmacological treatment of sterility is reported. Left central hemiparesis occurred suddenly within a few days after the embryo transfer. Magnetic resonance imaging diffusion-weighted images showed infarction in the right basal ganglia and magnetic resonance angiography (MRA) revealed the occlusion of the M1 segment of the right MCA. The haemodilution and the anticoagulation therapy were effective. Twenty-four hours after the stroke onset, MRA showed MCA recanalisation. The neurological deficit resolved completely within 3 months. The patient delivered 2 healthy infants at term. This case emphasises that the recent advent of ovulation induction and reproductive techniques is a newly recognised cause of cerebral stroke in otherwise healthy females.

The Safety and Efficacy of Continuous Transcranial Duplex Doppler Monitoring of Middle Cerebral Artery Occlusion in Acute Stroke Patients: Comparison of TCDD and Thrombolysis in MCA Recanalization

Assess the safety and efficacy of the continuous transcranial duplex Doppler (TCDD) monitoring of middle cerebral artery (MCA) (M1‐2) occlusion in acute ischemic stroke (IS) patients and compare TCDD to intra‐arterial thrombolysis (IAT) and intravenous thrombolysis (IVT).

Speckle tracking echocardiography derived systolic longitudinal strain is better than rest single photon emission tomography perfusion imaging for nonviable myocardium identification.

BACKGROUND The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL(Smax)) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q(REST)), and to define the optimal cut-offs for SL(Smax) to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). METHODS AND RESULTS In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL(Smax) (r=-0.59, P<0.0001) and DE on ceCMR. The SL(Smax) optimal cut-off -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL(Smax) for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL(Smax) resp. Q(REST), p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL(Smax) than Q(REST) in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SLSmax resp. Q(REST), P=0.001). CONCLUSIONS STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.

Comparison of two-dimensional longitudinal strain with rest single photon emission tomography perfusion imaging for transmural scar identification in patients with ischemic left ventricular systolic dysfunction.

was used for a detailed evaluation of the LV segments by all the applied methods. The mean LVEF in the total study population was 34.3±4.8%, the mean LV enddiastolic and endsystolic volume were 282±94 resp. 184±67 ml respectively. Description of all parameters in the whole dataset is depicted in Table 1. In 1471 LV segments (92%) echocardiographic image quality allowed assessment of segmental function with STE. Among the 1471 segments with adequate image quality tracking of acoustic markers, segmental analysis of ceCMR indicated 76–100% DE in 189 segments. Analysis of rest perfusion SPECT imaging indicated QREST 3 in 164 segments and QREST 4 in 92 segments. Based DE findings, SLSmax analysis allowed distinction of segments with a transmural scar and totally non-viable myocardium (DEN75%) from segments with a non-transmural, potentially ischemic or morphologically normal myocardium. Performing receiver operating curve (ROC) analysis for the distinction of transmural scarred myocardium from all other segments in the whole LV, the area under curve (AUC) was 0.866. The ROC analysis yielded a cut-off value of −5.3% for SLSmax with a sensitivity of 83.1%, specificity of 84.8% to identify segments with non-viable myocardium presence on ceCMR. Odds ratios and ROC analysis results of given model with a SLSmax cut-off value −5.3% for DEN75% prediction are depicted in Table 2. A statistically significant difference (AUC 0.866 vs. 0.822 for SLSmax resp. QREST, p=0.036) in accuracy of predicting a segmental DEN75%, was achieved as a result of higher accuracy of STE in comparison with QREST in the right coronary artery (RCA) perfusion territory (AUC 0.75 vs. 0.893 for QREST resp. SLSmax ,p b0.001). A QREST perfusion score 3–4 discriminated between segments with potentially viable myocardium and segments with DEN75% with a sensitivity of 86.2% and specificity of 66.3%.