Stroke-related seizures in patients with a partial anterior circulation syndrome

BACKGROUND

Partial anterior circulation syndrome (PACS), due to cerebral infarction, is the most common stroke presentation of patients with seizures. This study investigates the characteristics of such patients according to their seizure onset time.

PATIENTS AND METHODS

The characteristics of 151 patients with a PACS and seizures were compared to 310 without seizures. The seizure groups were classified as those of early- (EO), of late- (LO) and of very late-onset (VLO) and those due to recurrent infarcts (RI).

RESULTS

Temporal lobe infarction is the main risk factor for developing seizures (P < 0.02). Seizures are responsible for increased dependency except in patients with those of VLO (P < 0.03). Patients with EO seizures have the worse outcome (P = 0.0111) with a trend of more status epilepticus (P = 0.066) but less recurrence (P = 0.003). A cardiac-embolic source is more common in patients with seizures due to RI (P = 0.015). Post-ictal EEG patterns are significantly different from those in the patients without seizures (P < 0.001) except for seizures of VLO.

CONCLUSIONS

There are significant differences in the seizure characteristics according to their time of onset.

Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia

These guidelines on the management of HSV, VZV and EBV infection in patients with hematological malignancies and after SCT were prepared by the European Conference on Infections in Leukemia following a predefined methodology. A PubMed search was conducted using the appropriate key words to identify studies pertinent to management of HSV, VZV and EBV infections. References of relevant articles and abstracts from recent hematology and SCT scientific meetings were also reviewed. Prospective and retrospective studies identified from the data sources were evaluated, and all data deemed relevant were included in this analysis. The clinical and scientific background was described and discussed, and the quality of evidence and level of recommendation were graded according to the Centers for Disease Control criteria.

[Brain microbleeds]

Brain microbleeds (MB) are small, rounded, homogeneous, focal lesions seen as hyposignal on T2* gradient echo MR sequences. The prevalence of MB is around 5% among healthy people, 34% among people with ischemic stroke and 60% among people with hemorrhagic strokes. MB are found in the whole brain parenchyma. There are biomarkers of the severity of the microangiopathy and are more frequent in people with hypertension. MB are associated with lacunae and the severe leukoaraiosis. They might be associated with an increased risk of future stroke but their diagnostic and prognostic values remain controversial.

Differences between intracranial vascular malformation types in the characteristics of their presenting haemorrhages: prospective, population-based study

OBJECTIVE

To determine the imaging and demographic characteristics of intracranial haemorrhages, which are subsequently found to be due to an underlying intracranial vascular malformation (IVM).

METHODS

We compared the demographic and brain imaging characteristics of adults presenting with intracranial haemorrhage, subsequently found to be due to a brain arteriovenous malformation (BAVM), dural arteriovenous fistula (DAVF) or cavernous malformation (CM) in a prospective, population-based cohort of adults diagnosed for the first time with an IVM (The Scottish IVM Study (SIVMS)).

RESULTS

Of the 141 adults in SIVMS who presented with intracranial haemorrhage, those with CMs presented at a younger age and were less handicapped. A total of 115 (82%) had intracerebral haemorrhage (ICH) with or without subarachnoid, intraventricular or subdural extension. ICH without extension into other compartments accounted for all CM bleeds, but only 50% of BAVM and DAVF bleeds. Median haematoma volumes differed (Kruskal-Wallis, p<0.0001): ICH due to BAVM (16.0 cm3, inter-quartile range (IQR) 4.7 to 42.0) and DAVF (14.1 cm3, IQR 4.9 to 21.5) were similar, but CM haematoma volumes were smaller (median 1.8 cm3, IQR 1.3 to 4.3). These findings were robust in sensitivity analyses. Small haematoma volumes occurred among all IVM types; the largest haematoma volume due to CM was 12 cm3, and volumes of >34 cm3 were only due to BAVM.

CONCLUSIONS

Intracranial haemorrhages found to be due to IVMs differ in adults' age of presentation and clinical severity, as well as the volume and distribution of the haematoma within the brain compartments.

Liposomal amphotericin B (AmBisome�) efficacy in confirmed invasive aspergillosis and other filamentous fungal infections in immunocompromised hosts: a pooled analysis

A pooled efficacy analysis applying current diagnostic standards for case selection was performed on previously published trials of liposomal amphotericin B for invasive filamentous fungal infections (IFFI). Favourable responses were observed in 51% of microbiologically confirmed cases of proven or probable IFFI. Despite the limitations inherent in a retrospective analysis of pooled studies, the response rates observed in this analysis were consistent with previous reports for antifungal therapy with amphotericin B deoxycholate or voriconazole in the treatment of invasive aspergillosis.

[ABO incompatibility and non myeloablative allogeneic stem cell transplantation]

ABO incompatibility is not a barrier for allogeneic hematopoietic stem cell transplantation but is associated with specific complications. Major ABO incompatibility is associated with delayed erythroid engraftment, increased transfusion requirement and cases of pure red cell aplasia. Minor ABO incompatibility may be responsible for acute haemolytic reactions in the first months following transplantation. The widely used non myeloablative conditioning regimens might modify the management of ABO incompatibility. They could favour pure red cell aplasia development in the setting of major ABO mismatch since they are associated with a prolonged persistence of host anti-donor isohemagglutinins after allogeneic hematopoietic stem cell transplantation. In the setting of minor ABO incompatibility, the use of peripheral blood stem cells and the nature of graft-versus-host disease prophylaxis regimen may have an impact on the incidence of haemolytic reactions. In that review, the clinical and therapeutic aspects of ABO incompatibility are studied, especially regarding the impact of the conditioning regimen intensity.