Abstract Details

Title Pathological Features of Three Cases of Rapid Progressive Multifocal Infarcts

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 034

Objective

Background BACKGROUND: Intracranial atherosclerosis is a thought to account to most ischemic strokes worldwide .with a high annual stroke recurrence rate of about 15% and a variable clinical course. Whereas cerebral vasculitis is rare disorder with an annual incidence of 2.4 per million per year.

Design/Methods DESIGN/METHODS: We present 3 cases of rapidly evolving multiterritorial infarcts with a challenging clinical diagnosis, marked by rapid clinical evolution, suggesting inflammatory etiology, however subsequent postmortem pathological examination proved intracranial atherosclerosis to be the cause of strokes. We provide pertinent radiographic findings with correlated cross sectional pathologic images.

Results RESULTS: Case#1: MA 55-years-old white man with diabetes and hyperlipidemia, had multivessel ischemic infarcts, angiography showed multivascular narrowing, suggesting intracranial atherosclerosis verses CNS vasculitis, brain biopsy was none-diagnostic. The patient was treated with systemic steroids. Clinically, he showed initial neurological improvement followed by deterioration due to biopsy site abscess and gastric aneurysmal rupture leading to death. Case#2: LK: 74-years-old Asian hypertensive woman , presented with successive bilateral hemispheric infarcts over 5 weeks , had elevated inflammatory markers and an angiographic of multiple intracranial vessel stenosis, treated with IV steroids for presumed vasculitis, course progressed to death due to central herniation. Case#3 RM: 71-year-old white woman with hypertension, hyperlipidemia and diabetes ,presented bilateral cerebral infarcts, elevated inflammatory markers and an angiographic evidence of multiple intracranial stenotic lesions, treated for vasculitis with steroids , her course progressed to death over 2 weeks due to severe brain injury.

Conclusions CONCLUSIONS: Rapidly progressive simultaneous strokes, in the presence of multifocal intracranial stenosis, and elevated inflammatory markers, can mislead to the diagnosis of vasculitis. Subsequent treatments might contribute to patient's demise, by adversely affecting hemodynamic and metabolic factors which are particularly important in such clinical settings.

Authors/Disclosures
Nada El-Andary, MD PRESENTER	No disclosure on file
Nora S. Lee, MD	No disclosure on file
	No disclosure on file
Jeffrey A. Cohen, MD (Cleveland Clinic)	Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Convelo. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSI. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celltrion.
	No disclosure on file

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