Arterial Thrombosis in an Asymptomatic COVID-19 Complicated by Malignant Middle Cerebral Artery Syndrome: A Case Report and Literature Review

Coronavirus disease 2019 (COVID-19) is a severe infectious respiratory disease caused by the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Multiple studies in the literature highlight the association between COVID-19 and stroke. We report a case of acute ischemic stroke in a COVID-19 patient without displaying symptoms of active COVID-19 infection or risk factors for stroke with further review of the literature. The patient’s recovery was complicated by hemorrhagic stroke, which resulted in death. Acute ischemic strokes are one of the challenging complications of COVID-19 infection. Initial rapid assessment and management are crucial in optimizing the outcomes on these patients. Nevertheless, wearing appropriate PPE should be instituted while providing adequate care.

Association between craniovertebral junction abnormalities and syringomyelia in patients with chiari malformation type-1

Objectives:

To assess the correlation between craniovertebral junction (CVJ) abnormalities and syringomyelia in patients with Chiari malformation type-1 (CM1).

Methods:

This was a retrospective study including patients with CM1. Identification of cases was done by searching a radiology database at a university hospital from 2012 to 2017. Patients were divided into 2 groups based on whether CVJ abnormalities were present (CVJ+) or absent (CVJ-). The patients’ demographic and clinical data were reviewed. All magnetic resonance imaging studies were examined by a certified neuroradiologist.

Results:

Sixty-four consecutive patients with CM1 were included. The mean age was 24±17 years; 59% were females. The CVJ+ group had more female patients (p = 0.012). The most frequent CVJ abnormality was platybasia (71%), followed by short clivus (44%) and cervical kyphosis (33%). The CVJ abnormalities were more in Syringomyelia cases (p = 0.045). However, the results were not significant when hydrocephalus cases were excluded.

Conclusion:

Among CM1 patients, CVJ abnormalities were found more in patients with syringomyelia. Future studies with larger sample size are required to further study the correlation between CVJ abnormalities and both syringomyelia and hydrocephalus in CM1 patients.

INNV-02. ARE WE AGGRESSIVE WITH OUR GLIOBLASTOMA PATIENTS: A PROPOSED TOOL TO EVALUATE CENTERS ATTITUDES IN TREATMENT OF GLIOBLASTOMA

INTRODUCTION

Glioblastoma is the most common malignant primary brain tumor in adults. Optimal treatment for glioblastoma requires a multidisciplinary approach and knowledge of complications from both the disease and its treatment. Despite modern advances in the standards of care, the outcome in patients with Glioblastoma remains poor. Thus, it is crucial to optimize treatment strategies to improve over-all survival in patients with Glioblastoma, with the therapeutic challenge of “how aggressive a physician should be?” OBJECTIVES: We herein propose a novel method to compare aggressiveness in the standard of care between multiple centers, using a novel tool, and provide a more precise cut-off definition of aggressiveness.

METHOD

Multiple centers were included. A novel case-based questionnaire was generated which included only certain parameters, and then sent and answered jointly by tumor board members from each center. We then stratified centers into more aggressive vs. less aggressive based on our proposed Aggressiveness (AS) score.

RESULTS

In our novel cases, center A scored an AS score of 44 (Mean ± SD; 3.67 ± 1.07), while center B scored 49 (Mean ± SD; 4.08 ± 0.90) In real cases, center A scored 40 (Mean ± SD; 3.25 ± 1.42), while center B scored 44 (Mean ± SD; 3.75 ± 1.29). Our results showed consistency between centers evaluated using our tool. Age and presence of comorbidities were the most influential parameters.

CONCLUSION

In the current study, we present a novel and a reliable tool that can be easily used and replicated to compare aggressiveness in the treatment of Glioblastoma between multiple centers. The methodology we used has never been previously proposed and can serve as a novel concept to compare aggressiveness in treatment of all incurable diseases that require a multidisciplinary approach.