Background and Objectives: Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. Methods: This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. Results: Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEEGA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53– 1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23– 2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2–4 bleeding. Conclusions ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.

Objective: There has been a consistent import of Plasmodium falciparum malaria into South Korea. As artesunate has been shown to reduce malaria related mortality in other countries, we sought to evaluate the treatment outcomes of P. falciparum malaria with artesunate. Methods: We retrospectively reviewed demographic (age, sex, travel history, and year of admission) and clinical data (sign and symptoms, laboratory findings, complications, treatment outcome) of patients with imported P. falciparum malaria diagnosed between 2014 and 2019. Results: A total of 55 patients with P. falciparum malaria were included, of which 36.4% had severe P. falciparum malaria. Their mean (±standard deviation) age was 42.6 (±12.8) years. Overall, the median length of hospital stay was 6 days (interquartile range, 4-9; range, 3-36) and 21.8% of the patients needed intensive care unit (ICU) care. The overall mortality rate was 3.6%. In patients with severe P. falciparum malaria, half of the patients (50.0%) needed ICU care and the mortality rate was 10.0%. Conclusion This is the first study to report the outcomes of imported P. falciparum malaria treated with artesunate. The mortality rate for severe P. falciparum malaria in this study was higher than that in other non-endemic countries. Further studies are needed to evaluate the effect of treatment of P. falciparum malaria with artesunate.

The presence of primary intraventricular hemorrhage (IVH) without vascular lesion is very rare. We experienced solitary IVH without subarachnoid hemorrhage due to aneurysmal rupture in a 58-year-old man treated with coil embolization, which contributed to his good prognosis. After 33 days of hospitalization, he had mild right hemiplegic symptoms remaining, and he was transferred to a rehabilitation institute for further treatment. In cases of primary IVH, computed tomography angiography seems worthwhile for making a differential diagnosis, although the possibility of IVH due to cerebral aneurysmal rupture is very low. Endovascular intervention is a good option for diagnosis and treatment.
Aneurysm ; Angiography ; Cerebral Angiography ; Diagnosis ; Diagnosis, Differential ; Embolization, Therapeutic ; Endovascular Procedures ; Hemorrhage ; Hospitalization ; Humans ; Intracranial Aneurysm ; Middle Aged ; Prognosis ; Rehabilitation ; Rupture ; Subarachnoid Hemorrhage

PURPOSE: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. MATERIALS AND METHODS: From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. RESULTS: Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. CONCLUSION: A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.
Angiography ; Humans ; Logistic Models ; National Institutes of Health (U.S.) ; Stroke ; Thrombectomy

Anaphylaxis usually develop immediately after wasp sting, but may develop even after few days later. Neurological complications after stings are uncommon, although several cases have been reported involving central and/or peripheral nervous system. Although wasp sting-induced encephalitis has been rarely reported, all reported cases showed mental change and severe neurological deterioration. Herein, we report an atypical case who showed biphasic anaphylaxis and delayed-onset cerebellar ataxia following a wasp sting, characterized by mild cerebellar ataxia and excellent response to corticosteroids.
Adrenal Cortex Hormones ; Anaphylaxis ; Bites and Stings ; Cerebellar Ataxia ; Encephalitis ; Peripheral Nervous System ; Wasps

No abstract available.
Anaphylaxis*

Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbidity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvO₂) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvO₂ was used for appropriate brain oxygen monitoring.
Brain Edema ; Brain Injuries ; Brain* ; Early Diagnosis ; Hepatic Encephalopathy ; Humans ; Intracranial Pressure ; Jugular Veins ; Liver Failure, Acute* ; Mortality ; Oxygen Consumption ; Oxygen*

BACKGROUND AND PURPOSE: Recent advances in intra-arterial techniques and thrombectomy devices lead to high rate of recanalization. However, little is known regarding the effect of the evolvement of endovascular revascularization therapy (ERT) in acute basilar artery occlusion (BAO). We compared the outcome of endovascular mechanical thrombectomy (EMT) versus intra-arterial fibrinolysis (IAF)-based ERT in patients with acute BAO. METHODS: After retrospectively reviewed a registry of consecutive patients with acute ischemic stroke who underwent ERT from September 2003 to February 2015, 57 patients with acute BAO within 12 hours from stroke onset were enrolled. They were categorized as an IAF group (n=24) and EMT group (n=33) according to the primary technical option. We compared the procedural and clinical outcomes between the groups. RESULTS: The time from groin puncture to recanalization was significantly shorter in the EMT group than in the IAF group (48.5 [25.3 to 87.8] vs. 92 [44 to 179] minutes; P=0.02) The rate of complete recanalization was significantly higher in the EMT group than in the IAF group (87.9% vs 41.7%; P<0.01). The good outcome of the modified Rankin Scale score≤2 at 3 months was more frequent in the EMT group than in the IAF group, but it was not statistically significant (39.4% vs 16.7%; P=0.06). CONCLUSIONS: EMT-based ERT in patients with acute BAO is superior to IAF-based ERT in terms of the reduction of time from groin puncture to recanalization and the improvement of the rate of complete recanalization.
Basilar Artery* ; Cerebral Infarction ; Fibrinolysis* ; Groin ; Humans ; Punctures ; Retrospective Studies ; Stroke ; Thrombectomy* ; Thrombolytic Therapy