Steroid refractory giant cell arteritis with bilateral vertebral artery occlusion and middle cerebellar peduncle infarction

Giant cell arteritis is the most common primary systemic vasculitis in adults aged ≥50 years and peaks in the eighth decade of life. Common symptoms include headache, scalp tenderness and jaw claudication. Elevated acute phase reactants (erythrocyte sedimentation rate and C-reactive protein) are present in >90% of patients. Visual loss is a well-recognised complication, but approximately 2–4% of giant cell arteritis patients experience stroke, most frequently in the vertebrobasilar territory.

The increasing burden of atrial fibrillation in acute medical admissions, an opportunity to optimise stroke prevention

 

Background Atrial fibrillation is a major risk factor for ischaemic stroke. We investigated whether active screening for atrial fibrillation in secondary care, followed by careful evaluation of risk factors and communication to general practitioners from stroke specialists, could increase appropriate anticoagulation prescription.

Short runs of atrial arrhythmia and stroke risk: a European-wide online survey among stroke physicians and cardiologists

A recording of ≥ 30 seconds is required to diagnose paroxysmal atrial fibrillation when using ambulatory ECG monitoring. It is unclear if shorter runs are relevant with regards to stroke risk.

Methods An online survey of cardiologists and stroke physicians was carried out to assess current management of patients with short runs of atrial arrhythmia within Europe.

The history of stress hyperglycaemia

Stress hyperglycaemia, is a common phenomenon, frequently associated with adverse outcomes in a number of prevalent conditions including myocardial infarction and stroke. Knowledge on stress hyperglycaemia evolved in tandem with knowledge relating to homeostasis, stress and disease and involved some of the world’s most eminent thinkers. Despite this, it still remains under-recognised.

Case of the Quarter: Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

We report an unusual case of calcification of mitral valve annulus imaged with multiple non-invasive modalities in a patient who suffered a transient ischaemic attack, probably from thrombus overlying the mitral annular calcification. Both this mode of presentation and the imaging features of the annular calcification were relatively unusual, and the images obtained are remarkably clear and diagnostic.

Trainees and Members’ Committee symposium review: Identifying blood biomarkers to improve the diagnosis of stroke

Blood biomarkers are useful for the management of many diseases and could be useful for doctors caring for stroke patients, if they accurately predicted a diagnosis or recurrence of stroke. In a series of studies, we systematically reviewed the blood biomarker literature in stroke, determined the performance of existing blood biomarkers for the diagnosis of stroke and examined the value of markers of inflammation to predict recurrent stroke and myocardial infarction.

Care of the elderly symposium report

This symposium covered a wide range of conditions of interest to the geriatrician, the general physician and the general practitioner, including demographic shift, the epidemiology of ageing, diabetes in older people, investigation and management of falls, an update on stroke (including the role of neurovascular clinics, stroke thrombolysis and rehabilitation) and the management of coronary heart disease in the elderly.