Background/Aim. There is limited data on the frequency of intracranial hemorrhage (ICrH) in the first wave [beta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and second wave (delta variant of SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the appearance of ICrH in COVID-19 patients (CP). Methods. Among 505 CP treated at the Special Hospital for Cerebrovascular Diseases ?Sveti Sava? intermittently during the 2020?2021 period, ICrH was diagnosed in 76 (15.1%) patients. The available information from the medical records regarding clinical, demographic, as well as radiological data (multislice computed tomography examination of the endocranium) was collected and analyzed. Results. In the first wave, out of 308 CP, 63 (20.5%) were diagnosed with ICrH. In the second wave, out of 1 97 CP, ICrH was diagnosed in 13 (6.6%) patients, which was a statistically significant difference (p < 0.002). There was no statistically significant difference for the presence of hyper-tension (p = 0.271), diabetes mellitus (p = 0.558), and chronic obstructive pulmonary disease (p = 0.794) among CP with ICrH comparing the two waves of the pandemic. However, a statistically significant difference was proven in the frequency of patients with atrial fibrillation and anticoagulant drug therapy (p = 0.021 each). There was no statistically significant difference in the frequency of patients with fever ( p = 0.637), fatigue (p = 0.587), hemiparesis (p = 0.831), respiratory symptoms (p = 0.289), and loss of consciousness (p = 0.247). D-dimer values in the second pandemic wave were statistically significantly lower (p = 0.003). The combination of ischemic stroke and ICrH was six times more common in the second wave (p = 0.003). However, cerebral parenchymal hemorrhage was two times less frequent (p = 0.001) in the second wave but with statistically higher frequencies of multifocal (23.1%) and diffuse type (36.4%) of ICrH (p = 0.007). Combined hemorrhages, as well as subarachnoid and subdural sub-types, were more common in the second wave (23.1% each). Fatal outcomes occurred in 38.1% of patients in the first wave compared to 69.2% in the second wave (p = 0.039). Conclusion. In the first pandemic wave of COVID-19, ICrH in CP was significantly more frequent and D-dimer was singled out in laboratory analyses, the values of which were statistically significantly higher in comparison with second wave. In the second wave of COVID-19, parenchymal ICrH was less frequent and multifocal and diffuse ICrH were more common in CP with ICrH. The mortality rate was very high in the second wave.

Introduction: Very few studies address meningeal artery (MMA) histology, including some features of epidural hematomas (EDH). Materials and Methods: We microscopically analyzed 238 slices from ten MMA specimens. In addition, 61 patients with EDH were enrolled and examined. Both analyses were retrospective. Results: MMA analysis showed a larger subendothelial space and reduced media and adventitial coat, the latter continuous with the two dural parts (periosteal and meningeal layers). The 61 patients had an average age of 42.1 years. The EDH averaged 28.8 mm in diameter, but it did not affect outcomes (p=0.626). Vault bone fracture was seen in 95.1% of patients. An incidental fall was the most frequent cause (68.5%). Coma was present in 35.0%, whilst the Glasgow Coma Scale (GCS) on admission averaged 12. EDH was associated with other intracranial hemorrhages (19.7%), including subdural (9.8%), subarachnoid (4.9%), intracerebral (1.7%), or combinations thereof. Following EDH surgical evacuation, some patients had certain neurological or psychological disorders (19.7%). The mortality rate was 14%, especially in patients manifesting early neurologic symptoms (p=0.034). Conclusion: The MMA is well protected due to its structure and dural support. However, a strong head impact, especially associated with a bony fracture, leads to MMA rupture and a dural laceration resulting in EDH. The latter can be accompanied by neurological signs, as well as a mortality rate of 14%, which mainly depends on early neurological manifestation or coma occurrence.

Introduction: Antiphospholipid syndrome (APS) is an autoimmune disease characterised by arterious and venous thrombosis, miscarriage, and the presence of antiphospholipid antibodies (aPL) in the blood. As we know, APS is also characterised by accelerated atherosclerotic degeneration with an increased risk of thrombosis in all blood vessels, including the carotid arteries. Carotid artery stenosis can manifest in many different ways. The aim of this study is to present the results of our multidetector computerised tomography angiography (MDCTA) analysis of the carotid arteries in patients with primary and secondary APS compared with a control group. Materials and Methods: This study examined 50 patients with primary antiphospholipid syndrome (PAPS) and 50 patients with secondary antiphospholipid syndrome (SAPS). The results were compared with a control group also comprising 50 patients. The groups were analysed with respect to age, sex and the presence of well-established risk factors for vascular disease. The study was conducted using MDCTA, where we analysed the quantitative and qualitative (morphologic) characteristics of carotid artery lesions. Results: Patients from the control group had significantly elevated levels of cholesterol and triglycerides in comparison with patients with PAPS and SAPS (p < 0.001 and p < 0.05). The results show that carotid artery lesions were significantly more common in patients with APS (PAPS, n = 40, CI95: 0.50–0.75, p = 0.0322 and SAFS, n = 54, CI95: 0.59–0.80, p = 0.0004) than within the control group (n = 23). There was a statistically significant difference between patients with APS and the control group with respect to lesions in the distal segments (n = 27, CI95: 0.67–0.95, p = 0.0001), bulbi and proximal segments (n = 21, CI95: 0.84–1.00, p = 0.000005). The number of patients with one lesion (L) (n = 27) was significantly greater than the number of those with three (n = 10, CI95: 0.56–0.86, p = 0.0051) or four (n = 3, CI95: 0.73–0.98, p = 0.00001) lesions. There were also more patients with two lesions (n = 24) than those with four (n = 3) (CI95: 0.71–0.97, p = 0.00005). Carotid artery stenosis was shown as a percentage of the carotid artery lumen diameter (%DS). Stenosis of up to 30%, was more common in patients in the PAPS group (n = 12) than in the control group (n = 3) (CI95: 0.52–0.96, p = 0.0201), while the SAPS group (n = 17) had an even larger disparity (CI95: 0.62–0.97, p = 0.0017). We observed a highly significant difference in the frequency of stenoses between 30% and 50% DS between the PAPS group (n = 24) and the control group (n = 7) (CI95: 0.59–0.90, p = 0.0023), as well as the SAPS group (n = 30) (CI95: 0.65–0.92, p = 0.0002). A qualitative analysis of plaque morphology revealed that patients with PAPS had significantly more soft tissue lesions (n = 23) compared with calcified lesions (n = 2) (CI95: 0.74–0.99, p = 0.00003), as well as more mixed plaques (n = 9) and calcified plaques (n = 2) (CI95: 0.48–0.98, p = 0.0348). Patients within the SAPS group had significantly more soft tissue (n = 35) than calcified lesions (n = 3) (CI95: 0.79–0.98, p = 0.00000021), as well as more mixed lesions (n = 21) compared with calcified (n = 3) (CI95: 0.68–0.97, p = 0.0002). Conclusions: Our study shows that subclinical manifestations of carotid artery lesions were more common in patients with APS. We came to the conclusion that MDCTA is an accurate diagnostic method because it is a safe method that provides us with a great quantity of accurate information about the characteristics of atheromatous plaques, which aids us in the further planning of treatment for patients with APS.

Background and Objectives: Posterior circulation ischemic stroke (PCIS) is a life-threatening disease with a poor prognosis. It has nonspecific symptoms. It is very difficult to diagnose. The aim of the study is to examine to what degree radiological methods, in addition to standard clinical indicators, can serve as a reliable and independent predictor of death in patients with PCIS. Materials and Methods: It is a retrospective study on 175 patients at the Special Hospital “Saint Sava” (2023–2025) with symptoms of acute PCIS, who did not have proven PCIS on the initial non-contrast computed tomography (NCCT). The radiology protocol included NCCT, CT perfusion (CTP) and CT angiography (CTA). The experimental group (n = 116, CTP+) and the control group (n = 59, CTP-) were monitored clinically and radiologically, with a follow-up NCCT after 24 h when all had confirmed acute PCIS. At discharge, the outcome was monitored on the National Institutes of Health Stroke Scale (NIHSS 2) and the Modified Rankin Scale (mRs). Results: Of 175 patients with acute PCIS, 24% died within 30 days. Those who died were older (p < 0.05), had a lower Posterior Circulation Alberta Stroke Program Early CT Score (pcASPECT), and more often had hyperdensity (26.2% vs. 7.5%), occlusions (69% vs. 31.6%), and symptomatic blood vessels on CTA and CTP+ (81% vs. 61.7%, p < 0.01). Multivariate regression singled out CTP+ (OR = 4.08), complications (OR = 2.96), Israeli Vertebrobasilar Stroke Scale (IVBSS) (OR = 1.22) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) (OR = 1.92) as predictors of mortality, with shorter survival in CTP+ (949 vs. 1449 days, Log-rank p = 0.015), more NIHSS/mRS, lower Glasgow Coma Score, and more frequent obesity in the deceased. Conclusions: Negative CTP represents the protective factor against death in patients with acute PCIS. Complications, higher IVBSS, and TOAST classification (large vessels atherosclerosis) represent an increased risk. The importance of CTP for early detection of acute PCIS and early risk assessment is highlighted.

Background: Draining veins of the arteriovenous malformations (AVMs) can be the cause of hemorrhages, and the subject of a specific treatment. However, there are very scarce reports about their radiologic anatomy. Methods: Fifty-seven patients with cerebral AVMs were enrolled, almost with equal number of males and females. All of them underwent a neurologic examination, and then digital subtraction angiography, and computerized tomographic angiography. The obtained data were statistically analyzed. Results: The 57 patients had AVMs most often located in the frontal region (17.6%), and in the temporal and parietotemporal area (15.8% each). Supratentorial location existed in 88.4%, and infratentorial in 12.6%. Their draining veins ranged 1–17 in number (mean, 2.19). Singular veins were present in 22.8%, and double in 59.7%. Most of draining veins entered the superior sagittal sinus and other superficial vessels (63.2%), some terminated into deep veins or sinuses (12.3%), whilst both sites were present in 24.5%. Dilated draining veins existed in 88.9%, and venous aneurysms in 8.8%. An AVM hemorrhage was the initial sign in 49.2%. As for the AVMs treatment, endovascular embolization was performed (15.8%), surgical intervention (12.3%), and gamma knife irradiation (21.1%), whilst the remaining patients were treated conservatively, with a total mortality rate of 7.2%. Conclusion: Draining veins, which averaged 2.19 in number, terminated in various venous vessels. Most of them were dilated and tortuous, with rare aneurysms. A hemorrhage appeared in a half of the patients. Most of AVMs were treated by endovascular, neurosurgical, or radio-surgical interventions.