23SUMMARY Introduction. Meningiomas are common primary tumors of brain meninges. These neoplasms develop from arachnoid cap cells and are multiple in 1 -10% cases. Occasionally, significantly higher multiplicity rates have been reported, at least partially due to the increased application of computed tomography and magnetic resonance imaging in the diagnostics of intracranial pathologies. Meningiomas generally express progesterone receptors, but only few studies have focused on sex hormone receptor differences between solitary and multiple meningiomas. Similarly, there is limited information on cell proliferation and adhesion factors in solitary and multiple meningiomas. Aim of the study. Was to evaluate the immunohistochemical differences in sex hormone receptor expression, cell proliferation and adhesion within solitary and multiple meningiomas. Material and methods. In a retrospective study, 11 consecutive multiple meningiomas and 20 grade-matched solitary meningiomas were assessed by immunohistochemistry (IHC) to detect estrogen receptors (ER), progesterone receptors (PR), Ki-67 and neural cell adhesion molecule (NCAM). IHC was followed by quantitative microscopic evaluation. Descriptive and inferential statistics was applied including confidence interval (CI) analysis, Mann-Whitney U test and Spearmen correlation by IBM SPSS Statistics 22.0 software; p values less than 0.05 were regarded as statistically significant. Results. Although PR were found in all samples, the mean expression was significantly lower in multiple meningiomas (p = 0.03): 30.0% (95% CI: 10.4 -49.8) versus 70.6% (95% CI: 56.6 -84.7) in solitary meningiomas. ER were invariably absent in both groups. The proliferation index did not differ in solitary and multiple tumors. There was a trend (p = 0.07) to higher mean expression of NCAM in multiple meningiomas than in control group: 48.3% (95% CI: 25.8 -70.8) versus 24.6% (95% CI: 13.2 -36.0), respectively. The multiple meningiomas showed diverse histological types and immunophenotypes in up to 33.3% patients. Conclusions. Multiple meningiomas are characterized by significant down-regulation of PR and up-regulation of NCAM. The last finding can indicate neural differentiation and/ or peculiarities of cell adhesion and signaling that facilitate multifocal proliferation. Diverse histological types as well as PR and NCAM expression in separate meningiomas within same patient indicate independent multicentric origin.

Background and Objectives: Oral anticoagulants are the hallmark of cardioembolic stroke prevention, but they are frequently underused, especially in elderly patients and patients with paroxysmal atrial fibrillation. In our paper, we analyzed the long-term outcome of severely disabled cardioembolic stroke survivors depending on the prescribed antithrombotic secondary prevention medication. Materials and Methods: In our study, we retrospectively collected data for ischemic stroke (IS) patients treated in P. Stradins Clinical University hospital, Riga, Latvia, from 2014 until 2017. Patients' clinical data were collected using local stroke registry, including patients' demographic data, vascular risk factors, clinical findings, and laboratory results. Severely disabled stroke survivors were followed up by phone at 30/90/180/365 days after discharge. Patients' functional outcomes were assessed using the adapted version of The Rankin Focused Assessment-Ambulation. The collected data were compared in 4 groups according to prescribed secondary prevention medication. Results: A total of 682 (91.42%) patients were followed up and included in data analysis. The median age of patients was 80 (IQR = 75-85) years. Of these patients, 231 (31%) were males and 515 (69%) were females. One-year probability of survival of patients not taking any preventive medication was 53% (IQR = 29-76), while in patients taking antiplatelet agents it was 57% (IQR = 37-78), 78% (IQR = 68-88) of patients on Vitamin K antagonists (VKA) and 81% (IQR = 72-90) in patients on direct oral anticoagulants (DOACs). One year after discharge 73 (31%) had mRS 0-2, 50 (20.9%), 29 (12.1%) were still severely disabled, and 87 (36.4%) had died. Conclusions: Anticoagulant use in secondary prevention predicts better functional outcome and higher survival rate in patients with severe cardioembolic stroke due to non-valvular atrial fibrillation (NVAF), therefore severe neurological deficit must not be a reason of restriction of anticoagulation.