Posterior reversible encephalopathy syndrome (PRES) is a serious adverse event associated with calcineurin inhibitors used for graft-versus-host disease (GVHD) prophylaxis. We compared the incidence of PRES in children with thalassemia (n = 222, 1.4 to 17.8 years old) versus sickle cell disease (SCD; n = 59, 2 to 17 years old) who underwent hematopoietic cell transplantation from HLA-matched siblings or alternative donors and analyzed the risk factors for PRES. Overall, 31 children developed calcineurin inhibitor-related PRES (11%), including 30 patients with seizures and 1 patient without seizures. PRES incidence was significantly higher in SCD patients (22%; 95% confidence interval [CI], 10% to 32%) than in thalassemia patients (8%; 95% CI, 5% to 12%;P = .002). In multivariate analysis, factors associated with PRES were hypertension (hazard ratio [HR], 5.87; 95% CI, 2.57 to 13.43; P = .0001), SCD (HR, 2.49; 95% CI, 1.25 to 4.99; P = .009), and acute GVHD (HR 2.27; 95% CI, 1.06 to 4.85; P= .031). In the entire cohort overall survival (OS) was significantly higher in patients without versus with PRES (90% versus 77%; P = .02). In a subgroup analysis that including matched sibling transplants, OS and disease-free survival (DFS) were similar in thalassemia patients without PRES (92% and 88%, respectively) and with PRES (82% and 73%, respectively), whereas SCD patients with PRES had significantly lower OS (67%) and DFS (67%) than patients without PRES (94% and 94%, respectively; P = .008). Thus, SCD patients had a significantly higher incidence of PRES than thalassemia patients, and hypertension and GVHD were the 2 main risk factors for PRES in patients with hemoglobinopathies. Although PRES did not significantly influence survival in patients with thalassemia, patients with SCD had significantly lower survival after PRES.

Recently considerable attention has been given to a common complication of patients with COVID-19 infection such as the disseminated intravascular coagulation (DIC), especially observed in critically ill COVID-19 patients.We report the description of a patient with COVID-19 who developed thrombosis of the superior vena cava, pulmonary artery and deep intracerebral venous thrombosis. This case demonstrates that extending imaging from the chest to the brain district can be useful in identifying possible associated complications in COVID-19 patients.A 44-years old women with negative past medical history was admitted to emergency room due to worsening respiratory status, fever (38.5°C) and cough. At hospital admission she was hemodynamically stable and dyspnoeic; no abnormalities of the blood chemistry tests were detected. The nasopharyngeal swab specimen confirmed the diagnosis of COVID-19 by the Real-Time Reverse Transcriptase-Polymerase Chain Reaction assay.The admission non-contrast chest Computed Tomography (CT) showed multiple, widespread and subpleural ground-glass opacities with intralobular septal thickening and rare consolidative opacities findings consistent with COVID-19 pneumonia. Patient started oxygen therapy, Hydroxychloroquine and Azithromycin.Two weeks later the patient developed ingravescent dyspnea, headache, altered mental status, aphasia and right hemiparesis. Her nasopharyngeal swab specimen was negative; serological analysis revealed the presence of 2019-nCoV IgG antibodies. The blood test showed normal count of white blood cell (9600/μL; nv 4300-10,800/ μL) with remarkable neutrophilic leukocytosis, severe lymphocytopenia and reduction of all lymphocyte subpopulations; severe low platelets count (42,000/μL; nv 150,000-45,000/μL) high rates of D-dimer (5975 ng/mL; nv 0-500 ng/mL), serum Creatine Kinase MB (6.9 ng/mL; nv < 3.40 ng/mL) and serum troponin I hs (30.7 ng/mL; nv < 16.6 ng/ mL) were found.Autoimmune serologic testing showed the absence of anticardiolipin and anti-β2 -glycoprotein IgM and IgM antibodies as well as anti-ds -DNA antibodies.Considering the worsening of the clinical parameters, patient started treatment with Tocilizumab and low molecular weight heparin (Nadroparina Calcica).Chest CT revealed worsening of pulmonary findings with increased of pulmonary dis-ventilation and consolidation. CT pulmonary angio- Institute from which the work originatedDepartment of Biomedicine and Prevention, University of Rome "Tor Vergata". Declaration of Competing InterestThe authors declare that they have no financial activities related to the present article.

Background and Purpose— The benefit of endovascular therapy in extended time windows has been demonstrated in patients with anterior circulation large vessel occlusion ischemic stroke and favorable imaging profile. We evaluated whether collaterals and thrombus burden influence the associations between revascularization, time-to-treatment, and outcome in endovascular therapy-treated patients with basilar artery occlusion. Methods— We retrospectively analyzed clinical and imaging data of consecutive endovascular therapy-treated patients with basilar artery occlusion included in the multicenter Basilar Artery Treatment and Management Collaboration. The BATMAN (Basilar Artery on Computed Tomography Angiography score, which evaluates thrombus burden and collaterals) and the PC-CS (Posterior Circulation Collateral score, which evaluates collaterals) were assessed on computed tomography angiography, blinded to clinical outcome. Good outcome was defined as modified Rankin Scale score of ≤3 within 3 months; revascularization (successful reperfusion) as modified Thrombolysis in Cerebral Infarction 2b–3 (or TIMI [Thrombolysis in Myocardial Infarction] 2–3 in the BASICS [Basilar Artery International Cooperation Study] registry). Results— We included 172 patients with basilar artery occlusion treated with endovascular therapy (124 with mechanical thrombectomy): mean (SD) age 65 (13) years, median National Institutes of Health Stroke Scale 22 (interquartile range 12–30), 64 (37%) treated >6 hours. Revascularization (achieved in 79% of patients) was associated with good outcome ( P =0.003). The use of new generation thrombectomy devices was associated with good outcome ( P =0.03). In patients who achieved revascularization, 29/46 (63%) of patients with a favorable BATMAN score and 26/51 (51%) with favorable PC-CS had good outcomes. In logistic regression analysis (adjusted for age, National Institutes of Health Stroke Scale, and time-to-treatment ≤6/>6 hours), revascularization was associated with good outcome in patients with favorable BATMAN score (odds ratio, 15.8; 95% CI, 1.4–175; P =0.02) or PC-CS (odds ratio, 9.4; 95% CI, 1.4–64; P =0.02). In patients who achieved revascularization, early (time-to-treatment ≤6 hours) but not late treatment was associated with improved outcome in patients with unfavorable BATMAN score (18/52 [35%]; odds ratio, 15; 95% CI, 1.9–124; P =0.01) or PC-CS (16/44 [36%]; odds ratio, 5.5; 95% CI, 1.4–21; P =0.01). Conclusions— Revascularization is associated with good outcome in patients with basilar artery occlusion with good collaterals and less extensive occlusion, even >6 hours after onset.