No abstract

Carotid artery trauma is a known cause of stroke in young people. The vessel may occlude, dissect or shower thrombotic emboli into intracranial vessels. This paper reports the use of single photon emission computed tomography (SPECT) imaging in a 29 year old man who developed an embolic stroke after neck holding manoeuvres at a martial arts class. Awareness of the potential consequences of these procedures is matched by the need for rapid and accurate diagnosis of stroke now that thrombolytic and neuroprotective treatments are emerging, which are effective only within a short time window. (BrJ Sports Med 1997;31:346-347) initial fever (390C), which resolved quickly, and a mild non-fluent dysphasia. There was no external neck injury or neck stiffness and no visual field defect was identified. Clinically, a stroke was suspected.Compted tomography on admission was normal, confirming that no haemorrhagic lesion was present. At this stage aspirin was started at 150 mg/day. SPECT of cerebral perfusion (after intravenous injection of 500 MBq of technetium-99m HMPAO (Ceretec) and imaging with a Strichmann SME8 10 multidetector SPECT system) carried out the following day showed abnormally high perfusion in the left temporo-occipital regions (fig 1 C) with a small area of reduced perfusion in the high left parietal region ( fig 1D). A magnetic resonance (MRI) investigation performed four days later showed ( fig 1A and 1 B) several small areas of prolonged T2 signal within the left cortex, compatible with infarction in the distribution of the left middle cerebral artery following multiple cortical emboli. A cerebral angiogram excluded a dissection. Injection of contrast into the left internal carotid artery revealed an early arteriolar blush, corresponding to one of the MRI lesions and representing non-nutritional shunting of blood. A dominant left posterior communicating artery supplied the posterior cerebral artery. There was no evidence of stenosis or kinking of vessels. Follow up SPECT on day 60 showed the evolution of the ischaemic lesions ( fig IE and iF), to a slight hypoperfusion in the lower sections and a well demarcated hypoperfused area in the parietal region consistent with the lesion seen on MRI ( fig 1A). These appearances represent progression to infarction.A search for stroke aetiology (erythrocyte sedimentation rate, echocardiography, protein C and S, antithrombin III, platelet count, coagulation screen, antiphospholipid antibody, and factor V Leiden) was unsuccessful. Two months after the event the patient had fully recovered. DiscussionImmediate injuries from martial arts are usually easy to recognise.4 Non-penetrating carotid trauma can, however, present a diag-

No abstract

Background: In an effort to shorten door to needle times, stroke teams have moved towards injection of alteplase tPA (IVtPA) in the CT scan suite immediately after completion of the noncontrast CT, and before completion of the CTA. However, many stroke programs are prevented from initiating IVtPA in CT due to concerns about patient deterioration. We sought to determine the safety of this practice. Methods: 12 months of prospectively treated IVtPA cases from 2 comprehensive stroke centers were assembled for analysis. Cases were carefully examined to determine treatment location, and those treated inside the CT suite were selected for final review. Safety incidents were defined as those in which an IVtPA treated patient developed any condition requiring urgent or emergent management in the CT suite. sICH was defined as parenchymal hematoma type 2 in combination with a 4 or more point worsening on the NIHSS. Results: A total of 589 acute ischemic stroke patients were treated with IVtPA in calendar year 2016; of these 562 (95%) received their tPA bolus and start of infusion in the CT scan immediately after completion of the noncontrast CT, and prior to CTA. Zero safety incidents occurred in these cases. Additionally, there were no renal insults in the sample, despite not waiting for lab results prior to performing CTA. Median door to needle time was 22 minutes, and overall the sICH rate was 3% for the sample. Conclusions: Administration of IVtPA in the CT scan suite is safe and allows for faster administration of IVtPA. Use of this method should be adopted in a widespread manner to facilitate rapid early treatment of acute ischemic stroke.

We present a mobile dataset of ultrafine particles (UFPs) in Lancaster, UK, with measurements taken by car and bike over 5 days in May 2022. UFPs are a constituent of air pollution and comprise of particulate matter (PM) less than 0.1μm in diameter. UFPs are unregulated and less measured than larger constituents of PM, despite being harmful to health and an important part of the atmospheric and meteorological system. By making mobile UFP measurements, we have produced a street level dataset that captures the high spatial variability of UFPs at the scale an individual experiences it. The dataset is accessible through the LancasterAQ Python package and lends itself to modelling spatially or on a network. This dataset's potential use cases include route planning under constraints of air pollutant exposure, identifying processes that affect air pollution at street level, and investigating the causal relationship between human activity and UFPs.