The positivity of PCR- based diagnosis is higher in our study possibly related to highly selective group of patients. Phenotype and genotype correlation was not seen.

Stroke and infection have a close relationship! There is possibly interplay of inflammation with traditional risk factors of stroke such as hypertension, hyperlipidemia, diabetes, and smoking. Rickettsia infection is already known to have multisystemic involvement. Stroke, both ischaemic and hemorrhagic though rarely reported to be associated with this infection often resulted in drastic consequences. Here, we will present a case where a gentleman who presented with stroke following a ricketssial infection only few days after he was thrombolysed for an initial event. We probably managed to avoid a catastrophe by treating the infection at earliest! Key Messages: Infection may interact with traditional risk factors of stroke and may precipitate a vascular event. Epidemiological knowledge of existing infections in community, early detection and intervention may prevent complications even if stroke is precipitated.

Introduction: Alberta Stroke Program Early CT Score (ASPECTS) is a systematic approach to assess early ischemic change on non-contrast CT (NCCT). Concerns have however been expressed about its reliability when making clinical decisions in patients with acute ischemic stroke. We chose to systematically assess technical, environmental and patient specific variables that potentially affect ASPECTS interpretation. Methods: We randomly selected 150 patients with acute ischemic stroke from the PRoveIT database. All patients had baseline NCCT and CT angiography head and neck. Three raters (expert, fellow and trainee) read ASPECTS on the same NCCT three times (Sessions 1-3) at minimum interval of 10-14 days. Raters were kept blinded to follow-up data throughout the study. No baseline clinical information was provided in Session 1. Raters were provided clinical information (age, baseline NIHSS and side of stroke) in session 2 and additional multiphase CTA in session 3. Reading environment [room light and time pressure (<60 s for interpretation) vs. core lab] was altered during readings. Data on motion artifact, leukoaraiosis, old infarcts on NCCT were collected. Time taken for ASPECTS interpretation was collected across all the readings. Reliability was assessed using Intra-cluster correlation coefficient (ICC). Results: The highest inter-rater reliability was found in session 3 (ICC 0.47; p<0.001). The rest of the analyses was restricted to session 3. Reliability in session 3 was not affected by time pressure or ambient light settings (all p<0.01). In session 3, patient motion (ICC 0.35 present vs. 0.49 absent) and old infarcts (ICC 0.42 present vs. 0.48 absent) worsened reliability; however presence of leukoaraiosis did not affect reliability (ICC 0.48 present vs. 0.46 absent). Mean time for ASPECT interpretation by trainee, fellow and expert were 38.9 s (+/-12.8s), 49.8 s (+/-15.4s) and 38.9 s (+/-14s) respectively. Conclusion: ASPECTS interpretation on NCCT is most reliable when clinical and CTA information is available. Interpretation with this information is reliable even in a well-lit room and under time pressure, the environment that mimics real life acute stroke.

No abstract