- Email: [email protected]
INS;Is there an increased risk of hemorrhagic complication?
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
extracted information using a structured questionnaire, including the demographics, NIH and Glasgow Coma scales; risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol, previous vascular disease); type (ischemic vs. hemorrhagic) and localization of stroke (anterior vs. posterior circulation); motor deficit; time use of mechanical ventilation. Pneumonia was defined clinically and treated with antibiotics. Results: One hundred and fifty nine patients aged 18 to 90 (mean 63 ± 13.5) years were admitted. Incidence of pneumonia was 32.1%. Pneumonia incidence was higher in patients with ischemic stroke (OR: 4.36, 95% CI: 1.9–10.0). Pneumonia was most common in those with higher NIH and lower Glasgow coma scales (p b 0.0001). Patients with pneumonia had longer hospitalization (p b 0.0001). Logistic regression analyses identified only the NIH stroke scale as an independent predictor of pneumonia (p = 0.001). Conclusion: The severity of the deficit as evaluated by the NIHS scale was shown to be the only independent risk factor for pneumonia in acute stroke patients. doi:10.1016/j.jns.2013.07.923
Abstract — WCN 2013 No: 2318 Topic: 3 — Stroke New prognostic score for the prediction of 30-day outcome in spontaneous supratentorial cerebral hemorrhage L. Csibaa, I. Szélla, R. Szepesia, L. Lánczib, E. Berényib, K. Nagya, D. Bereczkic, L. Kardosd. aNeurology, Debrecen University, Debrecen, Hungary; bBiomedical Laboratory and Imaging Science, Debrecen University, Debrecen, Hungary; cNeurology, Semmelweis University Faculty of Medicine, Budapest, Hungary; dIndependent Statistician, ANTSZ, Debrecen, Hungary Objectives: The purpose of the present study was to evaluate predictors of outcome in primary supratentorial cerebral hemorrhage. Furthermore, we aimed to develop a prognostic model to predict 30-day fatality. Methods: We retrospectively analyzed a database of 156 patients with spontaneous supratentorial hemorrhage to explore the relationship between anamnestic, clinical and CT characteristics, and fatal outcome within 30 days using multiple logistic regression analysis. The analyzed factors included volumetric data assessed by neuropathological and CT volumetry. A second CT scan in survivors, or neuropathological ABC/2 volumetry in non-survivors was used along with the baseline CT to assess the growth index of hematoma. Results: Systolic blood pressure, serum potassium and glucose levels, platelet count, absolute and relative hematoma volumes, presence and size of intraventricular hemorrhage statistically significantly predicted the fatal outcome within 30 days. Based on our results we formulated a six-factor scoring algorithm named SUSPEKT to predict the outcome. Conclusions: After validation the SUSPEKT Score may be applicable in general clinical practice for early patient selection to optimize individual management or for assessment of eligibility for treatment trials. doi:10.1016/j.jns.2013.07.924
Abstract — WCN 2013 No: 2315 Topic: 3 — Stroke Association between metabolic syndrome and homocysteinemia in ischemic stroke M. Vujnica, N. Rasetaa, S. Miljkovicb, D. Racicb, V. Djajicb, O. Perazicc, S. Pericd. aDepartment for Pathophysiology, Faculty of Medicine, University Clinical Center in Banja Luka, Bosnia and Herzegovina;
e237
b
Neurology Clinic, University Clinical Center in Banja Luka, Bosnia and Herzegovina; cInstitute for Occupational and Sport Medicine of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; dNeurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia Background: Stroke is one of the leading causes of morbidity and mortality worldwide. The role of metabolic syndrome and homocysteinemia as risk factors for ischemic stroke is not completely clear. Aim: To determine the frequency of metabolic syndrome and homocysteinemia, as well as their association in patients with ischemic stroke. Method: The research included 53 subjects being on rehabilitation after stroke and 40 clinical controls without vascular disease that were on rehabilitation due to the back pain problems. Results: The frequency of metabolic syndrome was much higher in patients with stroke compared to control group (88.7% vs. 70.0%, p b 0.05). The level of homocysteinemia and the frequency of hyperhomocysteinemia were increased in the patients with stroke (15.0 ± 5.50 μmol/L vs. 11.2 ± 2.51 μmol/L, p b 0.01 and 39.2% vs. 11.4%, p b 0.01, respectively). Among patients with stroke, those with metabolic syndrome had higher frequency of hyperhomocysteinemia (42.2% vs. 16.7%, p b 0.05) and the serum level of homocysteine was significantly higher in patients with more individual components of metabolic syndrome (11.1% in patients with 3 components, 36.8% in patients with 4 components and 64.7% in patients with 5 components, p b 0.05). Conclusion: Our results suggest that metabolic syndrome and homocysteinemia represent significant risk factors for ischemic stroke. It seems that there is an association between these two factors in pathogenesis of the ischemic stroke, but further analyses are needed to confirm this hypothesis.
doi:10.1016/j.jns.2013.07.925
Abstract — WCN 2013 No: 2347 Topic: 3 — Stroke Thrombolysis in ischemic stroke in a familial amyloidotic polyneuropathy patient — Is there an increased risk of hemorrhagic complication? S. França, T. Mendonça, E. Azevedo, Grupo de Estudos de Doença Vascular Cerebral Centro Hospitalar de São João, Porto, Portugal Background: Patients with familial amyloidotic polyneuropathy (FAP) type I have typically a severe somatic and autonomic peripheral neuropathy. Amyloid deposits of the mutated transthyretin (frequently TTR Val30-Met, almost all produced by the liver) are said to mostly spare the brain in this type of FAP. Nevertheless, with longer survival induced by liver transplantation the choroid plexus TTR Val30-Met production might become relevant. Patients and methods: A 46-year-old woman with TTR Val30Met FAP, with liver transplant and pacemaker since age 37, and on immunosuppression with tacrolimus, was admitted by acute motor aphasia (NIHSS 4). Brain CT and analytical study were normal. Thrombolysis was started 3.5 h after symptom onset. At the stroke unit she worsened and repeated CT scan disclosing left temporal and right fronto-basal hematoma. Due to pacemaker MRI was not performed. Cervical and transcranial duplex scan was normal. She was discharged a week later asymptomatic, on triflusal 600 mg/d. Discussion: There is no data on thrombolysis safety in FAP patients. It is known that in some mutations there is an important amyloid
e238
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
deposition in the leptomenigeal and cortical vessels, with frequent intracerebral hemorrhagic stroke (IHS). Conclusion: Although with TTR Val30-Met mutation IHS is not common, in our liver transplanted patient the local and remote parenchymal hemorrhage after thrombolysis raises the hypothesis that cerebral amyloid angiopathy might develop in the long-term in these patients, due to maintained abnormal transthyretin production in the choroid plexus. Brain pathological studies are necessary to confirm this hypothesis in the TTR Val30-Met liver transplanted patients. doi:10.1016/j.jns.2013.07.926
Abstract — WCN 2013 No: 2319 Topic: 3 — Stroke Setting up a neuroscience stroke and rehabilitation centre 12,000 km away with the help of telemedicine U. Meyding-Lamadéa, E. Craemera, C. Jacobia, C. Mohsa, C. Schwarka, K. Enka, I. Jafaarb, A. Masrib, C. Chanb, B. Kressc. a Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany; b Bruneian Stroke and Rehabilitation Centre, Jerudong, Brunei; c Neuroradiology, Krankenhaus Nordwest, Frankfurt/Main, Germany Background: Due to world-wide aging population neurologists are urgently needed for stroke/non-stroke. In Brunei Darussalam we set up a national stroke unit, intensive care unit, neurorehabilitation on-site including tele-neurology and tele-teaching. Objective: The aim of this project “to teach to treat–to treat to teach” was to set up a world class centre of neurology. Methods: In 7/2010 set-up of the Bruneian Neuroscience Stroke and Rehabilitation Centre (BNSRC) has started. To overcome the distance of 12,000 km a telemedical network between the Department of Neurology (KHNW) and BNSRC started. This international cooperation includes a “specialist neurology” training program, accredited in Brunei Darussalam by an international advisory board. Daily teleteaching, 24/7 tele-neurology service, as well as all neurological laboratories have been set up on site by tele-cytology, and teleelectrophysiology including EEG and ultrasound. Awareness campaigns and telescience have been successfully started. Results: The BNRSC already has been successfully audited according to the STU requirements of the German Stroke Society. Over 2000 patients have been treated so far. Several Bruneian doctors are enrolled in the specialist curriculum. Conclusion: The program to teach to treat–to treat to teach resulted in a local set up of a BNSRC, being built up by KHNW. This outstanding project of a cooperation between the KHNW and BNSRC succeeded in building up a centre of excellence of high end acute neurological department including a stroke unit and neurorehabilitation. doi:10.1016/j.jns.2013.07.927
Abstract — WCN 2013 No: 2345 Topic: 3 — Stroke Stroke in patients with active and non-active malignancy A.G. Sliwinskaa, G. Gromadzkaa, M.A. Karlinskia, A. Czlonkowskaa,b. a Second Department of Neurology, Institute of Psychiatry and Neurology, Poland; bDepartment of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warszawa, Poland Background: Global burden of stroke and cancer is steadily increasing over the years. According to the previous studies, the pattern of stroke in cancer patients may differ from the conventional one.
Objectives: To compare vascular risk factors, stroke etiology and outcome among patients with positive or negative history of cancer, with emphasis on the activity of the malignancy. Methods: All consecutive acute stroke patients admitted to our department between September 2006 and September 2011 were included. We distinguished between patients: 1) with active malignancy (the diagnosis of cancer within 12 months before stroke, AM); 2) with non-active malignancy (non-AM); 3) cancer-free patients (CF), used as a reference. Results: Of 1558 acute stroke admissions, 90 (5.8%) had an additional diagnosis of cancer, including 41 cases of AM (2.6%) and 49 cases of non-AM (3.1%). Compared to CF group, non-AM patients did not differ in terms of vascular risk factors; they more frequently had stroke due to small vessel occlusion (18.4% vs 7.0%, p = 0.003). AM patients less frequently had atrial fibrillation (7.3% vs 23.5%, p = 0.016) and history of previous stroke (2.4% vs. 24.9%, p = 0.018). The most frequent stroke etiology in the AM group was undetermined (61.0%) and they had higher levels of serum inflammatory parameters. Stroke severity and outcome were similar across all groups. Conclusions: Compared to the CF patients, the pattern of stroke in non-AM patients appears similar. However, stroke pattern in patients with AM may be different from the conventional one, but it does not affect the short term prognosis. doi:10.1016/j.jns.2013.07.928
Abstract — WCN 2013 No: 2355 Topic: 3 — Stroke Late cerebrovascular complications of radiation therapy for pediatric primary central nervous system tumors J. Passosa, H. Nzwalob, J. Marquesa, A. Azevedoc, S. Nunesd, D. Salgadod. aNeurology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; bNeurology, Hospital de Faro EPE, Faro, Portugal; cNeurology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; dPediatric Neuro-Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal Background: Radiation therapy (RT) plays an important role in the management of primary central nervous system tumors (PCNST) in children. Despite field and dose optimization, late cerebrovascular complications (LCCs) still occur. However, the number of studies assessing the burden of these complications is limited. Objective: To describe the occurrence of LCCs in adult survivors who underwent RT for PCNST during childhood. Methods: Retrospective consecutive case series description of LCCs from a cohort of adult survivors of pediatric PCNST. Diagnosis of hemorrhagic LCCs was confirmed by gradient-echo MRI sequence. Results: We identified LCCs of RT in 35 of a total of 103 patients (34.0%); median age at RT was 8.4 years; and median follow-up was 18.7 years. Histological diagnoses were: medulloblastomas/primitive neuroectodermal tumors (16/45.7%), gliomas (15/42.9%) and germ cell tumors (4/11.4%). The most frequent PCNST site was the posterior fossa (21/60%). Mean total radiation dose was 48 Gy (18– 54 Gy); most patients received focal plus entire neuraxis RT (23/65.7%). Thirty-three patients had microbleeds, all asymptomatic; cavernomas occurred in eleven patients, causing epilepsy in 2; two patients had a symptomatic ischemic stroke (6 and 25 years after RT); two patients presented with symptomatic superficial siderosis (15 and 26 years after RT) and one patient developed symptomatic moyamoya syndrome 4 years after RT. In some patients, microbleeds and cavernomas increased in number during follow-up.
extracted information using a structured questionnaire, including the demographics, NIH and Glasgow Coma scales; risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol, previous vascular disease); type (ischemic vs. hemorrhagic) and localization of stroke (anterior vs. posterior circulation); motor deficit; time use of mechanical ventilation. Pneumonia was defined clinically and treated with antibiotics. Results: One hundred and fifty nine patients aged 18 to 90 (mean 63 ± 13.5) years were admitted. Incidence of pneumonia was 32.1%. Pneumonia incidence was higher in patients with ischemic stroke (OR: 4.36, 95% CI: 1.9–10.0). Pneumonia was most common in those with higher NIH and lower Glasgow coma scales (p b 0.0001). Patients with pneumonia had longer hospitalization (p b 0.0001). Logistic regression analyses identified only the NIH stroke scale as an independent predictor of pneumonia (p = 0.001). Conclusion: The severity of the deficit as evaluated by the NIHS scale was shown to be the only independent risk factor for pneumonia in acute stroke patients. doi:10.1016/j.jns.2013.07.923
Abstract — WCN 2013 No: 2318 Topic: 3 — Stroke New prognostic score for the prediction of 30-day outcome in spontaneous supratentorial cerebral hemorrhage L. Csibaa, I. Szélla, R. Szepesia, L. Lánczib, E. Berényib, K. Nagya, D. Bereczkic, L. Kardosd. aNeurology, Debrecen University, Debrecen, Hungary; bBiomedical Laboratory and Imaging Science, Debrecen University, Debrecen, Hungary; cNeurology, Semmelweis University Faculty of Medicine, Budapest, Hungary; dIndependent Statistician, ANTSZ, Debrecen, Hungary Objectives: The purpose of the present study was to evaluate predictors of outcome in primary supratentorial cerebral hemorrhage. Furthermore, we aimed to develop a prognostic model to predict 30-day fatality. Methods: We retrospectively analyzed a database of 156 patients with spontaneous supratentorial hemorrhage to explore the relationship between anamnestic, clinical and CT characteristics, and fatal outcome within 30 days using multiple logistic regression analysis. The analyzed factors included volumetric data assessed by neuropathological and CT volumetry. A second CT scan in survivors, or neuropathological ABC/2 volumetry in non-survivors was used along with the baseline CT to assess the growth index of hematoma. Results: Systolic blood pressure, serum potassium and glucose levels, platelet count, absolute and relative hematoma volumes, presence and size of intraventricular hemorrhage statistically significantly predicted the fatal outcome within 30 days. Based on our results we formulated a six-factor scoring algorithm named SUSPEKT to predict the outcome. Conclusions: After validation the SUSPEKT Score may be applicable in general clinical practice for early patient selection to optimize individual management or for assessment of eligibility for treatment trials. doi:10.1016/j.jns.2013.07.924
Abstract — WCN 2013 No: 2315 Topic: 3 — Stroke Association between metabolic syndrome and homocysteinemia in ischemic stroke M. Vujnica, N. Rasetaa, S. Miljkovicb, D. Racicb, V. Djajicb, O. Perazicc, S. Pericd. aDepartment for Pathophysiology, Faculty of Medicine, University Clinical Center in Banja Luka, Bosnia and Herzegovina;
e237
b
Neurology Clinic, University Clinical Center in Banja Luka, Bosnia and Herzegovina; cInstitute for Occupational and Sport Medicine of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; dNeurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia Background: Stroke is one of the leading causes of morbidity and mortality worldwide. The role of metabolic syndrome and homocysteinemia as risk factors for ischemic stroke is not completely clear. Aim: To determine the frequency of metabolic syndrome and homocysteinemia, as well as their association in patients with ischemic stroke. Method: The research included 53 subjects being on rehabilitation after stroke and 40 clinical controls without vascular disease that were on rehabilitation due to the back pain problems. Results: The frequency of metabolic syndrome was much higher in patients with stroke compared to control group (88.7% vs. 70.0%, p b 0.05). The level of homocysteinemia and the frequency of hyperhomocysteinemia were increased in the patients with stroke (15.0 ± 5.50 μmol/L vs. 11.2 ± 2.51 μmol/L, p b 0.01 and 39.2% vs. 11.4%, p b 0.01, respectively). Among patients with stroke, those with metabolic syndrome had higher frequency of hyperhomocysteinemia (42.2% vs. 16.7%, p b 0.05) and the serum level of homocysteine was significantly higher in patients with more individual components of metabolic syndrome (11.1% in patients with 3 components, 36.8% in patients with 4 components and 64.7% in patients with 5 components, p b 0.05). Conclusion: Our results suggest that metabolic syndrome and homocysteinemia represent significant risk factors for ischemic stroke. It seems that there is an association between these two factors in pathogenesis of the ischemic stroke, but further analyses are needed to confirm this hypothesis.
doi:10.1016/j.jns.2013.07.925
Abstract — WCN 2013 No: 2347 Topic: 3 — Stroke Thrombolysis in ischemic stroke in a familial amyloidotic polyneuropathy patient — Is there an increased risk of hemorrhagic complication? S. França, T. Mendonça, E. Azevedo, Grupo de Estudos de Doença Vascular Cerebral Centro Hospitalar de São João, Porto, Portugal Background: Patients with familial amyloidotic polyneuropathy (FAP) type I have typically a severe somatic and autonomic peripheral neuropathy. Amyloid deposits of the mutated transthyretin (frequently TTR Val30-Met, almost all produced by the liver) are said to mostly spare the brain in this type of FAP. Nevertheless, with longer survival induced by liver transplantation the choroid plexus TTR Val30-Met production might become relevant. Patients and methods: A 46-year-old woman with TTR Val30Met FAP, with liver transplant and pacemaker since age 37, and on immunosuppression with tacrolimus, was admitted by acute motor aphasia (NIHSS 4). Brain CT and analytical study were normal. Thrombolysis was started 3.5 h after symptom onset. At the stroke unit she worsened and repeated CT scan disclosing left temporal and right fronto-basal hematoma. Due to pacemaker MRI was not performed. Cervical and transcranial duplex scan was normal. She was discharged a week later asymptomatic, on triflusal 600 mg/d. Discussion: There is no data on thrombolysis safety in FAP patients. It is known that in some mutations there is an important amyloid
e238
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
deposition in the leptomenigeal and cortical vessels, with frequent intracerebral hemorrhagic stroke (IHS). Conclusion: Although with TTR Val30-Met mutation IHS is not common, in our liver transplanted patient the local and remote parenchymal hemorrhage after thrombolysis raises the hypothesis that cerebral amyloid angiopathy might develop in the long-term in these patients, due to maintained abnormal transthyretin production in the choroid plexus. Brain pathological studies are necessary to confirm this hypothesis in the TTR Val30-Met liver transplanted patients. doi:10.1016/j.jns.2013.07.926
Abstract — WCN 2013 No: 2319 Topic: 3 — Stroke Setting up a neuroscience stroke and rehabilitation centre 12,000 km away with the help of telemedicine U. Meyding-Lamadéa, E. Craemera, C. Jacobia, C. Mohsa, C. Schwarka, K. Enka, I. Jafaarb, A. Masrib, C. Chanb, B. Kressc. a Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany; b Bruneian Stroke and Rehabilitation Centre, Jerudong, Brunei; c Neuroradiology, Krankenhaus Nordwest, Frankfurt/Main, Germany Background: Due to world-wide aging population neurologists are urgently needed for stroke/non-stroke. In Brunei Darussalam we set up a national stroke unit, intensive care unit, neurorehabilitation on-site including tele-neurology and tele-teaching. Objective: The aim of this project “to teach to treat–to treat to teach” was to set up a world class centre of neurology. Methods: In 7/2010 set-up of the Bruneian Neuroscience Stroke and Rehabilitation Centre (BNSRC) has started. To overcome the distance of 12,000 km a telemedical network between the Department of Neurology (KHNW) and BNSRC started. This international cooperation includes a “specialist neurology” training program, accredited in Brunei Darussalam by an international advisory board. Daily teleteaching, 24/7 tele-neurology service, as well as all neurological laboratories have been set up on site by tele-cytology, and teleelectrophysiology including EEG and ultrasound. Awareness campaigns and telescience have been successfully started. Results: The BNRSC already has been successfully audited according to the STU requirements of the German Stroke Society. Over 2000 patients have been treated so far. Several Bruneian doctors are enrolled in the specialist curriculum. Conclusion: The program to teach to treat–to treat to teach resulted in a local set up of a BNSRC, being built up by KHNW. This outstanding project of a cooperation between the KHNW and BNSRC succeeded in building up a centre of excellence of high end acute neurological department including a stroke unit and neurorehabilitation. doi:10.1016/j.jns.2013.07.927
Abstract — WCN 2013 No: 2345 Topic: 3 — Stroke Stroke in patients with active and non-active malignancy A.G. Sliwinskaa, G. Gromadzkaa, M.A. Karlinskia, A. Czlonkowskaa,b. a Second Department of Neurology, Institute of Psychiatry and Neurology, Poland; bDepartment of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warszawa, Poland Background: Global burden of stroke and cancer is steadily increasing over the years. According to the previous studies, the pattern of stroke in cancer patients may differ from the conventional one.
Objectives: To compare vascular risk factors, stroke etiology and outcome among patients with positive or negative history of cancer, with emphasis on the activity of the malignancy. Methods: All consecutive acute stroke patients admitted to our department between September 2006 and September 2011 were included. We distinguished between patients: 1) with active malignancy (the diagnosis of cancer within 12 months before stroke, AM); 2) with non-active malignancy (non-AM); 3) cancer-free patients (CF), used as a reference. Results: Of 1558 acute stroke admissions, 90 (5.8%) had an additional diagnosis of cancer, including 41 cases of AM (2.6%) and 49 cases of non-AM (3.1%). Compared to CF group, non-AM patients did not differ in terms of vascular risk factors; they more frequently had stroke due to small vessel occlusion (18.4% vs 7.0%, p = 0.003). AM patients less frequently had atrial fibrillation (7.3% vs 23.5%, p = 0.016) and history of previous stroke (2.4% vs. 24.9%, p = 0.018). The most frequent stroke etiology in the AM group was undetermined (61.0%) and they had higher levels of serum inflammatory parameters. Stroke severity and outcome were similar across all groups. Conclusions: Compared to the CF patients, the pattern of stroke in non-AM patients appears similar. However, stroke pattern in patients with AM may be different from the conventional one, but it does not affect the short term prognosis. doi:10.1016/j.jns.2013.07.928
Abstract — WCN 2013 No: 2355 Topic: 3 — Stroke Late cerebrovascular complications of radiation therapy for pediatric primary central nervous system tumors J. Passosa, H. Nzwalob, J. Marquesa, A. Azevedoc, S. Nunesd, D. Salgadod. aNeurology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; bNeurology, Hospital de Faro EPE, Faro, Portugal; cNeurology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; dPediatric Neuro-Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal Background: Radiation therapy (RT) plays an important role in the management of primary central nervous system tumors (PCNST) in children. Despite field and dose optimization, late cerebrovascular complications (LCCs) still occur. However, the number of studies assessing the burden of these complications is limited. Objective: To describe the occurrence of LCCs in adult survivors who underwent RT for PCNST during childhood. Methods: Retrospective consecutive case series description of LCCs from a cohort of adult survivors of pediatric PCNST. Diagnosis of hemorrhagic LCCs was confirmed by gradient-echo MRI sequence. Results: We identified LCCs of RT in 35 of a total of 103 patients (34.0%); median age at RT was 8.4 years; and median follow-up was 18.7 years. Histological diagnoses were: medulloblastomas/primitive neuroectodermal tumors (16/45.7%), gliomas (15/42.9%) and germ cell tumors (4/11.4%). The most frequent PCNST site was the posterior fossa (21/60%). Mean total radiation dose was 48 Gy (18– 54 Gy); most patients received focal plus entire neuraxis RT (23/65.7%). Thirty-three patients had microbleeds, all asymptomatic; cavernomas occurred in eleven patients, causing epilepsy in 2; two patients had a symptomatic ischemic stroke (6 and 25 years after RT); two patients presented with symptomatic superficial siderosis (15 and 26 years after RT) and one patient developed symptomatic moyamoya syndrome 4 years after RT. In some patients, microbleeds and cavernomas increased in number during follow-up.