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Introduction: Multifocal atherosclerotic process affects multiple vessels throughout the body - cardiac, cerebral and peripheral arteries almost simultaneously or sequentially. Objective: We present a patient with a transient cerebrovascular accident. A diagnostic algorithm was applied, which led to the diagnosis of multifocal atherosclerosis Materials and methods: It concerns a 60-yearold man with weakness in the left limbs and difficulty in walking and speaking; with objectively a left-sided hemiparesis and a central lesion of the left 7th cranial nerve, and full recovery within 24 hours. Brain CT with angiography and neurosonography were performed and moderate to high grade stenosis of all extracranial cerebral vessels was found. Mild dyslipidemia was discovered. An aortography was performed with data for thrombosis of the left a. axillaris, thrombosis of the right AIE, and left AIC and AIE. The patient was referred for coronary pathology examination, which was confirmed, and for thrombophilia testing. Conclusion: The diagnosis and treatment of arterial thrombosis is complex, requiring multidisciplinary efforts. A systematic approach to its assessment is warranted and includes consideration of various etiological causes. A continuous follow-up is essential. Screening for multiplicity of the atherosclerotic process is important because more than one vascular area is often affected. [ABSTRACT FROM AUTHOR]

Introduction: Wallenberg-Zakharchenko syndrome (lateral medullary syndrome) occurs when a cerebral accident in the basin of the PICA (posterior inferior cerebellar artery), leads to infarction of the lateral medulla. In younger patients, infarcts in this area are often associated with variations in cerebral circulation. Objective: To present patients with clinical Wallenberg-Zakharchenko syndrome and variations in cerebral circulation as the only risk factor at a younger age. Materials and methods: Six patients (4 women and 2 men) with an average age of 50 years with brainstem ischemic stroke and clinical symptoms of Wallenberg-Zakharchenko syndrome were analyzed. To establish the causes of the cerebrovascular accidents at a younger age, the following investigations were performed: CTangiography, neurosonography, lipid profile, thrombophilia screening, cardiac evaluation. As the only identified risk factor, variations in cerebral circulation were specified. Vertebral artery hypoplasia was present in 5 patients with stroke-related location, in one of whom a multiple variety was found including also a hypoplastic posterior communicating artery. In one of the patients, hypoplasia of the vertebral artery, contralateral to the accident, and the presence of an anterior trifurcation were visualized. Conclusion: Vascular anomalies of cerebral circulation are among the risk factors for cerebrovascular accidents, especially among younger patients. Neurosonography is a non-invasive, easily applicable, painless and risk-free method for their visualization and follow-up for both diagnosis and prevention. [ABSTRACT FROM AUTHOR]

Introduction: Arterial dissection is a leading cause of stroke in young adults, with an incidence of up to 20% in this population and an annual incidence of 2.6 to 2.9 per 100,000. These patients mainly present with mild fluctuating neurological symptoms (low NIHSS) and possible rapid progression. Objective: To report our experience in the treatment and follow-up of acute ischemic strokes due to dissection of extracranial and intracranial vessels in 7 patients. Materials and methods: We present 7 patients treated at our center over a period of one and a half years. Five of them have been followed up and the patients show improvement assessed by mRS. The patients' age was between 29 and 60 years. Five of them were treated endovascularly, one of them by bridging therapy, one of the patients was treated with systemic thrombolysis, one - conservatively. Patients had severe neurologic deficits on admission (mean NIHSS score 16). Conclusion: Arterial dissection should be considered in the differential diagnosis of patients with acute stroke at a young age without other risk factors, especially in those with low baseline NIHSS. Endovascular treatment, preceded or not by IVT treatment, with the aim of achieving early recanalization of the dissected arterial vessel, reduces mortality and leads to a good clinical outcome. [ABSTRACT FROM AUTHOR]