Abstracts Presented at the 39th annual meeting of the American Society of Neuroimaging, Orlando, FL, January 2016

s Presented at the 39th annual meeting of the American Society of Neuroimaging, Orlando, FL, January 2016 1. Tuberculus Vasculitis and Strokes in an Immucompetent Patient Zain Guduru,1,2,3 Abhishek Purohit,1,2,3 Sandeep Rana1,2,3 1Allegheny General Hospital Pittsburgh, PA, USA, 2Drexel School of Medicine Philadelphia, PA, USA, 3Temple School of Medicine Philadelphia, PA, USA Background & Purpose: Tuburculosis (TB) Meningitis with infarcts is fatal up to 3 times more often than in those without infarcts. Location of strokes includes Deep Sylvain region (presence of TB meningitis exudates at the level of basal cisterna). It is assumed that infarcts are due to vasculitis/subsequent intimal proliferation +/− superadded thrombosis. Treatment includes combination of anti-TB drugs and dexamethasone. Methods: A 76-year-old Caucasian male with a history of hypertension presented with 2 months history of altered mental status. No TB risk factors. Ammonia (17) blood cultures, HIV, Hepatitis B, C and rheumatological panel were negative. CSF showed: opening pressure (20), WBC (230), RBC (233), Lymphs (58%), Neu (37%), Glu (30), Pro (195), IgG (24.5), ACE (4.7). VDRL, gram stain, strep B, H.influenza, S.pneumo: negative. All viral studies: negative. ADA: 1. Culture: negative. CSF cytology: mature lymphocytes, monocytes and few neutrophils. No malignant cells. Immunophenotype: findings were NOT diagnostic of lymphoproliferation. TB PCR was positive. Quantiferon gold test for TB was indeterminate. Dexamethasone and anti-TB drugs were started which showed improvement gradually. Results: Brain MRI showed multifocal infarctions and leptomeningeal enhancement. CT angiography of the head showed diffuse narrowing and irregularity involving the circle of Willis and the proximal vasculature. Meningeal biopsy AFB stain showed AFB positive structure in area of lymphohistocytic infiltrate. Conclusions: Although, the diagnosis of CNS TB is rare with no risk factors, it is very important to consider in the differential diagnosis, as failure of starting appropriate treatment causes higher mortality. TB vasculitis should be considered if any neurologic deterioration arises during the course of TB. 2. The Impact of Distal Embolization in acute ischemic stroke treatment for emergent large vessel occlusion Vishal Jani,1 Mohammad-Rauf Afzal,2 Muhammad Shah Miran,2 Ahmed Riaz,2 Jillian Schurr,1 Anmar Razzak,1 Syed Hussain,1 Adnan I Qureshi2 1Michigan State University/ Department of Vascular and Endovascular Neurology East Lansing, MI, USA, 2University of Minnesota/Department of Neurology and Neurosurgery Minneapolis, MN,