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1.
J Matern Fetal Neonatal Med ; 37(1): 2326302, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38442990

RESUMO

OBJECTIVES: Sonographic evaluation of the basilar artery is challenging, and a limited number of reports are available about the prenatal period, as manual positioning of probes is technically difficult. The objective of this study was to describe a sonographic transabdominal approach based on slowflow HD for screening of the basilar artery during the second trimester scan. METHODS: A total of 49 women who were enrolled in a second trimester screening were included when the fetus was in the occipitoanterior position. Dopper screening of the cerebral artery was performed, which revealed the "Y" sign indicating the basilar trunk arising from two vertebral arteries in the axial oblique view when the probe was located around the junction of the vertebral processes and occipital bone and was superior to the first vertebral body, sloping slightly to the cephalic side. The Doppler ultrasound probe was placed perpendicular to the basilar artery. The flow direction was below the baseline, away from the probe in the basilar artery, consistent with a caudocephalic orientation. Peak systolic and diastolic velocities were measured. RESULTS: The basilar artery was identified in all 49 fetuses, with a mean gestational age of 22 weeks (range 20 to 26 weeks). The mean peak systolic velocity of the basilar artery was 15.8 cm/second (range 9.12-26.44 cm/second). There was a slight increase in peak systolic velocity according to the gestational age of the fetus. CONCLUSIONS: This study demonstrated that evaluation of the basilar artery can be performed during the second trimester via a new transabdominal approach involving slowflow HD.


Assuntos
Angiografia , Artéria Basilar , Humanos , Gravidez , Feminino , Lactente , Segundo Trimestre da Gravidez , Artéria Basilar/diagnóstico por imagem , Diástole , Feto
2.
J Med Case Rep ; 18(1): 106, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38491407

RESUMO

BACKGROUND: Vertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death. CASE: A 31-year-old Sundanese woman with cerebral edema, C2-C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling. CONCLUSIONS: Brain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.


Assuntos
Lesões Encefálicas Traumáticas , Lesões das Artérias Carótidas , Fístula Carotidocavernosa , Traumatismos Craniocerebrais , Lesões do Pescoço , Feminino , Humanos , Adulto , Artéria Vertebral/diagnóstico por imagem , Morte Encefálica , Fístula Carotidocavernosa/cirurgia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem
3.
No Shinkei Geka ; 52(2): 335-346, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38514123

RESUMO

What is the most important factor to achieve successful surgery for deep-seated brain tumors with preservation of brain functions? Definitely, it is to identify the tumor origin site at which a tumor arose and select appropriate surgical approaches that immediately lead directly to the site in the early stage of surgery, minimizing damages of cortices and important white matter bundles, and controlling main arterial supply to the tumor. For this, neurosurgeons must have thorough knowledge of brain anatomy and function, and tailor the best surgical approach for each patient, based on three-dimensional anatomical simulation. For lesions situated in the posterior and lower part of the thalamus and extending to the lateral part, two "cross-court" approaches; the occipital transtentorial/falcine and infratentorial supracerebellar transtentorial approaches, provide a wide corridor to even the lateral aspect of the thalamus and early access to the posterior choroidal arteries, usually main feeders of this territory tumors, without damaging any cerebral cortices and major white matter bundles. Here, we describe the selection of approaches for two representative cases and demonstrate surgical procedures and postoperative courses.


Assuntos
Neoplasias Encefálicas , Procedimentos Neurocirúrgicos , Humanos , Procedimentos Neurocirúrgicos/métodos , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Tálamo/anatomia & histologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/patologia , Artéria Cerebral Posterior
4.
No Shinkei Geka ; 52(2): 415-421, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38514132

RESUMO

The craniovertebral junction not only contains anatomically important structures such as the medulla oblongata, upper cervical spinal cord, and vertebral artery, but also controls the dynamic movements of flexion, extension, and rotation of the head and neck. Consequently, instability and spinal deformities can easily occur in the craniovertebral region, and appropriate treatment should be selected based on the specificity of the lesion. Basilar invagination often involves bone and vascular anomalies and fusion surgery is often required. Therefore, careful pre-operative simulations are necessary. The creation and use of three-dimensional bone models, including image navigation, are useful for surgical simulation.


Assuntos
Articulação Atlantoccipital , Fusão Vertebral , Humanos , Articulação Atlantoccipital/anormalidades , Articulação Atlantoccipital/patologia , Articulação Atlantoccipital/cirurgia , Fusão Vertebral/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Artéria Vertebral/cirurgia , Descompressão Cirúrgica , Vértebras Cervicais/cirurgia
5.
Rinsho Ketsueki ; 65(2): 84-89, 2024.
Artigo em Japonês | MEDLINE | ID: mdl-38448003

RESUMO

A 63-year-old man with adult T-cell leukemia-lymphoma underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor. On day 17 after transplantation, chest computed tomography (CT) showed nodules in the lower lobes of both lungs, and invasive pulmonary aspergillosis (IPA) was suspected. Treatment with liposomal amphotericin B was started, and improvement of infectious lesions was confirmed with CT on day 28. The antifungal agent was changed to voriconazole on day 52 because of progressive renal dysfunction. Disorders of consciousness and paralysis of the left upper and lower extremities developed on day 61. Brain CT showed subcortical hemorrhage in the right parietal and occipital lobes, and the patient died on day 62. An autopsy revealed filamentous fungi, suspected to be Aspergillus, in the pulmonary nodules and a ruptured cerebral aneurysm. Although IPA occurs in 10% of transplant recipients, vigilant monitoring for mycotic cerebral aneurysms is required to prevent hematogenous dissemination of Aspergillus, which is associated with a high mortality rate.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Aneurisma Intracraniano , Leucemia-Linfoma de Células T do Adulto , Linfoma , Adulto , Masculino , Humanos , Pessoa de Meia-Idade , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/terapia , Transplante de Medula Óssea
6.
J Matern Fetal Neonatal Med ; 37(1): 2318604, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38373847

RESUMO

OBJECTIVE: To investigate midbrain growth, including corpus callusum (CC), cerebellar vermis (CV) and cortical development in late fetal growth restriction (FGR) depending on uterine artery (UtA) Pulsatility Index (PI) values. METHODS: This was a prospective study including singleton fetuses with late FGR characterized by abnormal cerebral placental ratio (CPR). According to UtA PI values, the FGR fetuses were subdivided into normal ≤95th centile) and abnormal (>95th centile). Neurosonography was performed at 33-44 weeks of gestations to assess CC and CV lengths and the depth of Sylvian fissure (SF), parieto-occipital (POF) and calcarine fissures (CF). Neurosonographic variables were normalized for fetal head circumference size. RESULTS: The study cohort included 60 fetuses with late FGR, 39 with normal UtA PI and 21 with abnormal PI values. The latter group showed significant differences in CC (median (interquartile range) normal 35.9 (28.49-45.53) vs abnormal UtA PI 25.31(19.76-35.13) mm; p < 0.0022), CV (normal 25.78 (18.19-29.35) abnormal UtA PI 17.03 (14.07-24.16)mm; p = 0.0067); SF (normal 10.58 (8.99-11.97)vs abnormal UtA PI 7.44 (6.23-8.46) mm; p < 0.0001), POF (normal 6.85 (6.35-8.14) vs abnormal UtA PI 4.82 (3.46-7.75) mm; p < = 0.0184) and CF (normal 04.157 (2.85-5.41) vs abnormal UtA PI 2.33 (2.49-4.01)); p < 0.0382). CONCLUSIONS: Late onset FGR fetuses with abnormal UtA PI showed shorter CC and CV length and delayed cortical development compared to those with normal uterine PI. These findings support the existence of a link between abnormal brain development and changes in utero placental circulation.


Assuntos
Recém-Nascido Pequeno para a Idade Gestacional , Placenta , Recém-Nascido , Gravidez , Humanos , Feminino , Estudos Prospectivos , Terceiro Trimestre da Gravidez , Estudos Transversais , Ultrassonografia Pré-Natal , Retardo do Crescimento Fetal/diagnóstico por imagem , Ultrassonografia Doppler , Mesencéfalo , Feto , Idade Gestacional , Artéria Uterina/diagnóstico por imagem
7.
Neurochirurgie ; 70(2): 101545, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38417248

RESUMO

INTRODUCTION: Traumatic intracranial aneurysms are rare, making up about 1% of all intracranial aneurysms. They can happen due to direct injury or blunt force, with the middle cerebral artery being the most frequent site. The middle meningeal artery (MMA) is the main artery that supplies the cranial dura mater, and, because of its location, is susceptible to damage after trauma. This article reported an unusual case of giant post-traumatic MMA pseudoaneurysm. CASE: A 45 year-old man was referred to our department with a history of craniectomy. He complained of non-specific headache, but neurological examination was normal. A follow-up brain CT scan identified a right temporal fossa hyperdense mass. Digital subtraction angiography diagnosed a traumatic MMA aneurysm. The patient was treated with preoperative aneurysm embolization and surgical resection. DISCUSSION: Traumatic MMA aneurysm is a rare presentation after head trauma. It can manifest as epidural hematoma, subdural hematoma or intraparenchymal hematoma, and sometimes resembles the present case, which was discovered incidentally. CONCLUSION: Pseudoaneurysm is a rare complication of MMA trauma, with late presentation. It should be considered in patients with history of traumatic brain injury and temporal fossa extra-axial mass lesion with vascular characteristics.


Assuntos
Falso Aneurisma , Traumatismos Craniocerebrais , Hematoma Epidural Craniano , Aneurisma Intracraniano , Masculino , Humanos , Pessoa de Meia-Idade , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Artérias Meníngeas/diagnóstico por imagem , Artérias Meníngeas/lesões , Hematoma Epidural Craniano/etiologia , Traumatismos Craniocerebrais/complicações
8.
Neurosurg Rev ; 47(1): 32, 2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-38182923

RESUMO

The purpose of this study was to investigate the application and efficacy analysis of in situ interposition bypass in complex intracranial aneurysms. This study retrospectively analyzed the clinical data of 21 patients with complex intracranial aneurysms treated with in situ interposition bypass grafting in the Department of Neurosurgery at Tianjin Huanhu Hospital from June 2015 to December 2022. The aneurysms were located in the middle cerebral artery in 16 cases, the anterior cerebral artery in 3 cases, the posterior cerebral artery in 1 case, and the posterior inferior cerebellar artery in 1 case. The interposition graft vessels were taken from the radial artery in 15 cases, the superficial temporal artery in 5 cases, and the occipital artery in 1 case. All patients underwent end-to-end anastomosis with in situ interposition bypass after aneurysm resection, including 13 cases of "I-shaped" type, 5 cases of "V-shaped" type, and 3 cases of "Y-shaped" type. Postoperative digital subtraction angiography (DSA) or computed tomography angiography (CTA) reviews were performed for all the patients, and modified Rankin Scale (mRS) score was used to assess patient prognosis. Three patients developed postoperative basal ganglia infarction and two of them recovered well. One case developed transient incomplete aphasia and one case developed mild hemiparesis, which recovered well after 3 months. The remaining 16 patients did not develop new neurological deficits. Postoperative DSA or CTA showed that the anastomosis of the bypass graft and the graft vessels were patent, and all aneurysms were completely eliminated. Regular postoperative follow-up ranged from 3 to 89 months, and no aneurysm recurred. The percentage of patients with mRS ≤ 2 at the final follow-up was 90.5%. Based on the experience of surgical treatment in our center, in situ interposition bypass technique is a safe and effective option for the treatment of some complex intracranial aneurysms.


Assuntos
Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/cirurgia , Estudos Retrospectivos , Procedimentos Neurocirúrgicos , Angiografia Digital , Artéria Cerebral Média
9.
Childs Nerv Syst ; 40(3): 791-800, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37955716

RESUMO

PURPOSE: To describe a surgical technique for posterior cerebral revascularization in pediatric patients with moyamoya arteriopathy. Here, we describe the clinical characteristics, surgical indications, operative techniques, and clinical and radiographic outcomes in a series of pediatric patients with moyamoya disease affecting the posterior cerebral artery (PCA) territory. METHODS: A retrospective single-center series of all pediatric patients with moyamoya disease who presented to our institute between July 2009 through August 2019 were reviewed. The clinical characteristics, surgical indications, operative techniques, and long-term clinical and radiographic outcomes of pediatric moyamoya patients with PCA territory ischemia were collected and analyzed. RESULTS: A total of 10 PCA revascularization procedures were performed in 9 patients, 5 female, ages 1 to 11.1 years (average 5.2 years). Complications included 1 stroke, with no infections, hemorrhages, seizures, or deaths. One patient had less than 1 year of radiographic and clinical follow-up. In 8 of 9 patients with at least 1 year of radiographic follow-up, there was engraftment of surgical vessels present in all cases. No new strokes were identified on long-term follow-up despite the radiographic progression of the disease. In the 8 cases available for analysis, the average follow-up was 50.8 months with a range of 12 to 117 months. CONCLUSIONS: PCA territory ischemia in patients with progressive moyamoya disease can be surgically treated with indirect revascularization. Here, we describe our experience with PCA revascularization procedures for moyamoya disease, including pial pericranial dural (PiPeD) revascularization and pial synangiosis utilizing the occipital artery. These surgical options may be useful for decreasing the risk of stroke in pediatric moyamoya patients with severe posterior circulation disease.


Assuntos
Isquemia Encefálica , Revascularização Cerebral , Doença de Moyamoya , Acidente Vascular Cerebral , Criança , Humanos , Feminino , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Angiografia Cerebral , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Infarto Cerebral/etiologia , Acidente Vascular Cerebral/etiologia , Revascularização Cerebral/métodos
10.
J Stroke Cerebrovasc Dis ; 33(1): 107490, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37988834

RESUMO

OBJECTIVE: Bloom syndrome is a chromosomal breakage disorder associated with immune deficiency, characterized by short stature, predisposition to early-onset cancer, and immune defects. Currently, there have been no reports of acute cerebral infarction in patients with Bloom syndrome. Here, we report a case of Bloom syndrome complicated by elevated antiphospholipid antibodies and acute cerebral infarction. MATERIALS AND METHODS: A 23-year-old male with a known genetic diagnosis of Bloom syndrome was admitted to the Respiratory Department due to pulmonary aspergillosis. The patient experienced sudden dizziness, and subsequent cranial MRI revealed a newly developed infarction in the right cerebellar hemisphere. RESULTS: Six days later, the patient presented with sudden right visual field loss, and a repeat cranial MRI showed new infarctions in the left occipital and temporal lobes. Positive lupus anticoagulant and prolonged activated partial thromboplastin time suggested elevated antiphospholipid antibodies causing thrombus formation. Unfortunately, anticoagulant treatment was not administered due to recurrent hemoptysis. CONCLUSION: This study reports the first case of a Bloom syndrome patient with elevated antiphospholipid antibodies and acute cerebral infarction, suggesting that the immune and coagulation abnormalities caused by Bloom syndrome may contribute to the development of acute cerebral infarction.


Assuntos
Síndrome Antifosfolipídica , Síndrome de Bloom , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Masculino , Humanos , Adulto Jovem , Adulto , Anticorpos Antifosfolipídeos , AVC Isquêmico/complicações , Síndrome de Bloom/complicações , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/complicações , Isquemia Encefálica/etiologia , Isquemia Encefálica/complicações , Infarto , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico por imagem
11.
Childs Nerv Syst ; 40(1): 239-243, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37594564

RESUMO

Paediatric patients receiving cranial irradiation therapy for brain tumours are at increased risk of cerebrovascular complications. Radiation-induced moyamoya syndrome (MMS) is a well-recognised complication of this. We present a case of an 8-year-old boy with a history of medulloblastoma, who underwent surgical excision followed by post-operative adjuvant oncological treatment. Six years later, he developed cerebellar/intraventricular haemorrhage. He underwent an emergency external ventricular drain (EVD) insertion followed by posterior fossa suboccipital craniotomy. On dural opening, an abnormal vessel was visualised on the surface of the right cerebellar hemisphere, which was not disturbed. No obvious abnormalities were identified intra-operatively. Cerebral catheter angiography confirmed the presence of a right-sided occipital artery (OA) to posterior inferior cerebellar artery (PICA) extracranial to intracranial (EC-IC) bypass with a zone of the distal PICA territory supplied by this EC-IC bypass. A presumed flow aneurysm originated from the bypass in the distal PICA, identified as cause for the haemorrhage. We highlight a rare cause for intracranial haemorrhage in this cohort of patients. Children who have undergone radiotherapy may have exquisitely sensitive cerebral vasculature and need careful vigilance and evaluation for vasculopathic complications following spontaneous haemorrhage.


Assuntos
Doenças Cerebelares , Neoplasias Cerebelares , Aneurisma Intracraniano , Masculino , Humanos , Criança , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/radioterapia , Neoplasias Cerebelares/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Cerebelo , Doenças Cerebelares/complicações , Hemorragia
12.
Brain Imaging Behav ; 18(1): 192-206, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37985612

RESUMO

Advanced carotid stenosis is a known risk factor for ischemic stroke and vascular dementia, and it is associated with multidomain cognitive impairment as well as asymmetric alterations in hemispheric structure and function. Here we introduced a novel measure-the asymmetry index of amplitude of low-frequency fluctuations (ALFF_AI)-derived from resting-state functional magnetic resonance imaging. This measure captures the hemispheric asymmetry of intrinsic brain activity using high-dimensional registration. We aimed to investigate functional brain asymmetric alterations in patients with severe asymptomatic carotid stenosis (SACS). Furthermore, we extended the analyses of ALFF_AI to different frequencies to detect frequency-specific alterations. Finally, we examined the coupling between hemispheric asymmetric structure and function and the relationship between these results and cognitive tests, as well as the white matter hyperintensity burden. SACS patients presented significantly decreased ALFF_AI in several clusters, including the visual, auditory, parahippocampal, Rolandic, and superior parietal regions. At low frequencies (0.01-0.25 Hz), the ALFF_AI exhibited prominent group differences as frequency increased. Further structure-function coupling analysis indicated that SACS patients had lower coupling in the lateral prefrontal, superior medial frontal, middle temporal, superior parietal, and striatum regions but higher coupling in the lateral occipital regions. These findings suggest that, under potential hemodynamic burden, SACS patients demonstrate asymmetric hemispheric configurations of intrinsic activity patterns and a decoupling between structural and functional asymmetries.


Assuntos
Estenose das Carótidas , Disfunção Cognitiva , Humanos , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Imageamento por Ressonância Magnética/métodos , Encéfalo/patologia , Mapeamento Encefálico
13.
World Neurosurg ; 181: e261-e272, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37832639

RESUMO

OBJECTIVE: Complex middle cerebral artery (MCA) aneurysms incorporating parent or branching vessels are often not amenable to standard microsurgical clipping or endovascular embolization treatments. We aim to discuss the treatment of such aneurysms via a combination of surgical revascularization and aneurysm exclusion based on our institutional experience. METHODS: Thirty-four patients with complex MCA aneurysms were treated with bypass and aneurysm occlusion, 5 with surgical clipping or wrapping only, and 1 with aneurysm excision and primary reanastomosis. Bypasses included superficial temporal artery (STA)-MCA, double-barrel STA-MCA, occipital artery-MCA, and external carotid artery-MCA. After bypass, aneurysms were treated by surgical clipping, Hunterian ligation, trapping, or coil embolization. RESULTS: The average age at diagnosis was 46 years. Of the aneurysms, 67% were large and most involved the MCA bifurcation. Most bypasses performed were STA-MCA bypasses, 12 of which were double-barrel. There were 2 wound-healing complications. All but 2 of the aneurysms treated showed complete occlusion at the last follow-up. There were 3 hemorrhagic complications, 3 graft thromboses, and 4 ischemic insults. The mean follow-up was 73 months. Of patients, 83% reported stable or improved symptoms from presentation and 73% reported a functional status (Glasgow Outcome Scale score 4 or 5) at the latest available follow-up. CONCLUSIONS: Cerebral revascularization by bypass followed by aneurysm or parent artery occlusion is an effective treatment option for complex MCA aneurysms that cannot be safely treated by standard microsurgical or endovascular techniques. Double-barrel bypass consisting of 2 STA branches to 2 MCA branches yields adequate flow replacement in most cases.


Assuntos
Revascularização Cerebral , Aneurisma Intracraniano , Humanos , Pessoa de Meia-Idade , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Revascularização Cerebral/métodos , Artéria Cerebral Média/cirurgia , Resultado do Tratamento , Artérias Temporais/cirurgia
14.
World Neurosurg ; 181: 59, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37838162

RESUMO

Fusiform vertebral artery (VA) aneurysms are challenging to treat due to their pathophysiology, morphology, and anatomic location.1,2 Endovascular treatments are considered to be a widely adopted safe option for this pathology.1 Open microsurgical treatment is considered for complex anatomy, important branch involvement, poor collateral flow, or failed endovascular therapy.3-7 This report aims to show the flow-replacement strategy and bypass technique for a VA aneurysm with complex anatomy and branch involvement. A 24-year-old man presented to our clinic with a bilateral fusiform VA aneurysm discovered during workup of progressive headaches. Further investigation revealed that the left-side aneurysm was mostly thrombosed and the posterior inferior cerebellar artery arose from the aneurysm dome with a fusiform enlargement within a few millimeters from the branching point. After evaluating all management options, the patient decided on surgical treatment of the left VA aneurysm. We performed an occipital artery to posterior inferior cerebellar artery end-to-side anastomosis distal to the fusiform enlargement, followed by trapping of the aneurysm and dome resection (Video 1). Antegrade flow to the distal VA was reestablished using a radial artery interposition graft, thus preventing any flow alterations that may cause growth or rupture of the contralateral aneurysm caused by increased hemodynamic stress if the ipsilateral VA flow is not preserved.8 After in-hospital physical rehabilitation, the patient was discharged with a modified Rankin Scale score of 1. The contralateral aneurysm is managed with serial imaging and treatment will ensue if there is clinical-radiologic evolution. The patient consented to the procedure and publication of his image.


Assuntos
Revascularização Cerebral , Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Masculino , Humanos , Adulto Jovem , Adulto , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Revascularização Cerebral/métodos , Procedimentos Neurocirúrgicos/métodos , Cerebelo/diagnóstico por imagem , Cerebelo/cirurgia , Cerebelo/irrigação sanguínea
15.
J Neurosurg ; 140(2): 522-536, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37548568

RESUMO

OBJECTIVE: Vertebral artery injury (VAI), a complication of blunt trauma, may cause posterior circulation stroke. An association of disease severity, classified in Denver grades, with stroke risk has not been shown. Using a literature-based analysis, the authors estimated the incidence of VAI following blunt trauma with the aim to investigate the impact of Denver grade and bilateral VAI on stroke occurrence. METHODS: A systematic review of the literature on VAI following blunt trauma was conducted, and data on its incidence, the severity per Denver grade, and stroke occurrence were collected. The incidence of VAI and stroke occurrence were analyzed cumulatively and between Denver grades. A meta-analysis with random-effects models was performed. RESULTS: Fifty-six studies including 2563 patients were identified. The overall incidence of VAI was 0.49% among blunt trauma cases and 14.5% among patients screened via any type of angiography. The incidence rates of bilateral VAI and concurrent carotid injury among all VAIs were 12.3% and 19.2%, respectively. VAI severity by Denver grade was as follows: grade I, 23.4%; grade II, 28.2%; grade III, 5.8%; grade IV, 42.1%; and grade V, 0.5%. The overall stroke risk was 5.32%, differing significantly among lesions of different Denver grades (p = 0.02). Grade III and IV lesions had the highest stroke prevalence (9.8% and 10.9% respectively), while strokes occurred significantly less frequently in patients with grade I and II lesions (1.9% and 3.0%, respectively). Denver grade V cases were too rare for meaningful analysis. Bilateral VAI was associated with a 33.2% stroke prevalence. The association between Denver grade and stroke occurrence persisted in a sensitivity subanalysis including only unilateral cases (p = 0.03). CONCLUSIONS: VAI complicates a small yet nontrivial fraction of blunt trauma cases, with Denver grade IV lesions being the most common. This is the first study to document a significantly higher stroke prevalence among grade III and IV VAIs compared with grade I and II VAIs independently from bilaterality. Bilateral VAIs carry a significantly higher stroke rate.


Assuntos
Traumatismos Craniocerebrais , Acidente Vascular Cerebral , Ferimentos não Penetrantes , Humanos , Artéria Vertebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/complicações , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Traumatismos Craniocerebrais/complicações , Angiografia/efeitos adversos , Estudos Retrospectivos
16.
Ann Vasc Surg ; 101: 186-192, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38128696

RESUMO

BACKGROUND: Management of traumatic vertebral artery injury (VAI) remains under debate. Current consensus reserves surgical or endovascular management for high-grade injury in order to prevent stroke. We sought to evaluate the factors that influence posterior fossa stroke outcomes following traumatic VAI. METHODS: A search of the prospectively maintained PROOVIT trauma registry of patients older than 18 years of age with a diagnosis of VAI was performed at a level 1 trauma center from 2013 to 2019. Patient demographics, type of injury, the timing of presentation, Biffl Classification of Cerebrovascular Injury Grade score, medical management, procedural interventions, and stroke outcomes were analyzed. RESULTS: VAIs were identified in 66 trauma patients were identified out of 14,323 patients entered into the PROOVIT registry. The dominant mechanism was blunt injury (91.5% vs. 8.5%, blunt versus penetrating). Nine patients presented with symptomatic ipsilateral posterior circulation strokes visible on imaging. The average Biffl classification grade was similar between the stroke and nonstroke groups (2.0 vs. 1.5; P = 0.39). The average injury severity score (ISS) between stroke and nonstroke groups was also similar (9.0 vs. 14.0; P = 0.35). All 9 patients in the stroke group had magnetic resonance imaging verification of their infarct within an average of 21.2 hr from presentation. In the stroke group, 1 patient underwent diagnostic angiography but had no intervention. In the nonstroke group, all were treated with medical management alone and none underwent vertebral artery intervention. During a mean follow-up of 14.5 months, no patients experienced a new neurological deficit. CONCLUSIONS: The severity of VAI by Biffl grading and ISS are not associated with ischemic stroke at presentation following VAI. Medical management of VAI appears safe regardless of Biffl and ISS staging in this trauma population. Neurological changes related to embolic stroke were generally appreciated on presentation. Conservative medical management was sufficient to protect from secondary neurological deficit regardless of index vertebral injury.


Assuntos
Traumatismos Craniocerebrais , Lesões do Pescoço , Acidente Vascular Cerebral , Ferimentos não Penetrantes , Humanos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/lesões , Resultado do Tratamento , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/complicações , Estudos Retrospectivos
17.
Eur J Ophthalmol ; 34(1): NP60-NP65, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38158829

RESUMO

PURPOSE: To report a case of branch retinal artery occlusion (BRAO) of the left eye combined with left congenital common carotid artery occlusion (CCAO) and internal carotid artery occlusion (ICAO). METHODS: Case report. RESULTS: A 36-year-old man presented with sudden vision loss of only the left eye without any signs or symptoms of brain diseases. Fluorescein fundus angiography (FFA) showed left BRAO, and computed tomography angiography (CTA) of the head and neck showed entire left CCAO and ICAO. The patient's left vertebral artery was anastomosed with the left occipital artery via the muscular branch, supplying blood retrogradely to the left external carotid artery. The right internal carotid artery compensated for blood supply to the left anterior cerebral artery and middle cerebral artery via anterior communication, and the left posterior communication artery compensated for blood supply to the left middle cerebral artery. CONCLUSIONS: To our knowledge, this study was the first to report a case of BRAO combined with congenital CCAO and ICAO with vision loss as the first symptom and proposed the importance of head and neck examination in retinal artery occlusion at the first visit to a doctor.


Assuntos
Arteriopatias Oclusivas , Oclusão da Artéria Retiniana , Masculino , Humanos , Adulto , Artéria Carótida Interna/diagnóstico por imagem , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Artéria Carótida Primitiva , Angiofluoresceinografia
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 35(12): 1286-1290, 2023 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-38149391

RESUMO

OBJECTIVE: To explore the diagnosis and treatment of acute cerebral infarction following extracorporeal membrane oxygenation (ECMO) therapy in patients with cardiogenic shock to review the literature. METHODS: The clinical data of two patients with cardiogenic shock treated with veno-arterial ECMO (VA-ECMO) complicated with acute cerebral infarction admitted to department of intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University were retrospectively analyzed and the treatment experience was shared. RESULTS: Case 1 was a 46-year-old male patient who was admitted to the hospital on September 16, 2021, due to "repeated chest tightness, shortness of breath, syncope for 2+ years, and worsened for 15 days. Coronary artery angiography showed 3-vessel coronary artery disease lesions. On October 15, 2021, coronary artery bypass grafting (CABG), pericardial fenestration and drainage, thoracic closed drainage, femoral bypass, thoracotomy exploration, and sternal internal fixation were performed under support of extracorporeal circulation. After surgery, the heart rate was 180-200 bpm, the blood pressure could not be maintained, and the improvement was not obvious after active drug treatment. The right femoral artery and femoral vein were intubated, VA-ECMO support treatment was performed, and the patient was transferred to the ICU. Intra-aortic balloon pump (IABP) was treated on the day of transfer because the circulation could not be maintained. Due to acute cerebral infarction in the left hemisphere and right parieto-occipital lobe, subfalcine herniation, tentorial herniation, the patient ultimately died after withdrawing from ECMO. Case 2 was a 43-year-old male patient who was admitted to the hospital on June 29, 2021, with "fever for 8 days and vomiting for 4 days". Bedside ultrasound showed cardiac enlargement and diffuse wall motion reduction in the left and right ventricles. On June 30, 2021, the patient underwent catheterization through the right femoral artery and femoral vein, VA-ECMO support, and was transferred to ICU for treatment. Acute cerebral infarction on both sides of the cerebellum occurred, and after treatment, the patient was discharged with mild impairment of daily living ability. CONCLUSIONS: Strengthen monitoring of anticoagulation; regular neurological examination of patients undergoing ECMO therapy; ECMO under light sedation or awake can be performed if the condition permitsif the condition permits, perform light sedation or awake ECMO, which helpful for the early detection of nervous system injury.


Assuntos
Oxigenação por Membrana Extracorpórea , Choque Cardiogênico , Masculino , Humanos , Pessoa de Meia-Idade , Adulto , Choque Cardiogênico/terapia , Estudos Retrospectivos , Ponte de Artéria Coronária/efeitos adversos , Infarto Cerebral/terapia
19.
Zh Nevrol Psikhiatr Im S S Korsakova ; 123(12): 109-115, 2023.
Artigo em Russo | MEDLINE | ID: mdl-38147390

RESUMO

OBJECTIVE: To develop indications for surgical treatment for positional disorders of blood flow in the vertebral-basilar territory caused by the damage to the V2-V3 segment of the vertebral artery (VA). MATERIAL AND METHODS: One hundred and fourteen patients with systemic and non-systemic dizziness were studied. To assess the state of the VA, blood circulation of the posterior cranial fossa and the base of the brain, ultrasound duplex scanning of blood vessels, selective angiography, MRI, single photon emission computed tomography (SPECT) of the brain and neuropsychological testing were performed. Patients were divided into three groups according to the severity of clinical manifestations of vertebrobasilar insufficiency (VBI). RESULTS: According to ultrasound data, patients of the third group with severe VBI had signs of extravasal compression in 94.3% of cases. In the same group, there was an increase in the systolic-diastolic (S/D) ratio by more than 2.5-3 times, as well as an increase in the resistive index (RI) by more than 1.75 units and pulsation index (PI) more than 2.2 units in V2-V3 segments of VA. In 42.9% of patients of the third group, zones of a decrease in the accumulation of 99mTc-ECD by more than 20% were found in the occipital region during the De Klein test. A direct correlation was established between the clinical manifestations of VBI and a decrease in perfusion during SPECT by 20% or more with the De Klein test (r=0.7). We developed an algorithm for diagnosing high-grade VBI with subsequent identification of a causal relationship with extravasal component effects on VA in the second segment. Indications for surgical intervention were determined in 33 patients with clinical manifestations of blood flow decompensation in the posterior cranial fossa. CONCLUSION: Decreased blood flow velocity in the vertebral or basilar artery by more than 50% with a decrease in PI, breath holding index <0.7 in the hypercapnic test, and no increase in blood flow velocity in a phototest and, in addition, the >20% defect of 99mTc-ECD accumulation in the posterior parts of the brain during SPECT with a De Klein test are the criteria for decompensation of blood flow in the vertebral-basilar territory, requiring surgical correction.


Assuntos
Artéria Vertebral , Insuficiência Vertebrobasilar , Humanos , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Compostos de Organotecnécio , Algoritmos
20.
Paediatr Int Child Health ; 43(1-3): 13-18, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37849317

RESUMO

Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia. Neuroradiological imaging showed left caudate, putaminal and posterior insular ischaemic infarct secondary to complete occlusion of the left ICA and accompanying partial left middle cerebral artery occlusion. He was treated with anticoagulant and anti-aggregant agents. Rarely, minor head trauma can result in internal carotid artery dissection, thrombus formation and arterial occlusion, leading to arterial ischaemic stroke. Prompt diagnosis and management are crucial to achieve a good neurological outcome.Abbreviations: AIS: arterial ischaemic stroke; ANA: anti-nuclear antibody; APA: anti-phospholipid antibody; APTT: activated partial thromboplastin time; CAD: carotid artery dissection; CCAD: cranio-cervical artery dissection; CRP: C-reactive protein; CT: computed tomography; CTA: computed tomography angiography; dsDNA: double-stranded DNA; ESR: erythrocyte sedimentation rate; ICA: internal carotid artery; LA: lupus anticoagulant; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; MTHFR: methylenetetrahydrofolate reductase; PT INR: prothrombin time international normalised ratio.


Assuntos
Isquemia Encefálica , Traumatismos Craniocerebrais , AVC Isquêmico , Acidente Vascular Cerebral , Trombofilia , Masculino , Criança , Humanos , Adolescente , Isquemia Encefálica/complicações , Acidente Vascular Cerebral/etiologia , Artéria Carótida Interna , Angiografia por Ressonância Magnética , Traumatismos Craniocerebrais/complicações , AVC Isquêmico/complicações , Trombofilia/complicações
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