RESUMO
BACKGROUND: Posterior cerebral arteries (PCAs) supply the ventrolateral thalamic sensory nuclei and white matter sensory tracts to the somatosensory parietal cortex. Patients with PCA territory strokes often have visual, memory, cognitive, and sensory signs. Clinicoanatomic correlation of visual, cognitive, and memory functions are well defined but, to our knowledge, no systematic study has analyzed the anatomy of sensory abnormalities. OBJECTIVE: To assess the frequency and anatomic correlation of sensory symptoms and signs in patients with PCA territory infarction. PATIENTS AND METHODS: Sixty patients with hemispheral and hemispheral and deep PCA territory infarcts apparent on computed tomographic and magnetic resonance imaging scans were studied for the presence of sensory findings and location of infarcts. RESULTS: Sensory symptoms or signs were present in 15 (25%) of 60 patients. Among patients with sensory findings, 11 of 15 had infarcts in the ventrolateral thalamus in the territory of the thalamogeniculate or lateral posterior choroidal arteries. The other 4 patients had no ventrolateral thalamic or white matter infarction but had severe proximal vascular occlusive lesions that could have caused temporary thalamic ischemia. One of these 4 patients had a medial thalamic infarct and transient hemisensory symptoms. Twelve patients had thalamic infarcts and no recorded sensory findings. Seven patients with thalamic infarcts (6 medial and 1 ventrolateral) had no sensory findings, and sensory findings could not be accurately assessed in 4 patients with ventrolateral and 1 patient with medial thalamic infarcts. CONCLUSIONS: All patients with PCA territory infarcts and sensory findings either had thalamic infarcts in thalamogeniculate or lateral posterior choroidal artery territory or had thalamic ischemia. Sensory findings in PCA territory infarction indicate ventrolateral thalamic ischemia.
Assuntos
Doenças Arteriais Cerebrais/complicações , Infarto Cerebral/etiologia , Lobo Parietal/irrigação sanguínea , Córtex Somatossensorial/fisiopatologia , Núcleos Talâmicos/irrigação sanguínea , Doenças Arteriais Cerebrais/diagnóstico , Infarto Cerebral/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Lobo Parietal/patologia , Estudos Retrospectivos , Núcleos Talâmicos/patologia , Tomografia Computadorizada por Raios X , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologiaRESUMO
PURPOSE: To review our experience with intracranial angioplasty, including the complications we encountered. METHODS: During a 3-year period, from 1993 to 1996, 10 patients had intracranial percutaneous transluminal angioplasty (PTA). The stenosed vessels included three internal carotid arteries, one middle cerebral artery, one basilar artery, and five vertebral arteries. Stenosis in all patients was 75%, or greater. PTA was technically successful in eight patients; in two patients it could not be performed owing to inability to traverse the stenosed area. RESULTS: Two patients had successful and uneventful PTA. Five patients had vasospasm, which resolved with local vasodilators in two and with repeat PTA in one. Vasospasm led to stroke in two patients. Compromise of perforating vessels and arterial dissection were associated with stroke in two patients. CONCLUSION: Intracranial PTA is technically feasible but associated with risks related to vasospasm, arterial trauma, and compromise of perforating vessels.
Assuntos
Angioplastia com Balão/instrumentação , Isquemia Encefálica/terapia , Estenose das Carótidas/terapia , Arteriosclerose Intracraniana/terapia , Insuficiência Vertebrobasilar/terapia , Adulto , Idoso , Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/terapia , Feminino , Seguimentos , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Falha de Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagemRESUMO
We describe the use of an epidural catheter adapter to salvage a flow-directed microcatheter in situ after fracture of the plastic catheter hub. This technique eliminates the need to remove the failed catheters prematurely and enables successful delivery of liquid embolic agent into arteriovenous malformations in the brain.
Assuntos
Cateterismo/instrumentação , Embolização Terapêutica/instrumentação , Microinjeções/instrumentação , Embucrilato/administração & dosagem , Embucrilato/uso terapêutico , Desenho de Equipamento , Falha de Equipamento , Humanos , Malformações Arteriovenosas Intracranianas/terapia , Plásticos , Propriedades de SuperfícieRESUMO
The treatment of a patient who had iatrogenic basilar artery thrombosis after endovascular occlusion of a recently ruptured wide-necked basilar apex aneurysm with a nondetachable silicone balloon is described. The rationale for the choice of a nondetachable balloon, the need for anticoagulation in the postoperative period, the timing of thrombolysis, and the choice of thrombolytic agents are discussed.
Assuntos
Aneurisma Roto/terapia , Artéria Basilar , Embolização Terapêutica , Aneurisma Intracraniano/terapia , Embolia e Trombose Intracraniana/tratamento farmacológico , Terapia Trombolítica , Insuficiência Vertebrobasilar/tratamento farmacológico , Adulto , Aneurisma Roto/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Testes de Coagulação Sanguínea , Angiografia Cerebral , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Embolia e Trombose Intracraniana/diagnóstico por imagem , Exame Neurológico/efeitos dos fármacos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Insuficiência Vertebrobasilar/diagnóstico por imagemRESUMO
PURPOSE: To assess the value of endovascular packing of intracranial bifurcation aneurysms with commercially available coils. METHODS: Carotid bifurcation aneurysms were surgically created in 12 New Zealand rabbits with subsequent assessment of the extent of aneurysm ablation following endovascular packing with polyester fiber-coated platinum coils. RESULTS: Follow-up angiograms obtained from 29 to 108 days postprocedures showed various degrees of aneurysm ablation. Complete obliteration of aneurysm dome occurred in seven out of eight rabbits, while ablation of aneurysm neck was successful in only one out of eight. No spontaneous thrombosis was observed in seven control animals over a 3-month period. Coils of various configurations used in this experiment all maintained stable intraaneurysmal position. Histologic examination of treated aneurysms consistently demonstrated extensive proliferation of spindle cells on the coil surface and in interstices between coils with channels lined by cells resembling endothelial cells. Organized thrombus was not a prominent feature. CONCLUSION: Endovascular packing of human bifurcation aneurysms with current commercially available polyester fiber-coated platinum coils may not result in complete obliteration of the aneurysm with reendothelialization occurring across the aneurysm neck.
Assuntos
Doenças das Artérias Carótidas/terapia , Embolização Terapêutica/métodos , Animais , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Embolização Terapêutica/efeitos adversos , Coelhos , RadiografiaRESUMO
Endovascular balloon occlusion is an alternative treatment for surgically unclippable cerebral aneurysms. The results of aneurysm occlusion with either a silicone or a latex balloon in a common carotid artery bifurcation aneurysm model are compared to determine which type of balloon was least likely to result in aneurysm recurrence. Five rabbits each underwent endovascular balloon occlusion with either a silicone or a latex balloon, with seven rabbits serving as controls. At 3 months postocclusion, nine of the 10 balloon-treated aneurysms had recurred. The recurrent aneurysm tended to be larger in animals treated with silicone than with latex balloons. A dense fibrotic response was present around the collar of the latex balloons, but no significant fibrotic response was found in the silicone balloon group. This study suggests that with currently available balloons, the initial complete angiographic obliteration of an aneurysm following balloon occlusion should not be interpreted as a cure and that periodic follow-up angiography should be performed.
Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Cateterismo , Aneurisma/diagnóstico por imagem , Animais , Doenças das Artérias Carótidas/diagnóstico por imagem , Complicações Pós-Operatórias , Coelhos , Radiografia , RecidivaRESUMO
Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a "water-hammer effect" and the possibility of hemorrhage following subtotal occlusion.
Assuntos
Artéria Basilar , Cateterismo/efeitos adversos , Aneurisma Intracraniano/terapia , Adulto , Artéria Basilar/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Metrizamida , Pessoa de Meia-Idade , Poli-Hidroxietil Metacrilato , Fluxo Pulsátil , RadiografiaRESUMO
Cirsoid aneurysms of the scalp are notoriously difficult lesions to manage. The authors report a patient in whom a large traumatic cirsoid aneurysm of the scalp was eliminated using a combined neurosurgical and interventional neuroradiological approach. Transarterial embolization was utilized to reduce arterial blood supply to the fistula. Thrombogenic Gianturco spring coils were then introduced via direct percutaneous puncture of the aneurysm. The aneurysm thrombosed and the multiple tortuous scalp vessels disappeared. One month after embolization, a small area of skin necrosis over the aneurysm necessitated surgical excision of the lesion. The thrombosed aneurysm was easily resected with minimal blood loss. Percutaneous embolization with thrombogenic coils in this case was a safe and effective ablative technique.
Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/instrumentação , Couro Cabeludo/irrigação sanguínea , Adulto , Embolização Terapêutica/métodos , Humanos , MasculinoRESUMO
One aneurysm of the basilar artery and three large, paraclinoid aneurysms of the internal carotid artery (ICA) were treated with the aid of intraoperative temporary balloon occlusion of the vessel. Optimal clip placement was confirmed using intraoperative angiography. This technique provided excellent proximal vascular control and for the large aneurysms of the paraclinoid ICA obviated the need for surgical exposure of the ICA in the neck. We think this is a useful adjunct in the surgical management of aneurysms of both the basilar artery and proximal ICA.
Assuntos
Cateterismo , Aneurisma Intracraniano/cirurgia , Adulto , Idoso , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
We reviewed CTs from 47 patients with 48 spontaneous, supratentorial brain hemorrhages to determine the effect of ventricular blood on outcome. We correlated volumetric analysis of the parenchymal (P) and ventricular (V) blood, as well as other clinical and CT features, with clinical outcome in a statistical analysis. Hemorrhages were located in putamen 20/48 (42%), thalamus 13/48 (27%), lobar 9/48 (19%), caudate 3/48 (6%), and miscellaneous locations 3/48 (6%). Outcome in putaminal hemorrhages was highly correlated with the total (P + V) and P blood volumes, whereas the V blood was less important. For thalamic hemorrhages, outcome correlated more highly with the V and P + V volumes than with the P portion. Outcome for all hemorrhages was significantly correlated, in descending order of importance, with the severity of the initial neurologic deficit, P + V blood, hydrocephalus, the number of ventricles containing blood, P, V, and blood in the 4th ventricle. In general patients with more than 20 cc of V blood did poorly. Although hydrocephalus was associated with poor outcome, ventricular drainage did not benefit 8 of 9 patients.
Assuntos
Sangue , Hemorragia Cerebral/diagnóstico por imagem , Ventriculografia Cerebral , Idoso , Hemorragia Cerebral/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Especificidade de Órgãos , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
Unilateral suppression of beta activity, unilateral suppression of sleep spindles, and unilateral delta slowing on EEG have not been previously compared regarding accompanying neuroradiological (NR) and clinical neurological (CN) findings in children. We studied EEGs in children under age 10 years with unilateral beta suppression (n = 80), spindle suppression (n = 51) or unilateral delta slowing (n = 49). There were no significant differences between the three groups of abnormal EEGs in their relationships with NR and CN. Unilateral suppression of sleep spindles and beta activity are at least as accurate as focal slowing in lateralizing NR and CN findings.
Assuntos
Eletroencefalografia , Sono/fisiologia , Ritmo beta , Criança , Pré-Escolar , Ritmo Delta , Humanos , LactenteRESUMO
Extracranial internal carotid artery occlusive disease usually produces stroke in the middle cerebral artery territory or the border zone between the middle and anterior cerebral arteries. It is unusual for occipital infarction in the posterior cerebral artery territory to be caused by internal carotid artery disease despite the fact that the posterior cerebral artery may arise directly from the internal carotid artery as an anatomic variation. We describe a patient with a fetal posterior cerebral artery originating from the internal carotid artery, and the initial manifestation of his extracranial internal carotid artery occlusive disease was hemianopsia from occipital infarction.
Assuntos
Arteriopatias Oclusivas/complicações , Doenças das Artérias Carótidas/complicações , Infarto Cerebral/etiologia , Hemianopsia/etiologia , Lobo Occipital , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Angiografia Cerebral , Infarto Cerebral/diagnóstico por imagem , Constrição Patológica , Humanos , Recém-Nascido , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/complicações , Tomografia Computadorizada por Raios XRESUMO
We studied seven patients with brainstem infarction and large fusiform vertebrobasilar (VB) aneurysms to clarify the clinical, radiologic, and pathologic features. All presented with pontine infarcts; one also had a cerebellar infarct. VB TIAs preceded brainstem infarction in four patients. Angiography and CT documented VB fusiform aneurysmal dilatation. Four had intraluminal thrombi and one had severe basilar artery stenosis. Two distinct clinical pictures emerged: unilateral pontine infarcts with favorable outcome, presumably related to obstruction of a pontine penetrating artery at its origin from the posterior wall of the aneurysmal basilar artery, and major fatal bilateral pontine infarcts from basilar artery occlusion. Two patients came to autopsy. One had thrombus in the dilated basilar artery and a posterior cerebral artery branch embolus with hemorrhagic occipital infarction; the other had basilar artery thrombus with aneurysmal rupture and subarachnoid hemorrhage. Fusiform VB aneurysms caused brainstem stroke by intraluminal thrombus, local embolism, atherostenosis, and obstruction of paramedian penetrating arteries. Subarachnoid hemorrhage is an uncommon complication.
Assuntos
Artéria Basilar , Transtornos Cerebrovasculares/etiologia , Aneurisma Intracraniano/complicações , Artéria Vertebral , Adulto , Idoso , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Encéfalo/patologia , Angiografia Cerebral , Transtornos Cerebrovasculares/complicações , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologiaRESUMO
We describe four patients and review prior reports to clarify the clinical, radiographic, and pathologic findings of intracranial vertebral artery (VA) dissection. A 43-year-old man and a 33-year-old woman had chronic bilateral VA dissecting aneurysms. The man had multiple episodes of subarachnoid hemorrhage (SAH) and necropsy showed multiple dissections and defects in the internal elastica. The woman had many brainstem TIAs and strokes during 3 years. Two other patients had SAH and unilateral dissections. Intracranial VA dissection causes four overlapping syndromes: (1) brainstem infarcts are usually due to subintimal dissection extending into the basilar artery, affect younger patients, and often are single fatal events; (2) SAH is due to subadventitial or transmural dissection; (3) aneurysms cause mass effect on the brainstem and lower cranial nerves; and (4) chronic dissections due to connective tissue defects cause extensive bilateral aneurysms and repeated TIAs, small strokes, and SAH.
Assuntos
Dissecção Aórtica , Artéria Vertebral , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/patologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologiaRESUMO
Three patients with surgically inaccessible giant carotid aneurysms/pseudoaneurysms and one patient with carotid cavernous fistula had endovascular occlusion with detachable silicone balloons filled with Cholografin. MR was performed before the procedures in three cases and again 18 hr to 44 days after embolization in all four cases. The age-related changes of arterial thrombi, as well as the optimal timing and value of different pulse sequences in the noninvasive follow-up, were evaluated. Arterial thrombi have some characteristics in common with intracerebral hematomas, being isointense on T1-weighted spin-echo images during acute phase and subsequently acquiring hyperintense signals on both T1- and T2-weighted spin-echo images during the subacute and chronic phases. Additional observations are that (1) hyperacute (less than 24 hr old) thrombus is hyperintense on T2-weighted spin-echo sequences; (2) hemosiderin is less conspicuous in chronic intraluminal thrombi than in intracerebral hematomas of comparable size; and (3) thrombosis is initiated at a site remote from the apex of the aneurysm and then progresses centripetally. The Cholografin-filled balloon is hypointense to gray matter on T1-weighted spin-echo images and isointense to both hyperacute and chronic thrombus on T2-weighted spin-echo images. The optimal timing and sequence for MR follow-up of a thrombosed aneurysm with conventional spin-echo technique is beyond 7 days on T1-weighted spin-echo images. The in vivo appearance of Cholografin-filled silicone balloons does not change appreciably on T1- and T2-weighted spin-echo sequences up to 6 weeks if filled according to the manufacturer's specification.
Assuntos
Fístula Arteriovenosa/terapia , Doenças das Artérias Carótidas/terapia , Cateterismo , Seio Cavernoso/patologia , Embolização Terapêutica , Aneurisma Intracraniano/terapia , Imageamento por Ressonância Magnética , Adulto , Fístula Arteriovenosa/patologia , Doenças das Artérias Carótidas/patologia , Artérias Cerebrais/patologia , Feminino , Humanos , Aneurisma Intracraniano/patologia , Embolia e Trombose Intracraniana/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
The Tolosa-Hunt syndrome (THS), a steroid-responsive painful ophthalmoplegia secondary to idiopathic granulomatous inflammation, historically has been categorized as a diagnosis of exclusion because of its nonspecific radiologic presentation. Five patients who satisfied the anatomic and clinical criteria of this syndrome underwent high-resolution CT of the orbital apex/cavernous sinus region. Two patients were diagnosed as having orbital apex pseudotumor, two as having cavernous sinus inflammation, and one as having a cavernous sinus epidermoid by the characteristic CT and clinical findings. Follow-up studies while the patients were asymptomatic demonstrated complete resolution of the CT abnormalities in four patients and clinical improvement in all five patients. Our data suggest that orbital apex pseudotumor and granulomatous inflammation of the cavernous sinus have similar clinical features and should be considered as part of the spectrum of THS. With the advent of high-resolution CT, THS may now be a diagnosis of inclusion. Symptomatic improvement after steroid therapy is an essential but not absolute proof of the syndrome, since lesions such as lymphomas may also respond to steroids. Resolution of the soft-tissue inflammation of CT is an additional criterion for diagnosis.
Assuntos
Oftalmoplegia/diagnóstico por imagem , Adulto , Dexametasona/uso terapêutico , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Oftalmoplegia/tratamento farmacológico , Prednisona/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
A new catheter system was used in ten patients (16 infusions) for infusion of chemotherapeutic agents to the sites of malignant gliomas. Thirteen infusions to the supraophthalmic region were successful, as were three infusions to the posterior cerebral region. There were no complications after the infusions. A neurologic complication occurred in one patient in whom two successful supraophthalmic infusions were previously carried out. In this patient the guide wire separated during catheter placement into the posterior cerebral artery.
Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Carmustina/administração & dosagem , Glioma/tratamento farmacológico , Infusões Intra-Arteriais/instrumentação , Carmustina/uso terapêutico , Artéria Carótida Interna , Cateteres de Demora , Artérias Cerebrais , HumanosRESUMO
Basilar artery territory stroke may result from embolism arising from the site of vertebral artery occlusion. This stroke mechanism (local embolism) has been well documented in the middle cerebral artery territory from extracranial internal carotid artery disease but not fully appreciated in the vertebral basilar circulation. We report two patients whose clinical presentation indicated major basilar artery territory infarction documented by angiography to be the result of vertebral artery occlusion and artery-to-artery embolism. Vertebral artery occlusion has often been associated with a benign course, but under certain circumstances embolism to the basilar artery may complicate the outcome.
Assuntos
Arteriopatias Oclusivas/complicações , Artéria Basilar , Embolia/etiologia , Artéria Vertebral , Adulto , Arteriopatias Oclusivas/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Embolia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Artéria Vertebral/diagnóstico por imagemRESUMO
The purpose of this study was to explore the value of high-detail MR imaging in the diagnosis of the Chiari II malformation. Twenty-four patients with known Chiari II malformation as diagnosed by CT scanning were evaluated with cranial MR scans. Two patients also had spine scans. The sagittal-plane images were the most informative, and abnormalities of the telencephalon, diencephalon, mesencephalon, rhomboencephalon, upper spinal cord, and mesencephalon were shown extremely well. We found MR to be an easy and accurate method for demonstrating the abnormalities of the Chiari II malformation, and it is our procedure of choice.