Perianeurysmal vasogenic oedema (PAVO): A single centre 10-year retrospective review.

INTRODUCTION: Perianeurysmal Vasogenic Oedema (PAVO) is a rare but important complication of endovascular treatment of intracranial aneurysms. Many potential risk factors have been identified including age, aneurysm size, aneurysm location, immunological profile, type of coil used, diabetes, hypertension, and smoking. PAVO can cause persistent post-procedural symptoms, subsequently increasing post-embolization morbidity. METHODS: A 10-year retrospective review was conducted between 2011 and 2021 at Royal Preston Hospital, Preston, UK. RESULTS: We identified 8 patients that fit our inclusion criteria. This included 6 (75%) females and 2 (25%) males. The mean age was 64. All patients had anterior circulation aneurysms with the middle cerebral artery (MCA) being the most common site. The mean aneurysm size was 12 mm. Our patients were managed with a range of endovascular techniques. One patient had pre-treatment PAVO while 7 patients had post-embolization PAVO. Five patients were symptomatic, and 3 cases were asymptomatic with only radiological evidence of PAVO. Five patients were managed with varying courses of dexamethasone. PAVO resolution was achieved in 4 cases. The oedema significantly improved in 3 cases, but transiently progressed in 1 case. CONCLUSIONS: PAVO is a rare but important complication of endovascular management of intracranial aneurysms. We have shown that patients can be effectively managed with steroids with resultant oedema regression and symptomatic improvement. Many risk factors have been associated with PAVO, but further research is needed to better understand their role in PAVO development and help develop other therapeutic options.

A worldwide study of white matter microstructural alterations in people living with Parkinson's disease.

The progression of Parkinson's disease (PD) is associated with microstructural alterations in neural pathways, contributing to both motor and cognitive decline. However, conflicting findings have emerged due to the use of heterogeneous methods in small studies. Here we performed a large diffusion MRI study in PD, integrating data from 17 cohorts worldwide, to identify stage-specific profiles of white matter differences. Diffusion-weighted MRI data from 1654 participants diagnosed with PD (age: 20-89 years; 33% female) and 885 controls (age: 19-84 years; 47% female) were analyzed using the ENIGMA-DTI protocol to evaluate white matter microstructure. Skeletonized maps of fractional anisotropy (FA) and mean diffusivity (MD) were compared across Hoehn and Yahr (HY) disease groups and controls to reveal the profile of white matter alterations at different stages. We found an enhanced, more widespread pattern of microstructural alterations with each stage of PD, with eventually lower FA and higher MD in almost all regions of interest: Cohen's d effect sizes reached d = -1.01 for FA differences in the fornix at PD HY Stage 4/5. The early PD signature in HY stage 1 included higher FA and lower MD across the entire white matter skeleton, in a direction opposite to that typical of other neurodegenerative diseases. FA and MD were associated with motor and non-motor clinical dysfunction. While overridden by degenerative changes in the later stages of PD, early PD is associated with paradoxically higher FA and lower MD in PD, consistent with early compensatory changes associated with the disorder.