Anatomical differences of the vertebrobasilar artery between normal subjects and patients with cerebral infarction.

Previous studies have reported various anatomical differences in the cerebral artery between healthy subjects and patients with posterior circulation cerebral infarction. In particular, basilar artery angulation has been associated with posterior circulation cerebral infarction. We compared anatomical variations and the degree of anterior and lateral vertebrobasilar artery angulation and deviation to compare the incidence of cerebral infarction of healthy subjects and patients with posterior circulation cerebral infarction. We compared basilar artery anatomy using brain magnetic resonance angiography in 97 patients who underwent brain magnetic resonance angiography during health checkups at our hospital and in 92 patients diagnosed with posterior circulation cerebral infarction between 2012 and 2022. Anatomical variations, including fetal-type posterior cerebral artery, hypoplastic P1 segment, vertebrobasilar dolichoectasia, and dominant vertebral artery, as well as the degree of anterior and lateral deviation and angulation, were evaluated. Correlations between these variations and the occurrence of cerebral infarction were analyzed. The prevalence of hypoplastic P1 was significantly differences in patients with posterior circulation cerebral infarction (odds ratio: 5.655). Furthermore, patients with posterior circulation cerebral infarction exhibited more acute anterior and lateral angulation, as well as lateral deviation. Hypoplastic P1 and more acute anterior or lateral angulation of the vertebrobasilar artery are associated with increased frequency of cerebral infarction.

Fatal intracerebral hemorrhage following endovascular Onyx embolization of an arteriovenous malformation: A case report.

INTRODUCTION: Patients with cerebral arteriovenous malformation (AVM) have a lifetime risk of hemorrhagic stroke. Although identified asymptomatic cases can be monitored with imaging follow-up, treatment is considered in cases of AVM rupture or hemodynamic instability. PATIENT CONCERNS: A 43-year-old man who had been taking antihypertensive drugs for the past 5 years visited our hospital 3 days after the abrupt onset of headache. The patient also complained of progressive ptosis in the left eye. DIAGNOSES: Brain computed tomography (CT) showed a small intraventricular hemorrhage with obstructive hydrocephalus. Subsequent brain CT angiography and magnetic resonance imaging confirmed the presence of an AVM in the cerebellar vermis. INTERVENTIONS: Endovascular embolization was performed directly through the right femoral artery. Near-total obliteration of the AVM nidus was achieved by using multiple Onyx castings. OUTCOMES: The patient developed an altered mental status and right hemiparesis after the procedure. CT performed after the procedure revealed intraventricular hemorrhage in all ventricles, with a left thalamic intracerebral hemorrhage. Despite emergency external ventricular drainage and aggressive treatment for intracranial pressure control, the patient expired on the 14th day after the embolization procedure. LESSONS: When treating AVMs, especially those with a large nidus of high flow, it is necessary to consider possible hemorrhagic complications and preventive measures.

Adrenocorticotropic hormone and ß-endorphin concentration as a prognostic factor in patients with subarachnoid hemorrhage due to aneurysmal rupture.

OBJECTIVE: Adrenocorticotropic hormone (ACTH) and ß-endorphin are pituitary neuro-peptides released by acute stress. We determined why the prognosis of patients with subarachnoid hemorrhages (SAH) due to aneurysmal rupture is not always dependent on the Hunt-Hess grading system (HHS) and delta-National Institutes of Health Stroke Scale (NIHSS), while studying endogenous neuropeptides, including ACTH and ß-endorphin. METHODS: We analyzed blood samples collected from patients with SAH (SAH group; n=37) and those with unruptured intracranial aneurysms (control group; n=37). Blood sampling was performed before any procedure or chemical agents administration. The results of ACTH and ß-endorphin measurements were compared using the delta-NIHSS and HHS. The data were analyzed using descriptive statistics, independent samples t-tests, and Pearson's correlations. RESULTS: Of the 18 patients with low-grade HHS, 13 had low delta-NIHSS and five showed high delta-NIHSS. Of the 19 patients with high-grade HHS, the delta-NIHSS was ≥14 in the other five patients. ACTH concentration was high (497.3 pg/mL) in five patients with high-grade HHS and high delta-NIHSS. ß-endorphin concentration was high (159.7 pg/mL) in 13 patients with low-grade HHS and low delta-NIHSS. CONCLUSIONS: High ACTH levels in patients with massive bleeding and poor neurological status suggests increasing ACTH secretion in response to bleeding stress, which may aggravate neurological status. Contrary to ACTH, high ß-endorphin levels in patients with low-grade HHS implied the involvement of additional factors in predicting fair outcomes related to low delta-NIHSS. These results may provide insight into the varying prognostic potential of HHS in SAH patients.