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1.
Neurol Sci ; 40(11): 2303-2309, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31203479

RESUMO

BACKGROUND: A common-stem origin of lenticulostriate arteries (CS-LSAs) is an anatomical variation that supplies a moderate to large section of the basal ganglia. We hypothesized that CS-LSAs with a patent orifice are located at distal positions of the acute-occluded middle cerebral artery (MCA) and that the blood flow of CS-LSAs is supplied by pail arterial anastomoses and results in hypoperfusion of CS-LSAs, similar to a deep watershed (DWS) infarction. OBJECTIVE: Our study evaluated the possibility of CS-LSAs in patients with DWS infarction and MCA occlusion and also assessed the safety of endovascular therapy (ET) in these patients. METHODS: A cohort of consecutive patients with DWS infarction and MCA occlusion and in whom full recanalization via ET was achieved were identified. Patients were divided into two groups based on the presence of CS-LSAs observed during ET. In addition, radiological and clinical data were retrospectively analyzed. RESULTS: Thirty-three patients were included, and CS-LSAs were observed in 48.5% (16/33) of patients. The possibility (72.2%, 13/18) of CS-LSAs was high in patients with DWS infarction companied with basal ganglia infarction. A good clinical outcome was similar in patients with CS-LSAs and basal ganglia infarction and in patients without CS-LSAs and basal ganglia infarction (69.2% vs. 81.8%, P = 0.649). CONCLUSIONS: The possibility of CS-LSAs was 48.5% in patients with DWS infarction and MCA occlusion, and the revascularization procedure was safe and feasible in these patients despite the moderate-to-large basal ganglia infarction.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Gânglios da Base/irrigação sanguínea , Gânglios da Base/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Idoso , Angiografia Digital , Doença Cerebrovascular dos Gânglios da Base/mortalidade , Infarto Cerebral/mortalidade , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Neuroradiology ; 61(10): 1131-1136, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31172226

RESUMO

PURPOSE: In acute ischemic stroke, infarct location and volume have, separately, been used to determine long-term outcomes after stroke. Little information exists on the combination of these imaging characteristics on rehabilitation outcomes. We evaluated the association between infarct lesion location volume with the Functional Independence Measure (FIM) measure during inpatient rehabilitation facility (IRF) in ischemic stroke patients. METHODS: Between 2012 and 2014, we prospectively enrolled consecutive acute ischemic stroke patients admitted from a Comprehensive Stroke Center and followed to an IRF in Chicago, Illinois. We adjudicated infarct volumes in specific lesion locations using a validated brain atlas. Volumes were calculated using an automated pipeline. FIM measure was extracted from IRF charts. We analyzed the association between acute infarct characteristics and functional measures using adjusted Spearman's correlation. RESULTS: Among 162 stroke patients (mean age 67.6 years, 48.1% male, 58.6% Caucasian), the median FIM at IRF was 52 (IQR 36-62). In an adjusted analysis, infarct volumes in the left basal ganglia (rs = - 0.45, p = 0.02) and left frontal lobe (rs = - 0.38, p = 0.04) were negatively correlated with FIM scores. CONCLUSIONS: There is an association between specific infarct lesion location volume and subsequent FIM scores assessed at IRF. Our findings suggest that imaging during index stroke hospitalization could be used to predict outcomes assessed during IRF.


Assuntos
Atividades Cotidianas/classificação , Mapeamento Encefálico , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/reabilitação , Imagem por Ressonância Magnética , Doença Aguda , Idoso , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/reabilitação , Correlação de Dados , Imagem de Difusão por Ressonância Magnética , Feminino , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
3.
BMC Pregnancy Childbirth ; 19(1): 87, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30871491

RESUMO

BACKGROUND: Transient donor hydrops (TDH) is defined as donor hydrops developed within days after laser therapy for twin-twin transfusion syndrome (TTTS) followed by resolution later. The purpose of this study was to evaluate the incidence, neonatal outcomes and predisposing factors of post laser therapy TDH in severe TTTS. METHODS: A total of 142 patients with severe TTTS who received laser therapy were included into this study. The pre-operative characteristics and neonatal outcomes were compared between TTTS with and without post laser therapy TDH. All live neonates received cranial ultrasound examination after delivery, mild cerebral injury was defined as exhibiting at least one of the following: intraventricular hemorrhage (IVH) grade I and II, lenticulostriate vasculopathy and subependymal pseudocysts; severe cerebral injury comprised at least one among the following: IVH grade III or grade IV, cystic periventriculoleukomalacia (PVL) grade II or more, porencephalic cysts, and ventricular dilatation. Fetal survival was defined as living more than 30 days after delivery.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Hidropisia Fetal/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Fotocoagulação a Laser/efeitos adversos , Adulto , Doença Cerebrovascular dos Gânglios da Base/epidemiologia , Doença Cerebrovascular dos Gânglios da Base/etiologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Estudos de Casos e Controles , Hemorragia Cerebral Intraventricular/epidemiologia , Hemorragia Cerebral Intraventricular/etiologia , Feminino , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/embriologia , Fetoscopia/métodos , Glioma Subependimal/epidemiologia , Glioma Subependimal/etiologia , Humanos , Hidropisia Fetal/etiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Fotocoagulação a Laser/métodos , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos
5.
J Clin Neurosci ; 60: 148-150, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30528357

RESUMO

The 2018 American Heart Association/American Stroke Association (AHA/ASA) guidelines stated that the administration of intravenous recombinant tissue-type plasminogen activator (rTPA) for acute ischaemic stroke is probably safe for patients with small (i.e. <10 mm) unruptured intracranial aneurysms. We present 2 cases of small (2 and 5 mm) lenticulostriate artery (LSA) aneurysms which ruptured immediately following rtPA infusion. The ensuing acute intracranial haemorrhages resulted in the death of one patient and severe functional impairment for the other. Given the limited literature available, the natural history of LSA aneurysms is largely unknown. This report suggests that LSA aneurysms, regardless of size, be considered separately from other conventional aneurysms as "high-risk" lesions and a contraindication to thrombolysis.


Assuntos
Aneurisma Roto/patologia , Doença Cerebrovascular dos Gânglios da Base/patologia , Fibrinolíticos/efeitos adversos , Aneurisma Intracraniano/patologia , Ativador de Plasminogênio Tecidual/efeitos adversos , Administração Intravenosa , Idoso , Doença Cerebrovascular dos Gânglios da Base/complicações , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem
6.
Clin Neuroradiol ; 29(3): 533-541, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29572675

RESUMO

PURPOSE: Our aims were to evaluate the feasibility of high-resolution magnetic resonance imaging (HR-MRI) for displaying the cerebral perforating arteries in normal subjects and to discuss the value of HR-MRI for detecting the causes of infarctions in the territory of the lenticulostriate artery (LSA). METHODS: Included in this study were 31 healthy subjects and 28 patients who had infarctions in the territory supplied by the LSA. The T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and HR-MRI, including 3­dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3D fast spin-echo T1WI (namely CUBE T1 in GE Healthcare), were applied on a 3-Tesla scanner. The numbers and route of the perforating arteries on both sides were independently confirmed on HR-MRI by two physicians. The Wilcoxon test was used to compare the differences. RESULTS: The numbers of perforating arteries in healthy subjects observed on 3D-TOF-MRA were as follows: numbers of the bilateral recurrent artery of Heubner (RAH) ranged from 0-3 (median 1), numbers of the left LSA ranged from 0-7 (median 3), numbers of the right LSA ranged from 0-5 (median 3), numbers of the bilateral anterior choroidal artery ranged from 1-2 (median 1) and the numbers of the bilateral thalamoperforating artery ranged from 1-2 (median 1). In the patients with lenticulostriate infarctions, the numbers of LSAs on the affected side were lower than on the opposite and ipsilateral sides in the healthy subjects. The results were statistically significant. An abnormality of the RAH may lead to a centrum semiovale infarct pattern, whereas an abnormality of the LSA is associated with a corona radiata infarct pattern. CONCLUSION: The use of HR 3D-TOF-MRA and CUBE T1 had unique advantages in displaying the tiny perforating arteries in vivo. Moreover, effective recognition of the associated cerebral perforating artery and infarct patterns may enhance our understanding of the mechanism of stroke in patients with lenticulostriate infarctions.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Criança , Estudos de Viabilidade , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Adulto Jovem
7.
Medicine (Baltimore) ; 97(39): e12480, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278535

RESUMO

RATIONALE: Cerebral microbleeds are lesions that appear as round low signal intensity areas with a diameter of 2-5 mm on gradient echo T2-weighted sequence magnetic resonance imaging. Cerebral microblees are hemorrhages found in the brain parenchyma and they are caused by the extravasation of the blood. Although more patients with ischemic stroke are found to have cerebral microbleeds, only a few studies have evaluated other neurologic abnormalities outside of cognitive dysfunction due to cerebral microbleeds. PATIENT CONCERNS: A 73-year-old female patient had only a lacunar infarction with the development of a new microbleed whenever a new neurologic symptom occurred, without the occurrence of acute ischemic stroke. DIAGNOSES: A 73-year-old female patient diagnosed symptomatic cerebral microbleeds. INTERVENTIONS: Brain magnetic resonance imaging was taken within a few hours of the occurrence of a new symptom and we confirmed increased cerebral microbleeds in the ventral-posterolateral area of the thalamus, consistent with the symptoms. OUTCOMES: This case study is meaningful because it proves that repeated occurrences of cerebral microbleeds in a specific area can induce acute ischemic stroke-like symptoms. LESSONS: Cerebral microbleeds have been considered to be asymptomatic lesions thus far. However, recent studies have reported the association of cerebral microbleeds with neurological symptoms including cognitive dysfunction. This study confirmed the presence of newly formed cerebral microbleeds through imaging follow-ups whenever a symptom occurred.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Núcleos Ventrais do Tálamo/irrigação sanguínea , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Idoso , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/patologia , Encéfalo/patologia , Hemorragia Cerebral/patologia , Cilostazol , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Fármacos Neuroprotetores/uso terapêutico , Recidiva , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Tetrazóis/administração & dosagem , Tetrazóis/uso terapêutico , Núcleos Ventrais do Tálamo/patologia
8.
Indian J Med Microbiol ; 36(2): 279-281, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30084424

RESUMO

Congenital Cytomegalovirus infection (CCMV) is the most common intrauterine infection. Early diagnosis of CCMV is hindered by three factors: There is no screening programme for CMV infection in pregnant women; a high percentage of infections in neonates are asymptomatic; the clinical signs of CCMV infection are uncharacteristic. The aim of this article is to analyse the clinical picture and course of CCMV treatment in a 3-week-old newborn, analyse adverse events in 14-week-long antiviral therapy and also assess intraventricular bleeding as an early indicator for the diagnosis of CCMV.


Assuntos
Infecções por Citomegalovirus/complicações , Doença Cerebrovascular dos Gânglios da Base/diagnóstico , Doença Cerebrovascular dos Gânglios da Base/etiologia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/etiologia , Citomegalovirus/patogenicidade , DNA Viral/genética , Feminino , Humanos , Recém-Nascido , Gravidez
9.
J Perinatol ; 38(10): 1370-1378, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30115968

RESUMO

OBJECTIVE: To examine the inter-rater reliability for the diagnosis of LSV on cranial ultrasound (cUS), determine the risk factors associated with LSV and its progression, and examine neurodevelopmental outcome. STUDY DESIGN: Prospective case-control study of neonates ≤32wks of gestation assessed for LSV by serial cUS (n = 1351) between 2012 and 2014 and their neurodevelopment at 18-36mon-corrected age compared to controls. RESULTS: Agreement for LSV on cUS improved from Κappa 0.4-0.7 after establishing definitive criteria and guidelines. BPD was the only variable associated with the occurrence and the progression of LSV. Cytomegalovirus (CMV) infection occurred in one neonate (1.5%). Neurodevelopmental outcome of neonates with LSV did not differ from controls. CONCLUSIONS: Establishment of well-defined stages of LSV improves the reliability of the diagnosis and allows identification of neonates with progression of LSV. Although LSV was associated with BPD, it was not associated with congenital CMV infection.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/classificação , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Displasia Broncopulmonar/complicações , Doenças do Prematuro/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/complicações , Displasia Broncopulmonar/diagnóstico , Estudos de Casos e Controles , Infecções por Citomegalovirus/diagnóstico , Ecoencefalografia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
10.
Cardiovasc Pathol ; 36: 30-34, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30005395

RESUMO

Candida parapsilosis is a rare cause of endocarditis, which is seen to affect the native valves in patients who are known intravenous drug abusers or following contamination during surgery for prosthetic valves. We discuss a unique constellation of autopsy findings in a 35-year-old chronic opium abuser who presented with left-sided weakness followed by low-grade fever. He was diagnosed to have C. parapsilosis native valve endocarditis with septic emboli involving the myocardial vessels, left middle cerebral artery, spleen, and common iliac artery. In addition, autopsy highlighted a right basal ganglia infarct, focal segmental glomerulonephritis, and talc granulomatosis in the lungs and liver.


Assuntos
Valva Aórtica/microbiologia , Candida parapsilosis/isolamento & purificação , Candidíase/microbiologia , Endocardite/microbiologia , Dependência de Ópio/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Valva Aórtica/patologia , Autopsia , Doença Cerebrovascular dos Gânglios da Base/microbiologia , Doença Cerebrovascular dos Gânglios da Base/patologia , Candidíase/diagnóstico , Endocardite/patologia , Evolução Fatal , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/patologia , Granuloma de Corpo Estranho/etiologia , Granuloma de Corpo Estranho/patologia , Humanos , Infarto da Artéria Cerebral Média/microbiologia , Infarto da Artéria Cerebral Média/patologia , Masculino , Sepse/microbiologia , Sepse/patologia , Talco/efeitos adversos
11.
World Neurosurg ; 118: e147-e154, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29959073

RESUMO

OBJECTIVE: To describe the critical role of endovascular treatment and safety for the patients who presented with intraventricular hemorrhage owing to rupture of the distal lenticulostriate artery aneurysms. METHODS: Three patients who underwent endovascular treatment for distal lenticulostriate artery aneurysms related to intraventricular hemorrhage were selected and retrospectively reviewed. RESULTS: Patients were treated successfully using endovascular embolization without any complications. CONCLUSIONS: Endovascular therapy is available and safe as a treatment option for distal lateral lenticulostriate artery aneurysms.


Assuntos
Aneurisma Roto/terapia , Doença Cerebrovascular dos Gânglios da Base/terapia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Adulto , Aneurisma Roto/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
12.
J Cardiovasc Magn Reson ; 20(1): 35, 2018 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-29880054

RESUMO

BACKGROUND: It has been shown that intracranial atherosclerotic stenosis (ICAS) has heterogeneous features in terms of plaque instability and vascular remodeling. Therefore, quantitative information on the changes of intracranial atherosclerosis and lenticulostriate arteries (LSAs) may potentially improve understanding of the pathophysiological mechanisms underlying stroke and may guide the treatment and work-up strategies. Our present study aimed to use a novel whole-brain high-resolution cardiovascular magnetic resonance imaging (WB-HRCMR) to assess both ICAS plaques and LSAs in recent stroke patients. METHODS: Twenty-nine symptomatic and 23 asymptomatic ICAS patients were enrolled in this study from Jan 2015 through Sep 2017 and all patients underwent WB-HRCMR. Intracranial atherosclerotic plaque burden, plaque enhancement volume, plaque enhancement index, as well as the number and length of LSAs were evaluated in two groups. Enhancement index was calculated as follows: ([Signal intensity (SI)plaque/SInormal wall on post-contrast imaging] - [SIplaque/SInormal wall on matched pre-contrast imaging])/(SIplaque / SInormal wall on matched pre-contrast imaging). Logistic regression analysis was used to investigate the independent high risk plaque and LSAs features associated with stroke. RESULTS: Symptomatic ICAS patients exhibited larger enhancement plaque volume (20.70 ± 3.07 mm3 vs. 6.71 ± 1.87 mm3 P = 0.001) and higher enhancement index (0.44 ± 0.08 vs. 0.09 ± 0.06 P = 0.001) compared with the asymptomatic ICAS. The average length of LSAs in symptomatic ICAS (20.95 ± 0.87 mm) was shorter than in asymptomatic ICAS (24.04 ± 0.95 mm) (P = 0.02). Regression analysis showed that the enhancement index (100.43, 95% CI - 4.02-2510.96; P = 0.005) and the average length of LSAs (0.80, 95% CI - 0.65-0.99; P = 0.036) were independent factors for predicting of stroke. CONCLUSION: WB-HRCMR enabled the comprehensive quantitative evaluation of intracranial atherosclerotic lesions and perforating arteries. Symptomatic ICAS had distinct plaque characteristics and shorter LSA length compared with asymptomatic ICAS.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Doenças Assintomáticas , Doença Cerebrovascular dos Gânglios da Base/complicações , Feminino , Humanos , Arteriosclerose Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia
13.
World Neurosurg ; 117: 80-83, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29886303

RESUMO

BACKGROUND: Delayed infarction in the lenticulostriate artery (LSA) area after insular glioma resection is not common, and its pathophysiology remains unknown. CASE DESCRIPTION: A 32-year-old right-handed man with a giant insular low-grade glioma with frontal and temporal extension underwent awake craniotomy with an intentional staged surgery strategy. Preoperative radiologic images demonstrated a diagonally elevated middle cerebral artery (MCA) by the temporal tumor and a significantly compressed striatum. With intraoperative subcortical direct electrical stimulation, the resection was finalized in the temporal part of the tumor due to the semantic paraphasia induced in the temporal stem, fatigue, and loss of concentration. The immediate postoperative clinical course was uneventful. However, on postoperative day 20, he suddenly experienced right hemiparesis. Repeated images revealed infarction in the LSA area. The previously compressed striatum was then relieved and relocated to its original position in just 20 days, and the M1 segment of the MCA was remarkably downward, in which the MCA resembled a hammock. Angiography confirmed the hammock-shaped MCA and significantly stretched LSA, suggesting the combination of freed striatum from the compression and loss of temporal structure by the tumor resection as the key mechanism of severe dislocation of the MCA and delayed ischemia. CONCLUSIONS: In a staged resection of giant insular glioma, attention should be paid to a possible severe dislocation of the MCA in a delayed postoperative period, which may lead to LSA stretching and delayed infarction.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/etiologia , Neoplasias Encefálicas/cirurgia , Doenças Arteriais Cerebrais/etiologia , Glioma/cirurgia , Infarto/etiologia , Complicações Pós-Operatórias , Adulto , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Doenças Arteriais Cerebrais/diagnóstico por imagem , Glioma/diagnóstico por imagem , Humanos , Infarto/diagnóstico por imagem , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Fatores de Tempo
16.
Neuropediatrics ; 49(4): 262-268, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29791933

RESUMO

Basal ganglia infarction in young children, mostly after mild head trauma, has been repeatedly reported. The pathogenesis and the risk factors are not fully understood. Lenticulostriate vasculopathy, usually referred to as basal ganglia calcification, is discussed as one of them. We describe five young (7-13 months old on presentation) male children who suffered from hemiparesis due to ischemic stroke of the basal ganglia, four of them after minor head trauma. All of them had calcification in the basal ganglia visible on computed tomography or cranial ultrasound but not on magnetic resonance imaging. Follow-up care was remarkable for recurrent infarction in three patients. One patient had a second symptomatic stroke on the contralateral side, and two patients showed new asymptomatic infarctions in the contralateral basal ganglia on imaging. In view of the scant literature, this clinic-radiologic entity seems under recognized. We review the published cases and hypothesize that male sex and iron deficiency anemia are risk factors for basal ganglia stroke after minor trauma in the context of basal ganglia calcification in infants. We suggest to perform appropriate targeted neuroimaging in case of infantile basal ganglia stroke, and to consider prophylactic medical treatment, although its value in this context is not proven.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Traumatismos Craniocerebrais/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/terapia , Isquemia Encefálica/terapia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/terapia , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Paresia/diagnóstico por imagem , Paresia/etiologia , Paresia/terapia , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia
17.
Brain Behav ; 8(4): e00946, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29670826

RESUMO

Objectives: The association of branch atherosclerotic disease (BAD) and diabetes mellitus (DM) in the territory of posterior circulation is rarely discussed. Intracranial BAD was divided into two different types: paramedian pontine arteries (PPA) disease (PPD) and lenticulostriate arteries (LSA) disease. The goal of the study was to evaluate the clinical characteristics of PPD and its association with hemoglobinA1c (HbA1c) in China. Materials and Methods: Radiologically confirmed PPD was defined as an isolated unilateral infarction extending to the ventral surface of the pons. Small deep cerebral infarctions are usually caused by two different pathological changes of arteries: BAD and lipohyalinotic degeneration (LD). We compared the vascular risk factors between BAD and LD in PPA territory. A total of 159 stroke patients were analyzed (PPD, n = 75; LD, n = 84). Patients with PPD were also categorized into two groups according to follow-up modified Rankin Scale (FmRS) scores. Logistic regression analyses were used for the evaluation of independent risk factors of PPD and prognosis. Results: Comparison between PPD and LD revealed statistical significance in fasting glucose, HbA1c, estimated glomerular filtration rate (eGFR), and uric acid (p = .011, p = .005, p = .027, p = .018, respectively). Compared with LD, PPD was only related to HbA1c (p = .011) in logistic regression analysis. There were statistically significant differences between the two groups based on the stratification of FmRS scores in fasting glucose, HbA1c, homocysteine, eGFR, and the occurrence of DM. After multivariate analysis, only HbA1c was related with poor prognosis of PPD (p = .002). Conclusions: The subtypes and prognosis of small deep brain infarcts are significantly influenced by elevated HbA1c level in PPA territory. DM might play an important role in the pathogenesis of PPD.


Assuntos
Artéria Basilar/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Diabetes Mellitus/metabolismo , Hemoglobina A Glicada/metabolismo , Arteriosclerose Intracraniana/diagnóstico por imagem , Ponte/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/metabolismo , Glicemia/metabolismo , Infartos do Tronco Encefálico/metabolismo , China , Feminino , Humanos , Arteriosclerose Intracraniana/metabolismo , Modelos Logísticos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte/irrigação sanguínea , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/metabolismo
18.
J Atheroscler Thromb ; 25(10): 1067-1075, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-29503412

RESUMO

AIM: Progress in neuroimaging techniques allows us to investigate the microvasculature characteristics including lenticulostriate arteries (LSA), which are closely associated with lacunar infarction. Because ischemic stroke is a more critical health problem in East Asian than in other populations, in order to clarify pathological changes underlying cerebral small vessel disease (SVD), we projected an imaging analysis of LSA using high-resolution brain magnetic resonance imaging (MRI) in middle-aged Japanese subjects with type 2 diabetes. METHODS: Twenty-five subjects with type 2 diabetes and 25 non-diabetic control subjects underwent 7 Tesla (7 T) brain MRI. The prevalences of SVD and LSA structural changes were determined in each group. RESULTS: SVD prevalence did not differ significantly between the type 2 diabetes and control groups. The average numbers of stems, as well as numbers of branches, of LSA were significantly smaller in diabetic subjects than non-diabetic control subjects. The signal intensity of LSA was markedly decreased, indicating reduced blood flow in type 2 diabetes. CONCLUSION: In spite of the prevalence of SVD being similar, structural changes and decreased signal intensity of LSA were highly detected in diabetic subjects compared with non-diabetic controls, suggesting that 7 T MRA enables us to determine LSA impairment prior to the development of SVD. Early detection of LSA impairment allows us earlier interventions aimed at the prevention of atherosclerotic events.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/patologia , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Doença Cerebrovascular dos Gânglios da Base/etiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
19.
Pediatr Neonatol ; 59(6): 553-560, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29373236

RESUMO

BACKGROUND: Lenticulostriate vasculopathy (LSV) is a hyperechogenicity of the lenticulostriate branches of the basal ganglia and/or thalamus' middle cerebral arteries and is frequently seen in neonatology. Our study primarily describes the perinatal data and long-term follow-up of newborns with lenticulostriate vessel hyperechoic degeneration. Secondly, it describes the cerebral imaging data as a function of perinatal factors and neurodevelopmental follow-up of these newborns. METHODS: This retrospective study assesses the outcome of newborns with LSV hyperechogenicity on cerebral ultrasound (two grades). These children were born between January 2008 and September 2015 and were treated in a large level III neonatal intensive care unit. Thirty-four term-equivalent age children underwent MRIs using a standardized protocol of T2, T1 3D, diffusion and spectro-MRI sequences. The MRIs retrospectively measured the white matter and basal ganglia apparent diffusion coefficients (ADC). RESULTS: Fifty-eight neonates, ranging from 25 to 42 weeks gestational age (GA), were diagnosed with LSV. There was a significantly increased high-grade LSV when accompanied by fetal heart rate abnormalities (p = 0.03) and the neonate's need for respiratory support at birth (P = 0.002). The mean ADC score was substantially superior in the high-grade versus the low-grade LSVs (p = 0.023). There were no noteworthy outcome differences between a high and low grade LSV. The mean ADC for basal ganglions was appreciably higher in children with a severe prognoses (death or developmental disorder) as compared to children with no abnormalities (p < 0.01). CONCLUSION: From the results of our study, it appears that a low-grade LSV could be considered as a normal variant. There are no unifying diagnostic criteria for LSV on cerebral ultrasound. With a cerebral MRI, the use of ADC values of basal ganglia may well underscore the importance of such data in predicting long-term outcomes.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Gânglios da Base/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/complicações , Doença Cerebrovascular dos Gânglios da Base/mortalidade , Pré-Escolar , Deficiências do Desenvolvimento/etiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Gravidez , Estudos Retrospectivos , Ultrassonografia
20.
Pediatr Neurol ; 78: 27-34, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29174857

RESUMO

BACKGROUND: Intracranial arteriopathies are frequent causes of pediatric stroke and important risk factors for stroke recurrence. Without tissue diagnosis, vascular imaging is relied upon to identify the underlying etiology and prognosis. We hypothesized that children with unilateral intracranial arteriopathy with lenticulostriate collaterals would demonstrate distinct vascular outcomes compared with children without collaterals. METHODS: We retrospectively identified children with unilateral intracranial arteriopathy from two institutions. Two blinded raters from each institution reviewed magnetic resonance or digital subtraction angiography at baseline and ≥12 months. Patients were grouped according to presence or absence of lenticulostriate collaterals. Clinical features and vascular imaging outcomes were compared using univariate analysis and multivariate logistic regression. RESULTS: Forty-four children were included: 22 males, median age 8.2 years (range two to 16.9 years), and further stratified into the collateral group (n = 20) and non-collateral group (n = 24), with median follow-up of 25.5 months and 23 months, respectively. Both groups demonstrated similar rates of progression on vascular imaging at ≥12 months, 50% in the collateral group versus 37.5% in the non-collateral group (P > 0.05). The collateral group was associated with asymptomatic clinical presentation, normal brain MRI, border zone infarcts, and either vascular stabilization or new contralateral disease. The non-collateral group demonstrated either vascular improvement or discordant progression (combination of improved and progressive lesions). Using a multivariate model, collaterals continued to be an independent predictor of vascular outcome. CONCLUSIONS: This study suggests that lenticulostriate collaterals in children with unilateral intracranial arteriopathy may serve as a useful neuroimaging biomarker that helps to stratify patients with distinct clinical features and patterns of vascular evolution.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Circulação Colateral/fisiologia , Progressão da Doença , Doenças Arteriais Intracranianas/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adolescente , Doença Cerebrovascular dos Gânglios da Base/complicações , Doença Cerebrovascular dos Gânglios da Base/fisiopatologia , Biomarcadores , Angiografia Cerebral , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Doenças Arteriais Intracranianas/complicações , Doenças Arteriais Intracranianas/fisiopatologia , Masculino , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
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