Flow Diverter Stents in the Treatment of Cerebral Aneurysms Less than 5 mm.

AIM: To evaluate the safety and efficacy of flow diverter (FD) stents in the treatment of intracranial aneurysms less than 5 mm. MATERIAL AND METHODS: We treated 66 aneurysms in 43 patients with aneurysms less than 5 mm. Of the patients, 29 were females and 14 males (mean age: 50.2 years). Headache was the most frequent symptom. In 8 patients, the aneurysms were recanalized and these had been treated with coils or stent-assisted coiling. All aneurysms were in the anterior circulation. In the treatment, one of the SILK, Pipeline, Derivo or FRED FD stents was used for each patient. Neurointerventional stent medication (double antiplatelet) was used. All patients were investigated for new ischemic lesions with diffusion-weighted imaging one day later. The first follow-up angiogram was planned 3-6 months later. RESULTS: The treatment was technically successful in all patients. Minor complications occurred in 3 patients (7%). In one patient, thrombus inside the SILK was seen and was relieved with tirofiban. The second patient bled from the right common femoral artery entrance, which was operated on. In the third patient, the complication was technical. All patients were discharged without any neurological deficit. The mean follow-up period was 26 (6-52) months. Of the aneurysms, 64 (97.0%) were completely closed. CONCLUSION: The FD treatment of cerebral, anterior circulation small aneurysms less than 5 mm is effective and safe.

Anterior cerebral artery infarcts; two years follow-up study.

BACKGROUND AND PURPOSE: Anterior cerebral infarct (ACA) infarcts are reported very rare that is due to the compensatory collateral circulation provided by the anterior communicating artery. There are very few studies reporting the long-term follow-up results of ACA infarcts regarding their aetiology, clinical features and prognosis. Most studies reported in the literature vary between several months to one year. METHODS: A total of 27 patients with ACA infarcts were registered (14 women and 13 men). The mean age of the patients was 68.5 (age range: 45-89 years). RESULTS: Bilateral ACA infarcts were reported in four patients (14.8%), right ACA infarct in 11 (40%) patients and left ACA infarct in 12 patients (44%). During the initial examination 15 patients (55.5%) were found to have apathy, 13 patients (48%) had incontinence, nine patients (33.3%) had primitive reflexes, 11 patients (40.7%) had aphasia, while six patients (22.2%) were found to suffer from neglect. At the end of one-year follow-up, five patients (22.7%) were reported to have apathy, 6 patients (27.2%) had incontinence, one patient (4.5%) had primitive reflexes, while one patient (4.5%) was found to have permanent aphasia, and no patients was found to suffer from neglect. CONCLUSION: Here we present our clinical data regarding the aetiology, specific clinical characteristics (including the speech disorders) and prognosis of 27 patients with ACA infarcts during a relatively longer follow-up period (3 months - 30 months) in compared to previous literature. We show that there are differences in the etiological factors of ACA infarcts between the Asian and European communities. Regarding speech disorders which are frequently reported during ACA infarcts, our study results are in agreement with other studies suggesting that this clinical picture is more than a real aphasia and associated with general hypokinesia and reduction in psychomotor activity.

Beyond The Therapeutic Effect of rTMS in Alzheimer's Disease: A Possible Neuroprotective Role of Hippocampal BDNF? : A Minireview.

Repetitive transcranial magnetic stimulation (rTMS) is a well known non-invasive brain stimulation procedure which is capable of inducing the expression of the hippocampal BDNF that has been already shown to exert significant neuroprotective and pro-cognitive effects in AD. However, it is nearly impossible directly to evaluate the BDNF expression in humans after rTMS application. Here we summarized the underlying mechanisms of the neuroprotective and procognitive effect of BDNF that can be induced through a region-specific rTMS approach. Additionally, we have also evaluated the role of Magnetic Resonance Spectroscopy in monitoring the BDNF response after rTMS application in Alzheimer's Disease. We have provided strong evidence that rTMS exerts significant neuroprotective and pro-cognitive effects through the expression of hippocampal BDNF. Furthermore, Magnetic Resonance Spectroscopy might play a critical role in monitoring the BDNF response after rTMS application in AD patients. Such a sophisticated approach might be able to enlighten us on the time-dependent cognitive and neuroprotective correlates of the rtMS application in AD patients.

18F-FDG-PET Correlates of Impulse Control Disorder in a Diabetic Patient.

BACKGROUND: Studies have already shown that hyperglycemia and insulin resistance are significantly associated with the impairment of cerebral glucose metabolism that may secondary lead to cognitive disturbances. In this study, we aimed to evaluate the neurometabolic correlates of diabetes in a patient with Intermittent explosive disorder (IED). METHODS: We have investigated the cerebral glucose metabolism via 2-[18F]-fluoro-2- deoxy-D-glucose positron emission tomography (FDG-PET) in a diabetic patient with aggressive outbursts. RESULTS: We have found significantly reduced glucose uptake in left temporoparietal region, pontin area, and left nucleus lentiformis. DISCUSSION: Our present results indicate decreased cerebral glucose metabolism in specific cerebral cortical and subcortical areas. The main limitation of this report is that, this is a single case study and that these findings need to be replicated in well- conducted randomized controlled studies by using additional neuroquantitative methods.