Carotid web: the challenging diagnosis of an under-recognized entity.

BACKGROUND: Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli. OBJECTIVE: The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events. METHODS: Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021. RESULTS: Nine patients were enrolled. The median age was 55 (43-62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6-68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13-35) months. CONCLUSION: Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.

Treatment of Intracranial Aneurysms With the SILK Embolization Device in a Multicenter Study. A Retrospective Data Analysis.

BACKGROUND: Flow-diverter technology has become an important stent-based embolization tool in the treatment of complex cerebrovascular pathology. We report here the experience of 4 Spanish centers with using the SILK flow-diverter (SFD) device. OBJECTIVE: To evaluate the safety and efficacy of using the SFD in the endovascular treatment of intracranial aneurysms with complex morphology. METHODS: We retrospectively examined a prospectively maintained database of patients treated with SFD devices between July 2008 and December 2013 at 1 of 4 institutions in Spain. Data regarding patient demographics, aneurysm characteristics, and technical procedure were analyzed. Angiographic and clinical findings were recorded during the procedure and at 12 months postoperatively. RESULTS: A total of 175 SFD devices were implanted in 157 patients (women/men: 119/38; mean, median, and range of age: 56.2, 56.7, and 19-80 years, respectively), who were treated in a delayed manner (3-6 months from the event) for 180 aneurysms (165 unruptured and 15 ruptured). Adverse events (acute and delayed) were observed in 28.7% of cases (45/157), and most were resolved (19.1%; 30/157). Six months after the procedure, total morbidity and mortality were 9.6% (15/157) and 3.2% (5/157), respectively. Long-term imaging follow-up showed complete occlusion, neck remnants, and residual aneurysm in 78.1% (100/128), 14.0% (18/128), and 7.8% (10/128) of cases, respectively. CONCLUSIONS: The SFD device is an effective tool for the treatment of challenging aneurysms, and allows complete occlusion within a year of the procedure in most patients, with morbidity and mortality comparable to those previously reported for similar devices.

Malformación arteriovenosa intracraneal múltiple / Multiple intracranial arteriovenous malformation

Las malformaciones arteriovenosas (MAV) cerebrales múltiples son poco frecuentes y la mayoría de las publicaciones existentes presentan casos clínicos aislados. Su incidencia en grandes series de MAV oscila entre el 0,3 y 9%, y en la mayoría de casos aparecen asociadas con otras anomalías vasculares del cerebro u otros tejidos. Presentamos el caso clínico de una mujer de 62 años que sufrió una hemorragia parenquimatosa temporal izquierda y que en los estudios neuro-radiológicos se evidenciaron 3 MAV localizadas en: lóbulo temporal izquierdo, hemisferio cerebeloso izquierdo y lóbulo temporal derecho. Las lesiones fueron tratadas con radiocirugía

Multiple cerebral arteriovenous malformations (AVMs) are thought to be exceedingly rare lesions and have usually been reported as single cases. The incidence of multiple cerebral AVMs in major series ranges from 0.3% to 9% and, in the majority of cases, these malformations are associated with other vascular anomalies of the brain or soft tissues. We report a 62-year-old woman that presented with a left temporal haemorrhage. Angiography showed 3 AVMs located in the left temporal lobe, left cerebellar hemisphere and right temporal lobe. The lesions were treated with radiosurgery

Schwannoma quístico medular / Cystic schwannoma of the spine

No disponible

[Multiple intracranial arteriovenous malformation]. / Malformación arteriovenosa intracraneal múltiple.

Multiple cerebral arteriovenous malformations (AVMs) are thought to be exceedingly rare lesions and have usually been reported as single cases. The incidence of multiple cerebral AVMs in major series ranges from 0.3% to 9% and, in the majority of cases, these malformations are associated with other vascular anomalies of the brain or soft tissues. We report a 62-year-old woman that presented with a left temporal haemorrhage. Angiography showed 3 AVMs located in the left temporal lobe, left cerebellar hemisphere and right temporal lobe. The lesions were treated with radiosurgery.

Compresión medular secundaria a un quiste sinovial cervical / Spinal cord compression secondary to a cervical synovial cyst

No disponible

Tratamiento de rescate en la trombosis aguda del stent intracraneal / Rescue treatment in acute thrombosis of intracranial stents

Introducción. La trombosis aguda intrastent es una complicación potencialmente grave en el stenting intracraneal. Es primordial determinar cuál es la terapia más adecuada en las trombosis intrastent. Caso clínico. Mujer de 58 años, el primer caso de trombosis aguda de un stent intracraneal, que fue tratada con éxito mediante fibrinólisis tras la implantación de un dispositivo diversificador de flujo (Silk) en un aneurisma basilar fusiforme. Conclusión. La administración de abciximab como tratamiento de rescate parece segura en los casos de formaciones de trombos agudos intrastent (AU)

Introduction. Acute intrastent thrombosis is a potentially serious complication in intracranial stenting. It is essential to determine which therapy is the most suitable in intrastent thromboses. Case report. Female aged 58, the first case of acute thrombosis of an intracranial stent to be treated successfully by fibrinolysis after the implantation of a flow diverter device (Silk) in a fusiform basilar aneurysm. Conclusion. The administration of abciximab as a rescue treatment seems safe in cases involving the formation of acute intrastent thrombosis (AU)

[Rescue treatment in acute thrombosis of intracranial stents]. / Tratamiento de rescate en la trombosis aguda del stent intracraneal.

INTRODUCTION: Acute intrastent thrombosis is a potentially serious complication in intracranial stenting. It is essential to determine which therapy is the most suitable in intrastent thromboses. CASE REPORT: Female aged 58, the first case of acute thrombosis of an intracranial stent to be treated successfully by fibrinolysis after the implantation of a flow diverter device (Silk) in a fusiform basilar aneurysm. CONCLUSION: The administration of abciximab as a rescue treatment seems safe in cases involving the formation of acute intrastent thromboses.

TITLE: Tratamiento de rescate en la trombosis aguda del stent intracraneal.Introduccion. La trombosis aguda intrastent es una complicacion potencialmente grave en el stenting intracraneal. Es primordial determinar cual es la terapia mas adecuada en las trombosis intrastent. Caso clinico. Mujer de 58 años, el primer caso de trombosis aguda de un stent intracraneal, que fue tratada con exito mediante fibrinolisis tras la implantacion de un dispositivo diversificador de flujo (Silk) en un aneurisma basilar fusiforme. Conclusion. La administracion de abciximab como tratamiento de rescate parece segura en los casos de formaciones de trombos agudos intrastent.

Using Leo Plus stent as flow diverter and endoluminal remodeling in endovascular treatment of intracranial fusiform aneurysms.

BACKGROUND AND PURPOSE: Treatment of intracranial fusiform aneurysms is complex and controversial, and is associated with high morbidity and mortality rates. The goal of this study was to evaluate the strategy of stent only therapy. MATERIALS AND METHODS: A retrospective analysis of 20 patients with 20 intracranial fusiform aneurysms undergoing endovascular treatment using stent only therapy was undertaken. Feasibility, safety, and angiographic follow-up were evaluated. RESULTS: 28 Leo Plus stents were successfully deployed in 20 patients. No technical difficulties in relation to stent navigation, placement, or detachment from the delivery system were observed. A 6 month, 1 year, and 2 year follow-up angiograms were performed in all patients. 15 aneurysms showed complete occlusion and five partial stable occlusion. During the follow-up period, there was no evidence of in-stent stenoses or occlusion of the incorporated branching vessels. In this study, no patient presented with subarachnoid hemorrhage or died during follow-up. CONCLUSIONS: Stent only therapy in this study proved very useful as a flow diverter for the treatment of intracranial fusiform aneurysms in which parent artery occlusion or stenting-coiling was not feasible.

Síndrome de hipotensión intracraneal espontánea: presentación de dos casos / Spontaneous intracranial hypotension syndrome: two case reports

Introducción. La hipotensión intracraneal espontánea es un cuadro clínico originado por una fístula de líquido cefalorraquídeo en la zona espinal. Se caracteriza por la presencia de cefalea ortostática, a la que se puede asociar un conglomerado de síntomas indicativos de afectación de diferentes estructuras tanto craneales como espinales. Casos clínicos. Presentamos los casos de dos varones jóvenes que comenzaron con cefalea ortostática. En las pruebas de imagen se observaron, además, colecciones líquidas extraaxiales intracraneales con un realce paquimeníngeo intenso. En ambos casos se diagnosticó fístula de líquido cefalorraquídeo en la región dorsal y los pacientes fueron tratados satisfactoriamente mediante el empleo de un parche hemático. Conclusiones. La hipotensión intracraneal espontánea no es una patología infrecuente. Habitualmente presenta problemas diagnósticos debido a la diversidad sintomatológica que puede exhibir. La resonancia magnética es fundamental para el diagnóstico al mostrar un realce paquimeníngeo, y para evidenciar la fuga de líquido cefalorraquídeo son útiles la resonancia magnética espinal, la mielografía asistida por tomografía computarizada o la cisternogammagrafía. Si falla el tratamiento conservador, el parche hemático consigue buenos resultados. Se recurre a la cirugía como última opción (AU)

Introduction. Spontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid leaks and is known for causing orthostatic headaches, and a wide variety of associated symptoms have been reported. Case reports. We described two cases with spontaneous intracranial hypotension, treated in a short period of time, who presented with orthostatic headache and the neuroimaging studies showed subdural collections. Both patients were diagnosed of spinal cerebrospinal fluid leaks and treated with blood patches. Conclusions. Although intracranial hypotension is not an uncommon pathology, it usually presents diagnostic problems due to the diversity of symptoms that can occur. MRI is essential for the diagnosis by showing enhancement of the pachymeninges following administration of gadolinium and to prove the cerebrospinal fluid leak are useful spinal MRI, the computerized tomography myelography and the radionuclide cisternography. If conservative treatment falls, the epidural blood patch is the initial treatment of choice, reserving surgery for patients with persistent symptoms (AU)

[Spontaneous intracranial hypotension syndrome: two case reports]. / Sindrome de hipotension intracraneal espontanea: presentacion de dos casos.

INTRODUCTION. Spontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid leaks and is known for causing orthostatic headaches, and a wide variety of associated symptoms have been reported. CASE REPORTS. We described two cases with spontaneous intracranial hypotension, treated in a short period of time, who presented with orthostatic headache and the neuroimaging studies showed subdural collections. Both patients were diagnosed of spinal cerebrospinal fluid leaks and treated with blood patches. CONCLUSIONS. Although intracranial hypotension is not an uncommon pathology, it usually presents diagnostic problems due to the diversity of symptoms that can occur. MRI is essential for the diagnosis by showing enhancement of the pachymeninges following administration of gadolinium and to prove the cerebrospinal fluid leak are useful spinal MRI, the computerized tomography myelography and the radionuclide cisternography. If conservative treatment falls, the epidural blood patch is the initial treatment of choice, reserving surgery for patients with persistent symptoms.

Early biomarkers of clinical-diffusion mismatch in acute ischemic stroke.

BACKGROUND AND PURPOSE: Clinical-diffusion mismatch (CDM; National Institutes of Health Stroke Scale score≥8 and diffusion-weighted imaging lesion volume<25 mL) has been suggested as a surrogate of ischemic brain at risk of infarction and might be used to recognize salvageable ischemic tissue. Our aim was to identify early biomarkers associated with the presence of CDM. METHODS: We prospectively evaluated CDM in 226 patients (71.6±11.1 years, 58% men) with hemispheric ischemic stroke within 12 hours from symptom onset (median, 3.6 hours). Diffusion-weighted MRI lesion volume was measured by manual segmentation method. Serum levels of glutamate, aspartate, interleukin-10, tumor necrosis factor-α, interleukin-6, S100ß, neuron-specific enolase, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, active matrix metalloproteinase-9, and cellular fibronectin were determined by immunoassay or high-performance liquid chromatography techniques in blood samples obtained at admission. RESULTS: CDM was found in 61 patients (26.9%). Patients with CDM had higher serum levels of interleukin-10, tumor necrosis factor-α, and glutamate and lower serum levels of neuron-specific enolase, interleukin-6, and active matrix metalloproteinase-9 (all P<0.0001). Binary logistic regression showed that tumor necrosis factor-α≥21 pg/mL (OR, 21), glutamate≥230 µmol/L (OR, 27), neuron-specific enolase≥23 ng/mL (OR, 0.05), interleukin-6≥10 pg/mL (OR, 0.06), and active matrix metalloproteinase-9≥21 ng/mL (OR, 0.28) were independent molecular predictors of CDM after adjustment for covariates. The association of interleukin-10≥23 pg/mL and glutamate≥230 µmol/L levels predicted CDM with a sensitivity of 96% and a specificity of 98%. CONCLUSIONS: High levels of interleukin-10, tumor necrosis factor-α, and glutamate as well as low levels of neuron-specific enolase, interleukin-6, and active matrix metalloproteinase-9 are associated with CDM.