Cerebral venous sinus thrombosis presenting as transient ischemic attacks: A case report.

Cerebral sinus venous thrombosis (CSVT) is a rare form of venous thromboembolism. Recurrent transient ischemic attacks were extremely rare clinical manifestation of CSVT. We reported a case of transient ischemic attack as an exceptionally rare form of CSVT. A 29-year-old woman presented with a headache and four episodes of a transient right limb weakness, numbness, and dysphasia lasting approximately 15 mins over the course of 2 weeks. Magnetic resonance venography revealed a superior sagittal sinus thrombosis with numerous prominent enlarged and dilated venous. Magnetic resonance imaging revealed venous infarction of the left frontal lobe. Transient ischemic attack-like episodes stopped with anticoagulation. We suggested that the patients with transient ischemic attack and symptoms of increased intracranial pressure should be carefully investigated in terms of CSVT.

Perfusion deficits in thrombolysis-treated acute ischemic stroke patients with negative or positive diffusion-weighted imaging.

OBJECTIVE: Magnetic resonance imaging (MRI) and CT perfusion may provide diagnostic information for intravenous tissue-type plasminogen activator (IV t-PA) administration in acute ischemic stroke (AIS) patients. We aimed to compare the clinical features and perfusion deficits of diffusion weighted imaging (DWI)-negative and DWI-positive AIS patients. METHODS: This retrospective and observational study included thrombolysis-treated AIS patients undergoing multimodel CT imaging before treatment and DWI after treatment between 2021 and 2022. Two experienced neuroradiologists blindly and independently examined the images to identify perfusion deficits in AIS patients. The patients were divided into DWI-positive and DWI-negative groups based on visible hyperintense lesions on DWI. A modified Rankin scale (mRS) score of ≤ 2 indicated good functional outcomes at discharge. Sensitivity analysis was conducted to determine whether CT perfusion was an independent predictor of positive DWI imaging on follow-up. RESULTS: This study included 151 patients, of whom 35 (23.2%) patients were DWI-negative on follow-up. These DWI-negative patients were less likely to have a medical history of atrial fibrillation; they had lower triglyceride levels, a shorter admission time, lower National Institutes of Health Stroke Scale (NIHSS) scores after IV t-PA and lower mRS scores at discharge, and had better functional outcomes. A total of 37.1% of DWI-positive and 25.7% of DWI-negative patients had vascular stenosis (P = 0.215). A total of 47.4% of DWI-positive and 37.1% of DWI-negative patients had CT perfusion deficits (P = 0.284). A total of 73.5% of patients with normal CT perfusion had positive DWI, while 19.1% of patients with perfusion deficits had negative DWI. The sensitivity and specificity of NCCT were 14.8% and 97.1% (Kappa = 0.061, P = 0.074), CTP was 47.4% and 62.9% for predicting DWI lesion (Kappa = 0.069, P = 0.284). CONCLUSIONS: About 23.2% of AIS patients who received intravenous thrombolysis treatment did not have a relevant DWI-MRI lesion on follow-up. Over one-third of patients in the DWI-MRI negative group showed CT perfusion deficits, with a sensitivity of 47.4% for predicting DWI lesions in non-mechanical thrombectomy patients.

Perfusion Deficits in Different Mechanisms of Two Subtypes of Acute Stroke with Diffusion MRI Confirmation.

BACKGROUND: Branch atheromatous disease (BAD) and lacunar infract (LI) are the different mechanisms of subtypes of acute stroke. We aimed to investigate perfusion deficits and clinical characteristics of the different mechanisms of two subtypes of acute stroke. MATERIALS AND METHODS: Five hundred and ninety-nine CTP examinations were retrospectively reviewed between January and December 2021 in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Based on diffusion MRI, the patients were assigned to one of two subtypes: BAD and LI. Lesion volumes were measured on NCCT, CTA, CBV, CBF, MTT, and TTP maps by region-of-interest analysis and were confirmed by follow-up MRI. RESULTS: One hundred thirty-three patients met the inclusion criteria (26.3% female). The BAD group was present in 104 of 133 (78.2%), and the LI group 29 of 133 (21.8%). Based on CT perfusion, 42 of 78 (53.8%) BAD group and 5 of 18 (27.8%) LI group had perfusion deficits in the supratentorial region. BAD had a higher proportion of abnormal perfusion than LI patients, with a significant difference (P < 0.05). The sensitivity of CTP ranged from 21.4% (CBV) to 90.5% (TTP); specificity ranged from 97.2% (TTP) to 100% (CBV, CBF, and MTT) in BAD patients. CONCLUSION: CTP has high specificity in identifying BAD. Compromised perfusion deficits are more presented in BAD patients compared with LI. CT perfusion imaging may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.

Risk factors related balance disorder for patients with dizziness/vertigo.

BACKGROUND: When dizziness/vertigo patients presented with balance disorder, it will bring severe morbidity. There is currently lack of research to explore risk factor related balance disorder in dizziness patients, especially in those who walk independently. AIM: To investigate risk factors related balance disorder in dizziness/vertigo patients who walk independently. METHODS: Medical data of 1002 dizziness/vertigo patients registered in vertigo/balance disorder registration database were reviewed. The demographic data, medical history, and risk factors for atherosclerosis (AS) were collected. Enrolled dizziness/vertigo patients could walk independently, completed Romberg test, videonystagmography (VNG), and limits of stability (LOS). The subjective imbalance was patient complained of postural symptom when performing Romberg test. Multivariable logistic regression analyzed risk factors related balance disorder. The receiver operating characteristic (ROC) curve evaluated the utility of regression model. RESULTS: Five hundred fifty-three dizziness/vertigo patients who walk independently were included in the final analysis. According to LOS, patients were divided into 334 (60%) normal balance and 219 (40%) balance disorder. Compared with normal balance, patients with balance disorder were older (P = 0.045) and had more risk factors for AS (P<0.0001). The regression showed that risk factors for AS (OR 1.494, 95% CI 1.198-1.863), subjective imbalance (OR 4.835, 95% CI 3.047-7.673), and abnormality of optokinetic nystagmus (OR 8.308, 95% CI 1.576-43.789) were related to balance disorder. The sensitivity and specificity of model were 71 and 63% (P<0.0001). The area under the curve (AUC) was 0.721. CONCLUSIONS: Risk factors for AS, subjective imbalance, and abnormality of optokinetic nystagmus were predictors for balance disorder in patients with dizziness/vertigo who walk independently.

Detection of Carotid Webs by CT Angiography, High-Resolution MRI, and Ultrasound.

BACKGROUND AND PURPOSE: We sought to examine carotid webs (intimal variant fibromuscular dysplasia) by studying their clinical features and imaging profiles. METHODS: All patients (n = 893) of the Department of Neurology at Beijing Tiantan Hospital between January and December 2019 were retrospectively reviewed for computed tomography angiography (CTA), high-resolution magnetic resonance imaging (HRMRI), and Doppler ultrasound data. Carotid webs were identified by two experienced neuroimaging experts according to the characteristics of a thin intraluminal filling defect along the posterior wall of the carotid bulb on sagittal CTA and a septum structure in arteries on axial CTA. RESULTS: We found eight carotid web patients by CTA and Doppler ultrasound. Four of eight (50%) carotid webs were observed in the bilateral carotid arteries and other four of eight (50%) were ipsilateral. The mean age of the 8 patients was 50.75 (range 38-65) years; two were in women. Six of 8 patients (75%) with carotid webs had acute ischemic stroke. Two-thirds of patients with ischemic stroke were treated with carotid revascularization. Doppler ultrasound indicated that the septum projected into the carotid arteries in all patients. Half of the carotid web patients underwent HRMRI, showing features consistent with CTA findings. The Cohen's kappa coefficient for interobserver agreement in diagnosing carotid webs was .76. CONCLUSIONS: Doppler ultrasound combined with CTA and HRMRI is effective and reliable method to identifying carotid webs, which may be associated with stroke.

Dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo and vestibular migraine.

ABSTRACT: To investigate the dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM).A prospective cohort study in which patients came from the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University was conducted. Patients were diagnosed with BPPV and VM from September 2016 to December 2017. Dizziness handicap inventory (DHI) scale and hospital anxiety and depression scale (HADS) were assessed among subjects before treatment and 3 months follow-up.We used the Mann-Whitney U test to compare the DHI and HADS scores of BPPV and VM patients before and after 3 months and found significantly statistical difference. Before treatment, the median DHI scores of BPPV and VM were 34 and 60, with a Z = -5.643 (P = .001); The median HADS scores were 6 and 14, with Z = -4.807 (P = .001). After 3 months follow-up, the median DHI scores of BPPV and VM were 0 and 22, with a Z = -8.425 (P = .001); The median HADS scores were 6 and 14, with Z = -7.126 (P = .001) 51.11% VM patients and 12.21% BPPV patients have anxiety and depression. A Spearman correlation revealed a significantly moderate positive correlation (r = .455, P < .001) between DHI and HADS scores.The emotional, functional and physical effects of vertigo on VM patients were more significant than BPPV patients. The change of DHI scores in BPPV and VM patients was positively correlated with changes in the anxiety and depression in the HADS.