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2.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33542025

RESUMEN

Horner's syndrome results from interruption of the sympathetic innervation to the eye. This interruption may occur at three anatomical levels along the sympathetic trunk pathway. There are numerous causes of Horner's syndrome, including injury to the carotid artery, of which arterial dissection is the commonest pathology. Occlusive carotid disease secondary to atherosclerosis is a relatively rare cause of Horner's syndrome. We describe a patient with Horner's syndrome due to complete occlusion of the ipsilateral internal carotid artery.


Asunto(s)
Arteria Carótida Interna/patología , Trastornos Cerebrovasculares , Síndrome de Horner/diagnóstico , Accidente Cerebrovascular/diagnóstico por imagen , Afasia/etiología , Angiografía por Tomografía Computarizada , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/etiología , Parestesia/etiología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico
3.
Zhonghua Yi Xue Za Zhi ; 101(1): 62-67, 2021 Jan 05.
Artículo en Chino | MEDLINE | ID: mdl-33423447

RESUMEN

Objective: To explore the relationship between the total cerebral small vessel disease (CSVD) score and retinal vessel diameters in patients with mild stroke. Methods: The patients with mild stroke who were hospitalized in the Second People's Hospital of Changzhou, Nanjing Medical University from March to December 2019 were continuously collected (National Institutes of Health Stroke Scale score≤3 points). All patients completed the head magnetic resonance imaging and retinal fundus photography examination, and then the retinal arteriovenous diameter was measured semi-automatically based on the pictures. According to the total CSVD score (0-4 points), the patients were divided into 5 groups. The baseline characteristics of the patients were compared. Moreover, the correlation of total CSVD with retinal blood vessel diameters were analyzed by spearman and linear regression. Results: A total of 206 patients were enrolled. There were 69, 51, 41, 30, and 15 patients with 0, 1, 2, 3, and 4 points, respectively. In CSVD subgroups, there were significant differences in age, duration of hypertension and diabetes (all P<0.05). The central retinal artery equivalent (CRAE), (CSVD scores 0-4 were (126±12) µm, (118±11) µm, (108±11) µm, (99±8) µm, (90±7) µm, P<0.001) and arteriole-to-venule ratio (AVR) (CSVD scores 0-4 were 0.65±0.05, 0.60±0.04, 0.56±0.04, 0.49±0.03, 0.44±0.02, P<0.001) were different in CSVD subgroups. With the increase of CSVD score, the diameter of artery and AVR became smaller. The total CSVD was significantly correlated with AVR by Spearman correlation analysis (r= 0.818, P<0.001). By constructing a linear regression equation model, the coefficient of determination of the total CSVD score (R2=0.694) was higher than that of lacunes, white matter hyperintensities, cerebral microbleeds and enlarged perivascular space. After adjusting for age, course of hypertension and diabetes, and different types of CSVD, further multiple linear regression analysis revealed that the total CSVD score was still an independent related factor of AVR (ß=-0.039, P<0.001, 95%CI=-0.051--0.028). Conclusions: Total CSVD score is negatively correlated with retinal artery diameters and AVR. Additionally, the total CSVD score can better reflect the degree of cerebral microvascular lesions than single type CSVD.


Asunto(s)
Enfermedades de los Pequeños Vasos Cerebrales , Hipertensión , Accidente Cerebrovascular , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Vasos Retinianos/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen
4.
Quintessence Int ; 0(0): 348-359, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33491393

RESUMEN

Objective: Calcified carotid artery atheroma (CCAA) detected by panoramic radiographs has been suggested as an accurate biomarker for cerebrovascular accidents (CVAs). However, there has not been agreement on the relationship between CCAA and risk for stroke or other CVA. Method and materials: The question asked was, "Are patients with CCAA detected on panoramic radiographs more likely to get a stroke or CVA in the future compared to those who do not have CCAA and, further, would Doppler ultrasonography of the neck obtained secondary to panoramic radiography in suspected individuals add value to this association with stroke or CVA?" This meta-analysis was conducted by searching PubMed, Ovid Medline, Dentistry & Oral Sciences Source, CINAHL, Web of Science, Google Scholar, and ClinicalTrials.gov. Six studies that met the inclusion criteria were included in the final analysis; three used panoramic radiography and the rest used panoramic radiography and ultrasonography. Multiple random effect meta-analyses were conducted using RevMan 5.2 software. Conclusion: Evidence from this meta-analysis shows that although detection of CCAA via panoramic radiography to predict risk for stroke may be comparable to Doppler ultrasonography, risk prediction is somewhat more significant when diagnostic confirmation is made using Doppler ultrasonography than panoramic radiography alone. Clinical implications: Because stroke risk assessment is complicated and comprises many additional systemic factors beyond calcification of the carotid artery, CVA prediction is more reliable when Doppler ultrasonography is used after panoramic radiography. Managing hypertension, diabetes, and smoking habit are far more important in risk management of patients with CCAA detection on panoramic radiography.


Asunto(s)
Placa Aterosclerótica , Accidente Cerebrovascular , Biomarcadores , Arterias Carótidas , Humanos , Placa Aterosclerótica/diagnóstico por imagen , Radiografía Panorámica , Medición de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Ultrasonografía , Ultrasonografía Doppler
5.
Nervenarzt ; 92(2): 107-114, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33481058

RESUMEN

BACKGROUND: Endovascular procedures are paramount in the treatment of cerebrovascular diseases, e.g. thrombectomy for stroke. The continuous further development of the devices used for these procedures (e.g. catheters and stents) requires permanent learning by the treating physician. OBJECTIVE: Technical support options for new neuroendovascular procedures. METHODS: Integration of streaming technologies into the training concept for neuroradiologists. RESULTS: The transmission of angiographic images to a remote computer workstation in real time is possible independent of location by means of specific streaming technology. This approach enables a neuroendovascular specialist to advise geographically distant interventionalists when performing catheter interventions of the brain, to oversee the handling of the materials used and to instruct them if necessary (remote proctoring). CONCLUSION: Especially during emergency interventions and during travel restrictions, patient safety can be increased by connecting to another neuroendovascular specialist via live streaming.


Asunto(s)
Procedimientos Endovasculares , Accidente Cerebrovascular , Humanos , Stents , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Trombectomía
7.
Clin Nucl Med ; 46(3): e171-e172, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33443953

RESUMEN

ABSTRACT: A 50-year-old man with angioimmunoblastic T-cell lymphoma in complete response to treatment presented new hypermetabolic brain lesions on 18F-FDG PET/CT suggestive of malignancy. These findings were correlated by MRI that showed cortical-subcortical peripheral lesions typical of acute ischemic infarction. A restaging 18F-FDG PET/CT showed that hypermetabolic lesions were replaced by ametabolic areas, supporting chronic infarction. Early ischemia presents transitory FDG increase. Brain lymphomas are highly FDG avid and difficult to differentiate from acute cerebral infarction. In view of the discordance of abnormal areas of intracranial uptake on PET FDG, MRI confirmation is required to avoid misinterpretation.


Asunto(s)
Fluorodesoxiglucosa F18 , Trastornos Linfoproliferativos/complicaciones , Imagen por Resonancia Magnética , Tomografía Computarizada por Tomografía de Emisión de Positrones , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Diagnóstico Diferencial , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/patología
9.
Neurosci Lett ; 743: 135564, 2021 01 19.
Artículo en Inglés | MEDLINE | ID: mdl-33352277

RESUMEN

Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of the Coronavirus disease-2019 (COVID-19). Accumulating data on patients with COVID-19-associated stroke have shed light on specificities concerning clinical presentation, neuroimaging findings, and outcome. Such specificities include a propensity towards large vessel occlusion, multi-territory stroke, and involvement of otherwise uncommonly affected vessels. Conversely, small-vessel brain disease, cerebral venous thrombosis, and intracerebral hemorrhage appear to be less frequent. Atypical neurovascular presentations were also described, ranging from bilateral carotid artery dissection to posterior reversible encephalopathy syndrome (PRES), and vasculitis. Cases presenting with encephalopathy or encephalitis with seizures heralding stroke were particularly challenging. The pathogenesis and optimal management of ischemic stroke associated with COVID-19 still remain uncertain, but emerging evidence suggest that cytokine storm-triggered coagulopathy and endotheliopathy represent possible targetable mechanisms. Some specific management issues in this population include the difficulty in identifying clinical signs of stroke in critically ill patients in the intensive care unit, as well as the need for a protected pathway for brain imaging, intravenous thrombolysis, and mechanical thrombectomy, keeping in mind that "time is brain" also for COVID-19 patients. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of stroke in patients with COVID-19, and delineate the principles for a rational approach toward precision medicine in this emerging field.


Asunto(s)
/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/patología , Accidente Cerebrovascular/virología , Humanos
10.
Vasc Endovascular Surg ; 55(1): 77-80, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32869715

RESUMEN

We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.


Asunto(s)
Angioplastia de Balón , Accidente Cerebrovascular/terapia , Trombectomía , Tiempo de Tratamiento , Insuficiencia Vertebrobasilar/cirugía , Anciano , Humanos , Masculino , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/fisiopatología
11.
Clin Imaging ; 69: 75-78, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32683139

RESUMEN

Acute stroke patients transferred to thrombectomy capable centers (TCC), undergo a CT head exam upon arrival at the TCC to evaluate for ASPECTS decay and intracranial hemorrhage. In patients who received iodinated contrast prior to transfer, parenchymal enhancement may simulate hemorrhage on this post-transfer CT. We report two cases utilizing CT spectral imaging to differentiate between parenchymal contrast enhancement and hemorrhage in this setting. TCC may consider dual-energy or dual-layer (spectral) imaging for this patient cohort.


Asunto(s)
Hemorragia Cerebral , Accidente Cerebrovascular , Hemorragia Cerebral/diagnóstico por imagen , Medios de Contraste , Humanos , Accidente Cerebrovascular/diagnóstico por imagen , Trombectomía , Tomografía Computarizada por Rayos X
12.
Clin Imaging ; 69: 246-254, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32980785

RESUMEN

Artificial intelligence (AI) is a fast-growing research area in computer science that aims to mimic cognitive processes through a number of techniques. Supervised machine learning, a subfield of AI, includes methods that can identify patterns in high-dimensional data using labeled 'ground truth' data and apply these learnt patterns to analyze, interpret, or make predictions on new datasets. Supervised machine learning has become a significant area of interest within the medical community. Radiology and neuroradiology in particular are especially well suited for application of machine learning due to the vast amount of data that is generated. One devastating disease for which neuroimaging plays a significant role in the clinical management is stroke. Within this context, AI techniques can play pivotal roles for image-based diagnosis and management of stroke. This overview focuses on the recent advances of artificial intelligence methods - particularly supervised machine learning and deep learning - with respect to workflow, image acquisition and reconstruction, and image interpretation in patients with acute stroke, while also discussing potential pitfalls and future applications.


Asunto(s)
Radiología , Accidente Cerebrovascular , Inteligencia Artificial , Predicción , Humanos , Aprendizaje Automático , Accidente Cerebrovascular/diagnóstico por imagen
13.
Arq Neuropsiquiatr ; 78(12): 757-761, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33331512

RESUMEN

BACKGROUND: The rapid evaluation of non-contrast-enhanced computed tomography (NCCT) brain scans in patients with anterior stroke symptoms saves time and favors optimal and prompt treatment. e-ASPECTS is a tool that automatically calculates the Alberta Stroke Program Early CT Score (ASPECTS) values, leading to a more accurate and timely image evaluation. OBJECTIVE: To determine the ability of e-ASPECTS in differentiating images with and without injury. METHODS: One-hundred sixteen patients admitted to a stroke unit in a Brazilian tertiary hospital underwent a CT scan at admission and at least one control brain imaging (NCCT or magnetic resonance imaging - MRI) 24 hours after admission. ASPECTS evaluation was performed by three neuroradiologists, three neurologists, and three neurology residents, all blinded to the symptoms and the injury side. The scores were compared to the ground truth, and an ASPECTS score was provided by two independent non blinded evaluators. Sensitivity and specificity were analyzed, and receiver operating characteristic curves, Bland-Altman plots with mean error score, and Matthews correlation coefficients (MCCs) were obtained for ASPECTS scores, assuming values equal to 10 for images without injury and values other than 10 for images with ischemic injury. RESULTS: e-ASPECTS demonstrated similar performance to that of neuroradiologists and neurologists, with an area under the curve of 0.78 and an MCC value of 0.48 in the dichotomous analysis. The sensitivity and specificity of e-ASPECTS were 75% and 73%, respectively. CONCLUSION: e-ASPECTS is a validated and reliable tool for determining early signs of ischemia in NCCT.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Alberta , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/terapia , Brasil , Humanos , Especialización , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia
14.
Proc Natl Acad Sci U S A ; 117(52): 33578-33585, 2020 12 29.
Artículo en Inglés | MEDLINE | ID: mdl-33318200

RESUMEN

Stroke patients with small central nervous system infarcts often demonstrate an acute dysexecutive syndrome characterized by difficulty with attention, concentration, and processing speed, independent of lesion size or location. We use magnetoencephalography (MEG) to show that disruption of network dynamics may be responsible. Nine patients with recent minor strokes and eight age-similar controls underwent cognitive screening using the Montreal cognitive assessment (MoCA) and MEG to evaluate differences in cerebral activation patterns. During MEG, subjects participated in a visual picture-word matching task. Task complexity was increased as testing progressed. Cluster-based permutation tests determined differences in activation patterns within the visual cortex, fusiform gyrus, and lateral temporal lobe. At visit 1, MoCA scores were significantly lower for patients than controls (median [interquartile range] = 26.0 [4] versus 29.5 [3], P = 0.005), and patient reaction times were increased. The amplitude of activation was significantly lower after infarct and demonstrated a pattern of temporal dispersion independent of stroke location. Differences were prominent in the fusiform gyrus and lateral temporal lobe. The pattern suggests that distributed network dysfunction may be responsible. Additionally, controls were able to modulate their cerebral activity based on task difficulty. In contrast, stroke patients exhibited the same low-amplitude response to all stimuli. Group differences remained, to a lesser degree, 6 mo later; while MoCA scores and reaction times improved for patients. This study suggests that function is a globally distributed property beyond area-specific functionality and illustrates the need for longer-term follow-up studies to determine whether abnormal activation patterns ultimately resolve or another mechanism underlies continued recovery.


Asunto(s)
Red Nerviosa/fisiopatología , Accidente Cerebrovascular/fisiopatología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Conducta , Mapeo Encefálico , Femenino , Humanos , Imagen por Resonancia Magnética , Magnetoencefalografía , Masculino , Persona de Mediana Edad , Red Nerviosa/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Síndrome , Análisis y Desempeño de Tareas , Factores de Tiempo , Adulto Joven
15.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-33318267

RESUMEN

A 75-year-old female patient presented with signs and symptoms of a right hemispheric syndrome. A CT scan of the brain with angiogram showed an acute infarct in the right middle cerebral artery (MCA) territory secondary to thromb-occlusion of the M1 segment of the right MCA. A follow-up CT scan 2 weeks later showed a large hyperdense region in the infarcted area. With the aid of a dual-energy CT scan, this was eventually shown to be due to contrast staining from an earlier administration of iodinated contrast on the same day, rather than frank haemorrhagic conversion of the recent right MCA infarct.


Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Medios de Contraste , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Yodo
16.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-33318278

RESUMEN

A 66-year-old woman with a remote history of breast cancer and prior tobacco use presented to the hospital with chest pain. She was found to have an elevated troponin consistent with a diagnosis of a non-ST segment elevation myocardial infarction (NSTEMI). A left heart catheterisation revealed non-obstructive coronary disease, and subsequent transthoracic and transoesophageal echocardiograms demonstrated vegetations on both the mitral and aortic valves. Multiple blood cultures showed no growth raising suspicion for non-bacterial thrombotic endocarditis (NBTE). A CT of the chest, abdomen and pelvis was obtained that was consistent with metastatic pancreatic cancer. Her hospital course was complicated by recurrent embolic strokes leading to a rapid clinical deterioration. As a result, she was transitioned to comfort measures and passed away shortly thereafter. To our knowledge, this is the first reported case of an NSTEMI as the initial presentation of NBTE due to underlying malignancy.


Asunto(s)
Neoplasias de la Mama/complicaciones , Endocarditis no Infecciosa/etiología , Infarto del Miocardio sin Elevación del ST/etiología , Neoplasias Pancreáticas/secundario , Accidente Cerebrovascular/etiología , Anciano , Válvula Aórtica/patología , Neoplasias de la Mama/patología , Dolor en el Pecho/etiología , Ecocardiografía Transesofágica , Endocarditis no Infecciosa/diagnóstico , Resultado Fatal , Femenino , Humanos , Válvula Mitral/patología , Infarto del Miocardio sin Elevación del ST/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Troponina/sangre
18.
Medicine (Baltimore) ; 99(45): e23071, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157968

RESUMEN

INTRODUCTION: Japanese encephalitis (JE) is one of the most serious viral infectious diseases of the central nervous system in Asia. The clinical manifestations of it might be non-specific. We herein report a case of JE mimicking acute ischemic stroke. PATIENT CONCERNS: A 52-year-old man presented with acute onset of left-sided limb weakness for 2 hours and a 5-year history of hypertension but with no fever or cold before the onset. Immediate cranial computed tomography scan showed small ischemic foci. DIAGNOSIS: Initial diagnosis revealed acute cerebral infarction as the symptoms mimicked stroke at onset. Furthermore, his symptoms progressed and magnetic resonance scan after 6 days of onset appeared negative on diffusion weighted imaging. Other etiologies were also then considered. Japanese encephalitis virus immunoglobulin M in the serum supported positive diagnosis of JE. INTERVENTIONS: The patient was given Ribavirin, and then his symptoms slowly improved. OUTCOMES: Brain MRI on day 29 after the onset revealed high-intensity lesions in bilateral thalamus on diffusion weighted imaging. During the follow-up (at about 2 months after the onset), the patient's consciousness was clear but could not walk. At about 6 months after the onset, he could walk with parkinsonian features. CONCLUSION: Diagnosis of JE that mimicked acute stroke at onset and with no fever can be challenging. Recognition of disease development, MRI and Japanese encephalitis virus immunoglobulinM findings are helpful in early definitive diagnosis.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Encefalitis Japonesa/diagnóstico por imagen , Imagen por Resonancia Magnética , Accidente Cerebrovascular/diagnóstico por imagen , Isquemia Encefálica/complicaciones , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/etiología
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