Concurrent Cardio-Cerebral Infarction - A Case Report and Literature Review.

Concurrent cardio-cerebral infarction (CCI) describes the simultaneous occurrence of an acute myocardial infarction and an acute ischemic stroke. It is a rare phenomenon, and no consensus yet exists on how to best treat it. CCI patients present with variable clinical scenarios and complications which makes the establishment of a treatment guideline difficult. We present here a case of a 67-year-old male with concurrent acute ST-elevation myocardial infarction and acute ischemic stroke due to right middle cerebral artery occlusion who was successfully treated with Tenecteplase and mechanical thrombectomy. A literature review was also conducted in search of potential reasonable management strategies of CCI.

Ferumoxytol-enhanced MRI differentiation of meningioma from dural metastases: a pilot study with immunohistochemical observations.

Malignant dural neoplasms are not reliably distinguished from benign dural neoplasms with contrast-enhanced magnetic resonance imaging (MRI). MRI enhancement in central nervous system (CNS) diseases imaged with ferumoxytol has been attributed to intracellular uptake in macrophages rather than vascular leakage. We compared imaging to histopathology and immunohistochemistry in meningiomas and dural metastases having ferumoxytol-enhanced MRI (FeMRI) and gadolinium-enhanced MRI (GdMRI) in order to correlate enhancement patterns to macrophage presence and vascular state. All patients having extraaxial CNS tumors were retrospectively selected from one of two ongoing FeMRI studies. Enhancement was compared between GdMRI and FeMRI. Diagnoses were confirmed histologically and/or by characteristic imaging. Tumor and vascular histology was reviewed. Immunohistochemical staining for CD68 (a macrophage marker), Connexin-43 (Cx43) (a marker of normal gap junctions), and smooth muscle actin (SMA) as a marker of vascularity, was performed in seven study cases with available tissue. Immunohistochemistry was performed on archival material from 33 subjects outside of the current study as controls: 20 WHO grade I cases of meningioma and 13 metastatic tumors. Metastases displayed marked delayed enhancement on FeMRI, similar to GdMRI. Four patients with dural metastases and one patient with meningioma showed similar enhancement on FeMRI and GdMRI. Five meningiomas with typical enhancement on GdMRI lacked enhancement on FeMRI. Enhancement on FeMRI was better associated with decreased Cx43 expression than intralesional macrophages. These pilot data suggest that FeMRI may better differentiate metastatic disease from meningiomas than GdMRI, and that differences in tumor vasculature rather than macrophage presence could underlie differences in contrast enhancement.

Technical Approach to Antegrade Femoral Access.

The number of endovascular procedures for treatment of peripheral arterial disease continues to increase as minimally invasive procedures have become the first-approach solution for lower extremity arterial lesions of any complexity, including Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) II category C and D. Although the usual treatment strategy has been to access the contralateral common femoral artery (CFA), an ipsilateral, antegrade CFA approach has certain advantages. The greatest advantages are the decrease in the access-to-lesion distance, which in turn improves the mechanical advantage and responsiveness of the tools used to perform the intervention. In certain clinical situations such as prior endovascular aneurysm repair, aortobifemoral surgical bypass, iliac kissing stents, and aortoiliac occlusive disease, an antegrade approach may be mandatory. In this article, we describe our institutional thought process and techniques for performing a successful antegrade puncture of the CFA, as well as highlight some pitfalls and the associated complication rates of which to be aware.

Trans-sodium crocetinate increases oxygen delivery to brain parenchyma in rats on oxygen supplementation.

Trans-sodium crocetinate (TSC) is a vitamin A-analog that increases diffusivity of oxygen in aqueous solutions, including plasma. The current study is the initial investigation of the effects of TSC on oxygen delivery to brain. Adult male rats were intubated and ventilated with 21%, 60%, or 100% oxygen. A craniotomy was performed and a Licox rat brain tissue PO(2) probe inserted into parietal cortex. Rats were then administered intravenous infusions of either TSC or saline and brain tissue PO(2) values were recorded. TSC significantly increased brain tissue oxygen delivery. This effect was minimal in rats ventilated with normal air and substantial in rats on oxygen supplementation. Arterial blood gas parameters did not differ within groups. These results provide clear indication to study the utility of TSC in ameliorating hypoxic/ischemic insults in neurological disorders.