Prevalence of fenestrated basilar artery with magnetic resonance angiography: a transversal study.

Fenestration of the basilar artery (BA) is a rare anatomical variation in comparison to those of the other intracranial arteries constituting the cerebral arterial circle. The incidence is difficult to ascertain and data vary according to type of series and modalities of detection. Basilar artery fenestration (BAF) has been reported in association with arteriovenous malformations, vascular variants, other developmental anomalies and neurovascular conflicts as a consequence of relations between the arterial branches of the BA and the nerves and other structures in the posterior cranial fossa. However, the real clinical interest of BAF is due to the possible formation of an aneurysm at the junction of the fenestrated segment and less frequently to the thrombosis of the vessels. With the aim to establish the prevalence of BAF in our population, we made a transversal pilot study of the first 200 MR angiographies performed on patients attending for the first time to control their base pathology (vascular or not). We have described three patients with this condition (representing a prevalence of 1.5 % on MR angiography) to shed additional light on this anomaly, two cases located at 1/3 proximal end (type 1-BAF) and one case located at joint 1/3 medium-1/3 distal end, locating distal to the anterior inferior cerebellar artery (type 4-BAF). In neither case was any other lesion found (i.e. aneurysm, infarctions, ischemia or thromboembolism). The pertinent clinical anatomy and embryological basis for this variation are reviewed, and the possible clinical implications and associated findings are discussed.

Difusión por resonancia magnética en el diagnóstico precoz de la embolia grasa cerebral / Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome

Introducción. El síndrome de embolia grasa (SEG) es una entidad de difícil diagnóstico y una causa importantede morbimortalidad en pacientes con politraumatismos. Caso clínico. Hombre de 19 años que ingresa con fracturaabierta de tibia y peroné sin traumatismo craneal niclínica neurológica. La fractura se reduce quirúrgicamentemediante osteosíntesis, presentando a las pocas horas, deforma brusca, un cuadro confusional y mioclonías en miembrossuperiores, sin otras manifestaciones. Se practica tomografíacomputarizada craneal y punción lumbar con resultados normales. El electroencefalograma demuestraactividad punta-onda frontotemporal con generalización. Con el diagnóstico de estatus epiléptico es tratado con valproato intravenoso con mejoría del nivel de conciencia y desaparición de las mioclonías. La imagen por resonanciamagnética (RM) cerebral practicada 68 h después muestra múltiples lesiones isquémicas agudas en coronas radiadas.La ecocardiografía no evidencia foramen oval permeable. El paciente es dado de alta sin secuelas con el diagnóstico deSEG. En la RM de control a las 5 semanas persisten las lesionessin restricción en secuencia de difusión.Conclusiones. El SEG es una complicación frecuente, infradiagnosticada y potencialmente grave que se debe considerar en pacientes politraumatizados. La manipulación llevada a cabo en la reducción ortopédica parece tener unpapel importante en su patogenia. La RM permite el diagnóstico y la caracterización de las lesiones agudas en el sistema nervioso central, descartando otras etiologías (AU)

Introduction. Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication inpolytraumatized patients. Case report. A 19 year-old male was admitted inour hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms.He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousnesssuddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of thebrain and lumbar puncture showed no abnormalities.The electroencephalograph demonstrated frontotemporalspike-wave activity with tendency to generalization.Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared andthe patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 hlater showed multiple high intensity signals throughout the white matter which were seen on the diffusionweighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient wasdischarged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showedthe persistence of the lesions without restriction in diffusionsequence. Conclusions. FES is a frequent complication that is underdiagnosed and potentially serious. It should beconsidered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to haveplayed an important role in the patient’s condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling outother etiologies (AU)

[Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome]. / Difusión por resonancia magnética en el diagnóstico precoz de la embolia grasa cerebral.

INTRODUCTION: Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication in polytraumatized patients. CASE REPORT: A 19 year-old male was admitted in our hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms. He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousness suddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of the brain and lumbar puncture showed no abnormalities. The electroencephalograph demonstrated frontotemporal spike-wave activity with tendency to generalization. Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared and the patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 h later showed multiple high intensity signals throughout the white matter which were seen on the diffusion weighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient was discharged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showed the persistence of the lesions without restriction in diffusion sequence. CONCLUSIONS: FES is a frequent complication that is underdiagnosed and potentially serious. It should be considered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to have played an important role in the patient's condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling out other etiologies.

Asociación de angiomas cavernosos con venosos / Association of cavernous and venous angiomas

Introducción. Los angiomas cavernosos y venosos deforma aislada son malformaciones vasculocerebrales frecuentes.Su asociación se identifica cada vez más debido ala mayor utilización de la resonancia magnética (RM) en losestudios cerebrales. Objetivo. Analizar las características de la asociaciónentre angioma cavernoso y venoso y la relación con su localizacióny tamaño, el sexo del paciente y el uso de contrasteintravenoso para el diagnóstico por RM. Métodos. Retrospectivamente se han revisado los estudiosde RM cerebral de 37 pacientes con angiomas cavernosos.Las relaciones estadísticas se establecieron con tablas decontingencia y el estadístico de la χ2 de Pearson y la t deStudent para muestras independientes. Resultados. Se identificaron 52 angiomas cavernososen 37 pacientes. No se han encontrado diferencias estadísticamentesignificativas que relacionen el tamaño del angiomacavernoso, su localización y el sexo del paciente con laexistencia de un angioma venoso asociado. Sólo la administraciónde contraste ha mostrado una relación estadísticamentesignificativa para su diagnóstico. Conclusiones. La asociación de angioma cavernoso y venosoes frecuente (30 %). Es necesario administrar contrastepara detectar los angiomas venosos. Esta asociación tiene implicacionespronósticas por el riesgo de sangrado y quirúrgicas,ya que la resección de la anomalía venosa no se aconsejapor la posibilidad de desencadenar infartos venosos

Introduction. Isolated cavernous and venous angiomasare common vascular cerebral malformations. Due to theroutine use of magnetic resonance imaging (MRI) in cerebral studies, their association has been identified more frequently. Objective. To analyze the characteristics of the association between both lesions (cavernous and venous angiomas), and the relationships with localization, size, patient gender and the use of intravenous contrast material in the diagnosis with MR.Methods. A retrospective analysis of the cerebral MRIstudies of 37 patients with cavernous angiomas was made.Statistical relationships were established with contingency tables and statistical methods of Pearson χ2 and of Student’s test for independent samples. Results. A total of 52 cavernous angiomas were identified in 37 patients. No significant statistical differenceswere found that related the cavernous angioma size, localization or patient gender with the existence ofan associated venous angioma. Only the administrationof contrast material has shown a statistically significantrelationship for the diagnosis. Conclusions. The association of cavernous and venous angioma is frequent (30 %). Contrast material must be administeredto detect venous angiomas. This association hasprognostic implications, due to bleeding risk and surgerysince resection of the venous anomaly is not recommendeddue to the possible venous infarction

[Association of cavernous and venous angiomas]. / Asociación de angiomas cavernosos con venosos.

INTRODUCTION: Isolated cavernous and venous angiomas are common vascular cerebral malformations. The routine use of magnetic resonance imaging (MRI) in cerebral studies has shown their frequent association. OBJECTIVE: An analysis of the association characteristics of both lesions (cavernous and venous angiomas), and the relationships with localization, size, patient sex and the use of intravenous contrast material in the diagnosis with MR. METHODS: A retrospective analysis of the cerebral MRI studies of 37 patients with cavernous angiomas. Statistical relations were established with contingency tables and statistical methods of Pearson c2 and t of Student for independent samples. Results. 52 cavernous angiomas were identified in the 37 patients. No significant statistical differences were found that related the cavernous angioma size, localization or patient sex with the existence of an associated venous angioma. Only the administration of contrast material has shown a statistical significance for the diagnosis. CONCLUSIONS: The association of cavernous and venous angioma is frequent (30%). This association has prognostic implications, due to bleeding risk, and surgical as it is not recommended the resection of the venous anomaly due to the possible venous infarction. To detect venous angiomas is necessary the administration of contrast material.

[Stenting without prior dilatation in intracranial stenosis of the internal carotid artery: a case report]. / Colocación de endoprótesis vascular sin dilatacion previa en estenosis intracraneal de la carótida interna. A propósito de un caso.

INTRODUCTION: Recent reports have described the application of coronary stents for the treatment of intracranial stenosis of the internal carotid artery (ICA), above all in patients who do not respond to medical treatment and display advancing neurological symptoms. Stenting in intracranial vascular lesions of the carotid territory has been used almost exclusively in the treatment of the complications due to transluminal angioplasties with balloons. In selected cases and without prior dilatation of the stenosis it would be possible to place a stent. CASE REPORT: We describe a case of intracranial carotid stenting, without previous dilatation, in a 57 year old male patient with multiple arteriosclerotic risk factors. The patient presented neurological symptoms with no response to medical treatment, caused by a stenosis that affected over 70% of the cavernous segment of the right ICA, which was shown up by the arteriographic study. A favourable anatomy and the material used allowed the stent to pass through the stenosis without the need for dilatation. No immediate complications were observed and the carotid artery was seen to be of a normal calibre for stenosis. The brain angiogram also proved to be normal. The patient continues with the medical treatment and has remained neurologically stable throughout the 9 month clinical follow up. CONCLUSION: In certain selected cases, placing an intracranial carotid stent, without previous balloon dilatation, can give good results and prevent the complications that can accompany angioplasty (such as dissection, rupture or embolism)