Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy.

OBJECTIVE: To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation and its clinical outcome. METHODS: We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24 hours. RESULTS: Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS: Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.

Tomografía computarizada multidetector en la planificación del tratamiento de la fibrilación auricular / Multidetector computed tomography in planning the treatment of atrial fibrillation

OBJETIVOS: Conocer la anatomía de las venas pulmonares (VVPP) mediante tomografía computarizada multidetector (TCMD) en pacientes con fibrilación auricular (FA) antes de la ablación. MATERIAL Y MÉTODOS: Realizamos TCMD a 89 pacientes con FA analizando número, variantes y venas accesorias pulmonares, diámetro y forma ostia, distancia a la primera bifurcación y trombo en la orejuela izquierda. RESULTADOS: El patrón venoso pulmonar más frecuente fue 4 VVPP (dos derechas y dos izquierdas) en 49 pacientes (55,1%). Las VVPP superiores presentaron mayor diámetro ostial que las inferiores [vena pulmonar superior derecha (VPSD)> vena pulmonar inferior derecha (VPID); p = 0,001 y vena pulmonar superior izquierda (VPSI)> vena pulmonar inferior izquierda (VPII); p <0,001]. El diámetro ostial de las VVPP derechas era mayor que el de las izquierdas (VPSD> VPSI; p <0,001 y VPID> VPII; p <0,001). El ostium más circular lo presentó la VPID (ratio: 0,885) respecto a la VPII (p <0,001) y a la VPSI (p <0,001). La distancia a la primera bifurcación ha sido mayor en las venas superiores (VPSD> VPID; p = 0,008 y VPSI> VPII; p = 0,038). La distancia a la primera bifurcación fue mayor en las VVPP izquierdas (VPSI> VPSD; p <0,001 y VPII> VPID; p <0,001). Otros hallazgos fueron: divertículos (30), apéndices auriculares accesorios (5), aneurismas septales (8), bolsas septales (6) y 1 trombo en la orejuela izquierda. CONCLUSIÓN: La TCMD antes de la ablación demuestra la anatomía de la aurícula izquierda (AI) y de las VVPP con diferencias significativas entre los diámetros y morfología de los ostia venosos

OBJECTIVE: To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation. MATERIALS AND METHODS: MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage. RESULTS: The most frequent venous pattern was 4 PVs (two right and two left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p = 0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p < 0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p < 0.001 and RIPV> LIPV; p < 0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p < 0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p = 0.008 and LSPV> LIPV; p = 0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p < 0.001and LIPV> RIPV; p < 0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage. CONCLUSION: MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia

Multidetector computed tomography in planning the treatment of atrial fibrillation. / Tomografía computarizada multidetector en la planificación del tratamiento de la fibrilación auricular.

OBJECTIVE: To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation. MATERIALS AND METHODS: MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage. RESULTS: The most frequent venous pattern was 4 PVs (two right and two. left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p=0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p<0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p<0.001 and RIPV> LIPV; p<0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p<0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p=0.008 and LSPV> LIPV; p=0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p<0.001and LIPV> RIPV; p<0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage. CONCLUSION: MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia.

Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy. / Incidencia, pronóstico y factores asociados al infarto estriatocapsular aislado tras trombectomía mecánica.

OBJECTIVES: To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation andits clinical outcome. METHODS: We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24h. RESULTS: Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS: Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.

[Influence of mechanical thrombectomy on the incidence of isolated striatocapsular infarction and a description of its clinical characteristics]. / Influencia de la trombectomia mecanica en la incidencia de infarto estriatocapsular aislado y descripcion de sus caracteristicas clinicas.

INTRODUCTION: The great vulnerability of the striatocapsular region to ischaemia means that mechanical thrombectomy has its limitations in occlusions of large-calibre vessels when it comes to preventing the striatocapsular region from undergoing infarction. AIMS: To analyse the effect of endovascular treatment on the incidence of isolated striatocapsular infarction (iSCI) and to describe its clinical characteristics. PATIENTS AND METHODS: We conducted a retrospective study to analyse the incidence of iSCI following treatment of cerebral reperfusion. The baseline and clinical characteristics of the patients identified with iSCI and the incidence of iSCI is compared between two groups according to the availability of mechanical thrombectomy: one (pre-thrombectomy group) that received intravenous fibrinolysis as the only treatment for cerebral reperfusion available in that moment; and another (post-thrombectomy group) that received a mechanical thrombectomy with or without intravenous fibrinolysis. RESULTS: Of the 390 patients who received reperfusion, 8.2% had iSCI. Of the 135 patients treated with intravenous fibrinolysis, 4.4% (n = 6) developed iSCI (pre-thrombectomy group), and of the 255 patients treated in the post-thrombectomy group, iSCI was observed in 10.2%. The statistical analysis of the incidence of iSCI between the two groups showed significant differences (p = 0.034). A sensory-motor clinical picture was the most frequent among the patients with iSCI (63.33%), with a frequency of cortical symptoms of 55.17%. CONCLUSIONS: According to the data, there has been an increase in the incidence of iSCI in our setting following the establishment of mechanical thrombectomy.

TITLE: Influencia de la trombectomia mecanica en la incidencia de infarto estriatocapsular aislado y descripcion de sus caracteristicas clinicas.Introduccion. La gran vulnerabilidad a la isquemia de la region estriatocapsular hace que la trombectomia mecanica tenga sus limitaciones en las oclusiones de vaso de gran calibre a la hora de evitar que la region estriatocapsular se infarte. Objetivos. Analizar el efecto del tratamiento endovascular en la incidencia de infarto estriatocapsular aislado (IECa) y describir sus caracteristicas clinicas. Pacientes y metodos. Estudio retrospectivo en el que se analiza la incidencia de IECa tras el tratamiento de reperfusion cerebral. Se describen las caracteristicas basales y clinicas de los pacientes identificados con IECa y se compara la incidencia del IECa entre dos grupos segun la disponibilidad de trombectomia mecanica: uno (grupo pretrombectomia) que recibio fibrinolisis intravenosa como unico tratamiento de reperfusion cerebral disponible en ese momento, y otro (grupo postrombectomia) que recibio trombectomia mecanica con o sin fibrinolisis intravenosa. Resultados. Del total de 390 pacientes reperfundidos, un 8,2% tuvo un IECa. De 135 pacientes tratados con fibrinolisis intravenosa, un 4,4% (n = 6) desarrollo un IECa (grupo pretrombectomia), y de 255 pacientes tratados en el grupo postrombectomia, se visualizo IECa en un 10,2%. El analisis estadistico de la incidencia de IECa entre ambos grupos mostro diferencias significativas (p = 0,034). La clinica sensomotora fue la mas frecuente entre los pacientes con IECa (63,33%), con una frecuencia de sintomas corticales de un 55,17%. Conclusiones. Segun los datos, hemos presenciado un aumento en la incidencia de IECa en nuestro medio tras la instauracion de la trombectomia mecanica.

[Signs predicting early growth of intracerebral haemorrhage in computer tomography without enhancement and mortality]. / Signos predictores de crecimiento precoz de la hemorragia intracerebral en la tomografia computarizada sin contraste y mortalidad.

INTRODUCTION: Intracerebral haemorrhage is associated with high morbidity and mortality, and an increase in its volume in the early phases entails a poorer prognosis. The blend sign, the heterogeneous density, the irregular morphology and a fluid level in the haematoma are related to an early growth of the haematoma. AIM: To determine whether these four characteristics are associated with greater mortality at 7, 30 and 90 days of the occurrence of the intracerebral haemorrhage. PATIENTS AND METHODS: A retrospective cohort study that included all the patients attended in our hospital between 2010 and 2015 for spontaneous intracerebral haemorrhage with a computed tomography brain scan performed in the first six hours following the onset of symptoms. RESULTS: Of the 158 patients included in the sample, 23 (14.6%) presented blend sign; 39 (24.7%), heterogeneity; 53 (33.5%), irregularity; and 33 (20.9%), fluid level. In the bivariate analysis, only heterogeneity and irregularity were associated with increased mortality at 7, 30 and 90 days. In the multivariate logistic regression analysis, previous treatment with an antiplatelet drug, a score on the Glasgow Coma Scale below 13 and irregularity were associated with higher mortality in the first seven days. CONCLUSION: The study shows an association between irregularity of the haematoma and mortality in the first seven days. Irregularity would allow identification of patients with a more unfavourable prognosis; in these cases, strict surveillance, especially of factors related to the growth of the haematoma, could improve their prognosis.

TITLE: Signos predictores de crecimiento precoz de la hemorragia intracerebral en la tomografia computarizada sin contraste y mortalidad.Introduccion. La hemorragia intracerebral esta asociada a una elevada morbimortalidad y su aumento de volumen en fases iniciales conlleva un peor pronostico. El signo de la mezcla, la densidad heterogenea, la morfologia irregular y un nivel liquido en el hematoma se relacionan con un crecimiento precoz del hematoma. Objetivo. Determinar si esas cuatro caracteristicas se asocian a una mayor mortalidad a los 7, 30 y 90 dias de ocurrida la hemorragia intracerebral. Pacientes y metodos. Estudio de cohortes retrospectivo que incluyo a todos los pacientes atendidos en nuestro hospital, entre 2010 y 2015, por una hemorragia intracerebral espontanea con tomografia computarizada cerebral realizada en las primeras seis horas tras el inicio de los sintomas. Resultados. De los 158 pacientes incluidos, 23 (14,6%) presentaban signo de la mezcla, 39 (24,7%) heterogeneidad, 53 (33,5%) irregularidad y 33 (20,9%) nivel liquido. En el analisis bivariante, solo la heterogeneidad y la irregularidad se asociaron a mayor mortalidad a los 7, 30 y 90 dias. En el analisis por regresion logistica multivariante, el tratamiento previo con antiagregante plaquetario, una puntuacion en la escala de coma de Glasgow menor de 13 y la irregularidad se asociaron a una mayor mortalidad en los siete primeros dias. Conclusion. El estudio muestra asociacion entre la irregularidad del hematoma y la mortalidad en los siete primeros dias. La irregularidad permitiria identificar a pacientes con peor pronostico, en los que una vigilancia estricta, especialmente de factores relacionados con el crecimiento del hematoma, podria mejorar su pronostico.

Diagnóstico por la imagen en neuroftalmología / Diagnostic imaging in neuro-ophthalmology

La neuroftalmología es la parte de la neurología y la oftalmología que se encarga del estudio de las enfermedades que afectan al sistema visual y a los mecanismos que controlan la motilidad ocular y la función pupilar. Las pruebas de imagen permiten realizar una adecuada valoración anatómica y patológica de las estructuras que conforman la vía visual, los nervios que controlan la motilidad ocular y pupilar, y las propias estructuras orbitarias. Este artículo se divide en tres apartados (recuerdo anatómico, técnicas de imagen apropiadas y valoración patológica en función de la sintomatología clínica) con el propósito de proporcionar herramientas útiles que permitan al radiólogo elegir en cada momento la técnica de imagen más adecuada para el correcto diagnóstico de las enfermedades y un ajustado diagnóstico diferencial

Neuro-ophthalmology is a field combining neurology and ophthalmology that studies diseases that affect the visual system and the mechanisms that control eye movement and pupil function. Imaging tests make it possible to thoroughly assess the relevant anatomy and disease of the structures that make up the visual pathway, the nerves that control eye and pupil movement, and the orbital structures themselves. This article is divided into three sections (review of the anatomy, appropriate imaging techniques, and evaluation of disease according to clinical symptoms), with the aim of providing useful tools that will enable radiologists to choose the best imaging technique for the differential diagnosis of patients’ problems to reach the correct diagnosis of their disease

Diagnostic imaging in neuro-ophthalmology. / Diagnóstico por la imagen en neuroftalmología.

Neuro-ophthalmology is a field combining neurology and ophthalmology that studies diseases that affect the visual system and the mechanisms that control eye movement and pupil function. Imaging tests make it possible to thoroughly assess the relevant anatomy and disease of the structures that make up the visual pathway, the nerves that control eye and pupil movement, and the orbital structures themselves. This article is divided into three sections (review of the anatomy, appropriate imaging techniques, and evaluation of disease according to clinical symptoms), with the aim of providing useful tools that will enable radiologists to choose the best imaging technique for the differential diagnosis of patients' problems to reach the correct diagnosis of their disease.