The effects of fibroblast growth factor-23 on diagnosis of cerebral infarction and vertebral basilar artery stenosis☆.

OBJECTIVES: This study aimed to explore the correlation between Fibroblast Growth Factor-23 (FGF23) levels and Cerebral Infarction (CI), and to determine whether there is a significant relationship between FGF23 and the occurrence and severity of CI. METHODS: The study categorized Cerebral Infarction (CI) patients into severe and mild stenosis groups based on vertebrobasilar artery stenosis, using Digital Subtraction Angiography (DSA) and Magnetic Resonance Imaging (MRI). The study compared the levels of Fibroblast Growth Factor-23 (FGF23) in the serum of CI patients and healthy controls using a t-test and evaluated the diagnostic effectiveness of serum FGF23 using a Receiver Operating Characteristic (ROC) curve. Additionally, the study analyzed the correlation between FGF23 levels and CI severity after treatment using the National Institute of Health Stroke Scale score. RESULTS: The study found a significant increase in serum Fibroblast Growth Factor-23 (FGF23) levels in patients with Cerebral Infarction (CI) compared to healthy volunteers, (p < 0.001). A higher serum FGF23 level was observed in the severe stenosis group than in the mild stenosis group (p < 0.001). Furthermore, the study showed that a high FGF23 level at admission was significantly related to more severe symptoms of CI as indicated by the National Institute of Health Stroke Scale (NIHSS) score on the 7th day after treatment (p < 0.001). CONCLUSIONS: This study discovered a correlation between Fibroblast Growth Factor-23 (FGF23) levels, vertebrobasilar artery stenosis, and short-term prognosis in patients who had recently experienced acute Cerebral Infarction (CI).

Vascular vertigo and dizziness: managing and treating outpatients.

OBJECTIVE: Due the lack of data on the treatment of Vascular Vertigo and Dizziness, this study aimed to report how we managed and treated those outpatients according to the recently introduced American Heart Association and Stroke Association guidelines. METHODS: We conducted a longitudinal case series from May 2022 to February 2023. We included patients who met the Bárány Society's Vascular Vertigo and Dizziness classification and were eligible for therapy in accordance with the American Heart Association and Stroke Association guidelines, featuring aspects of the stroke group and transient attack group. RESULTS: Overall, 41 patients (51.2% female; median age 72 years) were enrolled; 10 (24.3%) had ischemic strokes, 30 (73.1%) had transient ischemic attack, and 1 (2.4%) had a probable isolated labyrinthine infarction. The patients received dual antiplatelet (48.7%), single antiplatelet therapy (48.7%), and anticoagulant therapy (2.4%). No new crises occurred in 95.2% of the patients, and the transient ischemic attack group showed a significant decrease in discomfort from imbalance on the visual analog scale. CONCLUSIONS: Antiplatelets and anticoagulants are safe and effective in treating Vascular Vertigo and Dizziness as they prevent new ischemic events and increase the flow of the posterior circulation, reducing vertigo/dizziness attacks and imbalance complaints.

The effects of fibroblast growth factor-23 on diagnosis of cerebral infarction and vertebral basilar artery stenosis

Abstract Objectives: This study aimed to explore the correlation between Fibroblast Growth Factor-23 (FGF23) levels and Cerebral Infarction (CI), and to determine whether there is a significant relationship between FGF23 and the occurrence and severity of CI. Methods: The study categorized Cerebral Infarction (CI) patients into severe and mild stenosis groups based on vertebrobasilar artery stenosis, using Digital Subtraction Angiography (DSA) and Magnetic Resonance Imaging (MRI). The study compared the levels of Fibroblast Growth Factor-23 (FGF23) in the serum of CI patients and healthy controls using a t-test and evaluated the diagnostic effectiveness of serum FGF23 using a Receiver Operating Characteristic (ROC) curve. Additionally, the study analyzed the correlation between FGF23 levels and CI severity after treatment using the National Institute of Health Stroke Scale score. Results: The study found a significant increase in serum Fibroblast Growth Factor-23 (FGF23) levels in patients with Cerebral Infarction (CI) compared to healthy volunteers, (p < 0.001). A higher serum FGF23 level was observed in the severe stenosis group than in the mild stenosis group (p < 0.001). Furthermore, the study showed that a high FGF23 level at admission was significantly related to more severe symptoms of CI as indicated by the National Institute of Health Stroke Scale (NIHSS) score on the 7th day after treatment (p < 0.001). Conclusions: This study discovered a correlation between Fibroblast Growth Factor-23 (FGF23) levels, vertebroba-silar artery stenosis, and short-term prognosis in patients who had recently experienced acute Cerebral Infarction (CI).

Dynamic computed tomography angiography for noninvasive diagnosis of bow Hunter's syndrome: a case report

ABSTRACT The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck. This was followed by a second acquisition with the head and neck rotated to the side that triggered the symptoms, with technical parameters similar to the first acquisition. The acquired images were used to print a 3D model to better depict the findings for the surgical team. The dynamic computed tomography angiography protocol developed in this study helped visualize the vertebrobasilar arterial anatomy, detect vertebral artery stenosis produced by head and neck rotation, depict the structure responsible for artery stenosis (e.g., bony structure or membranes), and study possible complications of the disease (e.g., posterior cerebral circulation infarction). Additionally, the 3D-printed model better illustrated the findings of stenosis, aiding in surgical planning. In conclusion, dynamic computed tomography angiography for the evaluation of bow Hunter's syndrome is a feasible noninvasive technique that can be used as an alternative to traditional diagnostic methods.

Surgical treatment of craniovertebral stenosis in two siblings with type vi mucopolysaccharidosis / Tratamento cirúrgico de estenose craneo-vertebral em dois irmãos com mucopolisacaredose tipo vi / Tratamiento quirúrgico de estenosis craneo-vertebral en dos hermanos con mucopolisacaridosis tipo vi

ABSTRACT We describe two cases of surgical treatment of craniovertebral stenosis in preschool-aged brothers with Maroteaux-Lamy (MPS type VI) syndrome. The older brother was diagnosed with MPS during her second pregnancy. Literature describing familial cases of the disease and the treatment strategy in young children with MPS type VI and spinal canal stenosis is scarce. Based on the presented observations, indications, surgical treatment approaches, and perioperative management of patients with mucopolysac-charidosis are suggested. MPS type VI may have familial forms of the disease and the course of craniovertebral stenosis is similar in siblings. Surgical treatment of craniovertebral stenosis in these patients should be performed timely. We adhere to the point of view of early treatment of craniovertebral stenosis in patients with MPS before irreversible spinal cord dysfunction develops. Level of Evidence IV; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease and Case series.

Resumo: Descreve-se dois casos de tratamento cirúrgico de estenose craniovertebral entre irmãos em idade pré-escolar com síndrome de Maroteaux-Lamy (MPS tipo VI). O irmão mais velho foi diagnosticado com MPS durante a segunda gravidez. A literatura que descreve casos familiares da doença e a estratégia de tratamento em crianças pequenas com MPS tipo VI e estenose do canal raquidiano é escassa. Com base nas observações apresentadas, foram sugeridas indicações, abordagens de tratamento cirúrgico e manejo perioperatório de pacientes com mucopolissacaridose. A MPS tipo VI pode apresentar formas familiares da doença e o curso da estenose craniovertebral é semelhante entre irmãos. O tratamento cirúrgico da estenose craniovertebral nesses pacientes deve ser realizado em tempo hábil. Adere-se ao conceito de tratamento precoce da estenose craniovertebral em pacientes com MPS antes que se desenvolva uma disfunção irreversível da medula espinhal. Nível de Evidência IV; Estudos Prognósticos - Investigando o Efeito de uma Característica de Paciente sobre o Resultado de uma Doença e de uma Série de Casos.

Resumen: Se describen dos casos de tratamiento quirúrgico de estenosis craneovertebral en hermanos de edad preescolar con síndrome de Maroteaux-Lamy (MPS tipo VI). Al hermano mayor se le diagnosticó MPS durante el segundo embarazo. La bibliografía que expone casos familiares de la enfermedad y la estrategia de tratamiento en niños pequeños con MPS tipo VI y estenosis del tubo vertebral es escasa. Sobre el fundamento de las observaciones presentadas, se sugieren indicaciones, enfoques de tratamiento quirúrgico y manejo perioperatorio de pacientes con mucopolisacaridosis. La MPS tipo VI puede presentar formas familiares de la enfermedad y el curso de la estenosis craneovertebral es semejante en los hermanos. El tratamiento quirúrgico de la estenosis craneovertebral en estos pacientes debe realizarse tempranamente. Se adhiere al planteamiento del tratamiento precoz de la estenosis craneovertebral en pacientes con MPS anticipándose al desarrollo de una disfunción irreversible de la médula espinal. Nivel de Evidencia IV; Estudios Pronósticos - Investigando el Efecto de una Característica del Paciente en el Resultado de la Enfermedad y Series de Casos.

Arterial abnormalities and associated variations of the vertebrobasilar system on the brain base: apropos of a rare case / Anomalías arteriales y variaciones asociadas del sistema vertebrobasilar en la base del cerebro: un caso raro

SUMMARY: The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.

RESUMEN: El caso presentado caracteriza una asociación de arterias primitivas y definitivas con variaciones sobre la base cerebral cadavérica de un anciano. Este caso se encuentra mediante la revisión retrospectiva de datos obtenidos durante muchos años de un trabajo de cooperación del autor y coautores. La fenestración de la arteria basilar (ectásica), la duplicación parcial y total de algunas arterias cerebelosas se asoció con otras variaciones de los sistemas vertebrobasilar y carotídeo. Si bien se trata de un caso de autopsia a causa de un infarto del miocardio, la peculiaridad del caso radica en la ausencia del aneurisma en base a la fenestración o disección de una de las arterias cerebrales.

Morphologic characterisation of the posterior inferior cerebellar artery. A direct anatomic study.

BACKGROUND: The number of studies on the cerebellar arteries has increased. The purpose of this study was to determine the morphological expression of posterior inferior cerebellar artery in a sample of Colombian population. MATERIALS AND METHODS: One hundred eighty-six posterior inferior cerebellar arteries of fresh cadavers were studied. In each specimen, vertebral arteries were injected with 100 mL of semi-synthetic resin, dyed with mineral red. RESULTS: In the 93 blocks of brainstem and cerebellum evaluated, 174 (93.5%) posterior inferior cerebellar arteries were found. Also, there were 12 (6.5%) ageneses. There was single posterior inferior cerebellar artery in 159 (91.4%) samples and duplicate in 10 (5.7%), while 5 (2.9%) specimens showed hypoplasia. The posterior inferior cerebellar artery originated from the vertebral artery in 121 (69.5%) samples and from the basilar artery in 42 (24.1%) samples; while in 11 (6.4%) it originated in a common trunk with the anterior inferior cerebellar artery. In 101 (83.5%) cases, the posterior inferior cerebellar artery originated from the intracranial segment of the vertebral artery, while 20 (16.5%) samples originated from the extracranial segment. The calibres of posterior inferior cerebellar artery in its proximal and distal segments were 1.45 ± 0.37 mm and 1.33 ± 0.31 mm, respectively. CONCLUSIONS: This study, carried out in cadaveric material, provides relevant qualitative and morphometric information of the posterior inferior cerebellar artery, useful for the diagnosis and clinical management, as well as for the surgical approaches that may compromise this structure.

Rotational vertebral artery occlusion ("bow hunter syndrome").

PURPOSE: To review the literature, analyze and discuss diagnostic and treatment options for the Bowhunter Syndrome. A clinical case of idiopathic rotatory C1-C2 subluxation causing dynamic vertebral artery occlusion is presented. METHODS: Literature review between 1960 and 2019, discussion of diagnostic methods and treatment options. Description of diagnostic and treatment methods in the aforementioned case. RESULTS: We present a patient with dynamic left vertebral artery occlusion associated with idiopathic rotatory C1-C2 subluxation. A dynamic Angio-CT showed rotatory C1-C2 subluxation with significant flow reduction at the left vertebral artery at the exit of the C2 transverse foramen until the V3 segment when the head rotated towards the right. Due to clinical and radiological worsening in the following months, posterior C1-C2 arthrodesis was performed, with the disappearance of the symptoms. There are 193 cases reported with dynamic vertebral artery occlusion, but in only two, the etiology was primary rotational atlantoaxial instability. The most prevalent etiology was degenerative. CONCLUSION: Rotatory vertebral artery occlusion is a rare condition presented mostly in adults, aged 50-70 years. Vertebrobasilar insufficiency is triggered by the rotation of the head to the contralateral side of the dominant vertebral artery. Dynamic subtraction angiography is considered the diagnostic gold-standard method, but dynamic Angio-CT scan, Angio-MRI, or Doppler ultrasonography are less invasive options. The treatment options are conservative or surgical. Endovascular surgery is another option in specific cases.

Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.

Geometric features of vertebrobasilar arterial system in adult black Kenyans / Características geométricas del sistema arterial vertebrobasilar en kenianos negros adultos

Geometric features of vertebrobasilar system influence occurrence of posterior circulation atherosclerosis, aneurysms, stroke and neuroradiological procedures. These features show ethnic variation, but data from black Africans in Sub Saharan Africa are scarce. This study aimed to describe geometric features of vertebrobasilar system in a black Kenyan population. It was a descriptive cadaveric study at Department of Human Anatomy, University of Nairobi. One hundred and seventy three formalin-fixed adult brains of individuals (99 male; 74 female; Age range 20 - 79) who had died of non cerebrovascular causes were studied. Level and angle of confluence of vertebral artery; diameter, length and bifurcation angles of basilar artery were measured. Data were analysed by SPSS version 21 for windows. The student t - test was used to determine the sex differences at 95 % confidence interval. Data are presented in macrographs, tables and bar charts. Confluence of vertebral arteries occurred at the sulcus bulbopontinus in 79.8 %; rostral to it in 11.5 % and caudal to it in 8.7 % of cases. Mean angle of vertebral artery confluence was 46.7º and 68.9º in males and females respectively (p£0.042). Mean length of the basilar artery was 26.8 mm; 26.3 mm in males and 27.1 mm in females (p=0.465). Mean diameter was 3.52 mm; 3.32 mm in males and 3.72 mm in females (p=0.002). The mean angle of basilar artery bifurcation was 120.3º ± 15.2; 99.3º ± 32.9 in males and 140.3º ± 16.1 in females (p=0.024). It was wider than 90º in 82.9 % of males and 95.9 % females (p=0.032). In 85 (49.1 %) it was wider than 120º. The vertebrobasilar system in the Kenyan population has geometric features that constitute risk factors for atherosclerosis. These features display sex dimorphism which may explain differences in prevalence of atherosclerosis and aneurysms. Neurosurgeons and neurologists should be aware of these differences. Individuals with risk prone geometric features should be followed up for atherosclerosis.

Las características geométricas del sistema vertebrobasilar influyen en la aparición de aterosclerosis en la circulación posterior, aneurismas, apoplejía, detectados durante procedimientos neurorradiológicos. Estas características muestran variación étnica, pero los datos de los africanos negros en el África Subsahariana son escasos. Este estudio tuvo como objetivo describir las características geométricas del sistema vertebrobasilar en una población negra de Kenia. Fue un estudio descriptivo cadavérico en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se estudiaron 173 cerebros adultos (99 varones, 74 mujeres, rango de edad 20-79), fijados en formalina, de individuos que habían fallecido por causas no cerebrovasculares. Se midieron el nivel y ángulo de confluencia de la arteria vertebral, diámetro, longitud y bifurcación de la arteria basilar. Los datos fueron analizados por SPSS versión 21 para Windows. La prueba t de Student se utilizó para determinar las diferencias de sexo con un intervalo de confianza del 95 %. Los datos se presentan en macrografías, tablas y gráficos de barras. La confluencia de las arterias vertebrales se produjo en el surco bulbopontino en el 79,8 %; rostral al surco en 11,5 % y caudal al surco en 8,7 % de los casos. El ángulo medio de la confluencia de la arteria vertebral fue 46,70 y 68,90 en hombres y mujeres, respectivamente (p£0,042). La longitud media de la arteria basilar fue de 26,8 mm; 26,3 mm en hombres y 27,1 mm en mujeres (p=0,465). El diámetro promedio fue de 3,52 mm; 3,32 mm en hombres y 3,72 mm en mujeres (p=0,002). El ángulo medio de la bifurcación de la arteria basilar fue de 120,30 ± 15,2; 99.30 ± 32,9 en hombres y 140,30 ± 16,1en mujeres (p=0,024). Era más amplio que 90º. En un 82,9 % de los hombres y 95,9 % de las mujeres (p=0,032) se observó un ángulo más amplio que 90°. En 85 (49,1 %) fue más amplio que 120°. El sistema vertebrobasilar en la población de Kenia tiene características geométricas que constituyen factores de riesgo para la aterosclerosis. Estas características muestran dimorfismo sexual que puede explicar las diferencias en la prevalencia de aterosclerosis y aneurismas. Los neurocirujanos y los neurólogos deben tener en cuenta estas diferencias. Las personas con características geométricas propensas al riesgo deben ser seguidas por aterosclerosis.

Manejo endovascular de estenosis vertebral intracraneal con stent coronario balón expandible: reporte de dos casos y revisión de la literatura / Endovascular management of intracranial vertebral stenosis with a coronary balloon-expandable-stent: report of two cases and literature review

RESUMEN INTRODUCCIÓN: El manejo endovascular de la estenosis de la arteria vertebral en pacientes con infarto cerebral recurrente continúa siendo un tema con múltiples lagunas de conocimiento debido a la poca evidencia científica con la que se cuenta en la actualidad. CASOS CLÍNICOS: Se informan dos casos típicos de estenosis vertebral y recurrencia de infarto cerebral cerebral manejados con dispositivos endovasculares alternativos a los utilizados en la actualidad (stent balón expandible medicado con zotarolimus), con desenlaces clínicos e imagenológicos satisfactorios. Se describe la técnica usada, la condición clínica y se ilustran los resultados angiográficos. CONCLUSIÓN: A la luz de las nuevas generaciones de dispositivos y técnicas neuroendovasculares, consideramos que debe realizarse una evaluación cuidadosa e individual de los pacientes con recurrencia de enfermedad cerebrovascular y estenosis vertebral, a pesar de un manejo médico optimizado. Aún se requieren estudios conrolados que permitan la uniformidad futura en la selección de pacientes y la toma de decisiones.

SUMMARY INTRODUCTION: Endovascular management of vertebral artery stenosis in patients with recurrent cerebral infarction remains a topic with multiple gaps in knowledge because of poor scientific evidence is available today. REPORT OF CASES: Here are reported two typical cases of cerebral infarction recurrence due to vertebral artery stenosis managed with new endovascular devices (balloon-expandable-stent medicated with zotaroli-mus), with satisfactory clinical and neuroimaging outcomes. Herein it is described the technique used and the angiographic findings are illustrated. CONCLUSION: In light of new devices and neurointerventional techniques, we consider that it should be done a careful and individual evaluation of patients with vertebral stenosis and stroke recurrence despite an optimized medical management. It is still required more studies that allow future consistency in the selection of patients and decision making.

Síndrome de Locked-In: Reporte de Caso y Revisión de Literatura / Locked-In Syndrome: Case Report And Review Of Literature

RESUMEN El Síndrome de Locked-In también conocido como Síndrome de Enclaustramiento, de Deseferentización o de Encerramiento, se definió por primera vez en 1966 por Plum y Posner. Las causas pueden agruparse en vasculares y no vasculares, siendo las primeras las más frecuentes. Clínicamente este síndrome se caracteriza porque la conciencia y el estado de vigila están conservados, pero existe cuadriplejía, anartria, disfagia y dificultad para coordinar la mecánica ventilatoria, representando las complicaciones pulmonares la principal causa de muerte. En la mayoría de los casos, el paciente conserva la movilidad ocular vertical, por tanto, el único método de comunicación es por medio de parpadeo ocular y movimientos verticales oculares. A continuación, se hace la presentación de un caso y revisión de la literatura con los aspectos fisiopatológicos, clínicos, diagnósticos y terapéuticos más relevantes.

ABSTRACT Locked-In Syndrome, also known as Enclaustration, Deseferentization, or Enclosure Syndrome, was first defined in 1966 by Plum and Posner. Causes can be grouped into vascular and non-vascular, the former being the most frequent. Clinically this syndrome is characterized by consciousness and the state of watch conserved, but there is quadriplegia, anartria, dysphagia and difficulty to coordinate the ventilatory mechanics, representing pulmonary complications the main cause of death. In most cases, the patient retains vertical eye mobility, so the only method of communication is through eye blinking and vertical eye movements. Next, a case presentation and review of the literature with the most relevant pathophysiological, clinical, diagnostic and therapeutic aspects is done.

Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature

Abstract Introduction Vertebrobasilar insufficiency is defined as transitory ischemia of the vertebrobasilar circulation. Dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body are the most common symptoms. Objective To review the literature regarding the three available diagnostic testing in patients with dizziness complaints secondary to vertebrobasilar insufficiency (VBI): magnetic resonance angiography; transcranial Doppler ultrasound; and vertebrobasilar deprivation testing. Data Synthesis We selected 28 studies that complied with our selection criteria for appraisal. The most frequent cause of the hemodynamic changes leading to VBI is atherosclerosis. The main clinical symptoms are dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body. Even though arteriography is considered the most important exam to diagnose the disease, the inherent risks of this exam should be taken into consideration. The magnetic resonance angiography has been widely studied and is a good method to identify and localize any occlusions and stenosis in both neck and intracranial great vessels. Conclusion Each patient with a suspected diagnosis of VBI should be individually evaluated and treated, taking in consideration the pros and cons of each diagnostic testing and treatment option.

Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature.

Introduction Vertebrobasilar insufficiency is defined as transitory ischemia of the vertebrobasilar circulation. Dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body are the most common symptoms. Objective To review the literature regarding the three available diagnostic testing in patients with dizziness complaints secondary to vertebrobasilar insufficiency (VBI): magnetic resonance angiography; transcranial Doppler ultrasound; and vertebrobasilar deprivation testing. Data Synthesis We selected 28 studies that complied with our selection criteria for appraisal. The most frequent cause of the hemodynamic changes leading to VBI is atherosclerosis. The main clinical symptoms are dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body. Even though arteriography is considered the most important exam to diagnose the disease, the inherent risks of this exam should be taken into consideration. The magnetic resonance angiography has been widely studied and is a good method to identify and localize any occlusions and stenosis in both neck and intracranial great vessels. Conclusion Each patient with a suspected diagnosis of VBI should be individually evaluated and treated, taking in consideration the pros and cons of each diagnostic testing and treatment option.

Vascularização arterial da base do encéfalo do gerbil (Meriones unguiculatus Milne-Edwards, 1867) / Arterial vascularization of the base of the cerebrum of mongolian gerbils(Meriones unguiculatus Milne-Edwards, 1867)

Objetivou-se descrever e sistematizar as artérias da base do encéfalo. Foram utilizados dez gerbils que se encontravamarmazenados em freezer no laboratório de Morfofisiologia Animal Aplicada da Universidade Federal Rural do Semiárido. Osanimais foram descongelados, incisados na linha mediana para identificação do ventrículo esquerdo, o qual foi perfurado einjetados 3ml de Látex Neoprene 650 na concentração de 20% e no pigmento vermelho. Posteriormente aguardou-se cerca de 1minuto em virtude da polimerização do Látex e logo após foram fixados por imersão em solução aquosa de Formaldeído a 3,7% eapós 72 horas, tiveram os encéfalos removidos da calota craniana para análise de sua superfície ventral. Foi visto que o sistemavertebrobasilar e carótico estiveram presentes em todos os animais analisados, mostrando-se responsável pela vascularizaçãodo encéfalo caudal e rostral, respectivamente. As principais artérias observadas no modelo padrão incluem as ímpares: basilar,espinhal ventral, ramo medial da artéria cerebral rostral e as pares: vertebral, cerebelar caudal, cerebelar média, trigeminal,cerebelar rostral, ramo terminal da basilar, carótida interna, cerebral caudal, hipofisária, cerebral média, cerebral rostral, lateral dobulbo olfatório e etmoidal interna. Conclui-se com base nos resultados que a irrigação da superfície ventral encefálica do gerbilfoi suprida pelos sistemas vertebro-basilar e carótico de forma equivalente, pertencendo assim ao modelo do tipo II. O circuitoarterioso apresentou-se aberto caudalmente e fechado rostralmente, fato que difere do relatado em roedores como capivara,cutia, preá, chinchila e nutria.(AU)

The objective was to describe and systematize the arteries of the base of the brain. Ten gerbils were used, which were stored in afreezer in the Laboratory of Applied Animal Morphophysiology of the Federal Rural Semi-Arid University. The animals were thawed,incised in the midline to identify the left ventricle, which was punctured and injected 3 ml of Latex Neoprene 650 at a concentrationof 20% and red pigment. After about one minute the polymerization of the Latex was delayed and afterwards fixed by immersionin 3.7% aqueous Formaldehyde solution and after 72 hours the brain was removed from the skull cap for analysis of its ventralsurface. It was observed that the vertebro-basilar and carotid system were present in all animals analyzed, being responsible forthe vascularization of the caudal and rostral encephalon, respectively. The main arteries observed in the standard model includethe odd: basilar, ventral spinal, medial branch of the rostral cerebral artery and, the pairs: vertebral, cerebellar caudal, cerebellarmedial, trigeminal, cerebellar rostral, terminal branch of the basilar, internal carotid, caudal cerebral, Pituitary, middle cerebral, rostral,lateral, olfactory and internal ethmoidal. Based on the results, the irrigation of the ventral brain surface of the gerbil was suppliedby the vertebro-basilar and carotic systems in an equivalent way, thus belonging to the type II model. The arterial circuit was opencaudally and closed rostrally, a fact that differs from that reported in rodents such as capybara, agouti, cavy, chinchilla and nutria.(AU)

Vascularização arterial da base do encéfalo do gerbil (Meriones unguiculatus Milne-Edwards, 1867) / Arterial vascularization of the base of the cerebrum of mongolian gerbils (Meriones unguiculatus Milne-Edwards, 1867)

Objetivou-se descrever e sistematizar as artérias da base do encéfalo. Foram utilizados dez gerbils que se encontravam armazenados em freezer no laboratório de Morfofisiologia Animal Aplicada da Universidade Federal Rural do Semiárido. Os animais foram descongelados, incisados na linha mediana para identificação do ventrículo esquerdo, o qual foi perfurado e injetados 3ml de Látex Neoprene 650 na concentração de 20% e no pigmento vermelho. Posteriormente aguardou-se cerca de 1 minuto em virtude da polimerização do Látex e logo após foram fixados por imersão em solução aquosa de Formaldeído a 3,7% e após 72 horas, tiveram os encéfalos removidos da calota craniana para análise de sua superfície ventral. Foi visto que o sistema vertebrobasilar e carótico estiveram presentes em todos os animais analisados, mostrando-se responsável pela vascularização do encéfalo caudal e rostral, respectivamente. As principais artérias observadas no modelo padrão incluem as ímpares: basilar, espinhal ventral, ramo medial da artéria cerebral rostral e as pares: vertebral, cerebelar caudal, cerebelar média, trigeminal, cerebelar rostral, ramo terminal da basilar, carótida interna, cerebral caudal, hipofisária, cerebral média, cerebral rostral, lateral do bulbo olfatório e etmoidal interna. Conclui-se com base nos resultados que a irrigação da superfície ventral encefálica do gerbil foi suprida pelos sistemas vertebro-basilar e carótico de forma equivalente, pertencendo assim ao modelo do tipo II. O circuito arterioso apresentou-se aberto caudalmente e fechado rostralmente, fato que difere do relatado em roedores como capivara, cutia, preá, chinchila e nutria.

The objective was to describe and systematize the arteries of the base of the brain. Ten gerbils were used, which were stored in a freezer in the Laboratory of Applied Animal Morphophysiology of the Federal Rural Semi-Arid University. The animals were thawed, incised in the midline to identify the left ventricle, which was punctured and injected 3 ml of Latex Neoprene 650 at a concentration of 20% and red pigment. After about one minute the polymerization of the Latex was delayed and afterwards fixed by immersion in 3.7% aqueous Formaldehyde solution and after 72 hours the brain was removed from the skull cap for analysis of its ventral surface. It was observed that the vertebro-basilar and carotid system were present in all animals analyzed, being responsible for the vascularization of the caudal and rostral encephalon, respectively. The main arteries observed in the standard model include the odd: basilar, ventral spinal, medial branch of the rostral cerebral artery and, the pairs: vertebral, cerebellar caudal, cerebellar medial, trigeminal, cerebellar rostral, terminal branch of the basilar, internal carotid, caudal cerebral, Pituitary, middle cerebral, rostral, lateral, olfactory and internal ethmoidal. Based on the results, the irrigation of the ventral brain surface of the gerbil was supplied by the vertebro-basilar and carotic systems in an equivalent way, thus belonging to the type II model. The arterial circuit was open caudally and closed rostrally, a fact that differs from that reported in rodents such as capybara, agouti, cavy, chinchilla and nutria

Vascularização arterial da base do encéfalo de preá (Galea spixii) / Arterial vascularization of the base of the brain in galea (Galea spixii)

Background: Galea (Galea spixii) are rodents which are especially distributed in the northeastern region of Brazil, and have economic importance as their meat is used as a source of protein by the regional population. Currently, they have received attention from researchers in studies involving their morphology. Thus, seeking to contribute information that supports their sanitary management in addition to the lack of literature on their nervous system, our objective was to describe the arterial vascularization of the base of the brain in this species, in order to identify the arterial pattern and arterial circuit behavior, as well as possible variations in these vessels. Materials, Methods & Results: Brains were obtained from 20 animals (10 males and 10 females) aged between 11 and 12 months, obtained from the Wild Animal Multiplication Center (CEMAS) of the Federal Rural Semi-Arid University (UFERSA), under the approval of CEUA/UFERSA (case number 23.091.000653/2014-26 and opinion number 15/2014), euthanized according to anesthetic protocol recommended for rodents (resolution number 714/2002 of the CFMV/ UFERSA) and preserved frozen in a freezer for an average period of 30 days. The animals were thawed and a longitudinal incision was performed in the thoracic region to allow exposure of the aortic arch. Next, they were cannulated in the cranial direction and injected with Noprene Latex “650” stained with water-based white or red pigment. The animals were subsequently fixed in 3.7% aqueous formaldehyde solution for 48 h, and soon after the brain skull cap was dissected and removed, which was then analyzed, photographed and sketched. Of the 20 animals evaluated, 100% presented vertebrobasilar system responsible for encephalic irrigation of the rostral and caudal regions, and anastomosis of the left internal carotid artery was found in only […]

Arterial Vascularization of the Base of the Brain in Galea (Galea spixii)

Background: Galea (Galea spixii) are rodents which are especially distributed in the northeastern region of Brazil, and have economic importance as their meat is used as a source of protein by the regional population.  Currently, they have received attention from researchers in studies involving their morphology. Thus, seeking to contribute information that supports their sanitary management in addition to the lack of literature on their nervous system, our objective was to describe the arterial vascularization of the base of the brain in this species, in order to identify the arterial pattern and arterial circuit behavior, as well as possible variations in these vessels.Materials, Methods & Results: Brains were obtained from 20 animals (10 males and 10 females) aged between 11 and 12 months, obtained from the Wild Animal Multiplication Center (CEMAS) of the Federal Rural Semi-Arid University (UFERSA), under the approval of CEUA/UFERSA (case number 23.091.000653/2014-26 and opinion number 15/2014), euthanized according to anesthetic protocol recommended for rodents (resolution number 714/2002 of the CFMV/ UFERSA) and preserved frozen in a freezer for an average period of 30 days. The animals were thawed and a longitudinal incision was performed in the thoracic region to allow exposure of the aortic arch. Next, they were cannulated in the cranial direction and injected with

Vascularização arterial da base do encéfalo de preá (Galea spixii) / Arterial vascularization of the base of the brain in galea (Galea spixii)

Background: Galea (Galea spixii) are rodents which are especially distributed in the northeastern region of Brazil, and have economic importance as their meat is used as a source of protein by the regional population. Currently, they have received attention from researchers in studies involving their morphology. Thus, seeking to contribute information that supports their sanitary management in addition to the lack of literature on their nervous system, our objective was to describe the arterial vascularization of the base of the brain in this species, in order to identify the arterial pattern and arterial circuit behavior, as well as possible variations in these vessels. Materials, Methods & Results: Brains were obtained from 20 animals (10 males and 10 females) aged between 11 and 12 months, obtained from the Wild Animal Multiplication Center (CEMAS) of the Federal Rural Semi-Arid University (UFERSA), under the approval of CEUA/UFERSA (case number 23.091.000653/2014-26 and opinion number 15/2014), euthanized according to anesthetic protocol recommended for rodents (resolution number 714/2002 of the CFMV/ UFERSA) and preserved frozen in a freezer for an average period of 30 days. The animals were thawed and a longitudinal incision was performed in the thoracic region to allow exposure of the aortic arch. Next, they were cannulated in the cranial direction and injected with Noprene Latex “650” stained with water-based white or red pigment. The animals were subsequently fixed in 3.7% aqueous formaldehyde solution for 48 h, and soon after the brain skull cap was dissected and removed, which was then analyzed, photographed and sketched. Of the 20 animals evaluated, 100% presented vertebrobasilar system responsible for encephalic irrigation of the rostral and caudal regions, and anastomosis of the left internal carotid artery was found in only […](AU)