Clinical significance of common-stem lenticulostriate arteries in patients with internal watershed infarction.

BACKGROUND: A common-stem origin of lenticulostriate arteries (CS-LSAs) is an anatomical variation that supplies a moderate to large section of the basal ganglia. We hypothesized that CS-LSAs with a patent orifice are located at distal positions of the acute-occluded middle cerebral artery (MCA) and that the blood flow of CS-LSAs is supplied by pail arterial anastomoses and results in hypoperfusion of CS-LSAs, similar to a deep watershed (DWS) infarction. OBJECTIVE: Our study evaluated the possibility of CS-LSAs in patients with DWS infarction and MCA occlusion and also assessed the safety of endovascular therapy (ET) in these patients. METHODS: A cohort of consecutive patients with DWS infarction and MCA occlusion and in whom full recanalization via ET was achieved were identified. Patients were divided into two groups based on the presence of CS-LSAs observed during ET. In addition, radiological and clinical data were retrospectively analyzed. RESULTS: Thirty-three patients were included, and CS-LSAs were observed in 48.5% (16/33) of patients. The possibility (72.2%, 13/18) of CS-LSAs was high in patients with DWS infarction companied with basal ganglia infarction. A good clinical outcome was similar in patients with CS-LSAs and basal ganglia infarction and in patients without CS-LSAs and basal ganglia infarction (69.2% vs. 81.8%, P = 0.649). CONCLUSIONS: The possibility of CS-LSAs was 48.5% in patients with DWS infarction and MCA occlusion, and the revascularization procedure was safe and feasible in these patients despite the moderate-to-large basal ganglia infarction.

Señales asociadas a la muerte en la enfermedad cerebrovascular isquémica / Signs associated to death in ischemic cerebrovascular diseases

Introducción: la enfermedad cerebrovascular es la tercera causa de muerte en el mundo occidental. Existe la influencia de variables que anuncian el riesgo de morir. Objetivo: determinar las señales asociadas a las muertes por enfermedad cerebrovascular isquémica en pacientes hospitalizados de Mayabeque. Métodos: se realizó un estudio observacional analítico. El universo de estudio estuvo constituido por 982 pacientes. Se excluyeron de la investigación las historias clínicas incompletas. Para la selección de la muestra se realizó un muestreo no probabilístico intencional, quedando conformado por un total de 334 pacientes (167 vivos y 167 fallecidos). Para el procesamiento de los datos se aplicó el test Chi Cuadrado para medir la asociación entre las variables, con un nivel de confianza del 95 por ciento. Resultados: la mayor incidencia de fallecidos por enfermedad cerebrovascular ocurrió en el grupo 70 a 79 años. Predominaron los pacientes con tensión sistodiastólica para un total de 294 pacientes con 152 vivos y 142 fallecidos. Se aprecióla hiperuricemia en 109 fallecidos y 41vivos, así como la hiperglucemia en 128 fallecidos y 75 vivos. Predominaron los pacientes fallecidos con tromboembolismo pulmonar y neumonía en un 60 a un 75 por ciento respectivamente. Conclusiones: la mayor mortalidad por enfermedad cerebrovascular isquémica fueron los pacientes mayores de 70 años. La hipertensión arterial sistodiastólica,la hiperglicemia y la elevación de la urea se asociaron a los fallecimientos y la neumonía, el tromboembolismo pulmonar y los desequilibrios hidroelectrolítico, son las complicaciones que más se asocian a la mortalidad; así como la estadía mayor de 8 días se asoció a mayor mortalidad (AU)

Introduction: cerebrovascular diseases is the third cause of death in the western world. There is the influence of variables that inform the risk to die. Objective: to determine signs associated to death in ischemic cerebrovascular diseases in hospitalized patients from Mayabeque. Methods: an observational analytic study was performed. The universe of study was formed by 982 patients. Incomplete clinical records were excluded of the investigation. The sample was selected by a non- probabilistic intentional model, conformed by a total of 334 patients (167 alive and 167 deceased) For processing the data a which Chi square test was applied to measure the association between the variables, with a level of confidence of 95 por cent. Results: the highest incidence of deceased patients because of cerebrovascular diseases is in the 70 to 79 age group. Patients with sisto-diastolic blood pressure prevailed for a total of 294 patients with 152 alive and 142deceased. Hyperuricemia was appreciated in 109 deceased y 41 alive patients, as well as hyperglycemia in 128 deceased and 75 alive patients. Dead patients with pulmonary thromboembolism and pneumonia prevailed in a 60 and 75 por cent respectively. Conclusions: the highest mortality for ischemic cerebrovascular diseases was in patients older than 70 years old. Sisto-diastolic hypertension, hyperglycemia and hyperuricemia were associated to deaths. Pulmonary thromboembolism, pneumonia and hydro-electrolytic unbalances as well as a stay higher than 8 days were associated to higher mortality (AU)

Hyperechogenicity of lenticulostriate vessels: A poor prognosis or a normal variant? A seven year retrospective study.

BACKGROUND: Lenticulostriate vasculopathy (LSV) is a hyperechogenicity of the lenticulostriate branches of the basal ganglia and/or thalamus' middle cerebral arteries and is frequently seen in neonatology. Our study primarily describes the perinatal data and long-term follow-up of newborns with lenticulostriate vessel hyperechoic degeneration. Secondly, it describes the cerebral imaging data as a function of perinatal factors and neurodevelopmental follow-up of these newborns. METHODS: This retrospective study assesses the outcome of newborns with LSV hyperechogenicity on cerebral ultrasound (two grades). These children were born between January 2008 and September 2015 and were treated in a large level III neonatal intensive care unit. Thirty-four term-equivalent age children underwent MRIs using a standardized protocol of T2, T1 3D, diffusion and spectro-MRI sequences. The MRIs retrospectively measured the white matter and basal ganglia apparent diffusion coefficients (ADC). RESULTS: Fifty-eight neonates, ranging from 25 to 42 weeks gestational age (GA), were diagnosed with LSV. There was a significantly increased high-grade LSV when accompanied by fetal heart rate abnormalities (p = 0.03) and the neonate's need for respiratory support at birth (P = 0.002). The mean ADC score was substantially superior in the high-grade versus the low-grade LSVs (p = 0.023). There were no noteworthy outcome differences between a high and low grade LSV. The mean ADC for basal ganglions was appreciably higher in children with a severe prognoses (death or developmental disorder) as compared to children with no abnormalities (p < 0.01). CONCLUSION: From the results of our study, it appears that a low-grade LSV could be considered as a normal variant. There are no unifying diagnostic criteria for LSV on cerebral ultrasound. With a cerebral MRI, the use of ADC values of basal ganglia may well underscore the importance of such data in predicting long-term outcomes.

Dose-responses from multi-model inference for the non-cancer disease mortality of atomic bomb survivors.

The non-cancer mortality data for cerebrovascular disease (CVD) and cardiovascular diseases from Report 13 on the atomic bomb survivors published by the Radiation Effects Research Foundation were analysed to investigate the dose-response for the influence of radiation on these detrimental health effects. Various parametric and categorical models (such as linear-no-threshold (LNT) and a number of threshold and step models) were analysed with a statistical selection protocol that rated the model description of the data. Instead of applying the usual approach of identifying one preferred model for each data set, a set of plausible models was applied, and a sub-set of non-nested models was identified that all fitted the data about equally well. Subsequently, this sub-set of non-nested models was used to perform multi-model inference (MMI), an innovative method of mathematically combining different models to allow risk estimates to be based on several plausible dose-response models rather than just relying on a single model of choice. This procedure thereby produces more reliable risk estimates based on a more comprehensive appraisal of model uncertainties. For CVD, MMI yielded a weak dose-response (with a risk estimate of about one-third of the LNT model) below a step at 0.6 Gy and a stronger dose-response at higher doses. The calculated risk estimates are consistent with zero risk below this threshold-dose. For mortalities related to cardiovascular diseases, an LNT-type dose-response was found with risk estimates consistent with zero risk below 2.2 Gy based on 90% confidence intervals. The MMI approach described here resolves a dilemma in practical radiation protection when one is forced to select between models with profoundly different dose-responses for risk estimates.