Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.688
Filtrar
1.
Medicine (Baltimore) ; 99(12): e19574, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195967

RESUMO

RATIONALE: Fat embolism syndrome (FES) is characterized by the classical triad of cerebral, respiratory, and cutaneous manifestations. In contrast, cerebral fat embolism (CFE), corresponding to incomplete pure type FES, is much rarer and usually follows trauma. CFE typically shows a "starfield" pattern on diffusion-weighted magnetic resonance imaging due to the involvement of multiple small arteries. We report 2 unusual cases of CFE that showed a nontraumatic etiology and the involvement of a single dominant cerebral artery. PATIENT CONCERNS: Case 1 was a 33-year-old woman without a history of trauma who visited the emergency room due to hemiparesis and hemisensory deficits. She was a heavy smoker and had used oral contraceptives for several years. Most importantly, she had 2 experiences of autologous fat grafting 2 months previously. Magnetic resonance angiography (MRA) revealed acute occlusion of the right middle cerebral artery. Case 2 was an 80-year-old man suddenly presented with dizziness, ataxia, and left-sided sensorimotor dysfunction. He had a history of hypertension, untreated atrial fibrillation, and chronic alcoholism. MRA demonstrated the occlusion of the distal basilar artery. DIAGNOSIS: Case 1: Microscopic findings demonstrated variable sized fat vacuoles intermixed with moderate amounts of thrombi. Case 2: Histologically, mature adipocytes were intermingled with fibrin, blood cells, and a fragment of entrapped soft tissue resembling the vessel wall. INTERVENTION: Case 1 and 2 underwent aspirational thrombectomy guided by transfemoral cerebral angiography. OUTCOME: Case 1 recovered well but Case 2 still suffers from gait ataxia. LESSONS: CFE can rarely occur in various nontraumatic conditions, with or without evident etiology. Furthermore, it may not show characteristic clinicopathological manifestations. Therefore, careful follow up of those who have undergone procedures that are likely to trigger FES or who have hemodynamic or hypercoagulable risk factors is needed.


Assuntos
Embolia Gordurosa/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Paresia/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/etiologia , Embolia Gordurosa/patologia , Embolia Gordurosa/cirurgia , Feminino , Humanos , Embolia Intracraniana/patologia , Embolia Intracraniana/cirurgia , Angiografia por Ressonância Magnética , Masculino , Artéria Cerebral Média/patologia , Paresia/etiologia , Trombectomia/instrumentação , Trombectomia/métodos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(7): e19168, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049846

RESUMO

Ischemic moyamoya disease (MMD) can be treated with the revascularization of superficial temporal artery to middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-arterio-myo-synangiosis (EDAMS) effectively. The purpose of the present study was to quantify the revascularization of STA-MCA bypass combined with EDAMS via whole-brain computed tomography perfusion (WB-CTP).Seventy-nine consecutive patients with ischemic MMD who admitted to our hospital from August 2012 to October 2018 were carried out STA-MCA bypass combined with EDAMS. WB-CTP was performed at 24 hours prior to operation and 3 months following bypass with a follow-up WB-CTP, respectively. Both automatic analysis of WB-CTP (MIStar, Apollo Medical imaging Technology, Melbourne, Australia) for analyzing values of brain volume in delayed time (DT) >3 seconds and DT > 6 seconds, relative cerebral blood flow (γCBF) < 30% and its mismatch ratio or percentage and diffusion-weighted imaging of magnetic resonance imaging in the ischemic penumbra and the infarct core at the 2 time points were studied for verifying the effectiveness of the combined revascularization. Changes in DT values at MCA-terminal territory after revascularization had been investigated. The dynamic data were with reference to the individual cerebellar arteries.All patients with ischemic MMD underwent STA-MCA bypass combined with EDAMS successfully. The preoperative brain volume in DT > 3 seconds in MCA-terminal territory was significantly larger than that of postoperative one (P < .05) in the ischemic penumbra in ischemic MMD. The mismatch ratio in brain volume of 24 hours prior to revascularization in MCA-terminal territory was significantly lower than that of 3 months (P < .05) following combined revascularization. The percentage of mismatch in brain volume of 24 hours prior to revascularization vs that of 3 months and the value of γCBF < 30% were similar to the above mismatch ratio (P < .05). The ratio of postoperative brain volume in DT > 3 seconds vs DT > 6 seconds indicated no significant differences compared with that of preoperative one (P > .05).The WB-CTP can be regarded as a choice for quantifying the combined revascularization in the ischemic penumbra and the infarct core in ischemic MMD. As proposed methods, brain volume in DT > 3 seconds, the value of γCBF < 30% and mismatch ratio in brain volume in MCA-terminal territory should be paid more attention in assessing the validity of STA-MCA bypass combined with EDAMS in ischemic MMD.


Assuntos
Angiografia Cerebral/métodos , Revascularização Cerebral , Doença de Moyamoya/diagnóstico por imagem , Adolescente , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 29(2): 104504, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761735

RESUMO

BACKGROUND: Accurate assessment of the frequency of large vessel occlusion (LVO) is important to determine needs for neurointerventionists and thrombectomy-capable stroke facilities. Current estimates vary from 13% to 52%, depending on acute ischemic stroke (AIS) definition and methods for AIS and LVO determination. We sought to estimate LVO prevalence among confirmed and suspected AIS patients at 2 comprehensive US stroke centers using a broad occlusion site definition: internal carotid artery (ICA), first and second segments of the middle cerebral artery (MCA M1,M2), the anterior cerebral artery, vertebral artery, basilar artery, or the proximal posterior cerebral artery. METHODS: We analyzed prospectively maintained stroke databases of patients presenting to the centers between January and December 2017. ICD-10 coding was used to determine the number of patients discharged with an AIS diagnosis. Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) was reviewed to determine LVO presence and site. Percentages of patients with LVO among the confirmed AIS population were reported. RESULTS: Among 2245 patients with an AIS discharge diagnosis, 418 (18.6%:95% confidence interval [CI] 17.3%-20.0%) had LVO documented on CTA or MRA. Most common occlusion site was M1 (n=139 [33.3%]), followed by M2 (n=114 [27.3%]), ICA (n=69[16.5%]), and tandem ICA-MCA lesions (n=44 [10.5%]). Presentation National Institutes of Health Stroke Scale scores were significantly different for different occlusion sites (P=.02). CONCLUSIONS: The LVO prevalence in our large series of consecutive AIS patients was 18.6% (95% CI 17.3%-20.0%). Despite the use of a broad definition, this estimate is less than that reported in most previous studies.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Infarto da Artéria Cerebral Anterior/epidemiologia , Infarto da Artéria Cerebral Média/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
4.
World Neurosurg ; 133: e320-e326, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520758

RESUMO

BACKGROUND: Compared with intracranial aneurysms (IAs) at other locations, pericallosal artery aneurysms (PAAs) have demonstrated an extremely high risk of rupture. However, owing to their rarity, our understanding of their morphological characteristics has been limited, and whether the morphological characteristics of PAAs contribute to this high rupture risk has remained unexplored. In the present study, we aimed to provide a detailed description of the morphological characteristics of PAAs and investigate the association between its morphology and rupture risk compared with anterior circulation IAs at other locations. METHODS: A total of 40 patients with 45 PAAs and 348 patients with 392 anterior circulation IAs at other locations were recruited. The clinical and radiological data for these patients were retrospectively reviewed. The differences in the morphological parameters, including the aneurysm diameter, neck width, height, width, parent artery diameter, inflow angle, aspect ratio (AR), size ratio (SR), and aneurysm diameter/width ratio, between PAAs and other IA groups were compared. RESULTS: Of the 45 PAAs, 22 (48.9%) had ruptured. The proportion of ruptured aneurysms was greater for PAAs than for anterior circulation IAs at other locations. For both ruptured and unruptured anterior circulation IAs, PAAs had the highest AR and SR among all IA groups and had the largest inflow angle. CONCLUSION: The morphological characteristics of PAAs are unique. Compared with other anterior circulation IAs, PAAs have significantly increased ARs, SRs, and inflow angles, which, ultimately, promote their high propensity toward rupture.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Adolescente , Adulto , Idoso , Aneurisma Roto/epidemiologia , Aneurisma Roto/patologia , Artéria Cerebral Anterior/patologia , Corpo Caloso/irrigação sanguínea , Suscetibilidade a Doenças , Feminino , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
Radiol Med ; 125(1): 57-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31473929

RESUMO

INTRODUCTION: A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. METHODS: A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. RESULTS: Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). CONCLUSIONS: ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.


Assuntos
Isquemia Encefálica/cirurgia , Cateteres , Reperfusão/instrumentação , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Reperfusão/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/métodos , Resultado do Tratamento , Adulto Jovem
6.
J Stroke Cerebrovasc Dis ; 29(2): 104512, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786044

RESUMO

BACKGROUND: Extracranial carotid artery (ECA) tortuosity may influences successful recanalization rates of mechanical thrombectomy in acute ischemic stroke (AIS), yet the relationship between ECA tortuosity and the prognosis of patients with anterior circulation AIS who cannot undergo endovascular treatment remains uncertain. We hypothesized that increased tortuosity of the ECA leads to unfavorable outcomes in such patients. METHODS: Patients with anterior circulation AIS who underwent computed tomography angiography of the head and neck in our hospital between March 2018 and November 2018 were retrospectively analyzed. The tortuosity of the bilateral ECA was measured, and functional outcomes were evaluated by a modified Rankin Scale (mRS) at 90 days. Multivariate logistic regression models were used to determine the association between ECA tortuosity and outcomes of patients. RESULTS: A total of 203 patients were enrolled in our study, including 140 patients (68.97%) with favorable outcomes (mRS, 0-2) and 63 patients (31.03%) with unfavorable outcomes (mRS, 3-6). After adjusting for age, atrial fibrillation, stroke territory, and posthospital antithrombotics/statins therapy in multivariate logistic regression model I, ECA tortuosity (odds ratio, 1.052; 95% confidence interval, 1.010-1.096; P = .015) was an independent risk of unfavorable outcomes in enrolled patients. In the other 2 models (II and III) which adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, and with or without posthospital medication, ECA tortuosity was also showed independent relationship to unfavorable outcomes. The optimal cutoff was 12.5 to predict the unfavorable outcomes in a receiver operating characteristic curve. CONCLUSIONS: Our study demonstrated that the ECA tortuosity is an independent predictor of unfavorable outcomes for anterior circulation AIS patients who without undergoing endovascular treatment after hospital admission. ECA tortuosity values greater than 12.5 may indicate an unfavorable outcome.


Assuntos
Isquemia Encefálica/terapia , Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Artérias Carótidas/fisiopatologia , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 29(2): 104542, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31836359

RESUMO

OBJECTIVES: The aim of this study was to explore the role of the vessel diameter at the site of middle cerebral artery (MCA) occlusion in acute ischemic stroke patients who underwent mechanical thrombectomy (MT) regarding technical aspects, safety, and clinical outcomes. METHODS: In a retrospective analysis, cerebral artery diameters were measured using digital subtraction angiography in patients with isolated M1 or M2 occlusions undergoing MT. Associations between occluded vessel, occlusion diameter and outcomes were analyzed using logistic regression models adjusting for prespecified prognostic factors. RESULTS: 168 patients with M1 occlusions and 98 patients with M2 occlusions who underwent MT were included. Mean vessel diameters at M1 and M2 occlusion sites differed significantly (2.15 +/- .36 1.55 +/- .38, P < .001). Vessel diameters at the occlusion site and occluded vessel segment did not predict good functional outcome (aOR 1.2 CI .28-5.26, P = .659; aOR .84 CI .35-2.03, P = .841) or mortality (aOR .21 CI .04-1.01, P = .215; aOR 1.36 CI .55-3.37, P = .676). No significant differences in successful recanalization, good functional outcome, mortality, procedural complications, and intracranial hemorrhages between M1 and M2 occlusions was observed. CONCLUSIONS: In this study no significant effect of the MCA vessel diameter on successful recanalization, good functional outcome, or mortality of acute ischemic stroke patients treated with MT could be detected. However, these findings need to be confirmed in further studies.


Assuntos
Angiografia Digital , Angiografia Cerebral/métodos , Infarto da Artéria Cerebral Média/terapia , Artéria Cerebral Média/diagnóstico por imagem , Trombectomia , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/mortalidade , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
8.
J Vasc Res ; 56(6): 296-307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31671424

RESUMO

In this study, using fluid-structure interaction (FSI), 3-dimensional blood flow in an aneurysm in the circle of Willis - which is located in the middle cerebral artery (MCA) - has been simulated. The purpose of this study is to evaluate the effect of a partly blocked vessel on an aneurysm. To achieve this purpose, two cases have been investigated using the FSI method: in the first case, an ideal geometry of aneurysm in the MCA has been simulated; in the second case, modeling is performed for an ideal geometry of the aneurysm in the MCA with a partly blocked vessel. All boundary conditions, properties and modeling methods were considered the same for both cases. The only difference between the two cases was that part of the MCA parent artery was blocked in the second case. In order to consider the hyperelastic property of the wall and the non-Newtonian properties of the blood, the Mooney-Rivlin model and the Carreau model have been used, respectively. In the second case, the Von Mises stress in the peak systole is 26% higher than in the first case. With regard to the high amount of Von Mises stress, the risk of rupture of the aneurysm is higher in this case. In the second case, the maximum wall shear stress (WSS) is 12% higher than in the first case. And maximum displacement in the second case is also higher than in the first. So, the risk of growth of the aneurysm is higher in cases with a partly blocked vessel.


Assuntos
Circulação Cerebrovascular , Círculo Arterial do Cérebro/fisiopatologia , Simulação por Computador , Infarto da Artéria Cerebral Média/fisiopatologia , Aneurisma Intracraniano/fisiopatologia , Modelos Cardiovasculares , Idoso , Velocidade do Fluxo Sanguíneo , Angiografia Cerebral/métodos , Círculo Arterial do Cérebro/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Fluxo Sanguíneo Regional
9.
J Stroke Cerebrovasc Dis ; 28(12): 104473, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677961

RESUMO

BACKGROUND: Nontraumatic convexity subarachnoid hemorrhage (cSAH) is a nonaneurysmal variant that is associated with diverse etiologies. METHODS: With IRB approval, we retrospectively reviewed consecutive nontraumatic cSAH from July 1, 2006 to July 1, 2016. Data were abstracted on demographics, medical history, neuroimaging, etiology, and clinical presentation. RESULTS: We identified 94 cases of cSAH. The cases were classified according to the following etiologies: reversible cerebral vasoconstriction syndrome (RCVS) 17 (18%), cerebral amyloid angiopathy (CAA) 15 (16%), posterior reversible encephalopathy syndrome 16 (17%), cerebral venous thrombosis 10 (11%), large artery occlusion 7 (7%), endocarditis 6 (6%), and cryptogenic 25 (27%). Early rebleeding occurred in 9 (10%) patients. Time from initial imaging to CT rebleeding was 40 hours (range, 5-74). CAA was associated with the highest mean age at 75.8 and RCVS the lowest at 47.6 years (P< .0001). Among patients with RCVS, initial vascular imaging was negative in 6 (35%), and repeat imaging documented vasoconstriction at a mean delay of 5 days (range, 3-16). CONCLUSION: There were significant differences among the subgroups in cSAH, with CAA presenting as older men with transient neurological deficits, and RCVS presenting as younger women with thunderclap headache. Rebleeding was seen in 10% of cSAH patients. One-third of RCVS patients with cSAH required repeat vascular imaging to diagnose vasoconstriction.


Assuntos
Angiopatia Amiloide Cerebral/complicações , Endocardite/complicações , Trombose Intracraniana/complicações , Síndrome da Leucoencefalopatia Posterior/complicações , Hemorragia Subaracnóidea/etiologia , Vasoespasmo Intracraniano/complicações , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Endocardite/diagnóstico , Feminino , Humanos , Trombose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Valor Preditivo dos Testes , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Hemorragia Subaracnóidea/diagnóstico por imagem , Síndrome , Fatores de Tempo , Vasoconstrição , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , Adulto Jovem
10.
J Med Vasc ; 44(6): 387-399, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761306

RESUMO

The work's purpose is to make a general review on the various clinical-radiological aspects and the management of cerebral venous thrombosis (CVT) in our hospital and compare them to those described in the literature. MATERIAL AND METHOD: Our series included 62 patients aged over 18 years, collected over 7 years (2009-2016) in the radiology department of the CHU Hassan II of Fez (Morocco), in which the radiological diagnosis of TVC was retained. Our patients have benefited from a brain CT scan and brain MRI. Clinical and radiological characteristics and post-treatment progression were described. RESULTS: The average age was 35 years with a female predominance; sex ratio 3.76 (49F/13H). The symptomatology was non-specific, made mainly of headaches, comic crises, disturbances of consciousness and focal signs. The upper longitudinal sinus was dominant topography (51.61%). The etiological factors were varied: infectious (sinusitis, chronic otitis media, oto-mastoiditis, bacterial meningitis, and septicemia), gyneco-obstetrical (oral contraception, pregnancy, and postpartum), systemic (Behçet diseases, polycythemia of Vaquez, paraneoplastic syndrome, antiphospholipid syndrome), local (head trauma), undetermined etiological factors. The CT scan, but especially the cerebral MRI, made it possible to make the diagnosis but also to direct towards the etiology. CONCLUSION: Cerebral MRI is currently the best imaging in the diagnosis of CTV, allowing an accurate assessment of its location, extent and impact on the cerebral parenchyma. Multiple conditions are responsible for CTVs. Therapeutic management is based on heparinotherapy and etiological treatment.


Assuntos
Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Trombose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Flebografia , Trombose Venosa/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Trombose Intracraniana/etiologia , Trombose Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Trombose Venosa/etiologia , Trombose Venosa/terapia , Adulto Jovem
11.
Medicine (Baltimore) ; 98(48): e18184, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770272

RESUMO

RATIONALE: Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable. DIAGNOSIS: Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA. INTERVENTIONS: We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication. OUTCOMES: We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach. LESIONS: PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.


Assuntos
Aneurisma Roto , Aneurisma , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa , Seio Cavernoso/diagnóstico por imagem , Embolização Terapêutica/métodos , Aneurisma/complicações , Aneurisma/diagnóstico , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Aneurisma Roto/terapia , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/fisiopatologia , Fístula Carotidocavernosa/terapia , Angiografia Cerebral/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 28(11): 104365, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530482

RESUMO

A 64-year-old woman was admitted to our hospital 48 minutes after sudden onset of dysphasia and right hemiplegia. Head computed tomography revealed small infarcts in the left putamen and 4-dimensional computed tomography angiography depicted high-degree stenosis in the left middle cerebral artery and delayed filling of the contrast media in the left middle cerebral artery territory. The patient underwent intravenous tissue plasminogen activator treatment. On day 5 of hospitalization, the patient underwent conventional cerebral angiography, revealing internal carotid artery to middle cerebral artery dissection. Fortunately, subarachnoid hemorrhage as an adverse effect did not occur, although iv-tPA was administered without detecting middle cerebral artery dissection.


Assuntos
Angiografia Digital , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Fibrinolíticos/administração & dosagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
13.
J Stroke Cerebrovasc Dis ; 28(11): 104373, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31526564

RESUMO

BACKGROUND: Three-dimensional, black-blood, contrast-enhanced, T1-weighted magnetic resonance imaging (3D-BB-ceT1-MRI) could play a role in detection of thrombi and symptomatic intracranial atherosclerotic stenosis. We investigated the role of 3D-BB-ceT1-MRI in patients with acute ischemic stroke in the posterior circulation, and compared our findings with those from susceptibility-weighted imaging (SWI). MATERIALS AND METHODS: We retrospectively reviewed 3D-BB-ceT1-MRI for patients between January 2017 and August 2018 with acute ischemic symptoms in the posterior circulation. During this period, 199 patients with acute infarction in the posterior circulation were enrolled. Time-of-flight-magnetic resonance angiography or cerebral angiography was used as the reference standard. RESULTS: Of these 199 patients, 47 had vessel occlusion associated with acute infarction. The sensitivity of 3D-BB-ceT1-MRI for detection of vessel occlusion was significantly higher than that of SWI (95.7% versus 53.2%, P < .001). Twenty-one lesions with strong enhancement on 3D-BB-ceT1-MRI showed a negative susceptibility vessel sign (SVS) on SWI. CONCLUSIONS: 3D-BB-ceT1-MRI showed strong enhancement (due to contrast stagnation) in the intra-arterial thrombi of patients with acute infarction in the posterior circulation. 3D-BB-ceT1-MRI had higher sensitivity than that of an SVS on SWI for detection of intra-arterial thrombi.


Assuntos
Meios de Contraste/administração & dosagem , Imagem Tridimensional , Infarto da Artéria Cerebral Posterior/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Meglumina/administração & dosagem , Compostos Organometálicos/administração & dosagem , Artéria Cerebral Posterior/diagnóstico por imagem , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Feminino , Humanos , Infarto da Artéria Cerebral Posterior/fisiopatologia , Trombose Intracraniana/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
J Stroke Cerebrovasc Dis ; 28(11): 104353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31494013

RESUMO

OBJECTIVES: Endovascular therapy (EVT) improves outcomes for appropriately selected acute ischemic stroke patients. Guidelines suggest rapid acquisition of noninvasive vascular imaging to screen suspected ischemic stroke patients for large vessel occlusion (LVO) and candidacy for EVT. We sought to quantify the yield of an LVO stroke screening process in an undifferentiated emergency department (ED) suspected stroke population as well as identify predictors of successful EVT. METHODS: We identified a cohort of consecutive ED patients who received CT angiography and brain perfusion (CTA/P) imaging to determine candidacy for EVT during 2016. In keeping with the guidelines at that time, hospital protocol directed physicians to obtain CTA/P studies if time from the onset of symptoms was less than or equal to 6 hours, and the National Institute of Health Stroke Scale (NIHSS) more than or equal to 6 or if recommended by the consulting stroke neurologist. Final discharge diagnoses, EVT attempts, and successful reperfusion (TICI 2b or better) were recorded. Yield of CTA/P was compared among patients based on NIHSS and duration of symptoms. RESULTS: Over a 12-month period, 406 suspected stroke patients were screened with CTA/P; 273 (67%) received a final diagnosis of ischemic stroke. Among cases screened, 53 (13%) underwent attempted EVT; 35 (9%) achieved successful reperfusion. Only 1 of 113 (1%) patients with an NIHSS less than 6 was successfully treated with EVT compared to 34 of 285 (12%) with higher NIHSS (p = 0.001). The probability of successful EVT declined with increasing symptom duration (p = 0.009 for trend). In multivariable analysis, NIHSS more than or equal to 6 was associated with successful EVT (odds ratio [OR] 4.0 [1.6 to 9.9]) but presentation within 6 hours of onset was not (OR 2.3 [0.8 to 6.7]). CONCLUSIONS: EVT candidates were common among suspected stroke patients screened with CTA/P in the ED, however, patients with NIHSS less than 6 rarely received successful EVT.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Serviço Hospitalar de Emergência , Imagem de Perfusão/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/terapia , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 28(11): 104328, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471213

RESUMO

OBJECTIVE: Present study was aimed to precisely evaluate the angio-architectures in patients with asymptomatic moyamoya disease (MMD) by comparing with those with hemorrhagic stroke. METHODS: This study used the data set of cerebral angiography in Asymptomatic Moyamoya Registry (AMORE) Study and Japan Adult Moyamoya (JAM) Trial at enrollment. The development of 3 subtypes of collateral vessels, including lenticulostriate, thalamic, and choroidal anastomosis, was evaluated on cerebral angiography. Suzuki's angiographical stage and posterior cerebral artery (PCA) involvement were also assessed. These findings were compared between asymptomatic (AMORE) and hemorrhagic (JAM) groups. RESULTS: This study included 55 hemispheres of 35 patients in asymptomatic group and 75 hemispheres of 75 patients in hemorrhagic group. In asymptomatic group, thalamic anastomosis was less developed than in hemorrhagic group (P = .011), but there were no significant differences in the development of lenticulostriate and choroidal anastomosis between the 2 groups (P = .077 and P = .26, respectively). Suzuki's stage was more progressed and the prevalence of PCA involvement was significantly higher in hemorrhagic group than in asymptomatic group (P = .0033 and P = .016, respectively). CONCLUSIONS: This study reveals no significant differences in the development of choroidal anastomoses between asymptomatic and hemorrhagic-onset MMD. On the other hand, disease stage and PCA involvement were less advanced in asymptomatic MMD than in hemorrhagic-onset MMD. These findings strongly suggest a certain subgroup of asymptomatic patients with MMD is at potential risk for hemorrhagic stroke.


Assuntos
Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Doença de Moyamoya/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Doenças Assintomáticas , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Estudos Transversais , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Japão , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Doença de Moyamoya/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
17.
J Stroke Cerebrovasc Dis ; 28(11): 104304, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31399279

RESUMO

BACKGROUND: Internal carotid artery (ICA) hypoplasia (ICAH) is rare. The classification of ICAH is largely unclear. The aim of the study is to propose a new imaging classification for ICAH based on the occlusion of the distal ophthalmic segment and discuss the clinical and radiological differences between the different types. MATERIALS AND METHODS: This was a retrospective study of patients with congenital ICAH diagnosed at the Department of Neurology of the China-Japan Friendship Hospital between June 2011 and June 2016. The patients underwent temporal bone computed tomography (CT), brain CT, cranial magnetic resonance imaging, transcranial Doppler, and head and neck CT angiography. RESULTS: A total of 20 ICAH patients were divided into the distal occlusion (12 cases; 60%) and nondistal occlusion (8 cases; 40%) types based on whether the distal ophthalmic segment was occluded. The frequencies of collateral circulation from the circle of Willis (P = .01) and dilated cerebrovascular lesions (P = .001) in the distal occlusion type was higher than in the nondistal occlusion type. Five (25%) patients developed adverse cerebrovascular events during followup: 3 ischemic cases were of the nondistal occlusion type, and 2 cases with subarachnoid hemorrhage were of the distal occlusion type. CONCLUSIONS: A novel classification of ICAH was revealed based on the occlusion of the distal ophthalmic segment. The 2 types may show differences in collateral circulation patterns, coexisting cerebrovascular abnormalities, and potential clinical outcomes.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral/métodos , Imagem por Ressonância Magnética , Ultrassonografia Doppler Transcraniana , Adulto , Idoso , Angiografia Digital , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos
18.
J Stroke Cerebrovasc Dis ; 28(10): 104311, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31376998

RESUMO

BACKGROUND: Secondary embolism (SE) during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is the main reason for incomplete recanalization, while its risk factors are largely unknown. This study addresses a potential relationship between thrombus density on preinterventional computed tomography (CT) and the occurrence of SE. METHODS: We reviewed anterior circulation AIS patients who underwent MT from July 2015 to January 2019 in our center. Thrombus density was measured in Hounsfield Units (HU) on 1-mm and 5-mm preinterventional nonenhanced CT (NECT). Thrombus density, baseline characteristics, procedural, and clinical outcomes were compared between patients with SE and those without SE. Logistic regression was conducted to identified potential risk factors of SE. RESULTS: Sixty-four consecutively patients were included, of whom SE was identified in 16 (25.0%) patients. Compared with those without SE, patients with SE showed a higher thrombus density on both 1-mm (72.85 versus 64.28, P = .005) and 5-mm NECT (60.31 versus 49.71, P < .001), a higher proportion of atrial fibrillation (75.0% versus 45.8%, P = .043), a lower clot burden score (.5 versus 6.0, P = .029), and a higher proportion of front-line contact aspiration strategy (50.0% versus 16.7%, P = .020). Multivariate regression analysis showed that only thrombus density was the independent predictor of SE (for the model including HU values on 1-mm NECT, OR 1.11, 95%CI 1.01-1.23, P = .029; for the model including HU values on 5-mm NECT, OR 1.09, 95%CI 1.02-1.17, P = .018). CONCLUSIONS: Higher thrombus density was the independent predictor for SE. Further studies are needed to investigate its role in the optimization of thrombectomy strategy.


Assuntos
Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada/métodos , Embolia Intracraniana/terapia , Trombose Intracraniana/terapia , Tomografia Computadorizada Multidetectores/métodos , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Incidência , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Dados Preliminares , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
19.
World Neurosurg ; 132: e746-e751, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415894

RESUMO

BACKGROUND: Assessing clipped intracranial aneurysms for residues or incomplete occlusions is critical. Digital subtraction angiography (DSA) has been the gold standard for this. Previously, we presented subtracted computed tomography angiography (sub-CTA) from computed tomography perfusion as a more effective noninvasive technique for clipped aneurysms. The aim of this study was to compare effectiveness of sub-CTA with DSA in residue evaluation. METHODS: A retrospective study of 17 patients with aneurysmal subarachnoid hemorrhage operated on at our institution between November 1, 2016, and December 31, 2018, was performed. Residue aneurysms were evaluated with both sub-CTA and DSA. Positive predictive value and negative predictive value were calculated. Correlation between techniques was determined by the McNemar test and κ value. RESULTS: Sensitivity of sub-CTA in residue evaluation was low in aneurysms ≤3 mm (positive predictive value = 60%). DSA detected residue aneurysm in 29% (5/17) of patients, whereas sub-CTA detected residue aneurysm in 11% (2/17). Only 40% of aneurysms (2/5) were demonstrated by sub-CTA, all >3 mm; 60% (3/5) were missed, all ≤3 mm. CONCLUSIONS: This is the first study comparing the effectiveness of sub-CTA from computed tomography perfusion with DSA in residue aneurysm evaluation. Our results were suggestive, but not conclusive. DSA is still the gold standard in residue evaluation. Sub-CTA from computed tomography perfusion can be a reliable method in evaluation of residual aneurysm >3 mm.


Assuntos
Angiografia Digital/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Perfusão , Tomografia Computadorizada por Raios X/métodos , Adulto , Angiografia Cerebral/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
20.
World Neurosurg ; 132: e696-e703, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31421297

RESUMO

OBJECTIVE: The authors used a micromirror under a microscope with an indocyanine green (ICG) imaging system to assess clipped aneurysms and the blood flow in hidden regions during aneurysm surgery. This study then investigated the usefulness of such mirroring with ICG angiography (MICGA). METHODS: A micromirror was used during aneurysm surgery on 25 patients, and MICGA was performed on 10 of these 25 patients to inspect the hidden region after clipping. The mirrored aneurysms were located at the posterior communicating artery (n = 4), anterior choroidal artery (n = 4), proximal A1 segment (n = 1), and middle cerebral artery (n = 1). RESULTS: In all 10 cases, MICGA was successful in assessing the state of the clipped aneurysm and blood flow of the vessels in the hidden region after clipping. This led to clip repositioning in 3 patients (30.0%) because of incomplete clipping of a hidden aneurysm or occlusion of a hidden perforator. Complete occlusion of the aneurysm was achieved in 8 patients, and the other 2 patients showed near complete occlusion because of an intentional residual aneurysm to avoid a small vessel adherent to the posterior wall of the aneurysm base. CONCLUSIONS: MICGA can provide useful and reliable information on the state of a clipped aneurysm and the blood flow of associated vessels and perforators in a hidden region after aneurysm clipping.


Assuntos
Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Angiografia Digital , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/cirurgia , Circulação Cerebrovascular , Corantes , Feminino , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Artéria Cerebral Posterior/cirurgia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA