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1.
Medicine (Baltimore) ; 99(9): e19247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118730

RESUMO

RATIONALE: The capsular warning syndrome (CWS) is a rare and special type of transient ischemic attacks (TIAs) syndrome. The pathophysiology of CWS is very complicate, and intracranial atherosclerotic stenosis (ICAS) is rare cause. Moreover, the effective and standard therapy has not yet been established. PATIENT CONCERNS: A 47-year-old man experienced repeated and exacerbated TIAs of right hemiparesis and dysarthria. Fourteen hours after the first episode of TIAs, he developed more severe right hemiparesis and dysarthria, the National Institute of Health Stroke Scale (NIHSS) score was 12 points, and did not recover in a long time. DIAGNOSIS: The computed tomography (CT) angiography displayed high stenosis in the M1 segment of the left middle cerebral artery. The patient was diagnosed as CWS with ICAS. INTERVENTIONS: Loading dose of clopidogrel and aspirin were started but were ineffective, then we used recombinant tissue plasminogen (r-tPA) for thrombolysis therapy after repeat CT scan that showed small acute infarcts in the right putamen and no bleeding. OUTCOMES: The patient was successfully treated by r-tPA intravenous thrombolysis after loading dose of dual-anti-platelet. He recovered rapidly, and the NIHSS score was 0 point, modified Rankin Scale score was 0 point, and Barthel Index score was 100 points at 3-month follow-up. LESSONS: r-tPA combined with loading dose of dual antiplatelet appears safe and effective in carefully selected CWS patients with ICAS. The collection of similar cases and further randomized controlled trial research would be desirable.


Assuntos
Fibrinolíticos/uso terapêutico , Arteriosclerose Intracraniana/tratamento farmacológico , Ataque Isquêmico Transitório/tratamento farmacológico , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Clopidogrel/administração & dosagem , Clopidogrel/uso terapêutico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Fibrinolíticos/administração & dosagem , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/diagnóstico por imagem , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Síndrome , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X
2.
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
4.
Zhonghua Yi Xue Za Zhi ; 100(3): 202-206, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008287

RESUMO

Objective: To investigate the characteristics and possible mechanisms of differtent stroke patterns of single subcortical small infarction (SSSI) in the middle cerebral artery (MCA) territory. Methods: The clinical and imaging data of patients with acute SSSI in MCA territory admitted to the Neurology Department of People's Hospital of Zhengzhou City from January 2016 to December 2017 were retrospectively analyzed. According to the presence of MCA stenosis and whether the lesion sites on axial DWI-MRI involved the lowest basal ganglia, SSSl were divided into different patterns. The clinical and imaging characteristics of patients with different stroke patterns were compared. Results: Of the 91 patients, 24 (26.37%) were SSSI with parental artery disease (SSSIPAD), 28 (30.77%) were proximal SSSI without PAD (pSSSI-PAD) and 39 (42.86%) were distal SSSI without PAD (dSSSI-PAD). There were significant differences in age, hypertension, diabetes mellitus, smoking, NIHSS score, low density lipoprotein cholesterin (LDL-C) level, infarct layers ≥3, lesion diameter, white matter hyperintensity, lacunar infarction, enlarged perivascular space, cerebral microbleed, concomitant intracranial and extracranial atherosclerotic stenosis among the three groups (all P<0.05). Compared with SSSIPAD(-), patients with SSSIPAD(+) had significantly higher prevalence of smoking, proximal SSSI, ICAS, ECAS, NIHSS score, LDL-C level and larger lesion diameter (all P<0.05). Conclusions: The clinical characteristics and imaging features were different among different SSSI stroke patterns. SSSIPAD is an important infarct type. pSSSI-PAD may showed intermediate features of SSSIPAD and dSSSI-PAD, and evidence of atherosclerosis should be carefully searched for such patients.


Assuntos
Infarto Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Leucoaraiose , Artéria Cerebral Média/diagnóstico por imagem , Acidente Vascular Cerebral , Humanos , Infarto da Artéria Cerebral Média , Estudos Retrospectivos
5.
Adv Exp Med Biol ; 1232: 55-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893394

RESUMO

The aim was to investigate the feasibility of simultaneous comparison of cerebral circulation in major vessels and microvasculature in patients suffering traumatic brain injury (TBI) with or without intracranial hematomas (IH). METHODS: 170 patients were divided into two groups: Group 1 - diffuse TBI (75 patients); and Group 2 - TBI with IH (95 patients: 18 epidural, 65 subdural and 12 multiple). Perfusion computed tomography (PCT) for assessment of volumetric cerebral blood flow (CBF) was done 2-15 days after admission to hospital. Simultaneous assessment of cerebral blood flow velocity (CBFV) in both middle cerebral arteries was done by transcranial Doppler. RESULTS: In patients with diffuse TBI, CBF had statistically valid correlations with CBFV (r = 0.28, p = 0.0149 on the left side; r = 0.382, p = 0.00075 on the right side). In patients with TBI and IH, the analysis did not reveal any reliable correlations between the CBFV and CBF velocity in the temporal lobes, either on the side of the removed IH or on the opposite side. CONCLUSION: The greatest linear correlation was noted in patients with diffuse TBI without the development of a coarse shift of the midline structures and dislocation syndrome. This correlation decreases with the increase in injury severity and development of secondary complications in the acute period, which probably reflects impairment of the coupling of oxygen consumption by brain tissue and cerebral microcirculation.


Assuntos
Lesões Encefálicas Traumáticas , Circulação Cerebrovascular , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana , Velocidade do Fluxo Sanguíneo , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normas , Ultrassonografia Doppler Transcraniana/normas
6.
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
7.
World Neurosurg ; 133: 201-204, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605851

RESUMO

OBJECTIVE: Traumatic pseudoaneurysms of the proximal middle cerebral artery (MCA) segments are challenging to treat. We describe the management of traumatic internal carotid artery and MCA pseudoaneurysms with flow diversion. CASE DESCRIPTION: A 19-year-old man had sustained a gunshot wound to the head. Delayed digital subtraction angiography showed de novo formation of the left internal carotid artery ophthalmic segment and left MCA M2 segment pseudoaneurysms. We had initially performed coil embolization of the left MCA pseudoaneurysm. However, it had recurred 2 weeks later. We treated both pseudoaneurysms with flow diversion using the Pipeline Flex embolization device. The patient has continued with dual antiplatelet therapy of aspirin and ticagrelor. Follow-up digital subtraction angiography at 6 months showed complete obliteration of both pseudoaneurysms with patent parent vessels. The patient remained neurologically intact. CONCLUSIONS: Flow diversion can be an efficacious treatment of traumatic MCA pseudoaneurysms in appropriately selected cases. The risks versus benefits of dual antiplatelet therapy must be weighed in trauma settings.


Assuntos
Falso Aneurisma/terapia , Embolização Terapêutica/instrumentação , Artéria Cerebral Média/diagnóstico por imagem , Ferimentos por Arma de Fogo/terapia , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Angiografia Cerebral , Humanos , Masculino , Resultado do Tratamento , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto Jovem
8.
J Stroke Cerebrovasc Dis ; 29(2): 104467, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31767525

RESUMO

BACKGROUND AND AIM: Although fluid-attenuated inversion recovery vascular hyperintensities may be frequently seen in acute large-artery ischemic stroke, reports on their prognostic utility had been conflicting due to lack of quantitative evaluation of the perfusion status based on the signal intensity. We hypothesized that greater hyperintensity represents more severe hypoperfusion. METHODS: Overall, 27 patients with acute occlusion of the proximal middle cerebral artery were divided into 2 groups, based on their signal intensity in the insular segment of middle cerebral artery on the affected side, relative to that of the insular cortex: the low signal intensity group (hypo- or isointense signals, n = 12) and the high signal intensity group (hyperintense signals, n = 15). Using dynamic susceptibility contrast magnetic resonance imaging, we assessed the time of the maximum value of the residue function and mean transit time, in the entire middle cerebral artery cortical area and diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, including the corona radiata. RESULTS: The high signal intensity group had significantly longer time of the maximum value of the residue function in all the diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, except the M3 and M6 regions, and significantly longer mean transit time in the M1 and M4 regions. CONCLUSIONS: Quantitative analysis of the perfusion parameters revealed more severely compromised and widely disturbed perfusion status in the high signal intensity group than in the low signal intensity group.


Assuntos
Circulação Cerebrovascular , Imagem de Difusão por Ressonância Magnética , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Angiografia por Ressonância Magnética , Artéria Cerebral Média/diagnóstico por imagem , Imagem de Perfusão/métodos , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Artéria Cerebral Média/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
J Stroke Cerebrovasc Dis ; 29(2): 104488, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31787498

RESUMO

BACKGROUND: We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). METHODS: We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm3 within 10 hours of onset. Infarct lesions were segmented and co-registered onto MNI-152 brain space. Voxel-wise general linear models were applied to assess location-outcome correlations after correction for infarct volume as a co-variate. RESULTS: We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). CONCLUSIONS: Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Cérebro/irrigação sanguínea , Imagem de Difusão por Ressonância Magnética , Extremidades/inervação , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Administração Intravenosa , Idoso , Artéria Cerebral Anterior/fisiopatologia , Circulação Cerebrovascular , Ensaios Clínicos como Assunto , Ensaios Clínicos Fase II como Assunto , Avaliação da Deficiência , Feminino , Glibureto/administração & dosagem , Humanos , Hipoglicemiantes/administração & dosagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Infarto da Artéria Cerebral Anterior/terapia , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/terapia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
10.
J Stroke Cerebrovasc Dis ; 29(2): 104550, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31822375

RESUMO

We report a 77-year-old woman with marked enlargement of a middle cerebral artery (MCA) aneurysm 4 years after the successful intra-aneurysmal embolization of an ipsilateral large internal carotid artery (ICA) aneurysm. She intially presented with right third cranial nerve palsy due to a large ICA aneurysm, 20.8 mm in diameter. Initial magnetic resonance angiography (MRA) revealed a signal decrease in the right MCA, suggesting hemodynamic disturbance based on the contrast pooling in the right large ICA aneurysm exhibiting "Windkessel phenomenon". The large ICA aneurysm was successfully managed by intra-aneurysmal embolization with parent artery preservation, and immediate post-treatment MRA demonstrated significant signal recovery in the right MCA. Meticulous follow-up by MRA identified sudden growth in the aneurysmal height within 1 week after embolization, with further growth over the following 4 years, necessitating microsurgical clipping. Enlargement of the ipsilateral distal aneurysm following the treatment of proximal large aneurysm could be altered by marked distal hemodynamic change in view of the sudden amelioration of the "Windkessel phenomenon". Thus, we recommend meticulous follow-up of the associated distal aneurysm after the management of proximal large or giant aneurysms with parent artery preservation.


Assuntos
Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/terapia , Artéria Cerebral Média , Idoso , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Progressão da Doença , Feminino , Hemodinâmica , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Artéria Cerebral Média/cirurgia , Fatores de Tempo , Resultado do Tratamento
11.
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
12.
World Neurosurg ; 135: 183-187, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863893

RESUMO

BACKGROUND: Accuracy of intraoperative cerebrovascular neuronavigation is difficult to maintain because of the ongoing need for brain shift correction. By including 3-dimensional rotational intraoperative digital subtraction angiography (3D-iDSA), the intraoperative cerebrovascular neuronavigation can be updated and upgraded throughout the microneurosurgical procedure. The aim of this technical note is to demonstrate the feasibility and advantage of updating and upgrading the accuracy of targeted cerebrovascular neuronavigation with an intraoperative 3D-DSA dataset. METHODS: A preoperative diagnostic selective 3D-DSA was registered with the neuronavigation software, followed by the automated segmentation of the vascular object of interest (an aneurysm in this case). After acquiring additional 3D-iDSA volumes, these steps were repeated, thereby updating the cerebrovascular roadmap and neuronavigation accuracy (i.e., brain shift correction). RESULTS: This technique was applied successfully in a patient who underwent elective microneurosurgical clipping of a right-sided middle cerebral artery (MCA) bifurcation aneurysm in a hybrid neurosurgical operating setting. After clipping of the MCA aneurysm, a selective 3D iDSA was performed that was then used to update the projection and accuracy of the initial 3D neurovascular object of interest (i.e., the aneurysm). In this revised rotational view, the projection refined the target segments of the clipped MCA aneurysm, the accuracy of clipping, and brain shift correction. CONCLUSIONS: 3D-iDSA vascular segmentations can update und upgrade the intraoperative neurovascular roadmap by thereby enhancing accuracy of cerebrovascular neuronavigation, as well as correcting brain shift. This technique is feasible within the hybrid operation room. Evaluation in larger series is required to support these findings.


Assuntos
Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Angiografia Digital/métodos , Estudos de Viabilidade , Humanos , Imagem Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Microcirurgia/métodos , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
Int J Gynaecol Obstet ; 148(1): 41-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31544242

RESUMO

OBJECTIVES: To develop a model for predicting emergency cesarean for fetal distress (ECFD) at term using a combination of maternal and late pregnancy ultrasound parameters measured at more than 36 gestational weeks. METHODS: A study of prospectively collected data, including ultrasound scans at 36-38 weeks, for singleton non-anomalous deliveries at Mater Mother's Hospital, Brisbane, Australia, between January 2010 and April 2017. Univariable and multivariable mixed-effects generalized linear models were generated. The final model was validated by the K-fold cross validation technique. RESULTS: Overall, 5439 women met the inclusion criteria; of these, 230 (4.2%) underwent ECFD. There were more nulliparous women and women with induction of labor (IOL) in the ECFD cohort (both P < 0.001). ECFD neonates had lower z-scores for estimated fetal weight (EFW), cerebroplacental ratio (CPR), and middle cerebral artery pulsatility index; and higher scores for umbilical artery pulsatility index. Ethnicity, nulliparity, IOL, EFW z-score, and CPR z-score were included in the final prediction model, which showed high accuracy with an area under the receiver operator characteristic curve of 0.77. CONCLUSION: The study shows that a prediction model combining the continuous standardized measures of CPR and EFW and several maternal factors was able to identify ECFD with improved accuracy.


Assuntos
Cesárea/estatística & dados numéricos , Sofrimento Fetal/diagnóstico , Adulto , Austrália/epidemiologia , Feminino , Sofrimento Fetal/epidemiologia , Peso Fetal , Humanos , Recém-Nascido , Artéria Cerebral Média/diagnóstico por imagem , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem
14.
J Matern Fetal Neonatal Med ; 33(1): 162-166, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29888988

RESUMO

Objective: We aimed to review a single-center experience in follow-up and management of fetuses with umbilical vein varix (UVV) and to assess the effect of UVV on fetal Doppler parameters.Methods: We reviewed retrospectively maternal antenatal records, delivery records, and newborn records to identify cases of UVV. Further, we retrospectively compared 25 fetuses with isolated UVV and available cerebroplacental ratio (CPR) analysis with 75 matched controls.Results: We identified 67 cases of UVV. The median gestational age (GA) at diagnosis was 34 weeks (range: 26-41 weeks). The average diameter of UVV at diagnosis was 10.1 mm (range: 9-14 mm). The median GA at delivery was 36 + 6 (range: 33-41 weeks), with an average birth weight of 2918 g (range: 1278-4140 g). There was a single case of intrauterine death at 35 weeks. CPR was 2.13 ± 0.62 in isolated UVV group compared with 1.84 ± 0.61 in the control group (p < .05). Other Doppler parameters did not differ between fetuses with UVV compared with controls.Conclusions: CPR was significantly increased in the UVV group compared with control fetuses. This finding suggests that UVV is not associated with chronic fetal oxygen deprivation; it, therefore, may contribute to our understanding of the pathophysiology explaining abnormal pregnancy outcome in cases with UVV.


Assuntos
Cefalometria , Retardo do Crescimento Fetal/etiologia , Placenta/diagnóstico por imagem , Artérias Umbilicais/irrigação sanguínea , Varizes/diagnóstico , Adulto , Estudos de Casos e Controles , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiologia , Placenta/anatomia & histologia , Placenta/irrigação sanguínea , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Fluxo Pulsátil , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Pré-Natal , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/patologia , Veias Umbilicais/irrigação sanguínea , Veias Umbilicais/diagnóstico por imagem , Veias Umbilicais/patologia , Varizes/complicações , Varizes/epidemiologia
15.
Zhonghua Nei Ke Za Zhi ; 58(11): 814-818, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665856

RESUMO

Objective: To investigate the clinical significance of transcranial Doppler (TCD) in early diagnosis of sepsis-associated encephalopathy(SAE). Methods: Septic patients admitted to the intensive care unit(ICU) were recruited at Xiangya Hospital, Central South University from July 2015 to March 2016. Clinical data and TCD parameters during 24 hours after admission were collected. All patients were screened for delirium using the confusion assessment method for the intensive care unit (CAM-ICU) twice a day. The gold standard of the diagnosis of SAE was positive CAM-ICU evaluation. Patients were divided into SAE group and the non-SAE group. TCD data including systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI) and resistant index (RI) were analyzed to determine the optimal diagnostic cut-off value. Results: A total of 43 patients were enrolled including 12 in SAE group and 31 in non-SAE group. Vm and Vd were lower in SAE group [Vm: (53.50±12.22) cm/s vs. (61.68±9.63) cm/s, P<0.05; Vd: (33.42±10.87) cm/s vs. (43.16±7.84) cm/s, P<0.01] but PI and RI were significant higher in SAE group[PI:(1.16±0.2) vs. (0.90±0.15), P<0.01;RI:(0.65±0.08) vs. (0.56±0.06), P<0.01] than in non-SAE group. The cut-off values of Vs, Vm, Vd, PI and RI for the diagnosis of SAE were 112cm/s, 55.50cm/s, 34.50cm/s, 1.16, 0.65, respectively, with the relevant sensitivities of 19.4%, 83.9%, 93.5%, 58.3%, 58.3% and the specificities of 100.0%, 50.0%, 58.3%, 96.8%, 96.8%, respectively. The diagnostic AUC of Vd, PI and RI were 0.741, 0.808 and 0.808 respectively. Conclusions: The parameter changes of TCD suggest that the pathogenesis of SAE is related to cerebral hypoperfusion, TCD is a helpful method for the early diagnosis of SAE.


Assuntos
Circulação Cerebrovascular , Artéria Cerebral Média/diagnóstico por imagem , Encefalopatia Associada a Sepse/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Diagnóstico Precoce , Humanos , Unidades de Terapia Intensiva
17.
J Stroke Cerebrovasc Dis ; 28(12): 104458, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31662241

RESUMO

BACKGROUND: Computed tomography angiogram (CTA) derived from computed tomography perfusion (CTP) has been proposed to avoid addition of separate CT perfusion protocol for selection of large vessel occlusion in acute stroke patients. Previous studies have validated this technique for proximal large vessel occlusions. In this study, we test reliability for identifying M2 occlusions on CTA derived from CTP. METHODS: Through a retrospective search of the institutional thrombectomy database, we identified 28 cases with M2-MCA occlusion, of which 24 met the inclusion criteria for analysis. An additional 20 cases without M2-MCA occlusion (either normal or M1-MCA occlusion) were randomly mixed in the database to reduce observer bias. The baseline images of the CTP study in these 48 cases were then independently analyzed by 3 readers with varying level of expertise. The digital subtraction angiography (DSA) images were also independently reviewed where available. The percentage of agreement among reviewers as well as the probability of agreement of the reviewers, when compared to the DSA findings was also calculated. RESULTS: The observed agreement for the image quality amongst the 3 readers (n = 48) varied between 0.78 and 0.95 and tended to be higher for the M1 segment MCA and lower for distal M2-MCA. The observed agreements comparing 3 image reviewers versus DSA in M2 patients (n = 24) was 98% for identifying occlusion (95% CI 95%-100%), 94% for identifying proximal M2 occlusion (95% CI 88%-98%), and 91% (95% CI 84%-97%) and 90% (95% CI 83%-95%), respectively for correctly identifying inferior and superior branch of M2 occlusion. CONCLUSION: CTA data derived from CT Perfusion study preserves diagnostic yield for correctly identifying M2 occlusion.


Assuntos
Angiografia Cerebral , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Meios de Contraste/administração & dosagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Iopamidol/administração & dosagem , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Imagem de Perfusão/métodos , Bases de Dados Factuais , Humanos , Infarto da Artéria Cerebral Média/fisiopatologia , Artéria Cerebral Média/fisiopatologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
Clin Nucl Med ; 44(11): 907-910, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31592826

RESUMO

A 70-year-old woman had spontaneous resolution of an embolism in her right middle cerebral artery (MCA) (day 1); another embolism occurred in her left MCA (day 3), which was promptly removed. On day 5, F-FDG PET/CT performed for staging mediastinal lymphoma showed marked FDG accumulation in the left MCA territory, whereas a defect was seen in the right insular region. Eventually, bilateral lesions developed irreversible infarction. Anaerobic metabolism and/or inflammation in acute-phase infarction were the supposed mechanism for the increased accumulation of FDG in her left MCA territory.


Assuntos
Fluordesoxiglucose F18/metabolismo , Infarto da Artéria Cerebral Média/metabolismo , Artéria Cerebral Média/metabolismo , Doença Aguda , Idoso , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
20.
World Neurosurg ; 132: e109-e115, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518737

RESUMO

OBJECTIVE: Computed tomography images of patients with chronic subdural hematoma (CSDH) sometimes show obliteration of the basal cistern with high density in an obliterated Sylvian cistern, termed pseudo-subarachnoid hemorrhage (SAH). The present study aimed to clarify the characteristics and outcomes of these conditions. METHODS: We retrospectively investigated 669 consecutive patients who were surgically treated for CSDH between January 2006 and May 2019. RESULTS: Basal cistern effacement and pseudo-SAH were found in 24 (3.6%) and 11 (1.6%) patients, respectively. Predictors of basal cistern effacement in patients with CSDH were younger age, cerebrospinal fluid leak, and bilateral CSDH (P < 0.05). In patients with basal and Sylvian cistern effacement, the significantly different main features to differentiate patients with and without pseudo-SAH were younger age, cerebrospinal fluid leak, and thick small hematomas on computed tomography slices of the Sylvian cistern (P < 0.05). Magnetic resonance imaging showed that high-density areas in the Sylvian cistern of pseudo-SAH on precontrast computed tomography images corresponded to the M1 segment of the middle cerebral artery. The outcomes of patients with basal cistern effacement and of patients with pseudo-SAH did not differ from other patients with CSDH, although rates of surgical complications were significantly higher among patients with basal cistern effacement. CONCLUSIONS: Although the outcomes of patients with basal cistern effacement and pseudo-SAH were similar to outcomes of other patients with CSDH, problematic postsurgical complications and cerebrospinal fluid leaks were more likely to arise in such patients.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Escala de Coma de Glasgow , Hematoma Subdural Crônico/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
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