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1.
J Stroke Cerebrovasc Dis ; 29(1): 104460, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699578

RESUMO

Medullary compression syndrome due to anomalous course of blood vessels is a rare disease most commonly seen in the adult population. The offending vessels causing this syndrome are mostly posterior inferior cerebellar artery or the vertebral artery. The symptoms of this syndrome vary from most common hypertension to various other neurologic deficits like hemiplegia, dysesthesia, and dysarthria. Intractable dizziness is a rare symptom of this disease. The definite management plan for this disease is microvascular decompression. We present our case of medullary compression syndrome which manifested as intractable dizziness. We describe our experience in the management of this patient as well as present a review of literature of this rare disease.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Bulbo/irrigação sanguínea , Artéria Vertebral/anormalidades , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/cirurgia , Descompressão Cirúrgica , Dilatação Patológica , Tontura/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Artéria Vertebral/cirurgia
2.
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
3.
World Neurosurg ; 133: 69-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550540

RESUMO

BACKGROUND: Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-Langerhans cell reactive histiocytic disorder that rarely occurs in the central nervous system (CNS). Extranodal RDD most frequently involves the skin, upper respiratory tract, soft tissue, gastrointestinal tracts, bones, breast, and CNS. CASE DESCRIPTION: RDD of the CNS infiltrates most commonly the dura of the sella, cavernous sinus, and the periclival regions. It is usually clinically and radiologically mistaken for meningioma because of its focal dural-based aspect. RDD is confirmed histologically by lymphoplasmacytic cells and histiocytes of varying size showing emperipolesis (lymphocytophagocytosis). To date, only 4 cases of RDD displaying spinal cord compression secondary to craniocervical junction involvement have been reported. CONCLUSION: We report the case of a patient diagnosed with RDD localized at the foramen magnum extending to the base of the odontoid process and involving the V4 segment vertebral artery.


Assuntos
Histiocitose Sinusal/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Artéria Vertebral/cirurgia , Diagnóstico Diferencial , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia
4.
World Neurosurg ; 133: 253-255, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629150

RESUMO

Rare anomalous courses of vertebral arteries in the craniovertebral junction may compress the spinal cord causing myelopathy. We report here the severest form of this pathologic condition successfully treated with transposition of bilateral vertebral artery using Gore-Tex tapes. A 73-year-old man presented with progressive tetraparesis and gait disturbance. Imaging studies showed bilateral atresia of the C1 transverse foramina and the both vertebral arteries penetrating the dura below the C1 lamina. Pinched by the vertebral artery loops on both sides, the spinal cord was severely deformed. Through the standard midline approach, we carefully transposed both vertebral arteries off the spinal cord, placing them at the optimal position using Tanaka et al's Gore-Tex tape technique originally reported for microvascular decompression. The Gore-Tex tape transposition technique proved to be versatile and useful for safe transposition of the vertebral artery in this challenging case.


Assuntos
Descompressão Cirúrgica/métodos , Politetrafluoretileno , Quadriplegia/cirurgia , Compressão da Medula Espinal/cirurgia , Artéria Vertebral/anormalidades , Idoso , Progressão da Doença , Humanos , Masculino , Quadriplegia/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem
5.
World Neurosurg ; 133: e459-e472, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526888

RESUMO

BACKGROUND: Anterior inferior cerebellar artery (AICA) can present with a myriad of variations. However, the previous studies of AICA anatomy were based on small-scale cadaveric investigation. In this study, we performed an angiographic study of AICA in 500 Chinese with Han nationality based on digital subtraction angiography (DSA). METHODS: Patients admitted to our institution between 2015 and 2018 who had underwent DSA were potential candidates for this retrospective evaluation. The exclusion criteria were: a) patients with vascular diseases of the posterior circulation; b) ischemic diseases or moyamoya disease of the anterior circulation. RESULTS: Five hundred patients were identified. The patients ranged in age from 6 to 75 years. Two hundred thirty-seven (62.9%, 237 of 377) patients had bilateral AICAs at the same level, and 140 (37.1%, 140 of 377) had bilateral AICAs at different levels. The developing states of AICA were grade 0 in 31 (3.5%, 31 of 896), grade 1 in 373 (41.6%, 373 of 896), grade 2 in 313 (34.9%, 313 of 896), and grade 3 in 179 (20.0%, 179 of 896) hemispheres. Two hundred twenty-one (22.1%, 221 of 1000) presented with AICA-PICA common trunks. Thirty-one (3.1%, 31 of 1000) hemispheres showed no obvious AICA angiographically. AICA arose as a single trunk in 865 (86.5%, 865 of 1000) hemispheres, and as duplicate trunks in 104 (10.4%, 10 of 1000) hemispheres. Triplicate or more trunks were not seen. AICA originating from the basilar artery fenestration accounted for 4% (20 of 500) of the cases. CONCLUSIONS: This is the first attempt using DSA data to perform a large-scale investigation of AICA variations. The ever-growing need of endovascular intervention calls for more suitable anatomical explanation of the vascular structures.


Assuntos
Angiografia Digital , Artéria Basilar/anatomia & histologia , Cerebelo/irrigação sanguínea , Angiografia Cerebral , Artéria Vertebral/anatomia & histologia , Adolescente , Adulto , Idoso , Artéria Basilar/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Artéria Vertebral/diagnóstico por imagem , Adulto Jovem
6.
J Stroke Cerebrovasc Dis ; 29(1): 104492, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31727598

RESUMO

Complete spontaneous thrombosis of intracranial aneurysms is uncommon. Although this type of thrombosis is largely asymptomatic, in rare cases it can be accompanied by parent artery occlusion and ischemic stroke. There are limited reports of complete thrombosis of an unruptured aneurysm of the internal carotid artery and middle cerebral artery. Furthermore, there are no reports of occlusion of the vertebral artery caused by thrombosis of an aneurysm. The mechanisms of spontaneous thrombosis are not established. However, aneurysm morphology, arteriosclerosis, and stagnation of aneurysm flow have been suggested. Herein, we present a novel case of Wallenberg's syndrome caused by a fusiform aneurysm in which complete thrombosis of the proximal vertebral artery occurred. We discuss the mechanisms of thrombosis caused by an unruptured aneurysm, which may be useful for managing such patients who present with transient ischemic attacks.


Assuntos
Aneurisma Intracraniano/complicações , Trombose Intracraniana/etiologia , Síndrome Medular Lateral/etiologia , Artéria Vertebral , Fibrinolíticos/uso terapêutico , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/tratamento farmacológico , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Síndrome Medular Lateral/diagnóstico por imagem , Síndrome Medular Lateral/reabilitação , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem
9.
J Stroke Cerebrovasc Dis ; 28(12): 104440, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31611167

RESUMO

Carotid artery web has been frequently reported. However, the vertebral artery web has been less reported. It is difficult and seldom to diagnose vertebral artery web with noninvasive examinations. Here, we present a case of asymptomatic vertebral artery web diagnosed by ultrasound and confirmed by digital subtraction angiography.


Assuntos
Angiografia Digital , Ultrassonografia Doppler em Cores , Malformações Vasculares/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Pessoa de Meia-Idade , Paresia/etiologia , Valor Preditivo dos Testes , Prognóstico , Malformações Vasculares/complicações , Malformações Vasculares/fisiopatologia , Malformações Vasculares/terapia , Artéria Vertebral/anormalidades , Artéria Vertebral/fisiopatologia
10.
Medicine (Baltimore) ; 98(41): e17466, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593105

RESUMO

RATIONALE: Vertebral arteriovenous fistulas (VAVFs) are depicted with anomalous connections between the vertebral artery, or its branches, and the adjacent venous system. Most VAVFs occur as a result of direct trauma during accidents, whereas others have iatrogenic origin. PATIENT CONCERNS: We report a case of 11-year-old male who presented with right limb weakness and walking instability. DIAGNOSIS: Magnetic resonance angiography as well as digital subtraction angiogram (DSA) of the neck demonstrated a right VAVF. The cervical medulla was compressed by a dilated vein in vertebral canal. The blood supply of the fistula was from the right vertebral artery, whereas drainage was via epidural and paraspinal venous plexus. INTERVENTIONS: We introduced the TransForm Occlusion Balloon Catheter into right vertebral artery, identified the VAVF, and occluded it with the balloon. OUTCOMES: We successfully obliterated the VAVF with patency of parent vertebral artery with a balloon. The symptoms of the patient were relieved after the procedure. Two years' follow-up revealed no recurrence of the fistula. The patient is currently well. LESSONS: Patency of the parent artery following obliteration a VAVF is still a challenge. Obliteration of the VAVF with a balloon while the parent vertebral artery is still patent is very possible.


Assuntos
Fístula Arteriovenosa/cirurgia , Oclusão com Balão/métodos , Artéria Vertebral/anormalidades , Angiografia Digital , Fístula Arteriovenosa/diagnóstico por imagem , Criança , Humanos , Angiografia por Ressonância Magnética , Masculino , Pescoço/irrigação sanguínea , Pescoço/diagnóstico por imagem , Resultado do Tratamento , Grau de Desobstrução Vascular , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia
11.
Am J Case Rep ; 20: 1509-1514, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31607743

RESUMO

BACKGROUND Subclavian stenosis is an uncommon clinical condition associated with severe cardiovascular complications, usually presenting with claudication and subclavian steal syndrome. Here we describe the rare case of bilateral subclavian artery stenosis in an asymptomatic patient. CASE REPORT Our patient was a 63-year-old chronic smoker with no prior medical history whose chief complaint was dyspnea from an exacerbation of his chronic obstructive pulmonary disease (COPD). He was hypotensive with blood pressure 74/56 mmHg at admission, which raised suspicion for sepsis, adrenal insufficiency but the workup (renal panel, full blood count and synacthen tests) were normal. He quickly recovered after we treated his COPD exacerbation, but his hypotension persisted despite repeated fluid challenges. To evaluate for structural causes of his hypotension, we performed a full cardiovascular examination with 4 limb blood pressure measurements and found upper limb hypotension and lower limb hypertension. Subsequent imaging with ultrasound and computed tomography confirmed the presence of bilateral subclavian artery stenosis. Our diagnosis was thus bilateral subclavian artery stenosis secondary to atherosclerosis from chronic smoking. The patient was subsequently referred to vascular surgery for consideration of surgical revascularization. CONCLUSIONS Bilateral subclavian stenosis is extremely rare and requires a high index of clinical suspicion. Early diagnosis is important in the primary prevention of associated cardiovascular diseases.


Assuntos
Hipotensão/etiologia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Doenças Assintomáticas , Aterosclerose/complicações , Angiografia por Tomografia Computadorizada , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Fumantes , Artéria Subclávia/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Artéria Vertebral/diagnóstico por imagem
13.
Medicine (Baltimore) ; 98(37): e17159, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517864

RESUMO

RATIONALE: Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique. PATIENT CONCERNS: A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week. DIAGNOSES: Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA. INTERVENTIONS: TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively. OUTCOMES: The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up. LESSONS: This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares , Úlcera/cirurgia , Artéria Vertebral/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Humanos , Masculino , Úlcera/diagnóstico , Artéria Vertebral/diagnóstico por imagem
14.
Drug Discov Ther ; 13(4): 228-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31534075

RESUMO

We describe a rare case of neurovascular compression syndrome (NVCS) of the brain stem and opsoclonus-myoclonus syndrome (OMS) complicated with vestibular paroxysmia (VP) and autonomic symptoms. Moreover, we discuss the case with respect to the available information in medical literature. A 36-year-old man with vertigo and nausea had difficulty standing, and was transported by an ambulance to our hospital. He had VP, opsoclonus, cervical myoclonus, anxiety, and restless legs syndrome. Magnetic resonance imaging at hospitalization showed that the dolichoectatic vertebral artery was in contact with the postero-lateral side of the pontomedullary junction. He was diagnosed with NVCS of the brain stem (most likely of the input to the vestibular nucleus) associated with contact with the dolichoectatic vertebral artery. Combination therapy using multiple antiepileptic drugs, such as low-dose carbamazepine, clonazepam, and lacosamide, improved his clinical symptoms. He was finally able to walk and was discharged on day 42 after admission. He is being routinely followed-up since then. Further research is needed to confirm the validity of the combination therapy.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Síndrome de Opsoclonia-Mioclonia/diagnóstico por imagem , Vertigem/diagnóstico por imagem , Adulto , Anticonvulsivantes/uso terapêutico , Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Quimioterapia Combinada , Humanos , Síndrome de Opsoclonia-Mioclonia/tratamento farmacológico , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Vertigem/tratamento farmacológico , Vertigem/patologia
15.
World Neurosurg ; 132: 321-325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470149

RESUMO

BACKGROUND: Since the first report about nail gun injuries in 1959, there has been an average of approximately 37,000 patients hurt by nail guns and treated in emergency departments. Carotid arterial injury by nail gun has been reported, but vertebral artery damage is extremely rare. CASE DESCRIPTION: A 42-year-old man was transported to the emergency department after suffering an accidental self-inflicted nail gun injury to the left lateral aspect of his neck. Radiographic imaging of the cervical spine revealed a 3.1-cm metallic nail in the C5 region. A computed tomography (CT) angiogram revealed the nail passing through the left C5 transverse foramen and compressing the left vertebral artery. He was immediately brought to the operating room for removal of the nail. At 1-month follow-up, the patient did not have any neck complaints and postoperative CT angiogram indicated the patient was asymptomatic with no signs of complication or infection. CONCLUSIONS: Based on our experience and a review of the literature, in terms of treating a nail gun injury to the cervical spine, we would like emphasize that preoperative CT scan or CT angiogram is necessary to assess the location and shape of the nail, especially nails with barbers or washers. Improving awareness of the risk from accidental nail gun trauma may lead to better prevention of this rare but potentially life-threatening injury.


Assuntos
Lesões do Pescoço/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Artéria Vertebral/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Adulto , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Lesões do Pescoço/cirurgia , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/cirurgia , Artéria Vertebral/diagnóstico por imagem , Ferimentos Penetrantes/cirurgia
16.
J Neurol Surg A Cent Eur Neurosurg ; 80(5): 365-370, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31272118

RESUMO

BACKGROUND: The aim of this retrospective case-control study was to determine the association of vertebral artery hypoplasia (VAH) and other anatomical variants with saccular vertebral artery posterior inferior cerebellar artery (VA-PICA) aneurysms. METHODS: The frequency of VAH, vertebral artery (VA) atresia, VA aplasia, and PICA aplasia was analyzed using computed tomography (CT) angiography in 64 patients with VA-PICA aneurysms (43 ruptured and 21 unruptured) and compared with 128 age- and sex-matched controls. Logistic regression was performed to identify independent risk factors for aneurysm formation. RESULTS: Univariate analysis showed that patients with VA-PICA aneurysms had a significantly higher frequency of VAH (53% versus 17%; odds ratio [OR] 4.8; 95% confidence interval [CI], 2.4-9.4; p < 0.0001) and VA aplasia (14% versus 1%; OR 20.8; 95% CI, 2.5-168.0; p = 0.004) compared with controls. VA-PICA aneurysms are detected significantly more often in the dominant VA, which is contralateral to VAH. Other anatomical variants are not related to aneurysm formation. CONCLUSIONS: VAH and VA aplasia are potential risk factors for VA-PICA aneurysms. Altered hemodynamics caused by VAH may result in intracranial aneurysm formation. Additional research should clarify the pathophysiologic association of VAH, VA aplasia, or vascular occlusion with arteriosclerosis and intracranial aneurysm formation.


Assuntos
Cerebelo/irrigação sanguínea , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Vertebral/anormalidades , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Artéria Vertebral/diagnóstico por imagem
17.
Biomed Eng Online ; 18(1): 82, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340820

RESUMO

BACKGROUND: The use of flow-diverters for non-saccular cerebral posterior circulation aneurysms requires complex deployment techniques and is associated with high mortality and morbidity. Therefore, further studies are required to clarify the effect of stenting on post-treatment hemodynamics in such aneurysms. In this study, we evaluated flow alterations in a treated giant fusiform aneurysm of the vertebrobasilar junction and correlated them with the clinical outcome. METHODS: A patient-specific aneurysm model was acquired by rotational angiography, and three SILK flow-diverters (4.5 × 40, 5 × 40 and 5.5 × 40 mm) were virtually deployed in series along the basilar and right vertebral arteries. Image-based blood flow simulations before and after the treatment were performed under realistic pulsatile flow conditions. The flow reduction, velocity and wall shear stress (WSS) distribution, streamlines and WSS-derived parameters were evaluated before and after the treatment. RESULTS: The computed velocity streamlines showed substantial alterations of the flow pattern in the aneurysm and successful redirection of blood flow along the series of flow-diverters with no flow through the overlapping stents. The obtained flow reduction of 86% was sufficient to create thrombogenic flow conditions. Moreover, a 6.2-fold increase in relative residence time and a decrease by 87% of time-averaged WSS contributed to a successful treatment outcome observed during the follow-up. CONCLUSIONS: We found a correlation between the numerically predicted flow alterations and the available treatment outcome. This shows the potential of image-based simulations to be used in clinical practice for treatment planning and estimation of possible risk factors associated with a complex stent deployment in fusiform aneurysms of the posterior circulation.


Assuntos
Hemodinâmica , Aneurisma Intracraniano/fisiopatologia , Aneurisma Intracraniano/terapia , Stents , Artéria Vertebral/fisiopatologia , Angiografia , Simulação por Computador , Humanos , Imagem Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem
18.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340945

RESUMO

Bow Hunter's syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and is reported to most commonly be caused by vertebral artery impingement on cervical vertebrae osteophytes. We report a case in a 56-year-old male patient who on investigation of recurrent posterior circulation ischaemic strokes was found to have BHS. The aetiology of the syndrome in this patient is due to a particularly unusual aberrancy in the path of the atlantoaxial portion of the culprit left vertebral artery. Aberrancy of the distal portion of the vertebral artery is in itself a rare entity, and there are few reports of it in relation to BHS. The patient in this case was successfully treated with endovascular sacrifice of the vertebral artery with no further dynamic occlusive symptoms.


Assuntos
Angiografia por Ressonância Magnética/métodos , Artéria Vertebral/anormalidades , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/tratamento farmacológico , Angiografia Cerebral/métodos , Tratamento Conservador , Diagnóstico Diferencial , Tontura/diagnóstico , Tontura/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/etiologia , Medição de Risco , Síndrome , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
19.
World Neurosurg ; 130: e672-e679, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279109

RESUMO

BACKGROUND: Cervical spine trauma (CST) may result in vertebral artery injury (VAI), increasing the risk of developing stroke. Stroke risk following CST is poorly reported. METHODS: In total, 729 patients with CST were retrospectively analyzed, including rates of VAI, age at injury, cause of injury, cardiovascular history, smoking history, substance abuse history, embolization therapy, and antiplatelet or anticoagulant therapy prior or after injury. VAIs were identified and graded following the Modified Denver Criteria for Blunt Cerebrovascular Injury using magnetic resonance angiography and computed tomography angiography. Brain scans were reviewed for stroke rates and statistically significant variations. RESULTS: Thirty-three patients suffered penetrating trauma, whereas 696 patients experienced blunt trauma. In total, 81 patients met the criteria for analysis with confirmed VAI. VAI was more common in penetrating injury group compared with blunt injury group (64% vs. 9%, P < 0.0005). However, low-grade VAI (less than grade III) was more common in blunt injury group versus penetrating group (37% vs. 14%, P < 0.05). The frequency of posterior circulation strokes did not vary significantly between groups (26.3% vs. 13.8%, P = 0.21). Cardiovascular comorbidities were significantly more common in the blunt group (50%, P = 0.0001) compared with the penetrating group (0%). CONCLUSIONS: VAI occurs with a high incidence in penetrating CST. Although stroke risk following penetrating and blunt CST did not vary significantly, they resulted in serious complications in a group of patients. Further study of this patient population is required to provide high-level, evidence-based preventions for VAI complications.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/complicações , Acidente Vascular Cerebral/etiologia , Artéria Vertebral/lesões , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações
20.
Arthritis Rheumatol ; 71(11): 1780-1787, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31309732

RESUMO

The systemic large vessel vasculitides consist mainly of giant cell arteritis and Takayasu arteritis. Both diseases affect the large blood vessels and can lead to ischemia and end-organ damage. Ultrasound is an imaging technique that can depict inflammation of the vessel wall in large and medium vessel vasculitis. In this article, we critically review the current evidence for the clinical use of ultrasound for systemic large vessel vasculitides, regarding the clinical applicability, technical requirements, challenges, and cost. A roadmap for the development of a fast-track ultrasound clinic for giant cell arteritis is also provided.


Assuntos
Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Takayasu/diagnóstico por imagem , Ultrassonografia/métodos , Aorta Abdominal/diagnóstico por imagem , Artéria Axilar/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Humanos , Artéria Subclávia/diagnóstico por imagem , Vasculite Sistêmica/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem
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