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1.
J Stroke Cerebrovasc Dis ; 30(7): 105822, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33895426

RESUMO

There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.


Assuntos
Aspirina/uso terapêutico , COVID-19/complicações , Artérias Cerebrais/efeitos dos fármacos , Nimodipina/uso terapêutico , Vasoconstrição/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/tratamento farmacológico , Adulto , COVID-19/diagnóstico , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Feminino , Humanos , Síndrome , Resultado do Tratamento , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/fisiopatologia
2.
Acta Neurochir Suppl ; 131: 131-134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33839833

RESUMO

Transcranial Doppler ultrasound (TCD) enables assessment of brain hemodynamics through insonation of cerebral arteries and veins. Few studies have investigated whether the normal ranges of flow velocities in both arterial and venous compartments may be affected by age and sex.The purpose of this study was to determine the normal blood flow velocities across different sex and age subgroups in a cohort of healthy volunteers by studying the middle cerebral arteries (MCAs) and the straight sinus (SS).A total of 122 healthy volunteers undergoing preanesthetic assessment were recruited at Galliera Hospital in Genoa, Italy. The cohort was stratified for sex (males and females) and for age (18-44 years, 45-64 years, and ≥65 years). Data on systolic, diastolic, and mean flow velocities (FVs, FVd, and FVm, respectively) in the MCA and peak venous flow velocity in the SS (FVVs) were collected from each volunteer.The arterial FVs and FVm were significantly higher in males than in females; FVs, FVm, FVd, and FVVs increased across the age spectrum, especially in the elderly female population.Our findings suggest that there are differences in cerebrovascular flow velocities due to age and sex, which may be correlated to hormonal variations during the lifespan.


Assuntos
Circulação Cerebrovascular , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo , Artérias Cerebrais/diagnóstico por imagem , Feminino , Voluntários Saudáveis , Humanos , Itália , Masculino , Ultrassonografia Doppler Transcraniana , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 30(6): 105719, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33813083

RESUMO

Cerebrovascular events in pediatric population are very rare. Up to 30% may result from varicella zoster (VZV) arteriopathy, usually as a delayed complication of varicella primary infection. The most typical pattern includes involvement of anterior brain circulation arteries, probably by VZV migration from the trigeminal ganglia. Strokes related with VZV usually have a good prognosis, but risk of recurrence is greater when compared to other stroke etiologies in this age group. We report the case of a 4-year-old boy, immunocompetent, who presented a basilar artery stenosis and a cerebellar stroke, an extremely rare presentation of VZV arteriopathy. The investigation workup and treatment are detailed, as the clinical and imaging follow-up after one year.


Assuntos
Cerebelo/irrigação sanguínea , Artérias Cerebrais/virologia , Varicela/virologia , Herpesvirus Humano 3/patogenicidade , AVC Isquêmico/virologia , Insuficiência Vertebrobasilar/virologia , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Artérias Cerebrais/diagnóstico por imagem , Varicela/complicações , Varicela/diagnóstico , Varicela/tratamento farmacológico , Pré-Escolar , Glucocorticoides/uso terapêutico , Interações Hospedeiro-Patógeno , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/tratamento farmacológico , Masculino , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/tratamento farmacológico
4.
J Stroke Cerebrovasc Dis ; 30(7): 105798, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33878548

RESUMO

A 71-year-old man, with a pial micro-arteriovenous malformation (pAVM) draining into the confluence of the vein of Trolard and the vein of Labbé was surgically removed, sparing these cortical veins. 4-months MR and angiographic controls showed a de novo dural arteriovenous fistula (dAVF) draining into the previously spared cortical veins. It was removed using intraoperative motor evoked potentials (MEP). This is the first case of iatrogenic dAVF developing on the same draining vein of a previously treated pAVM. De novo dAVFs are generally iatrogenic. This case suggests that the unresected venous drainage of an AVM might be the substratum for neo-angiogenetic processes; moreover inflammation related to surgery might be the trigger factor for the development of the dAVF.


Assuntos
Fístula Arteriovenosa/etiologia , Artérias Cerebrais/cirurgia , Veias Cerebrais/cirurgia , Doença Iatrogênica , Malformações Arteriovenosas Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Pia-Máter/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Artérias Cerebrais/anormalidades , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Veias Cerebrais/anormalidades , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/fisiopatologia , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/fisiopatologia , Masculino , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgia
5.
J Stroke Cerebrovasc Dis ; 30(6): 105737, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33774553

RESUMO

Aneurysmal subarachnoid Hemorrhage is a major cause of neurological morbidity and mortality. Over the years vascular neurosurgery has witnessed technological advances aimed to reduce the morbidity and mortality. Several endovascular devices have been used in clinical practice to achieve this goal in the management of ruptured and unruptured cerebral aneurysms. Recurrence due to recanalization is encountered in all of these endovascular devices as well as illustrated by Barrow Ruptured Aneurysm Trial. Histological and molecular characterization of the aneurysms treated with endovascular devices is an area of active animal and human research studies. Yet, the pathobiology illustrating the mechanisms of aneurysmal occlusion and healing lacks evidence. The enigma of aneurysmal healing following treatment with endovascular devices needs to be de-mystified to understand the biological interaction of endovascular device and aneurysm and thereby guide the future development of endovascular devices aimed at better aneurysm occlusion. We performed a comprehensive and detailed literature review to bring all the known facts of the pathobiology of intracranial aneurysm healing, the knowledge of which is of paramount importance to neurosurgeons, an interventional neuroradiologist, molecular biologist, geneticists, and experts in animal studies. This review serves as a benchmark of what is known and platform for future studies basic science research related to intracranial aneurysms.


Assuntos
Aneurisma Roto/terapia , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/terapia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/metabolismo , Aneurisma Roto/fisiopatologia , Animais , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/metabolismo , Procedimentos Endovasculares/efeitos adversos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/metabolismo , Aneurisma Intracraniano/fisiopatologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/metabolismo , Hemorragia Subaracnóidea/fisiopatologia , Resultado do Tratamento , Remodelação Vascular , Cicatrização
6.
Zhonghua Wai Ke Za Zhi ; 59(3): 210-215, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685055

RESUMO

Objective: To investigate the strategy and the clinical effect of single stage treatment for intracranial or extracranial artery stenosis with intracranial aneurysm. Methods: The clinical data of 15 patients with intracranial aneurysms and extracranial or intracranial artery stenosis treated by one-stage endovascular therapy at Department of Neurosurgery of Peking University First Hospital from April 2013 to September 2018 were analyzed,respectively.There were 6 males and 9 females,aged (63.9±9.1)years (range:43 to 79 years).Fifteen arterial stenosis were found, including 8 in anterior circulatiion and 7 in posterior circulation, and the stenosis rates ranged from 75% to 95%. There were 17 aneurysms, among which 11 in the anterior circulation and 6 in the posterior.The maximal diameter was (5.3±1.2)mm (range:3 to 7 mm).All patients were treated with stenting and embolization at one stage. The operation choices, perioperative and postoperative symptoms,imaging data and complications were recorded. Results: Stents were successfully implanted into arterial stenosis of 15 cases, reducing the stenosis rates to less than 30%.Among the 17 aneurysms,10 cases were treated by coil embolization alone,7 cases by stenting and coil embolization. Eventually all the 17 aneurysms reached complete embolization.One patient had mild symptoms of the cerebral infarction during the perioperative period,and the rest had not shown surgical complications.The follow-up time was (43.8±8.2)months (range:24 to 85 months). All the patients underwent digital subtraction angiography 6 to 12 months after operation.Among them,2 cases had asymptomatic in-stent restenosis,and no recurrence was found in aneurysms.Up to the last follow-up,no patients had showed new symptoms or signs of intracranial hemorrhage or ischemic stroke. Conclusions: For patients suffered from both stenosis and aneurysms,individualized treatment should be made based on the location and severity of the vascular stenosis and aneurysms.With careful preoperative evaluation and surgical planning,the single stage endovascular treatment for intracranial or extracranial artery stenosis combined with intracranial aneurysm is safe,feasible and effective for selected patients.


Assuntos
Constrição Patológica/terapia , Embolização Terapêutica , Aneurisma Intracraniano , Adulto , Idoso , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/terapia , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
7.
Acta Neurochir (Wien) ; 163(4): 1181-1189, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33566192

RESUMO

BACKGROUND: Pure arterial malformations (PAMs) are rare vascular lesions characterized by dilated, tortuous arterial loops without venous shunting. The natural history of PAMs remains unclear. We report the mid-term radiological and longer-term clinical outcomes of the largest series of patients with PAM. METHODS: Retrospective review at a tertiary academic referral center for patients with a PAM. Follow-up clinical and radiological data were collected and analyzed for clinical symptoms and radiographic changes. RESULTS: Twenty-five patients met the inclusion criteria. The mean age at presentation was 30.9 ± 14 years. Nineteen (76%) patients were female, and six (23.1%) were male. Eleven (44%) patients had ≥1 symptom at presentation, of which only 3 (12%) could be linked to PAM. The most common symptom was headache (n=8). PAMs involved a single vessel in 16 (64%) cases and ≥2 vessels in 9 cases (36%). Fifteen (60%) lesions were isolated to the anterior circulation compared to 6 (24%) in the posterior circulation. The most frequently involved vessel was the supraclinoid internal cerebral artery (36%). An associated saccular aneurysm was present in 32% of patients. Ten lesions were partially calcified. The mean radiographic and clinical follow-up was 21.9 ± 26.5 months and 44.6 ± 34.8 months, respectively. None of the patients developed new symptoms related to their lesion or radiographic progression over the duration of follow-up. CONCLUSIONS: PAMs are found most frequently in young, asymptomatic females. PAMs have a benign natural history and are best managed conservatively with serial imaging.


Assuntos
Calcinose/epidemiologia , Artérias Cerebrais/diagnóstico por imagem , Cefaleia/epidemiologia , Aneurisma Intracraniano/diagnóstico por imagem , Adolescente , Adulto , Angiografia Cerebral , Artérias Cerebrais/patologia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade
8.
J Stroke Cerebrovasc Dis ; 30(5): 105676, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33640784

RESUMO

INTRODUCTION: Dural arteriovenous fistulae (DAVF) are intracranial vascular abnormalities encountered in neurosurgery practice. Treatment options are microsurgical disconnection, endovascular embolization and/or radiosurgery. Past studies have reported the efficacy, safety, and predictors of success of radiosurgery. In this study, we investigated the angioarchitecture of fistulae at the time of radiosurgery and how the anatomy changed in the time after treatment based on angiogram follow-ups. METHODS: A retrospective analysis was performed on patients with angiographic diagnosis of DAVF treated with Gamma Knife radiosurgery (GKRS) between 2013 and 2018. Data collection included demographics, symptoms, grading scores, vascular anatomy, radiation data, treatment strategy, angiographic results, and length of patient follow-up. RESULTS: Our study reports data on 10 patients with a total of 14 fistulae. On follow-up angiography, 8 (57%) had complete occlusion of the fistula with a median time to follow up of 19.5 months. The remaining 6 (43%) were deemed as near-complete occlusion of fistula with a median time to follow up of 12.0 months. Time from radiosurgery to angiogram revealing incomplete vs. angiogram revealing complete obliteration was significantly different (p=0.045). Nearly all AVFs had decreased feeders over time after treatment with only one AVF developing an additional feeder post-treatment. Arterial feeders, drainage site, sex, Borden type, lesion volume and treatment volume had no predictive value of obliteration outcome. CONCLUSIONS: This study provides data on the angioarchitecture of fistulae treated with GKRS and also serves as an extension of previous studies reporting the safety and efficacy of GKRS treatment for DAVF in a specific patient population.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/radioterapia , Artérias Cerebrais/fisiopatologia , Veias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Radiocirurgia , Adulto , Idoso , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Artérias Cerebrais/anormalidades , Artérias Cerebrais/diagnóstico por imagem , Veias Cerebrais/anormalidades , Veias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
11.
Magn Reson Med ; 85(5): 2735-2746, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33347641

RESUMO

PURPOSE: Characterizing vessel territories can provide crucial information for evaluation of cerebrovascular disorders. In this study, we present a novel postprocessing pipeline for vascular territorial imaging of cerebral arteries based on a noncontrast enhanced time-resolved 4D magnetic resonance angiography (MRA). METHODS: Eight healthy participants, 1 Moyamoya patient, and 1 arteriovenous malformations patient were recruited. Territorial segmentation and relative blood flow rate calculations of cerebral arteries including left and right middle cerebral arteries and left and right posterior cerebral arteries were carried out based on the 4D MRA-derived arterial arrival time maps of intracranial vessels. RESULTS: Among healthy young subjects, the average relative blood flow rate values corresponding to left and right middle cerebral arteries and left and right posterior cerebral arteries were 35.9 ± 5.9%, 32.9 ± 7.5%, 15.4 ± 3.8%, and 15.9 ± 2.5%, respectively. Excellent agreement was observed between relative blood flow rate values obtained from the proposed 4D MRA-based method and reference 2D phase contrast MRI. Abnormal cerebral circulations were visualized and quantified on both patients using the developed technique. CONCLUSION: The vascular territorial imaging technique developed in this study allowed for the generation of territorial maps with user-defined level of details within a clinically feasible scan time, and as such may provide useful information to assess cerebral circulation balance in different pathologies.


Assuntos
Angiografia por Ressonância Magnética , Doença de Moyamoya , Artérias Cerebrais/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Imageamento por Ressonância Magnética , Marcadores de Spin
12.
Cerebrovasc Dis ; 49(5): 522-530, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33091907

RESUMO

BACKGROUND AND PURPOSE: To compare the risk factors and risk of stroke between lacune and large perivascular spaces (PVSs) in a community-based sample. METHODS: Large PVSs were assessed using 3.0T MRI in a population-based cohort consisting of 1,204 participants. The relationship between cardiovascular risk factors, neuroimaging changes, and incidental stroke risk and the presence of lacune or large PVSs was assessed with univariate and multivariable ordinal logistic regression analysis. RESULTS: Of the 1,204 study participants (55.7 ± 9.3 years, 37.0% men), a total of 347 large PVSs were detected in 235 (19.5%) subjects, while a total of 219 lacunes were detected in 183 subjects (15.2%). The presence of lacunes was found to be significantly associated with age, male gender, hypertension, and diabetes, whereas only age (p < 0.01) and ApoEε4 carrier status (p < 0.01) were related to the presence of large PVSs. Those who had lacunes detected on MRI at baseline had a significant increased risk of stroke (hazard ratio [HR] 4.68; 95% confidence interval [CI], 1.15-19.07) during the 3-year follow-up independent of age, gender, and other vascular risk factors. However, there was no significant relationship between the presence of large PVSs and incident stroke (HR 3.84; 95% CI, 0.82-18.04). CONCLUSIONS: The lack of association between large PVSs and cardiovascular risk factors or risk of stroke indicated a nonvascular pathogenic mechanism underlying large PVSs, suggesting the importance of distinguishing large PVSs from lacunes in clinical practice.


Assuntos
Artérias Cerebrais/diagnóstico por imagem , Sistema Glinfático/diagnóstico por imagem , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral Lacunar/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral Lacunar/etiologia
14.
Stroke ; 51(10): 3124-3128, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32867597

RESUMO

BACKGROUND AND PURPOSE: Few previous studies have comprehensively explored the relationship between the onset pattern of adult moyamoya disease and risk factors for stroke. We performed a retrospective analysis focusing on risk factors for stroke and related findings on magnetic resonance imaging/angiography with respect to the pattern of disease onset. We also examined whether risk factors for stroke were associated with an increased risk for symptomization in asymptomatic patients. METHODS: A total of 178 adult patients with moyamoya disease (asymptomatic, n=84; ischemic, n=71; hemorrhagic, n=23) at the University of Tokyo Hospital from 2000 to 2018 were included in this study. Data pertaining to patient background and magnetic resonance imaging findings were analyzed retrospectively. In the asymptomatic group, the effects of stroke-associated risk factors on symptom onset were analyzed. RESULTS: Comparisons among the 3 groups revealed no significant difference in the frequency of risk factors for stroke. The proportion of patients with magnetic resonance imaging/angiography findings indicating anterior choroidal artery anastomosis or microbleeds was significantly higher in the hemorrhagic group than in the asymptomatic or ischemic group. Among asymptomatic patients, the hazard ratios for symptomization with hypertension and dyslipidemia were 6.69 ([95% CI, 1.23-36.4] P=0.028) and 8.14 ([95% CI, 1.46-45.2] P=0.017), respectively. CONCLUSIONS: The development of anterior choroidal artery anastomosis and microbleeds on magnetic resonance imaging/angiography was significantly associated with hemorrhagic onset. Hypertension and dyslipidemia may increase the risk of cerebrovascular events in asymptomatic patients, and thus, early intervention to these factors may be important.


Assuntos
Encéfalo/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Doença de Moyamoya/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Adulto , Feminino , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Estudos Retrospectivos , Fatores de Risco
15.
Rinsho Shinkeigaku ; 60(9): 573-580, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779599

RESUMO

MRI is a non-invasive imaging modality with a high contrast resolution useful in diagnosing intracranial artery dissections. However, conventional MRI techniques, including time-of-flight MR angiography or basi-parallel anatomical scanning provide only limited information because they focus on imaging findings rather than the vessel walls. A newly devised MRI technique, high-resolution vessel wall imaging (HRVWI), enables direct visualization of vessel wall and therefore more accurate diagnosis. With increasing use of HRVWI, physicians need to understand the clinical indications, MR sequences for assessment, optimization of acquisition parameters, and limitations in the interpretation of images. For precise interpretation of images, physicians should be aware of the pathological condition of intracranial artery dissection and its radiological findings. In this review, we provide an overview and principles of MRI assessment used for intracranial artery dissection paying special attention to its pathological findings and radiological presentations on HRVWI.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia por Ressonância Magnética , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Stroke Cerebrovasc Dis ; 29(9): 105011, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807426

RESUMO

The current COVID-19 pandemic has recently brought to attention the myriad of neuro- logic sequelae associated with Coronavirus infection including the predilection for stroke, particularly in young patients. Reversible cerebral vasoconstriction syndrome (RCVS) is a well-described clinical syndrome leading to vasoconstriction in the intracra- nial vessels, and has been associated with convexity subarachnoid hemorrhage and oc- casionally cervical artery dissection. It is usually reported in the context of a trigger such as medications, recreational drugs, or the postpartum state; however, it has not been described in COVID-19 infection. We report a case of both cervical vertebral ar- tery dissection as well as convexity subarachnoid hemorrhage due to RCVS, in a pa- tient with COVID-19 infection and no other triggers.


Assuntos
Betacoronavirus/patogenicidade , Artérias Cerebrais/fisiopatologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Hemorragia Subaracnóidea/complicações , Vasoconstrição , Dissecação da Artéria Vertebral/complicações , Adulto , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/efeitos dos fármacos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/fisiopatologia , Síndrome , Vasoconstrição/efeitos dos fármacos , Vasodilatação , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/tratamento farmacológico , Dissecação da Artéria Vertebral/fisiopatologia
17.
J Stroke Cerebrovasc Dis ; 29(9): 105058, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807463

RESUMO

OBJECTIVES: Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique used to assess cerebral perfusion. When tissue perfusion is impaired, such as in Moyamoya disease, a hyperintense band called the arterial transit artifact (ATA) may occur, which interferes with accurate measurements on ASL-MRI. In this study, we evaluated the correlation of ATAs with magnetic resonance angiography (MRA) and single-photon emission computed tomography (SPECT) imaging results in Moyamoya disease. The aim of our study was to elucidate the pathophysiology of ATAs and risk factors for high ATA scores. MATERIALS AND METHODS: This retrospective study included 28 patients (56 hemispheres) with Moyamoya disease treated at our institution. MRI, MRA, ASL perfusion, and N-isopropyl-[123I] b-iodoamphetamine (123I-IMP) SPECT were performed. In order to semi-quantitatively evaluate the degree of ATA, the ATA scores were measured according to the number of hyperintense signal bands in the cerebral cortex. The relationship between the ATA scores and clinical and radiological factors were analyzed. RESULTS: Regional cerebral blood flow (rCBF) determined with ASL weakly correlated with that determined by 123I-IMP SPECT (ρ=0.31, p=0.027). There was no significant association between the ATA scores and rCBF values determined with 123I-IMP SPECT (p=0.872, 0.745, 0.743 at PLD1000 (post-labeling delay), 1500, and 2000, respectively). However, there was a significant correlation between ATA scores and MRA scores (ρ=0.427 p=0.001; ρ=0.612 p=0.001; ρ=0.563 p=0.001 at PLD1000, 1500, and 2000, respectively). An analysis of patient background characteristics revealed a significantly higher incidence of high ATA scores in female patients, patients with high MRA scores, and patients with a distinguishable ivy sign. A multivariate analysis confirmed that female sex, high MRA score, and presence of an ivy sign were risk factors for high ATA scores. CONCLUSION: ATA scores were moderately correlated with MRA scores, and presence of an ivy sign was the most predictive factor for high ATA scores. A high ATA score determined using ASL in a patient with Moyamoya disease might suggest an advanced disease stage and a reduction in cerebrovascular reserve capacity.


Assuntos
Artefatos , Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Circulação Cerebrovascular , Angiografia por Ressonância Magnética , Doença de Moyamoya/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Marcadores de Spin , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Velocidade do Fluxo Sanguíneo , Artérias Cerebrais/fisiopatologia , Feminino , Humanos , Iofetamina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/fisiopatologia , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/administração & dosagem , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
J Stroke Cerebrovasc Dis ; 29(9): 105062, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807467

RESUMO

BACKGROUND AND PURPOSE: To study the feasibility and clinical utility of head-neck joint high-resolution vessel wall imaging (HNJ-VWI) in the assessment of ischemic stroke. METHODS: We reviewed our institutional HNJ-VWI database. Patients with transient ischemic attack (TIA) or ischemic stroke were included. Abnormal findings of intracranial and/or extracranial artery were assessed on three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) and HNJ-VWI modified from high-resolution 3D T1 sequence and classified into three groups including intracranial, extracranial and coexisting based on the locations. Etiologies of stroke were recorded according to Trial of Org 10172 in Acute Stroke Treatment criteria. RESULTS: One hundred and ten consecutive patients were studied. 3D TOF MRA displayed 71.8% (79/110, based on patients) abnormal arteries (stenosis or occlusion) , while HNJ-VWI displayed 96.3% (106/110) abnormal arteries (plaque,wall thickness and occlusion) including four isolated extracranial lesions and ten coexisting lesions. The etiologies of TIA/ischemic stroke included large artery atherosclerosis (80 cases), cerebral small vessel disease (6 cases), cardiogenic (2 cases), dissection (6 cases), vasculitis (4 cases), moyamoya disease (6 cases), others (2 cases) and undetermined (4 cases). For patients with atherosclerosis stroke, re-infarctions were more common in coexisting group than intracranial group (extracranial vs. intracranial vs coexisting: 0% vs. 9.1% vs. 43.7%, p = 0.001). CONCLUSIONS: HNJ-VWI is a feasible and valuable technique in assessment of ischemic stroke by detecting extracranial and intracranial artery abnormalities with one-step scan.


Assuntos
Infarto Encefálico/diagnóstico por imagem , Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Ataque Isquêmico Transitório/diagnóstico por imagem , Articulações/irrigação sanguínea , Angiografia por Ressonância Magnética , Adulto , Infarto Encefálico/etiologia , Estudos de Viabilidade , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco
19.
Stroke ; 51(9): 2801-2809, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32757756

RESUMO

BACKGROUND AND PURPOSE: We aimed to use novel whole-brain vessel-wall magnetic resonance imaging (WB-VWI) to investigate the association between plaque distribution of middle cerebral artery (MCA) and morphological changes of the lenticulostriate arteries (LSAs) in single subcortical infarctions. METHODS: Forty single subcortical infarction patients with no relevant MCA disease on magnetic resonance angiography were prospectively enrolled. Plaque location in the MCA was dichotomized as proximal (located adjacent to the LSA origin) or distal (located distal to the LSA origin) on whole-brain vessel-wall magnetic resonance imaging. The MCAs with proximal plaques were divided into the symptomatic and asymptomatic side, and asymptomatic side MCAs without proximal plaques were the control group. The morphological characteristics of the LSAs and features of proximal plaques were analyzed. RESULTS: A total of 71 MCAs in 40 patients were analyzed (31 on the symptomatic side, 22 on the asymptomatic side, and 18 in the control group). Superior-wall plaques of MCAs were observed more frequently on the symptomatic side than the asymptomatic side (45.2% versus 9.1%, P=0.005). The wall area index, plaque burden, and remodeling index did not differ significantly between the symptomatic and asymptomatic side. The number of LSA branches was smaller (P=0.011) in the symptomatic side (5.48±1.88) compared with the control group (6.83±1.92). The symptomatic side exhibited shorter average length of the LSAs (23.23±3.44 versus 25.75±3.76 mm, P=0.025) and shorter average distance of the LSAs (16.47±3.11 versus 21.53±4.76 mm, P<0.001) compared with the asymptomatic side. CONCLUSIONS: Superiorly distributed MCA plaques at the LSA origin are closely associated with morphological changes of the LSA in symptomatic MCAs, suggesting that the distribution, rather than the inherent features of plaques, determines the occurrence of single subcortical infarctions. Our findings provide insight into the etiologic mechanism of branch atheromatous disease in single subcortical infarctions.


Assuntos
Artérias Cerebrais/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Lateralidade Funcional , Humanos , Processamento de Imagem Assistida por Computador , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
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