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1.
Medicine (Baltimore) ; 99(4): e18865, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977887

RESUMO

This study aimed to explore the risk factors for severity of white matter lesions and its correlation with in the elderly with lacunar infarction.Patients (range, 70-85 years) with lacunar infarction treated in a hospital in China from 2016 to 2017were enrolled. Fazekas rating scale (0-6 points) was used to assess severity of white matter lesions. Risk factors for the severity of white matter lesions and correlation between cerebral microbleeds and white matter lesions in the elderly with lacunar infarction were studied.The elderly (81-85 years' old, odds ratio [OR]: 2.423, 95% confidence interval [CI]: 1.795-3.271, P = .018; 76∼80 years' old, OR: 3.113, 95% CI: 1.723-5.625, P = .043), carotid atherosclerosis (OR: 3.062, 95% CI:1.715-5.468, P < .001), history of hypertension (OR: 3.694, 95% CI: 2.031-6.717, P < .001) were risk factors for the severity of white matter lesions. The white matter lesions score increased corresponding to increase in the cerebral microbleeds grade (P < .001). The white matter lesions score was higher in the cerebral microbleeds combined with the white matter lesions group than in the white matter lesions group (P < .01). After correcting the effects of age, there was a correlation between white matter lesions and cerebral microbleeds (P < .001). Logistic analysis revealed that the patients' age (81-85 years' old, OR: 2.722, 95% CI: 1.985-3.734, P = .019; 76∼80 years' old, OR: 1.857, 95% CI: 1.075-3.207, P = .031), history of hypertension (OR: 2.931, 95% CI: 1.136-7.567, P = 0.0.036), systolic blood pressure (OR: 1.049, 95% CI: 1.015-1.084, P = .007), high-sensitivity C-reactive protein (OR: 1.504, 95% CI: 1.254-1.803, P < .001), homocysteine (OR: 1.076, 95% CI: 1.020-1.136, P = .009), and carotid atherosclerosis (OR: 1.389, 95% CI: 1.103-1.748, P = .010) were significant risk factors for combined cerebral microbleeds with white matter lesions in patients with lacunar infarction.The elderly, carotid atherosclerosis, history of hypertension were risk factors for the severity of white matter lesions. Cerebral microbleeds were positively correlated with the severity of white matter lesions.


Assuntos
Hemorragia Cerebral/etiologia , Acidente Vascular Cerebral Lacunar/etiologia , Substância Branca/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Hemorragia Cerebral/epidemiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral Lacunar/epidemiologia , Substância Branca/diagnóstico por imagem
2.
World Neurosurg ; 133: e767-e773, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605843

RESUMO

BACKGROUND: Cavernous malformations (CMs) are low-flow vascular malformations of the central nervous system which are incidental or present with hemorrhage, seizures, or focal neurologic deficit (FND). Little is known about the time course of symptoms and the predictors of initial hemorrhagic presentation. METHODS: Beginning in 2015, consecutive patients with radiologically confirmed CMs were recruited and completed a structured interview and written survey at baseline. Medical records and magnetic resonance imaging studies were reviewed. Data collected included the following: comorbid conditions, select medication use, and location of CMs. Logistic-regression models determined predictors of initial presentation with hemorrhage. RESULTS: Of 202 patients, 58.4% were women (average age at diagnosis, 43.7 ± 16.5 years). Of the patients, 37.1%, 6.5%, and 14.8% presented with hemorrhage, FND, and seizures, respectively. CM was an incidental finding in 40.6%. Most patients presenting with hemorrhage (66.7%) deteriorated over 2-30 days after symptom onset. Brainstem location correlated with a higher likelihood of initial presentation with hemorrhage. Aspirin use and nonsteroidal anti-inflammatory drug use were more common in patients with CMs who did not present with hemorrhage. The effect of estrogen and aspirin was stronger in the sporadic compared with the familial form of CMs. In women, estrogen use increased the likelihood of presenting with hemorrhage. CONCLUSIONS: This prospective cohort study confirms brainstem location increases the likelihood of presenting with hemorrhage, but also supports a potential role of select medications on the initial clinical presentation of CMs. Further data from combined cohorts may aid in determining whether the influence of medications is different in familial versus sporadic form CMs.


Assuntos
Neoplasias Encefálicas/complicações , Hemorragia Cerebral/etiologia , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
3.
World Neurosurg ; 133: e716-e721, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589987

RESUMO

BACKGROUND: The clinical significance of asymptomatic microbleeds in moyamoya disease remains unclear. The purpose of this study was to clarify the relationship between bypass surgery and the incidence of asymptomatic microbleeds. METHODS: This retrospective study included 142 adult patients (mean age, 37.7 ± 13.5 years) with moyamoya disease, 36 of whom (25.3%) underwent bypass surgery in childhood. Hemorrhagic onset was diagnosed in 31 patients (21.8%). The incidence of microbleeds was evaluated on T2*-weighted or susceptibility-weighted imaging from 3-T magnetic resonance imaging. The patients were subsequently categorized into MBs (microbleeds) or non-MBs groups. Because previous microbleeds potentially lead to hemorrhage, the MBs group was defined as patients with radiographic evidence of bleeding, including asymptomatic microbleeds and/or hemorrhagic onset. The association of baseline characteristics was evaluated. RESULTS: Asymptomatic microbleeds were detected in 38 patients (26.8%). Of 31 patients with hemorrhagic onset, 18 had microbleeds, whereas 13 had no microbleeds. Therefore, 51 patients (35.9%) were classified into the MBs group. Bypass surgery in childhood (MBs, 7.8% vs. non-MBs, 35.2%; P < 0.01) and age (MBs, 42.9 ± 1.8 years vs. non-MBs, 34.7 ± 1.4 years; P < 0.01) were statistically significant factors associated with microbleeds, but only bypass surgery in childhood remained statistically significant after multivariable adjustment (odds ratio, 0.25; 95% confidence interval, 0.07-0.87; P = 0.03). CONCLUSIONS: This study shows the clinical significance of revascularization surgery in childhood associated with a low incidence of asymptomatic microbleeds in adult patients with moyamoya disease. This finding indicates that a newly established bypass can reduce hemodynamic overstress.


Assuntos
Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Revascularização Cerebral , Doença de Moyamoya/complicações , Doença de Moyamoya/cirurgia , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos
4.
World Neurosurg ; 133: e121-e128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476469

RESUMO

BACKGROUND: Primary intraventricular hemorrhage (PIVH) is rare, and causes, characteristics, and outcomes remain unknown in children. METHODS: We retrospectively analyzed the clinical characteristics of patients 1 month to 21 years of age who were admitted to the hospital with PIVH over a 7-year period. PIVH was defined as bleeding confined to the ventricular system without parenchymal or subarachnoid hemorrhage involvement. RESULTS: Of 18 included patients, 55.6% were female, and mean age was 13.8 ± 6.0 years. The most common presenting symptoms were headache (77.8%) and vomiting (33.3%). In 15 patients (83.3%), known etiologies were diagnosed, including arteriovenous malformations (66.7%), moyamoya disease (11.1%), and aneurysms (5.6%). Idiopathic PIVH was the diagnosis in 3 patients (16.7%). Surgery was performed in 15 patients (83.3%), and 3 patients (16.7%) received conservative treatment. Four patients (28.6%) had an unfavorable outcome at discharge, and 3 patients (16.7%) had an unfavorable outcome at the 3-month follow-up. Higher Graeb score was associated with an unfavorable outcome in both short-term and long-term follow-up. CONCLUSIONS: Arteriovenous malformations were diagnosed in most pediatric patients with PIVH. Specific surgical treatment of underlying etiologies should be required to increase clinical improvement. Children with a higher Graeb score at admission tended to have poor early and late outcomes.


Assuntos
Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/irrigação sanguínea , Adolescente , Malformações Arteriovenosas/complicações , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Cefaleia/etiologia , Humanos , Lactente , Recém-Nascido , Aneurisma Intracraniano/complicações , Masculino , Doença de Moyamoya/complicações , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia , Adulto Jovem
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(8. Vyp. 2): 28-34, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825359

RESUMO

Cervical artery dissection is the common cause of ischemic stroke in young and middle-age patients. According to our previous studies, dissection is related to arterial wall dysplastic changes, which in their turn are due to mitochondrial cytopathy. The authors describe three male patients who at the age of 53, 25 and 35 years underwent internal artery (ICA) dissection with occlusion of its lumen and subsequent recanalization in one of them. In 3.5 months, 13.5 years and 3 years respectively, patients developed intracerebral hemorrhage (IСH), which was not related to arterial hypertension, cerebral arterial aneurysms and anticoagulants. IСH were located on the side of ICA occluded after dissection (2 patients) or bilaterally in the territory of patent ICA (1 patient). Multivoxel 1H-MR spectroscopy performed in one patient on 40 and 48 days after ICH revealed a high lactate peak in the externally unchanged hemispheric white matter. It is assumed that mitochondrial cytopathy in patients with dissection may involve large as well as small intracerebral arteries (mitochondrial microangiopathy), which could be the cause of ICH.


Assuntos
Dissecação da Artéria Carótida Interna , Hemorragia Cerebral , Aneurisma Intracraniano , Acidente Vascular Cerebral , Artéria Carótida Interna , Dissecação da Artéria Carótida Interna/complicações , Hemorragia Cerebral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
No Shinkei Geka ; 47(12): 1281-1287, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874950

RESUMO

BACKGROUND: Patients with hereditary hemorrhagic telangiectasia(HHT)are known to have high rates of cerebral arteriovenous malformations(AVMs). Compared to patients with sporadic AVMs, patients with HHT are less likely to present with ruptured AVMs. CASE REPORT: A 14-year-old male patient presented with headache that had lasted for 2 days. CT revealed an intracerebral hemorrhage in the right parietal lobe, and enhanced CT revealed an AVM in the upper part of the hematoma. The size of the nidus was 20 mm, and its feeders were the right superior internal parietal artery and a branch of the anterior cerebral artery. In addition, the AVM had no deep drainer. We also found another AVM in the right temporal lobe and identified telangiectasia of the nose using digital subtraction angiography. We suspected HHT and performed whole body CT, which revealed an arteriovenous fistula in the right lung and a hematoma-like lesion in the spleen. Thus, we diagnosed the patient with HHT. His ruptured AVM was removed electively. CONCLUSION: We report a case of HHT that presented as an intracerebral hemorrhage in a patient. Based on our case study findings, it is necessary to perform long-term follow-up not only for brain AVMs but also for visceral vascular malformations in such patients, as well as perform HHT screening for families. Although such cases are rare, some features of HHT must be considered to accurately diagnose suspected HHT.


Assuntos
Fístula Arteriovenosa , Hemorragia Cerebral/cirurgia , Malformações Arteriovenosas Intracranianas , Telangiectasia Hemorrágica Hereditária , Adolescente , Angiografia Digital , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Hemorragia Cerebral/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Telangiectasia Hemorrágica Hereditária/etiologia , Telangiectasia Hemorrágica Hereditária/cirurgia
7.
Medicine (Baltimore) ; 98(51): e18296, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860978

RESUMO

RATIONALE: Cerebral microbleeds are increasingly recognized in various neurological disorders such as cerebral amyloid angiopathy (CAA), Alzheimer disease, and stroke. The presence and number of cerebral microbleeds are known to be independent predictors of cognitive impairment. PATIENT CONCERNS: A 73-year-old woman visited our memory disorder clinic complaining of progressive memory impairment, which started 2 years ago. DIAGNOSES: The patient had innumerable cortical/subcortical cerebral microbleeds in the entire brain. We diagnosed the patient with amnestic mild cognitive impairment due to CAA. Interestingly, only focal ß-amyloid deposits at the bilateral parietal cortices were seen on amyloid positron emission tomography (PET) scan. INTERVENTIONS: We have observed changes in her cognitive function without any medication. OUTCOMES: The cognitive function of the patient was unchanged during the follow-up period. LESSONS: Our case was interesting in a few aspects, including the number of cerebral microbleeds and the atypical ß-amyloid deposition pattern on amyloid PET scan. Further studies on more cases are needed to evaluate ß-amyloid burden and distribution patterns in CAA.


Assuntos
Angiopatia Amiloide Cerebral/complicações , Hemorragia Cerebral/etiologia , Idoso , Encéfalo/diagnóstico por imagem , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Feminino , Humanos , Transtornos da Memória/etiologia , Neuroimagem , Tomografia por Emissão de Pósitrons
8.
Cancer Radiother ; 23(8): 860-866, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677901

RESUMO

PURPOSE: Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy are standard treatments for brain metastases when they are small in size (at the most 3cm in diameter) and limited in number, in patients with controlled extracerebral disease and a good performance status. Large inoperable brain metastases usually undergo hypofractionated stereotactic radiotherapy while haemorrhagic brain metastases have often been contraindicated for both stereotactic radiosurgery or hypofractionated stereotactic radiotherapy. The objective of this retrospective study was to assess a six 6Gy-fractions hypofractionated stereotactic radiotherapy scheme in use at our institution for haemorrhagic brain metastases, large brain metastases (size greater than 15cm3) or brain metastases located next to critical structures. MATERIAL AND METHODS: Patients with brain metastases treated with the 6×6Gy scheme since 2012 to 2016 were included. Haemorrhagic brain metastases were defined by usual criteria on CT scan and MRI. Efficacy, acute and late toxicity were evaluated. RESULTS: Sixty-two patients presenting 92 brain metastases were included (32 haemorrhagic brain metastases). Median follow up was 10.1 months. One-year local control rate for haemorrhagic brain metastases, large brain metastases, or brain metastases next to critical structures were 90.7%, 73% and 86.7% respectively. Corresponding overall survival rates were 61.2%, 32% and 37.8%, respectively. Haemorrhagic complications occurred in 5.3% of patients (N=5), including two cases of brain metastases with pretreatment haemorrhagic signal. Tolerance was good with only one grade 3 acute toxicity. CONCLUSION: The 6×6Gy hypofractionated stereotactic radiotherapy scheme seems to yield quite good results in patients with haemorrhagic brain metastases, which must be confirmed in a prospective way.


Assuntos
Neoplasias Encefálicas/radioterapia , Hemorragia Cerebral/radioterapia , Hipofracionamento da Dose de Radiação , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Hemorragia Cerebral/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Radiocirurgia/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Carga Tumoral
10.
BMC Neurol ; 19(1): 249, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646971

RESUMO

BACKGROUND: Cardiac myxoma is the most common benign cardiac tumor. Brain metastases or multiple cerebral aneurysms are extremely rare, especially for the case of both complications. Brain metastases are usually found at the same time or few months after the diagnosis or surgical removal of cardiac myxoma CASE PRESENTATION: We describe a case of patient, operated for a cardiac myxoma, who presented multiple central nervous system metastases associated, cerebral aneurysms and subsequent intracerebral hemorrhage CONCLUSIONS: The long-term follow-up of the patients with atrial myxoma even after complete surgical excision is recommended, especially for the patient with central nervous system manifestations before atrial myxoma excision.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Cardíacas/patologia , Aneurisma Intracraniano/etiologia , Mixoma/patologia , Adulto , Hemorragia Cerebral/etiologia , Feminino , Átrios do Coração/patologia , Humanos
11.
Medicine (Baltimore) ; 98(42): e17558, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626120

RESUMO

BACKGROUND: Microsurgery is widely utilized for patients with cerebral hemorrhage (CH). The purpose of this study is to assess the efficacy and safety of microsurgery for the treatment of patients with CH secondary to gestational hypertension (GH). METHODS: Relevant randomized controlled trials in eight electronic databases of Cochrane Library, PUBMED, EMBASE, Web of Science, VIP, WANFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be included. All electronic databases will be searched from inceptions to the present without language restriction. RevMan 5.3 software will be applied for statistical analysis. RESULTS: This study will summarize a high-quality synthesis of maternal mortality, severe maternal complications, maternal quality of life, limbs function, muscle strength, and muscle tone to evaluate the efficacy and safety of microsurgery for patients with CH secondary to GH. CONCLUSIONS: This study will provide evidence that microsurgery is an effective intervention in patients with CH secondary to GH. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019145750.


Assuntos
Hemorragia Cerebral/cirurgia , Hipertensão Induzida pela Gravidez/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Hemorragia Cerebral/etiologia , Feminino , Humanos , Gravidez , Resultado do Tratamento
12.
Cochrane Database Syst Rev ; 9: CD003436, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503327

RESUMO

BACKGROUND: Brain arteriovenous malformations (AVMs) are the single most common cause of intracerebral haemorrhage in young adults. Brain AVMs also cause seizure(s) and focal neurological deficits (in the absence of haemorrhage, migraine or an epileptic seizure); approximately one-fifth are incidental discoveries. Various interventions are used in an attempt to eradicate brain AVMs: neurosurgical excision, stereotactic radiosurgery, endovascular embolization, and staged combinations of these interventions. This is an update of a Cochrane Review first published in 2006, and last updated in 2009. OBJECTIVES: To determine the effectiveness and safety of the different interventions, alone or in combination, for treating brain AVMs in adults compared against either each other, or conservative management, in randomized controlled trials (RCTs). SEARCH METHODS: The Cochrane Stroke Group Information Specialist searched the Cochrane Stroke Group Trials Register (last searched 7 January 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library, MEDLINE Ovid (1980 to 14 January 2019), and Embase OVID (1980 to 14 January 2019). We searched international registers of clinical trials, the contents pages of relevant journals, and bibliographies of relevant articles (November 2009). We also contacted manufacturers of interventional treatments for brain AVMs (March 2005). SELECTION CRITERIA: We sought RCTs of any intervention for brain AVMs (used alone or in combination), compared against each other or against conservative management, with relevant clinical outcome measures. DATA COLLECTION AND ANALYSIS: One author screened the results of the updated searches for potentially eligible RCTs for this updated review. Both authors independently read the potentially eligible RCTs in full and confirmed their inclusion according to the inclusion criteria. We resolved disagreement by discussion. We assessed the risk of bias in included studies and applied GRADE. MAIN RESULTS: We included one trial with 226 participants: A Randomized trial of Unruptured Brain Arteriovenous Malformations (ARUBA), comparing intervention versus conservative management for unruptured brain AVMs (that had never bled). The quality of evidence was moderate because we found just one trial that was at low risk of bias other than a high risk of performance bias due to participants and treating physicians not being blinded to allocated treatment. Data on functional outcome and death at a follow-up of 12 months were provided for 218 (96%) of the participants in ARUBA. In this randomized controlled trial (RCT), intervention compared to conservative management increased death or dependency (modified Rankin Scale score ≥ 2, risk ratio (RR) 2.53, 95% confidence interval (CI) 1.28 to 4.98; 1 trial, 226 participants; moderate-quality evidence) and the proportion of participants with symptomatic intracranial haemorrhage (RR 6.75, 95% CI 2.07 to 21.96; 1 trial, 226 participants; moderate-quality evidence), but there was no difference in the frequency of epileptic seizures (RR 1.14, 95% CI 0.63 to 2.06; 1 trial, 226 participants; moderate-quality evidence). Three RCTs are ongoing. AUTHORS' CONCLUSIONS: We found moderate-quality evidence from one RCT including adults with unruptured brain AVMs that conservative management was superior to intervention with respect to functional outcome and symptomatic intracranial haemorrhage over one year after randomization. More RCTs will help to confirm or refute these findings.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Adulto , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Tratamento Conservador , Embolização Terapêutica , Epilepsia/etiologia , Epilepsia/prevenção & controle , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
No Shinkei Geka ; 47(8): 859-867, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31477629

RESUMO

We report an extremely rare case of dural arteriovenous fistula(DAVF)involving the superior sagittal sinus(SSS)that presented as a primary intraventricular hemorrhage(PIVH). A 79-year-old man who presented with disturbance of consciousness and vomiting was transferred to our hospital. The initial head CT revealed an intraventricular hemorrhage in the lateral, third, and fourth ventricles, predominantly involving the right lateral ventricle associated with obstructive hydrocephalus. CT angiography and three-dimensional rotational angiography(3D-RA)revealed SSS-DAVF with retrograde venous drainage from the cortical venous system to the subependymal venous system through engorged superficial/anastomotic/deep medullary or transcerebral veins, showing a pseudophlebitic pattern. A severe stenosis of the SSS was observed at the site just proximal to the shunting point. A varix of the right transvers caudate vein(TCV)was observed within the thickest portion of the hematoma in close contact with the wall of the right lateral ventricle. A stenosis of the branching point of the right TCV was detected on the 3D-RA image. The DAVF was completely cured after transarterial embolization. The varix gradually shrank and finally disappeared after 2 months. This is the first report of a case of PIVH due to SSS-DAVF with a subependymal varix considered as the bleeding point. Serial gadolinium-enhanced MR images clearly showed the shrinking of the varix. Our case is the second reported case of spontaneous resolution of the varix after embolization of the DAVF. The obstructive changes of the two venous outflow pathways(SSS/TCV)might further worsen the state of venous congestion in the deep medullary venous system and eventually lead to formation and rupture of the varix.


Assuntos
Fístula Artério-Arterial , Malformações Vasculares do Sistema Nervoso Central , Hemorragia Cerebral , Embolização Terapêutica , Idoso , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Hemorragia Cerebral/etiologia , Humanos , Masculino , Procedimentos Neurocirúrgicos , Seio Sagital Superior
14.
Neurology ; 93(11): e1068-e1075, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31409735

RESUMO

OBJECTIVE: To determine whether dual energy CT with a combined approach (cDECT) using a plain noncontrast monochromatic CT (pCT), a water-weighted image after iodine removal, and an iodine-weighted image changes the diagnosis and classification of intracranial hemorrhage (ICH) after endovascular thrombectomy (EVT) in acute ischemic stroke compared to a pCT image alone without separate water and iodine weighting. METHOD: During 2012 to 2016, 372 patients at our comprehensive stroke center underwent DECT scans within 36 hours after EVT. Two readers evaluated pCT compared to a second reading with cDECT, establishing the diagnosis of ICH and grading it per the Heidelberg and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) classifications. RESULT: Using cDECT changed the ICH diagnosis to contrast staining only in 34% (52 of 152), modified the ICH grade in 10% (15 of 152), and diagnosed initially undetected ICH in 2% (5 of 220). pCT alone had 95% sensitivity, 80% specificity, 66% positive predictive value, 98% negative predictive value, and 85% accuracy for ICH compared to cDECT. Interreader agreement on the presence of ICH increased with cDECT compared to pCT (Cohen κ = 0.77 [95% confidence interval 0.69-0.84] vs 0.68 [0.61-0.76]). CONCLUSION: cDECT within 36 hours after EVT changes the radiologic report regarding posttreatment ICH in a considerable proportion of patients undergoing EVT compared to pCT alone. This could affect decision-making regarding monitoring, secondary prevention, and prognostication. The cDECT scan could improve the interpretation consistency of high-attenuating changes on post-EVT images.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/tendências , Tomografia Computadorizada por Raios X/tendências , Idoso , Isquemia Encefálica/cirurgia , Hemorragia Cerebral/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos
15.
World Neurosurg ; 132: 41-46, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470162

RESUMO

BACKGROUND: Primary angiosarcoma of the brain is an extremely rare malignant tumor that that arises from vascular endothelial cells of the brain or meninges. The presentation, characteristics, and prognosis of this disease are not well understood. Here we report such a case. CASE DESCRIPTION: A 68-year-old Chinese man presented with confusion and progressive impairment of right limb movement. Magnetic resonance imaging (MRI) revealed a hemorrhagic lesion in the left frontal lobe. Exploratory surgery revealed a hematoma-like lesion and extensive superficial hemosiderin deposition. The postoperative pathological diagnosis was angiosarcoma. The tumor recurred at 1 month after the operation, with extensive tumor regrowth in the left hemisphere. The patient died after 4 weeks. CONCLUSIONS: Although accurate preoperative diagnosis of angiosarcoma of the brain is difficult, radiologists and neurosurgeons need to be aware of this rare entity. The prognosis of intracranial angiosarcoma is heterogenous. Intraoperatively, the presence of extensive superficial hemosiderosis may aid in its diagnosis.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Lobo Frontal/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Hemorragia Cerebral/etiologia , Lobo Frontal/patologia , Hemangiossarcoma/complicações , Hemangiossarcoma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino
16.
World Neurosurg ; 131: e277-e283, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31351211

RESUMO

OBJECTIVE: To explore the feasibility of computed tomography perfusion imaging (CTP) for evaluating hemodynamics in hemorrhagic moyamoya disease (MMD). METHODS: The retrospective analysis included 25 patients with hemorrhagic MMD who underwent brain CTP examination. Two experienced radiologists manually delineated regions of interest (ROIs) in the bilateral frontal lobe, temporal lobe, brain tissue adjacent to the hemorrhagic foci, and brainstem as a control region. The perfusion values for all ROIs were extracted, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). Subsequently, the differences in perfusion values for different brain tissues were compared between the hemorrhagic side and the nonhemorrhagic side. For patients who underwent revascularization surgery, differences in perfusion values from before to after surgery were determined in brain tissues on the ipsilateral side. RESULTS: CBF in the area around the hematoma and the lateral temporal lobe on the hemorrhage hemisphere was lower than that on the contralateral side, whereas TTP and MTT were higher. Among the 14 patients who underwent revascularization, CBF and CBV in the postoperative temporal lobes were higher than the preoperative values, whereas TTP and MTT were lower. CBF and CBV in the frontal lobe were higher after the operation. CONCLUSIONS: Hemorrhagic MMD results in cerebral ischemia, and CTP could be used to localize such ischemic brain tissue and objectively evaluate the changes in cerebral hemodynamics with revascularization.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Revascularização Cerebral , Doença de Moyamoya/diagnóstico por imagem , Adulto , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Doença de Moyamoya/cirurgia , Imagem de Perfusão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
Georgian Med News ; (290): 38-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322512

RESUMO

The association of cerebral arteriovenous malformations (bAVM) and associated paranidal aneurysms, that is closely related to the AVM nidus, carry a high risk of rapture and re-rapture after initial hemorrhage. This association is consider as therapeutic challenge and supportive data about their natural history and best treatment modalities are still lacking. In this article we report our experience of their treatment. We reviewed 443 cases of patients with AVMs between 2004 and 2018, who were treated at our institution and found 73 (16,5%) cases of AVM association with paranidal aneurysms (22 (30,2%) arterial - prenidal, 20 (27,4%) intranidal, and 19 (26,0%) venous - postnidal). Twelve (16,4 %) patients had multiple aneurysm. All patients received endovascular treatment with n-butyl cyanoacrylate (NBCA), ONYX or Embolin embolization. We evaluated clinical and radiological data, treatment and outcomes at discharge. Among 73 patients (32 (43,8 %) women and 41 (56,2 %) men, mean age - 34 years, 8 - 65 years) with AVM and paranidal aneurysms who were enrolled in our study, hemorrhage was the most frequent presenting symptom (47 patients (64.4%). The timing of procedure varied between 3 - 23 days. Total occlusion of AVM was achieved in 23 (31,5%) cases, in all other cases partial or target occlusion with obligatory aneurysm embolization was done. Seven (9,6%) patients had complication (5 ischemic and 2 hemorrhagic) after procedure. Clinical improvement was seen in all groups at discharge. Mean change of mRS score between admission and discharge was 0,2-0,5 point. Excellent or good outcome (mRS - 0,1,2) was observed in 58 (79,5%) patients at discharge. Unfavorable outcome (mRS - 3-5) had 13 (17,8%) patients, mRS - 6 - 2 (2,7%) patients. Patients sustaining AVM and multiple paranidal aneurysms had higher risk of hemorrhage comparing with single one (OR-17,5 (95% CI -1,0-309,8 (p=0,010). Relationship between AVM with paranidal aneurysms and hemorrhagic presentation is obvious, however definite source of hemorrhage is difficult to evaluate. To our belief arterial prenidal and intranidal aneurysms especially multiple are the most dangerous and should be in therapeutic focus after it's finding. Endovascular embolization has the potential to be effective and safe in treatment of AVM with paranidal aneurysms.


Assuntos
Artérias/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Embolização Terapêutica , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Adolescente , Adulto , Idoso , Angiografia Cerebral , Circulação Cerebrovascular/fisiologia , Criança , Feminino , Humanos , Aneurisma Intracraniano/patologia , Malformações Arteriovenosas Intracranianas/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
18.
J Stroke Cerebrovasc Dis ; 28(10): 104300, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31358356

RESUMO

GOAL: There are an increasing idea that the inflammation contributes to vascular diseases in various organs. The pathogenesis of both cerebral small vessel disease such as cerebral microbleeds and carotid plaque may be associated with chronic inflammation. This study was aimed to evaluate the correlation between microbleeds and carotid plaque characteristics. MATERIALS AND METHODS: This study enrolled 85 patients who underwent surgical/endovascular treatments for carotid artery stenosis between January 2009 and July 2016. Their clinical data were precisely analyzed. T2*-weighted magnetic resonance (MR) imaging was performed to detect the cerebral microbleeds. The carotid plaque with high signal intensity on T1-weighted MR imaging was categorized into vulnerable plaque. FINDINGS: The microbleeds was detected in 17 of 85 (20%). The prevalence of vulnerable carotid plaque and previous symptomatic lacunar infarction was significantly greater in the patients with microbleeds than in those without (P = .001 and P = .03, respectively). Multiple logistic regression analysis showed that the vulnerable plaque was significantly associated with the presence of microbleeds when adjusted for age, alcohol intake, antiplatelet drug use, the presence of previous symptomatic lacunar infarction, and coronary artery disease (P = .009, OR = 5.38, 95% CI = 1.51-21.0). CONCLUSIONS: These findings suggest the correlation between microbleeds and vulnerable plaque in patients with severe (>70%) carotid artery stenosis. Systemic, chronic inflammation may play a key role in both small and large arteries' disease of the brain. The knowledge may be valuable to fully understand the entity of cerebrovascular diseases as one of systemic, chronic inflammation.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Imagem por Ressonância Magnética , Placa Aterosclerótica , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/terapia , Hemorragia Cerebral/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença
19.
World Neurosurg ; 129: e429-e435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150855

RESUMO

OBJECTIVE: To evaluate the 30-day outcomes of using the Enterprise stent to treat patients with hypoperfusion of symptomatic severe intracranial stenosis. METHODS: Patients with symptomatic severe intracranial stenosis (70%-99%) who underwent Enterprise stent intervention between August 2014 and November 2018 were retrospectively analyzed. The 30-day primary outcomes included the success rate of stenting and the incidence of complications, including ischemic stroke, cerebral hemorrhage, and death. The 30-day complication rates of patients with different lesion locations and classifications of Mori morphology were compared. RESULTS: Sixty-eight patients were treated using 70 Enterprise stents. The success rate was 100%. The 30-day complication rate was 4.4%. The rates of ischemic stroke, cerebral hemorrhage, and death were 1.5%, 2.9%, and 0%, respectively. No significant difference was found in the 30-day complication rate between patients with different lesion locations and classifications of Mori morphology (P > 0.05). CONCLUSION: Enterprise stents were relatively safe in treating patients with hypoperfusion of symptomatic severe intracranial stenosis.


Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/etiologia , Hemorragia Cerebral/etiologia , Procedimentos Endovasculares/métodos , Stents , Acidente Vascular Cerebral/etiologia , Idoso , Arteriopatias Oclusivas/complicações , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
20.
Am J Case Rep ; 20: 844-850, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31201298

RESUMO

BACKGROUND Cerebral amyloid angiopathy (CAA) results from progressive deposition of amyloid-ß in the walls of cortical and leptomeningeal vessels, leading to CAA-associated intracerebral hemorrhage (ICH). Hematoma expansion is a common early complication of spontaneous ICH, and is a strong independent predictor of poor outcome. However, there are limited reports of hematoma expansion related to CAA-associated ICH. Herein, we describe a novel case of hematoma expansion with a fluid-blood level in the cystic cavity of CAA-associated ICH. CASE REPORT A 76-year-old male was initially diagnosed with probable CAA according to the modified Boston criteria, and presented with lobar ICH in the left frontal lobe 4 months later. Admission computed tomography scans showed an ICH including a high-density hematoma within a cystic cavity, revealing a clearly lower-density fluid component. Serial computed tomography scans showed no evidence of an expansion of the high-density clot, but obvious expansion of the fluid component containing a fluid-blood level. We recognized a bleeding site with no enhancement on preoperative magnetic resonance imaging. Left frontal craniotomy revealed a liquefied hematoma, which was removed by suction. We subsequently evacuated the blood clot extending into the left frontal sulcus, and confirmed and cauterized the bleeding site, leading to successful hemostasis. CONCLUSIONS We report a CAA-associated ICH case showing hematoma expansion with a fluid-blood level. Intraparenchymal fluid-blood level suggests extravasation of blood into pre-existing cystic cavities because of hematoma liquefaction. Thus, fluid-blood levels are an important finding of hematoma expansion in acute CAA-associated ICH, and early treatment should be considered.


Assuntos
Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Hematoma/diagnóstico , Hematoma/etiologia , Idoso , Angiopatia Amiloide Cerebral/terapia , Hemorragia Cerebral/terapia , Hematoma/terapia , Humanos , Masculino
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