Recanalization after Extracranial Dissection: Effect of Antiplatelet Compared with Anticoagulant Therapy.

BACKGROUND: Cervical arterial dissection is a leading cause of stroke in young patients, yet optimal management remains controversial. Existing studies focusing on recurrent stroke were underpowered to demonstrate differences between antithrombotic strategies. Vessel recanalization is a more prevalent outcome and is potentially clinically important. We aimed to assess recanalization rates with anticoagulation compared with antiplatelet therapy. METHODS: We studied a single-center retrospective cohort of patients with extracranial carotid or vertebral artery dissection. Subjects with baseline and follow-up imaging between 1999 and 2013 were included. Stenosis was measured using North American Symptomatic Carotid Endarterectomy Trial methodology. Univariate and multivariable analyses were performed to determine factors associated with recanalization, defined as ≥50% relative improvement in stenosis from baseline to follow-up imaging. Secondary analyses assessed absolute and relative stenosis change and limited the cohort to >50% stenosis at diagnosis. RESULTS: We identified 75 patients with 84 dissections, mean age 47 years, 43% female, 39% non-white. Patients treated with anticoagulation had worse stenosis at baseline (median 99% versus 50%, P = .02). Comparing anticoagulation with antiplatelet therapy in the first month, there were no differences in the rates of ≥50% relative improvement in stenosis (50% versus 48%, P = .84) nor in absolute (median 16% versus 7%, P = .34) or relative (median 48% versus 43%, P = .92) change in stenosis from baseline to follow-up. In multivariable analysis, anticoagulation was not associated with recanalization (odds ratio [OR] 1.41, 95% confidence interval [CI]: .5-4.1, P = .52), whereas hypertension was negatively associated (OR .26, 95% CI: .09-.72, P = .009). CONCLUSIONS: Anticoagulation was not associated with greater likelihood of recanalization compared with antiplatelet medication therapy.

"Scout No Scan" Technique Reduces Patient Radiation Exposure During CT-Guided Spine Biopsy.

OBJECTIVE: The objective of this article is to report our experience with a technique for CT-guided spine biopsies that we refer to as the "scout no scan" technique. CONCLUSION: The scout no scan technique can significantly lower radiation exposure while maintaining high diagnostic yields for CT-guided spinal biopsies.

CT-guided Cervical Bone Biopsy in 43 Patients: Diagnostic Yield and Safety at Two Large Tertiary Care Hospitals.

RATIONALE AND OBJECTIVES: The cervical spine is a high-risk area for percutaneous biopsy compared to the thoracic and lumbar regions. Biopsy of the cervical spine is less commonly undertaken, and previously published series on diagnostic yield and safety of cervical spine biopsy have been limited to 12 patients or less. The purpose of our study is to further define the diagnostic yield of computed tomography (CT)-guided biopsy for bony lesions identified in the cervical spine, by combining data from two large tertiary care referral centers. METHODS: A retrospective review of an imaging database was performed to identify all percutaneous CT-guided biopsies of the cervical spine performed at two tertiary care hospitals from 2010 to 2015. Core biopsies were obtained whenever possible and supplemented with fine-needle aspiration in some cases. Histopathologic results of the biopsy were recorded, as were changes in subsequent management, need for repeat biopsy, and complications. RESULTS: Forty-three patients underwent CT-guided biopsy of the cervical spine. Sufficient tissue for histopathologic analysis was obtained in 41 out of 43 cases, for a yield of 95%. One case was false-negative and one was deemed insufficient by the pathologist for diagnostic purposes; in both of these cases, only a fine-needle aspiration was obtained. There were no immediate or delayed complications. CONCLUSIONS: Percutaneous biopsy of the cervical spine is a safe and high-yield method of obtaining a tissue diagnosis when performed under image guidance with CT.

Mechanical thrombectomy for cerebral venous sinus thrombosis employing a novel combination of Angiojet and Penumbra ACE aspiration catheters: the Triaxial Angiojet technique.

Cerebral venous sinus thrombosis (CVST) can be life threatening. A previously healthy woman in her early forties on oral contraceptives presented with global CVST and rapid clinical deterioration. A novel 'Triaxial Angiojet technique' (KSAW Shuttle [Cook Inc., Bloomington, IN, USA], 5 MAX ACE [Penumbra Inc., Alameda, CA, USA], and Angiojet [Boston Scientific, Marlborough, MA, USA]) was employed to gain access into the superior sagittal sinus. The 5 MAX ACE reperfusion catheter was shortened prior to placing a 4 Fr Angiojet catheter through it. This resulted in markedly improved recanalization with good anterograde flow. The patient was extubated on postoperative day 2 and discharged neurologically intact on postoperative day 10. We report the first case of placing an Angiojet catheter through a larger Penumbra reperfusion catheter when access through a tortuous sigmoid and transverse sinus could not be obtained with a 6 Fr support catheter.

Classic Cushing's syndrome in a patient with adrenocortical carcinoma.

Adrenocortical carcinoma is an aggressive but rare neoplasm of the adrenal cortex, with an estimated incidence of approximately 2.5 per one million patients. The prognosis for patients with adrenocortical carcinoma is often very poor. Patients often present with symptoms of hormone hypersecretion but may also present with pain or a palpable mass. Imaging plays an important role in preoperative planning when clinical and biochemical findings are compatible with adrenal cortical carcinoma. We report a case of adrenocortical carcinoma in a young woman who presented with classical Cushing syndrome, but who had an atypical hormonal profile.

Long-term behavioural and molecular alterations associated with maternal separation in rats.

In this study we addressed whether certain behavioural measures, endocrine levels and specific stress-related proteins exhibit long-term alterations in adult rats following repeated postnatal maternal separation. Rats were subjected to daily maternal separation for 15 min (HMS15) or 180 min (HMS180) from postnatal day 2-14. Adult HMS180 animals were hypoactive and had increased levels of stereotypy compared to HMS15 and normal animal facility-reared (AFR) animals. HMS180 animals also had augmented plasma adrenocorticotropin (ACTH) and corticosterone (CORT) concentrations following an acute stressor, compared to the other two groups. We assessed persistent changes in proteins regulated by stress in hippocampus, cortex, ventral tegmental area, nucleus accumbens, striatum and amygdala. Western blotting analysis revealed a decrease in the levels of mature brain-derived neurotrophic factor (BDNF) in hippocampus and striatum, but an increase in the ventral tegmental area in the HMS180 rats. Levels of pro-BDNF were significantly increased in the ventral tegmental area of HMS180 animals but were unchanged in other brain regions compared to the other two groups. Levels of the transcription factors cAMP response element binding protein (CREB) and DeltaFosB were unchanged in all of the brain regions studied in the maternally separated rats. These data show that maternal separation induces long-term changes in BDNF expression, and more specifically the processing of BDNF, in the hippocampus, striatum and ventral tegmental area. Recognition of these adaptations begins to define the brain regions, and neural circuitry, associated with persistent alterations induced by early life stressors and the development of mood disorders.