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cerebral vasospasm diagnosis

Georgios Tsivgoulis, Andrei V Alexandrov
PURPOSE OF REVIEW: Low cost, avoidance of irradiation, and high temporal resolution are inherent advantages of ultrasound imaging that translate into multiple clinical uses in many domains of neurology. This article presents clinical uses of ultrasound examination in cerebrovascular, neurodegenerative, and peripheral nervous system diseases. RECENT FINDINGS: Modern treatment and prevention of ischemic stroke rely on prompt diagnosis. Ultrasonography has found a place as a noninvasive screening test and bedside technique that provides estimates of the degree of stenosis as well as hemodynamic and structural information about intracranial and extracranial vessels in real time...
October 2016: Continuum: Lifelong Learning in Neurology
Elisabeth B Marsh, Wendy C Ziai, Rafael H Llinas
INTRODUCTION: Reversible cerebral vasoconstriction syndrome (RCVS) typically affects young patients and left untreated can result in hemorrhage or ischemic stroke. Though the disorder has been well characterized in the literature, the most appropriate way to diagnose, treat, and evaluate therapeutic response remains unclear. In previous studies, transcranial Doppler ultrasound (TCD) has shown elevated velocities indicative of vasospasm. This imaging modality is noninvasive and inexpensive; an attractive option for diagnosis and therapeutic monitoring if it is sensitive enough to detect changes in the acute setting given that RCVS often affects the distal vessels early in the course of disease...
May 2016: Case Reports in Neurology
Chuanyuan Tao, Jiajing Wang, Yuekang Zhang, Shirong Qi, Fan Liu, Chao You
OBJECTIVE: Cerebral vasospasm can occur after skull base tumor removal. Few studies concentrated on the posterior circulation vasospasm after tumor resection in the posterior fossa. We aimed to identify the risk factors associated with postoperative vertebrobasilar vasospasm after tumor resection in the foramen magnum. METHODS: We retrospectively reviewed the data of 62 patients with tumors in the foramen magnum at our institution from January 2010 to January 2015...
2016: PloS One
Joana Chaves Gonçalves Rodrigues de Carvalho, Francisco Javier Tercero Machin, Luis San Roman Manzanera, Jordi Blasco Andaluz, Sílvia Herrero Nogués, Núria Peix Soriano, Victor Obach Baurier, Enrique Jesus Carrero Cardenal
BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage...
September 24, 2016: Revista Brasileira de Anestesiologia
M Trolliet, A Sevely, J-F Albucher, N Nasr, C Hachon Lecamus, K Deiva, E Cheuret
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches with diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. We report on a case of a 13-year-old boy presenting with acute severe headaches, triggered by physical exertion. His past medical history was uneventful. Moderate headache persisted between exacerbations for 4 weeks. He secondarily presented with signs of intracranial hypertension. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries...
September 14, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Anastasia Tsyben, Iddo Paldor, John Laidlaw
Although common after subarachnoid haemorrhage, cerebral vasospasm (CVS) and delayed ischaemic neurological deficit (DIND) rarely occur following elective clipping of unruptured aneurysms. The onset of this complication is variable and its pathophysiology is poorly understood. We report two patients with CVS associated with DIND following unruptured aneurysmal clipping. The literature is reviewed and the potential mechanisms in the context of patient presentations are discussed. A woman aged 53 and a man aged 70 were treated with elective clipping of unruptured middle cerebral artery aneurysms, the older patient also having an anterior communicating artery aneurysm clipped...
September 2, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jay H Levin, Jorge Benavides, Claudine Caddick, Kathleen Laurie, Janet Wilterdink, Shadi Yaghi, Brian Silver, Muhib Khan
BACKGROUND AND PURPOSE: Reversible cerebral vasoconstriction syndrome (RCVS) is a vascular headache disorder characterized by severe headaches with vasospasm of cerebral arteries. Transcranial Doppler ultrasonography (TCD) has been widely applied and validated in studying vasospasm of intracranial vessels, but the role of TCD in the diagnosis and monitoring of RCVS is less well established. We sought to determine the reliability of TCD for diagnosis and monitoring of RCVS. METHODS: Patients admitted to an inpatient neurology service between 2011 and 2014 with a discharge diagnosis of RCVS were retrospectively analyzed for demographics, neuroimaging, and functional outcomes...
2016: Rhode Island Medical Journal
Álvaro Sánchez-Larsen, Tomás Segura, Susana García-Muñozguren, Javier Peinado-Ródenas, Joaquín Zamarro, Francisco Hernández-Fernández
BACKGROUND: Magnesium has a regulatory role in the excitability of cell membranes, and is also a cofactor in the phosphorylation of thiamine. Hypomagnesemia has been associated with coronary vasospasm, but its role in cerebrovascular pathology is controversial, and cerebral vasospasm exclusively attributable to hypomagnesemia has not been reported in humans. CASE PRESENTATION: We report the case of a 51-year-old man in whom uncontrollable vomiting, treatment with omeprazole and thiazide, and renal impairment lead to a severe hypomagnesemia (magnesium below the level of detection in blood tests), which secondarily caused Wernicke's encephalopathy and vasospasm in multiple cerebral arteries (seen with cerebral angiography and CT angiography) that presented with a complete right hemisphere neurological deficit...
2016: BMC Neurology
Joanna Wojczal, Tomasz Tomczyk, Piotr Luchowski, Grzegorz Kozera, Radosław Kaźmierski, Zbigniew Stelmasiak
The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description...
June 2016: Journal of Ultrasonography
Ruth-Mary deSouza, Munirih Shah, Panayiotis Koumellis, Mansoor Foroughi
BACKGROUND: To identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3-54 (mean 24.8). METHODS: Case series and literature search to identify all reported cases. RESULTS: In our series, two of three cases were fatal as a result of rebleed, and one case had a good outcome with no deficit, following prompt diagnosis and embolisation...
September 2016: Acta Neurochirurgica
Hideyuki Ishihara, Michiyasu Suzuki
After an interval of 6 years, the Japanese Guidelines for the Management of Stroke were revised in 2015 in accordance with recent advances in clinical knowledge. The chapter on subarachnoid hemorrhage includes new and revised recommendations for diagnosis, treatment selection, and management of vasospasm. The chapter on diagnosis recommends re-examination of vascular images at regular intervals in cases in which cerebral aneurysm was not detected on the first examination. The section dealing with treatment selection for cerebral aneurysmal emphasizes that the method for aneurysm obliteration should be selected based on consultation with both surgical and endovascular specialists...
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
Pierre Bouzat, Jean-Francois Payen, Ilaria A Crippa, Fabio S Taccone
The development of delayed cerebral ischemia after subarachnoid hemorrhage is one of the most important determinants of poor neurologic outcome. The pathophysiology of delayed cerebral ischemia relies on a complex interplay between a significant reduction of the diameter of large intracranial arteries (vasospasm), microvascular disturbances, and spreading cortical depolarization that lead to an inadequate oxygen supply to the brain parenchyma. The early diagnosis of cerebral vasospasm is a real challenge for clinicians and requires a multimodal approach to evaluate the consequences of vascular narrowing on cerebral function...
June 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
James Noraky, George C Verghese, David E Searls, Vasileios A Lioutas, Shruti Sonni, Ajith Thomas, Thomas Heldt
Intracranial pressure (ICP) should ideally be measured in many conditions affecting the brain. The invasiveness and associated risks of the measurement modalities in current clinical practice restrict ICP monitoring to a small subset of patients whose diagnosis and treatment could benefit from ICP measurement. To expand validation of a previously proposed model-based approach to continuous, noninvasive, calibration-free, and patient-specific estimation of ICP to patients with subarachnoid hemorrhage (SAH), we made waveform recordings of cerebral blood flow velocity in several major cerebral arteries during routine, clinically indicated transcranial Doppler examinations for vasospasm, along with time-locked waveform recordings of radial artery blood pressure (APB), and ICP was measured via an intraventricular drain catheter...
2016: Acta Neurochirurgica. Supplement
Alessandro Stecco, Francesco Fabbiano, Paola Amatuzzo, Martina Quagliozzi, Eleonora Soligo, Ignazio Divenuto, Gabriele Panzarasa, Alessandro Carriero
BACKGROUND: The aim of the study was to evaluate the effectiveness and reliability of a combined computed tomography angiography (CTA) and computed tomography perfusion (CTP) approach in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. METHODS: 19 patients with clinical signs of arterial vasospasm and positive trans-cranial Doppler (TCD) were enrolled and underwent CTP. Mean time transit (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) values of 20 standardized ROI (regions of interest) were analysed, and CTA used to measure the gauge of 26 arterial ramifications...
April 28, 2016: Journal of Neurosurgical Sciences
Didem Ardicli, Rahsan Gocmen, Kader K Oguz, Ali Varan, Dilek Yalnizoglu
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare complication of cranial radiotherapy characterized by migraine-like headache and transient neurological deficits with typical gyriform enhancement on magnetic resonance imaging (MRI). Potential underlying mechanisms are endothelial damage or dysfunction, vascular instability, vasospasm and, neuronal dysfunction.We report an 11-year-old girl with a primary diagnosis of medulloblastoma presented with acute-onset severe headache and left-sided weakness, 20 months after completing cranial radiotherapy...
August 2016: Neuropediatrics
Joanna Wojczal, Tomasz Tomczyk, Piotr Luchowski, Grzegorz Kozera, Radosław Kaźmierski, Zbigniew Stelmasiak
The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description...
March 2016: Journal of Ultrasonography
Hui Chen, Gang Luo, Xue Bai, Si-jin Yang
OBJECTIVE: To establish the migraine rheumatism stasis syndrome animal model. METHOD: The rat migraine rheumatism stasis syndrome animal model was established through rheumatism stimulation with manual climate box, 5-HT reduction caused by reserpine and local cerebral vasospasm. General vital signs (activity, weight, eye gum, hair, feeding, excrement), head scratch frequency and image collection were observed to analyze the changes in biological signs of stasis syndrome (tongue image RGB), thrombin and serotonin of model rats...
November 2015: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Christine Hammer, Badih Daou, Nohra Chalouhi, Robert M Starke, Lina Ya'qoub, Nikolaos Mouchtouris, Sravanthi Koduri, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVE: Vasospasm is a significant cause of morbidity and mortality among those with aneurysmal subarachnoid hemorrhage (aSAH). Treating increased intracranial pressure by drainage of cerebral spinal fluid through an external ventriculostomy is routine practice. The objective of this study is to evaluate the trends of CSF output in patients who experience vasospasm. METHODS: Electronic medical charts were reviewed to identify two groups of patients with aSAH, 75 consecutive patients who developed vasospasm and 75 matched patients who did not develop vasospasm...
May 2016: Clinical Neurology and Neurosurgery
You-Sub Kim, Sung-Hyun Kim, Seung-Hoon Jung, Tae-Sun Kim, Sung-Pil Joo
BACKGROUND: A lumbar drainage catheter is frequently placed intra-operatively to decrease fluid pressure on the brain in aneurysmal subarachnoid cases. In rare cases, this catheter placement can lead to intracranial hypotension, resulting in brain stem herniation termed "brain sag" and it can lead to neurological injury and may prove to be fatal. We present our patient with brain sag secondary to intraoperative lumbar drainage. CASE DESCRIPTION: A 56-year-old woman was admitted with a sudden onset of severe headache...
2016: SpringerPlus
Paul M Foreman, Michelle Chua, Mark R Harrigan, Winfield S Fisher, Nilesh A Vyas, Robert H Lipsky, Beverly C Walters, R Shane Tubbs, Mohammadali M Shoja, Christoph J Griessenauer
OBJECTIVE Delayed cerebral ischemia (DCI) is a recognized complication of aneurysmal subarachnoid hemorrhage (aSAH) that contributes to poor outcome. This study seeks to determine the effect of nosocomial infection on the incidence of DCI and patient outcome. METHODS An exploratory analysis was performed on 156 patients with aSAH enrolled in the Cerebral Aneurysm Renin Angiotensin System study. Clinical and radiographic data were analyzed with univariate analysis to detect risk factors for the development of DCI and poor outcome...
February 12, 2016: Journal of Neurosurgery
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