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https://www.readbyqxmd.com/read/28647705/revolution-in-acute-ischaemic-stroke-care-a-practical-guide-to-mechanical-thrombectomy
#1
REVIEW
Matthew Evans, Phil White, Peter Cowley, David Werring
Rapid, safe and effective arterial recanalisation to restore blood flow and improve functional outcome remains the primary goal of hyperacute ischaemic stroke management. The benefit of intravenous thrombolysis with recombinant tissue-type plasminogen activator for patients with severe stroke due to large artery occlusion is limited; early recanalisation is generally less than 30% for carotid, proximal middle cerebral artery or basilar artery occlusion. Since November 2014, nine positive randomised controlled trials of mechanical thrombectomy for large vessel occlusion in the anterior circulation have led to a revolution in the care of patients with acute ischaemic stroke...
June 24, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28644968/serum-lipoprotein-associated-phospholipase-a2-predicts-the-formation-of-carotid-artery-plaque-and-its-vulnerability-in-anterior-circulation-cerebral-infarction
#2
Yuping Yang, Tao Xue, Juehua Zhu, Jiayi Xu, Xiaowei Hu, Penghao Wang, Tao Kong, Yan Yan, Lihui Yang, Shouru Xue
OBJECTIVE: Circulation inflammation markers such as high-sensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are considered as predictors of cerebral and cardiac vascular diseases. However, the role of hsCRP and Lp-PLA2 in the anterior circulation cerebral infarction (ACI) is to be elaborated. PATIENTS AND METHODS: We included 100 patients with acute anterior circulation cerebral infarction (AaCI group) and 50 non-infarction subjects (control group)...
June 12, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28644261/is-intravenous-thrombolysis-safe-and-effective-in-central-retinal-artery-occlusion-a-critically-appraised-topic
#3
Oana M Dumitrascu, Joanne F Shen, Madhavi Kurli, Maria I Aguilar, Lisa A Marks, Bart M Demaerschalk, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. OBJECTIVE: To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28640793/intraoperative-computed-tomography-ct-for-treating-giant-carotid-intracavernous-aneurysms
#4
Zhe Xue, Fuyu Wang, Zhenghui Sun, Hui Zhang, Chen Wu, Dongsheng Kong, Bainan Xu
BACKGROUND Giant carotid intracavernous aneurysm refers to those lesions larger than 2.5 cm and derived from a cavernous segment, accounting for about 30% of all intracranial tumors. Dynamic CT perfusion imaging (PCT) is a common method recently employed to evaluate cerebral perfusion. This study investigated the efficacy and clinical application of intraoperative CT in the surgery for giant symptomatic carotid intracavernous aneurysm. MATERIAL AND METHODS A retrospective analysis was performed on 23 cases with giant symptomatic carotid intracavernous aneurysm...
June 22, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28634312/-a-case-of-dural-arteriovenous-fistula-in-the-anterior-cranial-fossa-that-developed-remote-from-the-craniotomy-site-after-surgery
#5
Ichiro Kawahara, Takashi Fujimoto, Makoto Hirose, Keisuke Toyoda, Naoki Kitagawa
Dural arteriovenous fistula(dAVF)is relatively rare, and its etiology remains uncertain. Generally, dAVF is thought to be acquired and has been reported to develop secondary to sinus thrombosis, head injury, infection, and surgery. We report a rare case of dAVF in the anterior cranial fossa that developed remote from the craniotomy site after surgery. A 52-year-old man underwent surgery for hypertensive intracerebral hemorrhage 4 years prior. Perioperative imaging modalities demonstrated no abnormal vascular malformation except for an un-ruptured anterior communicating artery aneurysm...
June 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28627790/regional-cerebral-blood-flow-in-opiate-dependence-relates-to-substance-use-and-neuropsychological-performance
#6
Donna E Murray, Timothy C Durazzo, Thomas P Schmidt, Troy A Murray, Christoph Abé, Joseph Guydish, Dieter J Meyerhoff
Neuroimaging of opiate-dependent individuals indicates both altered brain structure and function. Magnetic resonance-based arterial spin labeling has been used to measure noninvasively cerebral blood flow (i.e. perfusion) in alcohol, tobacco and stimulant dependence; only one arterial spin labeling paper in opiate-dependent individuals demonstrated frontal and parietal perfusion deficits. Additional research on regional brain perfusion in opiate dependence and its relationship to cognition and self-regulation (impulsivity, risk taking and decision making) may inform treatment approaches for opiate-dependent individuals...
June 19, 2017: Addiction Biology
https://www.readbyqxmd.com/read/28626262/a-case-of-anterior-communicating-artery-aneurysm-successfully-treated-after-a-stent-migration-during-stent-assisted-endovascular-coil-embolization
#7
Tomotaka Ohshima, Andrey Belayev, Shunsaku Goto, Taiki Yamamoto, Kojiro Ishikawa, Yoko Kato
Stent migration is a complication associated with endovascular coil embolization of intracranial aneurysms. We report a case of anterior communicating artery (ACoA) aneurysm that was successfully treated after stent migration during endovascular coil embolization without retrieval of the stent. A 47-year-old man presented with sudden onset severe headache. Patient was noted to have subarachnoid hemorrhage from a ruptured ACoA aneurysm. Emergency endovascular coil embolization was performed. The second coil embolization was scheduled for the neck-remnant portion with a stent after 16 days from the initial operation...
February 2017: Nagoya Journal of Medical Science
https://www.readbyqxmd.com/read/28625587/a-rabbit-model-of-aneurysmal-subarachnoid-hemorrhage-by-ear-central-artery-suprasellar-cistern-shunt
#8
Jing Lu, Fuxiang Chen, Bing Cai, Fan Chen, Dezhi Kang
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening hemorrhagic cerebrovascular disease. The concept of early brain injury (EBI), induced by sharply increased intracranial pressure (ICP) and low cerebral perfusion pressure (CPP) with cerebral global ischemia following aneurysm rupture, has been increasingly accepted. However, EBI has not been well studied partly due to lack of an ideal animal model. The purpose of this study was to establish a new aSAH model which can mimic the pathophysiological damage of EBI...
June 15, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28623116/comparison-of-the-prevalence-of-ruptured-and-unruptured-cerebral-aneurysms-in-a-poor-urban-minority-population
#9
Todd S Miller, David Altschul, Nrupen Baxi, Joaquim Farinhas, David Pasquale, Judah Burns, David Gordon, Jacqueline Bello, Allan Brook, Eugene Flamm
BACKGROUND: Most ruptured cerebral aneurysms are small (<7 mm). Evidence suggests low rupture rates for such lesions (<1% per year). Population studies demonstrate a prevalence rate of 3.2%. This study simultaneously estimates the prevalence of aneurysms in a single geographic population while reporting the observed rate of aneurysmal subarachnoid hemorrhage (aSAH) in the same geographic region composed of a poor urban minority demographic. METHODS: This is an institutional review board-approved, Health Insurance Portability and Accountability Act of 1996-compliant retrospective study performed between 2005 and 2011 at a single center...
June 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28622069/spontaneous-coronary-artery-dissection-in-a-woman-with-a-past-medical-history-of-subarachnoid-hemorrhage-a-case-report
#10
Jean Bardon, Fabien Picard, Franck Barbou, Olivier Varenne, Benoît Vivien
Spontaneous coronary artery dissection (SCAD) is an uncommon disease. We report the case of a 50 year-old woman with a past medical history of aneurysmal subarachnoid hemorrhage, presenting with acute chest pain and diffuse ST segment elevation on ECG. Coronary angiogram revealed a SCAD of the left anterior descending coronary artery. The association between cerebral aneurysms and SCAD should trigger providers concern for fibromuscular dysplasia. We hereby report on a rare and atypical case involving the relationship between fibromuscular dysplasia and SCAD...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28619499/results-of-early-high-flow-bypass-and-trapping-for-ruptured-blood-blister-like-aneurysms-of-the-internal-carotid-artery
#11
Yuichiro Kikkawa, Toshiki Ikeda, Ririko Takeda, Hiroyuki Nakajima, Takeshi Ogura, Hidetoshi Ooigawa, Hiroki Kurita
OBJECTIVE: The aim of this study is to clarify the efficacy and safety of early surgery using trapping of the affected internal carotid artery (ICA) and high-flow bypass between second portion of the middle cerebral artery and cervical external carotid artery with radial artery graft for ruptured blood blister-like aneurysms (BBAs) arising from anterior wall of the ICA. METHODS: Medical chart of consecutive 16 patients (M:F=7:9, mean 59 years) with subarachnoid hemorrhage (WFNS grade I:2, II:5, III:2, IV:4, V:3) due to ruptured BBA surgically treated between July 2010 and October 2015 were retrospectively reviewed...
June 12, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28611828/heads-up-a-novel-provocative-maneuver-to-guide-acute-ischemic-stroke-management
#12
Latisha K Ali, Julius K Weng, Sidney Starkman, Jeffrey L Saver, Doojin Kim, Bruce Ovbiagele, Brian H Buck, Nerses Sanossian, Paul Vespa, Oh Young Bang, Reza Jahan, Gary R Duckwiler, Fernando Viñuela, David S Liebeskind
BACKGROUND: A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. METHODS: A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28611648/complete-recovery-from-blindness-in-case-of-compressive-optic-neuropathy-due-to-unruptured-anterior-cerebral-artery-aneurysm
#13
Yurie Fukiyama, Hidehiro Oku, Yusuke Hashimoto, Yuko Nishikawa, Masahiro Tonari, Jun Sugasawa, Shigeru Miyachi, Tsunehiko Ikeda
It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20...
January 2017: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/28598141/evaluation-of-cerebral-perfusion-by-contrast-enhanced-ultrasound-at-low-mechanical-index-in-cerebral-ischemia-rat-model
#14
Xiaolei Wang, Bo Liu, Jiongou Liu, Aitong Sun, Yan Cui, Rui Xiao, Chunyang Li
BACKGROUND: No data is available for brain low mechanical index (low-MI) contrast-enhanced ultrasound (CEUS). This study aimed to assess low-MI CEUS for cerebral ischemia in rats. METHODS: Twenty adult Wistar rats were divided to the brain ischemia (n=12) and sham (n=8) groups. A Logiq E9 (GE; ML6-15 probe) was used. Bolus injection of SonoVue (Bracco) at 3.6 ml/kg was performed. Cerebral perfusion was evaluated using time to peak (TTP) and area under the curve (AUC) of time-intensity curves (TIC)...
June 9, 2017: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/28596462/-pure-amnesia
#15
Koichi Tagawa, Haruki Tokida
Pure amnesia (amnesic syndrome) is an organic brain syndrome characterized by impairment in episodic memory, with either an anterograde or sometimes retrograde loss of memories. Although episodic memory is impaired, semantic memory, immediate memory, and procedural memory are preserved. The Papez circuit is a network of nerve fibers and nerve centers that starts and ends in the hippocampus travelling by way of the fornix, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, and parahippocampal gyrus...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28596196/effect-of-retrievable-stent-size-on-endovascular-treatment-of-acute-ischemic-stroke-a-multicenter-study
#16
D Yang, Y Hao, W Zi, H Wang, D Zheng, H Li, M Tu, Y Wan, P Jin, G Xiao, Y Xiong, G Xu, X Liu
BACKGROUND AND PURPOSE: In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS: Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device...
June 8, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28587530/endovascular-treatment-of-wide-neck-intracranial-bifurcation-aneurysms-with-y-configuration-double-neuroform%C3%A2-stents-assisted-coiling-technique-experience-in-a-single-center
#17
C Castaño, M Terceño, S Remollo, M R García-Sort, C Domínguez
Background Intracranial wide-neck aneurysms at the arterial bifurcations, especially in the aneurysms where the bifurcating branches emanate directly from the base of the aneurysm, have been particularly difficult on which to perform endovascular treatment. The 'Y'-configuration, double stent-assisted coil embolization is an option for the treatment of these difficult aneurysms, allowing the closure of the aneurysm, preserving the parent arteries. Material and methods In a nine-year period, 546 intracranial aneurysms in 493 patients were treated at our center by endovascular approach...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28585670/association-of-two-primitive-carotid-basilar-anastomoses-and-cerebrovascular-abnormalities-on-the-brain-base-a-case-report
#18
Milena TRANDAFİLOVİć, Ljiljana VASOVİć, Slobodan VLAJKOVİć, Marija DAKOVİć-BJELAKOVİć
Simultaneous presence of the persistent primitive trigeminal artery and so-called intermediate communicating artery in a 77-years-old cadaver autopsied due to the myocardial infarction was discovered. Many vascular variants and abnormalities such as an aplasia of the right vertebral artery (VA), a presence of two right posterior cerebral arteries (PCAs), partial duplication of the right superior cerebellar artery, hypoplasia of the pre-communicating part (A1) of the right anterior cerebral artery and the right PCA of basilar origin, a special configuration of the anterior communicating artery (ACoA), and a small aneurysm at the right A1-ACoA junction were associated...
April 27, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28583450/intraprocedural-rupture-of-unruptured-cerebral-aneurysms-during-coil-embolization-a-single-center-experience
#19
Su Hee Cho, Mohammed Denewer, Won Hyong Park, Jae Sung Ahn, Byung Duk Kwun, DeokHee Lee, Jung Cheol Park
OBJECTIVE: The incidence of intraprocedural rupture (IPR) during endovascular coiling is reported to range from 2% to 5%. In this study, we reviewed the single center experiences of IPR during coil embolization for unruptured intracranial aneurysm. METHODS: At our institution, 849 patients were treated with endovascular therapy for unruptured intracranial aneurysm between January 2011 and April 2016. Ten (1.18%) of these patients had documented IPR. We reviewed the medical data to evaluate the characteristics of the aneurysms, angiographic findings related to rupture, management, and outcomes...
June 2, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28581366/flat-head-positioning-increases-cerebral-blood-flow-in-anterior-circulation-acute-ischemic-stroke-a-cluster-randomized-phase-iib-trial
#20
Verónica V Olavarría, Pablo M Lavados, Paula Muñoz-Venturelli, Francisca González, Javier Gaete, Sheila Martins, Hisatomi Arima, Craig S Anderson, Alejandro M Brunser
Background Whether lying-flat improves blood flow in patients with acute ischemic stroke is unknown. Our aim was to investigate if lying-flat "changes" cerebral blood flow velocities assessed by transcranial Doppler in acute ischemic stroke patients. Methods In a multicenter cluster clinical trial, we randomly assigned patients within 12 h from onset of a neurological deficit due to cerebral ischemia of the anterior circulation to lying-flat or upright head positioning. The primary outcome was a change of 8 cm/s or more in mean cerebral blood flow velocities on transcranial Doppler to the middle cerebral artery at 1 and 24 h post-randomization, adjusted for imbalance in baseline variables...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
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