Brain herniation on computed tomography is a poor predictor of whether patients with a devastating brain injury can be confirmed dead using neurological criteria.

Background: It is unclear if the presence of compartmental brain herniation on neuroimaging should be a prerequisite to the clinical confirmation of death using neurological criteria. The World Brain Death Project has posed this as a research question.

Methods: The final computed tomography of the head scans before death of 164 consecutive patients confirmed dead using neurological criteria and 41 patients with devastating brain injury who died following withdrawal of life sustaining treatment were assessed by a neuroradiologist to compare the incidence of herniation and other features of cerebral swelling.

A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct.

Purpose: The safety and efficacy of endovascular thrombectomy (EVT) for patients with proximal occlusive stroke presenting beyond 6 hours and selected on the basis of favorable neuroimaging remains unclear.

Materials And Methods: A systematic search was performed from four electronic databases from their inception to Jan 2017. A meta-analysis of outcomes from studies with patients treated beyond 6 hours was compared to those treated within the established 6 hour therapeutic window in randomized trials, selected using conventional imaging methods with CT/CT angiography.

Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms.

Endovascular coil embolization is a widely accepted and useful treatment modality for intracranial aneurysms. However, the principal limitation of this technique is the high aneurysm recurrence. The adjunct use of stents for coil embolization procedures has revolutionized the field of endovascular aneurysm management, however its safety and efficacy remains unclear.

Endovascular therapy including thrombectomy for acute ischemic stroke: A systematic review and meta-analysis with trial sequential analysis.

One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to reassess the functional outcomes and complications of IV thrombolysis with and without endovascular treatment for acute ischemic stroke using conventional meta-analysis and trial sequential analysis.

Delayed infarction following aneurysmal subarachnoid hemorrhage: Can the role of severe angiographic vasospasm really be dismissed?

Background: The recent literature pertaining to delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage has downplayed the role of angiographic vasospasm. However, it is our hypothesis that angiographic vasospasm has a significant pathophysiological role in this disease. We undertook an observational radiographic study of patients who presented in a delayed manner (>72 h from ictus) with evidence of severe angiographic vasospasm on initial angiography in order to describe an apparent association between vasospasm and infarct location.

The negative predictive value of CT angiography in the setting of perimesencephalic subarachnoid hemorrhage.

Background: Perimesencephalic subarachnoid hemorrhage (PMSAH) is only rarely associated with a ruptured cerebral aneurysm and CT angiography (CTA) has very good sensitivity and specificity for aneurysm detection. The necessity for invasive imaging with digital subtraction angiography (DSA) is therefore debatable. We chose to assess the negative predictive value (NPV) of CTA in a series of patients with PMSAH treated at our institution over a 9-year period.

Endovascular treatment of jugular bulb diverticula causing debilitating pulsatile tinnitus.

We describe the case of a patient who presented with debilitating pulsatile tinnitus in association with two jugular bulb diverticula. The diverticula were treated with stenting of the jugular bulb and coil embolization of the diverticula over two procedures. This resulted in successful resolution of symptoms and at 10 months follow-up the patient is asymptomatic.

Endovascular treatment of jugular bulb diverticula causing debilitating pulsatile tinnitus.

We describe the case of a patient who presented with debilitating pulsatile tinnitus in association with two jugular bulb diverticula. The diverticula were treated with stenting of the jugular bulb and coil embolization of the diverticula over two procedures. This resulted in successful resolution of symptoms and at 10 months follow-up the patient is asymptomatic.

Institution of sustained endovascular treatment prior to clinical deterioration in patients with severe angiographic vasospasm: A retrospective observational study of clinico-radiological outcomes.

Unlabelled: Severe angiographic vasospasm (aVSP) is a risk factor for infarction following subarachnoid haemorrhage and infarction is strongly associated with poor outcome. We present the clinico-radiological results of cohort with severe aVSP who underwent a program of angiographic surveillance and sustained endovascular treatment using multiple verapamil infusions and/or transluminal balloon angioplasty (TBA).

Methods: This was a dual-centre retrospective observational study.

Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms.

Background: Surgical clipping and endovascular coiling yield similar functional outcomes for the treatment of saccular aneurysms of the anterior communicating (ACOM) artery. However, surgical treatment may be associated with greater rates of cognitive impairment due to injury of adjacent structures. We aimed to quantify the rates of injury (infarction/hemorrhage) for both clipping and coiling of ACOM aneurysms.

Short term outcomes following clipping and coiling of ruptured intracranial aneurysms: does some of the benefit of coiling stem from less procedural impact on deranged physiology at presentation?

Background: Endovascular coiling (EVC) has been shown to yield superior clinical outcomes to surgical clipping (SC) in the treatment of ruptured cerebral aneurysms. The reasons for these differences remain obscure. We aimed to assess outcomes of EVC and SC relative to baseline physiological derangement.

The detrimental clinical impact of severe angiographic vasospasm may be diminished by maximal medical therapy and intensive endovascular treatment.

Objective: Severe angiographic vasospasm (aVSP) is a risk factor for poor functional outcome following subarachnoid hemorrhage. We investigated the impact of angiographic surveillance and intensive endovascular treatment using transluminal balloon angioplasty (TBA) and/or verapamil infusion for severe aVSP through comparison of clinical outcomes in patients of similar presenting grade but with no/mild vasospasm.

Methods: This was an analysis of prospectively acquired clinical trial data.

Is long-term follow-up of adequately coil-occluded ruptured cerebral aneurysms always necessary? A single-center study of recurrences after endovascular treatment.

Purpose: Aneurysm recurrence following coil occlusion is well recognized. However, there is controversy as to how long these patients should be followed up after coiling to detect reopening. We aimed to identify the rate of late reopening and the risk factors for reopening in a large single-center cohort of ruptured aneurysms that appeared adequately occluded at 6 months.

Endovascular therapy in hyperacute ischaemic stroke: history and current status.

This is a literature review on to the use of endovascular therapy in hyperacute ischaemic stroke secondary to large vessel occlusion (LVO). The prognosis for LVO is generally poor and the efficacy of intravenous tissue plasminogen activator (IV TPA) in the treatment of this subtype of stroke is questionable. It is well documented that recanalisation is associated with improved outcomes but IV TPA has limited efficacy in LVO recanalisation and the complication rates are higher for IV TPA in this stroke subset.

Endovascular treatment of children with cerebral venous sinus thrombosis: a case series.

Background: Cerebral venous sinus thrombosis is a potentially serious condition affecting 0.56 to 0.67 per 100,000 children annually; adverse outcomes are common.

Thrombus length estimation in acute ischemic stroke: a potential role for delayed contrast enhanced CT.

Purpose: Thrombus length has been shown to be an important determinant of recanalization using intravenous thrombolysis in hyperacute ischemic stroke. Various studies have attempted to quantify thrombus based on non-contrast CT (NCCT) or CT angiography (CTA). However, thrombus may not be seen on NCCT, and CTA may fail to delineate the distal extent of the thrombus.

Neuroimaging in dementia: a practical guide.

Over 800 000 people in the UK are demented. Alzheimer's disease, dementia with Lewy bodies, vascular dementia and frontotemporal lobar degeneration account for the majority. Although detailed clinical assessment forms the basis of evaluating a patient with cognitive impairment, structural and functional imaging techniques are increasingly being used.

A rare cause of neural foraminal widening.

The differential diagnosis for lesions causing neural foraminal widening is vast. The majority are solitary benign peripheral nerve sheath tumours, such as neurofibromas or schwannomas. We present a case of a rare cause of neural foraminal expansion secondary to a posterior thoracic extradural angiolipoma.

The influence of ultrasound probe orientation on prostate cancer detection rate during transrectal ultrasonography-guided prostate biopsy.

Purpose: We aim to determine whether end-fire probe orientation (and therefore image orientation and biopsy needle direction) during transrectal ultrasonography-guided prostate biopsy has an effect on the prostate cancer (PCa) detection rate, the number of positive biopsy cores, the proportion of diseased tissue in the samples obtained, and the Gleason score. We compared two different axial image protocols and a sagittal image protocol for PCa yield. We hypothesize that axial probe methods direct more of the biopsy needle through the peripheral zone, the principal site for PCa, and therefore improve PCa yield.