Adult hemiconvulsive hemiatrophy syndrome: a novel clinicoradiologic disorder in adults.

The association of focal motor seizures with cerebral hemiatrophy is a recognised rare paediatric syndrome known as 'hemiconvulsion, hemiatrophy and epilepsy' (HHE). To date, HHE has not been reported in adults. We present four adult patients with striking similarities to HHE, following alcohol withdrawal in chronic alcoholics.

The Great Contrast Shortage of 2022-Lessons learnt in Australia.

Introduction: Computed tomography (CT) imaging is one of the most commonly used diagnostic tools. Iodine-based contrast media (IBCM) are frequently administered intravenously to improve soft tissue contrast in a wide range of CT scans. Supply chain disruptions triggered by the SARS-CoV-19 pandemic led to a global shortage of IBCM in mid-2022.

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases.

Objective: To compare transradial artery access (TRA) to the gold standard of transfemoral artery access (TFA) in mechanical thrombectomy (MT) for stroke caused by anterior circulation large vessel occlusion.

Methods: The clinical outcomes, procedural speed, angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional service.

Results: There was no significant difference in patient characteristics, stroke parameters, imaging techniques or intracranial techniques.

Perianeurysmal vasogenic oedema (PAVO) following aneurysm embolisation: a unique case of asymptomatic long-term progression and review of the literature.

Perianeurysmal vasogenic oedema is a recognised although rare phenomenon following endovascular treatment of certain intracranial aneurysms. We present a unique case of asymptomatic perianeurysmal vasogenic oedema following bare platinum coil embolisation of an incidentally discovered right middle cerebral artery aneurysm that slowly increased over a period of 6 years before stabilising and regressing. During this time, the coiled aneurysm per se remained completely stable on serial magnetic resonance angiography.

A rare suspected case of chronic nodular granulomatous herpes simplex encephalitis in an adult.

Herpes simplex encephalitis is the most common sporadic viral encephalitis in the western world, HSV-1 (herpes simplex virus) being the mostly commonly implicated serotype. The disease is usually monophasic, although patients may relapse weeks, months or years after initial infection. This chronic granulomatous inflammatory process is almost exclusively described in children and rarely forms discrete enhancing parenchymal nodules.

Embolization for the treatment of intractable epistaxis: 12 month outcomes in a two centre case series.

Objective: Embolization is a treatment option for intractable epistaxis; however, concerns regarding tissue necrosis, stroke and blindness persist in the literature.

Methods: A retrospective review of patients from September 2010 to January 2016 treated with embolization for epistaxis was performed. No patient was excluded.

Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre.

Background And Purpose: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks.

Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites.

Objective: To audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.

Methods: A database of 100 MT cases was maintained throughout May 2010-February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded.

CT perfusion in acute stroke calls: A pictorial review and differential diagnoses.

CT perfusion is increasingly utilised in hyperacute stroke to facilitate diagnosis and patient selection for reperfusion therapies. This review article demonstrates eight examples of how CT perfusion can be used to diagnose stroke mimics and small volume infarcts, which can be easily missed on non-contrast CT, and to suggest the presence of an ischaemic penumbra. Radiologists involved in stroke management must understand the importance of rapid imaging acquisition and be confident in the prospective interpretation of this powerful diagnostic tool as we move into a new era of hyperacute stroke care.

De novo cavernoma developing from an asymptomatic thalamic microhemorrhage.

Cavernomas are low-flow vascular lesions affecting approximately 0.5% of the population. Historically these have been considered congenital lesions, but numerous reports have demonstrated de novo formation.

Endovascular treatment of complex aneurysms at the vertebrobasilar junction with flow-diverting stents: initial experience.

Background: Large or giant complex vertebrobasilar junction aneurysms have a dismal natural history and are often challenging to treat with standard endovascular or neurosurgical techniques.

Objective: To report initial experience with endovascular treatment of these aneurysms using flow-diverting stents (FDS).

Methods: Ten patients with FDS treatment of complex vertebrobasilar junction aneurysms were collected from 4 large cerebrovascular centers.

Arterial origin subdural hematoma and associated pial pseudoaneurysm following minor head trauma.

The vast majority of primary acute subdural hematomas following trauma are venous in origin. We report a very rare case of a primary acute subdural hematoma following minor head trauma that was arterial in origin and was associated with a pial cortical branch pseudoaneurysm. The patient was managed conservatively, and follow-up imaging demonstrated complete resolution of both lesions.

Vertebrobasilar insufficiency.

Vertebrobasilar insufficiency presents with characteristic symptoms and signs due to impaired perfusion of the cerebellum, the brain stem, and the occipital cortex. This may be due to reduced perfusion usually due to atherosclerosis or thromboembolism. Choice of treatment depends on understanding the different underlying pathophysiologic mechanisms.

Incidental discovery of a dural arteriovenous fistula in a patient with activated protein C resistance.

A dural arteriovenous fistula was discovered incidentally in a 58-year-old man with activated protein C resistance who underwent routine outpatient cerebral angiography for workup of multiple intracranial aneurysms.

Basilar trunk occlusion during endovascular treatment of giant and fusiform aneurysms of the basilar artery.

Giant and fusiform aneurysms of the basilar artery (BA) are difficult to manage surgically, and they still present a challenge for the neurosurgeon despite progress in posterior fossa surgery. Guglielmi detachable coils have provided an alternative approach to treatment, but they have their own difficulties. We present a series of three patients with BA aneurysms treated with endovascular occlusion of the aneurysm and basilar trunk.