Volumetric Artificial Intelligence Analysis of Prerupture and Postrupture Cerebral Aneurysms: Assessment of Morphologic Change.

Background: Cerebral aneurysm rupture is a major cause of potential years of life lost. Research on rupture risk has often compared unruptured and ruptured aneurysms, with the implicit assumption that the rupture event does not significantly change aneurysm morphology. However, aneurysm morphology is charged by rupture, although precisely how remains a matter of debate.

Supranuclear Palsy as an Initial Presentation of the Adult-Onset Niemann-Pick Type C.

(1) Background: Niemann-Pick type C1 (NP-C1) is a lysosomal storage disorder that results in the defective trafficking of cholesterol and other cellular lipids in the endosomal-lysosomal pathway. This rare autosomal recessive disorder presents in three forms based on the age of onset. The adult form presents in patients greater than 15 years of age but is rarely seen after the age of 30.

Management of Super-refractory Postoperative Lumbar Cerebrospinal Fluid Leak: A Case Report and Review of the Literature.

One well-documented risk of spinal surgery is cerebrospinal fluid (CSF) leak in the immediate postoperative period. While the majority of CSF leaks occur due to an obvious intraoperative dural tear, several reports have documented delayed CSF leakage from occult intraoperative dural tears. There is a paucity of published literature regarding the true incidence of dural tears in minimally invasive spinal surgery.

Acute Caudate Nucleus Stroke Presenting As Hemiballismus.

Hemiballismus is defined as irregular, involuntary, large-amplitude flinging movements by the limbs, confined to one side of the body. Hemichorea refers to a state of excessive and irregularly timed, non-repetitive and randomly distributed, spontaneous, involuntary, and abrupt movements. It is widely believed that hemiballismus and chorea are suggestive of a lesion to the basal ganglia and subthalamic nucleus (STN).

Single-Center Outcomes of WATCHMAN™ Implantation with Comparison to Oral Anticoagulant and Dual Antiplatelet Therapy.

Background The WATCHMAN™ device is a Food and Drug Administration (FDA)-approved device that reduces the risk of stroke from atrial fibrillation (AF) in those who have a contraindication to taking oral anticoagulation. A key aspect of this device implantation is the choice of medical therapy in the months after device implantation with Vitamin K antagonist oral anticoagulants (OAC) being the mainstay of therapy but dual antiplatelet therapy (DAPT) poses as a potential alternative to patients who have a contraindication to OAC use. Methods Our single-center study retroactively followed 150 patients post-WATCHMAN™ implantation and evaluated outcomes at 12 months post-implantation in two cohorts, those treated with OAC or DAPT.

Intracranial Angioplasty via Type II Proatlantal Intersegmental Artery.

A proatlantal intersegmental artery (PIA) is an exceedingly rare primitive anastomosis between the carotid and vertebrobasilar circulations. PIAs may be accompanied by ipsilateral or bilateral vertebral artery (VA) agenesis and can originate from the cervical internal carotid artery (ICA, type I) or external carotid artery (ECA, type II) before eventually joining the vertebrobasilar system. Several authors have described this anomaly in different clinical scenarios, but to our knowledge, there are no studies documenting VA angioplasty through a type II PIA in the setting of vertebrobasilar stroke.

Hypoglycemic hemineglect a stroke mimic.

Acute hypoglycemia may mimic acute ischemic stroke, but to our knowledge this has never been reported as transient hemineglect syndrome. We present a 60-year-old male with known diabetes mellitus who was brought to the hospital as a stroke alert. The patient had undetectable glucose levels upon arrival of emergency medical services (EMS), therefore hypertonic glucose was given.

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.

Background And Objectives: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19.

Methods: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection.

Acute subdural hematoma due to acute myeloid leukemia and B-cell lymphoma.

Chloroma, is an rare malignant tumor characterized by the extramedullary blast proliferation of myeloid lineages that subsequently change the normal architecture of surrounding tissues. Because this is very rare disease, primary central nervous system myeloid sarcoma has not been widely reported. Myeloid sarcoma, as a group of heterogenetic diseases, presents with differential clinical and histological pictures depending upon the primary affected site.

Ruptured Intracranial Aneurysm Presenting as Isolated Acute Subdural Hemorrhage.

Ruptured intracranial aneurysms are often associated with serious neurologic sequelae, often as a result of subarachnoid or intraparenchymal hemorrhage. Less commonly, ruptured intracranial aneurysms can lead to subdural hemorrhage. However, the characteristic clinical presentation and optimal treatment of associated subdural hemorrhage are unclear due to the paucity of such cases that exist in the current literature.

Posterior reversible encephalopathy syndrome due to unilateral renal artery stenosis: A case report.

A tricenarian female with a past medical history of status epilepticus secondary to posterior reversible encephalopathy syndrome (PRES) of unknown etiology presented with a 2-week history of double vision, dizziness, elevated blood pressure, and altered mental status. On hospital day 2, she experienced status epilepticus, during which her blood pressure rose to 240/160 from her baseline of around 140/90. The patient was subsequently intubated for airway protection and transferred to the intensive care unit, where she was started on a nicardipine drip.

Neurologic Sequela of COVID-19: Guillain-Barré Syndrome Following Johnson & Johnson COVID-19 Vaccination.

Guillain-Barré syndrome after Pfizer and Astra-Zeneca vaccinations against COVID-19 has been previously reported in the literature. The objective of this study was to report the first case of Guillain-Barré following the COVID-19 vaccination with the Johnson & Johnson COVID-19 vaccine. We report the case of a 53-year-old female who presented to the Emergency Department complaining of bilateral lower extremity weakness, paresthesias, and gait difficulties 14 days after having received the Johnson & Johnson COVID-19 vaccination.

Recurrent Cardioembolic Strokes Due to Marantic Endocarditis As the Initial Presentation of Colorectal Adenocarcinoma.

Metastases to the brain from primary colorectal carcinoma are rare. Existing literature describing cranial nerve palsy from metastatic colorectal cancer is scattered. To our knowledge, we are the first to describe the combination of CN deficits V, VII, and XII as the initial presentation of colorectal malignancy.

Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review.

The expansion of indications for neurointerventional procedures, combined with the need to treat a diverse patient population, has driven a need for broader access options. Concurrent arterial and venous access is often necessary for the diagnosis and treatment of various neurovascular diseases. Although complication rates are low, life-threatening severe complications have been reported with these access methods.

Multiple watershed and cardioembolic strokes in 84-year-old male after cardiac ablation procedure: Case report.

Current guidelines do not include radiologic assessment of the carotid arteries before catheter ablation procedures. There are multiple studies describing the risks of periprocedural cardioembolic strokes during cardiac ablation procedure but none describing the risks of periprocedural watershed strokes due to hypoperfusion during cardiac ablation. It is critically important for neurologists, cardiologists, and all other associated health-care workers to recognize the risks of neurologic complications, such as watershed strokes, before cardiac procedures are performed.

Microdiscectomy Under Local Anesthesia and Spinal Block in a Pregnant Female.

The surgical plan and the anesthetic approach are vital in determining the proper treatment of lumbar disc herniation in pregnancy. The diagnostic tools available, as well as the anesthetic agents and methods of delivery, vary in pregnant patients due to factors such as radiation exposure and hemodynamics in the patient and fetus. The gestational age also plays an important role in determining treatment options.

Five-Level Anterior Cervical Discectomy And Fusion.

Anterior cervical discectomy and fusion (ACDF) is a common treatment modality that has shown good clinical results in patients with cervical degenerative disc disease. ACDF remains the procedure of choice for most patients given its satisfactory clinical outcomes and proven radiological fusion ranging from 90-100%. Five-level ACDF is a very rare type of surgery, even in large spine centers.

Low Anterior Cervical Approach Without Sternotomy or Clavicle Resection for Upper Thoracic Vertebra Corpectomy.

The spine is the third most common site for metastatic disease following the lung and the liver. Approximately 60-70% of patients with metastatic cancer will have metastasis to the spine, but only 10% of these will be symptomatic. Metastases to the spine may involve the bone, epidural space, or the spinal cord.

Surgical Treatment of Dural Arteriovenous Fistula: A Case Report and Literature Review.

Dural arteriovenous fistulas (dAVF) are rare, acquired intracranial arteriovenous malformations consisting of a pathological shunt located within the intracranial dura matter. The etiology of dAVFs remains unclear, but current thought suggests that these lesions are associated with thrombosis of the dural sinuses and other intracranial veins. dAVF's with severe symptomatology or high-risk angioarchitecture should be treated without delay, and endovascular repair is generally accepted as the first-line treatment.

Secreted frizzled-related protein 2, a novel mechanism to induce myocardial ischemic protection through angiogenesis.

Our hypothesis is that Secreted Frizzled-Related Protein 2 (sFPR2) is an important mechanism mediating ischemic cardioprotection, since it is the most upregulated gene in the third window of ischemic preconditioning. One week after permanent coronary artery occlusion (CAO), sFRP2 TG mice exhibited a 49% higher LV ejection fraction and a 36% reduction in infarct size, p < 0.05, and reduced fibrosis in both adjacent and remote zones, along with an increase in collagen type III and a decrease in the collagen type I/III ratio compared with WTL.

Mechanisms of increased vascular stiffness down the aortic tree in aging, premenopausal female monkeys.

Protection against increased vascular stiffness in young women is lost after menopause. However, little is known about vascular stiffness in older, premenopausal females, because most of the prior work has been conducted in rodents, which live for only 1-3 yr and do not go through menopause. The goal of the current investigation was to quantitate differences in stiffness down the aortic tree and the mechanisms mediating those differences in older, premenopausal (24 ± 0.

Rats are protected from the stress of chronic pressure overload compared with mice.

The goal of this investigation was to compare the effects of chronic (4 wk) transverse aortic constriction (TAC) in Sprague-Dawley rats and C57BL/6J mice. TAC, after 1 day, induced similar left ventricular (LV) pressure gradients in both rats ( = 7) and mice ( = 7) (113 ± 5.4 vs.

Mechanisms of sex differences in exercise capacity.

Sex differences are an important component of National Institutes of Health rigor. The goal of this investigation was to test the hypothesis that female mice have greater exercise capacity than male mice, and that it is due to estrogen, nitric oxide, and myosin heavy chain expression. Female C57BL6/J wild-type mice exhibited greater ( < 0.