Acute fulminant hepatic failure, encephalopathy and early CT changes.

Background: Acute fulminant hepatic failure (AFHF) is common in tertiary care centres with transplant facilities. Cerebral edema frequently threatens the lives of such patients. We reviewed our cases of AFHF, noting the incidence of cerebral edema with serial CT scans and factors associated with mortality.

Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective.

Spontaneous low cerebrospinal fluid pressure headaches are a rare but treatable cause of debilitating headaches. The condition is characterized by a postural headache in the absence of any recent spinal procedures and is exacerbated when upright and relieved when supine. Diagnosis and treatment are often delayed, however, due to a lack of recognition and awareness, as illustrated by this case report of a patient who had multiple emergency department visits before further investigations were sought.

Hemodynamic instability during carotid artery stenting: the relative contribution of stent deployment versus balloon dilation.

Object: Hemodynamic instability may complicate carotid angioplasty and stenting in up to 40% of patients. The authors have previously demonstrated that primary self-expanding stent placement alone can gradually dilate severely stenosed carotid arteries without the use of balloons. The authors hypothesized that eliminating the balloon would reduce carotid baroreceptor stimulation, thereby decreasing the incidence of hemodynamic instability.

Results using a self-expanding stent alone in the treatment of severe symptomatic carotid bifurcation stenosis.

Object: Conventional endovascular therapy for carotid stenosis involves placement of an embolic protection device followed by stent insertion and angioplasty. A simpler approach may be placement of a stent alone. The authors determined how often this approach could be used to treat patients with carotid stenosis, and assessed which factors would preclude this approach.

White matter thresholds for ischemic penumbra and infarct core in patients with acute stroke: CT perfusion study.

Purpose: To prospectively determine the parameters derived at admission computed tomographic (CT) perfusion imaging admission that best differentiate ischemic white matter that recovers from that which infarcts, with the latter retrospectively defined at a CT examination performed without contrast material (unenhanced CT) 5-7 days after the event.

Materials And Methods: Ethics committee approval and informed consent were obtained. Thirty patients with stroke underwent unenhanced CT, CT angiography, and CT perfusion studies at admission.

Comparison of maximum intensity projection and digitally reconstructed radiographic projection for carotid artery stenosis measurement.

Digital subtraction angiography is being supplanted by three-dimensional imaging techniques in many clinical applications, leading to extensive use of maximum intensity projection (MIP) images to depict volumetric vascular data. The MIP algorithm produces intensity profiles that are different than conventional angiograms, and can also increase the vessel-to-tissue contrast-to-noise ratio. We evaluated the effect of the MIP algorithm in a clinical application where quantitative vessel measurement is important: internal carotid artery stenosis grading.

Efficacy of treatment of severe carotid bifurcation stenosis by using self-expanding stents without deliberate use of angioplasty balloons.

Background And Purpose: One of the limitations of carotid artery angioplasty is the potential for embolic stroke. Our purpose was to assess whether the force of a self-expanding stent alone is usually sufficient to dilate severely stenotic atherosclerotic plaques without the deliberate use of an angioplasty balloon. If so, the procedural stroke risk might be reduced.

Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion.

Object: The authors report on important factors that influenced clinical and angiographically demonstrated outcomes in patients treated using coil embolization.

Methods: This study included 160 consecutive patients who underwent endovascular coil embolization for treatment of intracranial aneurysms. Univariate and multivariate logistic regression analyses were performed to assess factors that influenced the immediate posttreatment angiographic result.

Internal carotid artery stenosis measurement: comparison of 3D computed rotational angiography and conventional digital subtraction angiography.

Background And Purpose: Clinical trials have shown that carotid endarterectomy reduces stroke risk in symptomatic individuals with severe internal carotid artery (ICA) stenosis. As a result of these trials, digital subtraction angiography (DSA) became a standard of reference for ICA stenosis diagnosis. Newer 3D techniques provide a larger number of views than DSA, which may influence the estimated degree of stenosis.

Idiopathic free-floating thrombus of the common carotid artery.

Background: The observation of an intraluminal common carotid artery thrombus overlying a wall defect at ultrasonography or angiography is unusual. To our knowledge, there are no previous reports of a free-floating thrombus in the common carotid artery.

Case Report: A 45-year-old woman who was previously healthy and on no medications presented with acute hemiparesis and aphasia.