Current management of symptomatic intracranial stenosis.

Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death.

Use of a new double-lumen balloon catheter for single-catheter balloon-assisted coil embolization of intracranial aneurysms: technical note.

Background: The prevalence of intracranial aneurysms is approximately 2% with an annual rupture rate of 0.7%.

Objective: We describe our initial feasibility experience using a new double-lumen balloon catheter for single-catheter balloon-assisted coil embolization of wide-neck intracranial aneurysms.

Onyx pulmonary artery embolization after treatment of a low-flow dural arteriovenous fistula: case report.

Background And Importance: Endovascular management of dural arteriovenous fistulas (DAVFs) has become an accepted primary and often definitive therapy. We present the first documented case of Onyx pulmonary embolism after embolization of a low-flow DAVF.

Clinical Presentation: A 63-year-old man presented with subarachnoid hemorrhage secondary to a DAVF.

Intracranial vertebrobasilar artery dissection associated with postpartum angiopathy.

Background. Cervicocephalic arterial dissection (CCAD) is rare in the postpartum period. To our knowledge this is the first reported case of postpartum angiopathy (PPA) presenting with ischemic stroke due to intracranial arterial dissection.

Narrowing of the middle cerebral artery: artificial intelligence methods and comparison of transcranial color coded duplex sonography with conventional TCD.

The goal of the study was to compare performances of transcranial color-coded duplex sonography (TCCS) and transcranial Doppler sonography (TCD) in the diagnosis of the middle cerebral artery (MCA) narrowing in the same population of patients using statistical and nonstatistical intelligent models for data analysis. We prospectively collected data from 179 consecutive routine digital subtraction angiography (DSA) procedures performed in 111 patients (mean age 54.17+/-14.

Middle cerebral artery vasospasm: transcranial color-coded duplex sonography versus conventional nonimaging transcranial Doppler sonography.

Objective: To prospectively compare accuracies of transcranial color-coded duplex sonography (TCCS) and transcranial Doppler sonography (TCD) in the diagnosis of middle cerebral artery (MCA) vasospasm.

Design: Prospective blinded head-to-head comparison TCD and TCCS methods using digital subtraction angiography (DSA) as the reference standard.

Setting: Department of Radiology in a tertiary university health center in a metropolitan area.

Endovascular and surgical treatment of ruptured cerebral aneurysms in pediatric patients.

Objective: Pediatric cerebral aneurysms are rare. There are very few recent studies that focus on the multidisciplinary treatment of ruptured aneurysms. We reviewed our pediatric endovascular and surgical experience with ruptured cerebral aneurysms.

Neurovascular emergencies in the elderly.

Neurovascular diseases are major causes of disability and death in the elderly; many present as medical emergencies. With the continuing growth of the geriatric population, there has been increasing interest in the impact of aging on the cerebrovascular system. Recent advances in the clinical neurosciences have demonstrated that neurovascular emergencies in the elderly often are amenable to treatment; neuroimaging plays a critical role in diagnosis and neurointerventional techniques are becoming increasingly important therapeutic options.

Learning vector quantization neural networks improve accuracy of transcranial color-coded duplex sonography in detection of middle cerebral artery spasm--preliminary report.

To determine the performance of an artificial neural network in transcranial color-coded duplex sonography (TCCS) diagnosis of middle cerebral artery (MCA) spasm. TCCS was prospectively acquired within 2 h prior to routine cerebral angiography in 100 consecutive patients (54M:46F, median age 50 years). Angiographic MCA vasospasm was classified as mild (<25% of vessel caliber reduction), moderate (25-50%), or severe (>50%).

Obstructive hydrocephalus from venous sinus thrombosis.

Background: Cerebral venous sinus thrombosis (CVST) is a rare form of stroke. Although increased intracranial pressure is a well-described complication of CVST, hydrocephalus has rarely been reported.

Case: We present the case of a 49-year-old woman who presented with one week of headache, vomiting, and progressive neurologic deterioration leading to coma.

Rheolytic thrombectomy for cerebral sinus thrombosis.

Introduction: Cerebral venous and sinus thrombosis (CVST) is an uncommon cause of stroke that is associated with poor outcomes in high-risk patients who present with stupor or coma, rapidly progressive neurologic deficits or progressive neurologic deficits during therapeutic anticoagulation.

Methods And Results: We report the rapid treatment of CVST in six patients at high risk for poor outcomes (death or dependency) using rheolytic thrombectomy combined with locally administered low-dose recombinant tissue plasminogen activator (rt-PA), and review the literature on rheolytic thrombectomy for CVST. All of the procedures were technically successful.

Current management of symptomatic intracranial stenosis: medical versus endovascular therapy.

Approximately 8% to 10% of all ischemic strokes are caused by intracranial arterial stenosis (IAS). After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin has been shown to be no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death.

Admission angiographic cerebral circulation time may predict subsequent angiographic vasospasm after aneurysmal subarachnoid hemorrhage.

Objective: Angiographic cerebral vasospasm occurs in approximately 70% of patients hospitalized after aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor outcome. In this study, we examined whether or not cerebral circulation time (CCT) measured with digital subtraction angiography was associated with angiographic vasospasm.

Methods: Patients who underwent cerebral angiography within 24 hours of SAH were analyzed.

Reversible cerebral vasoconstriction syndrome associated with subarachnoid hemorrhage.

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare vasculopathy of unknown etiology. Ischemic stroke and intracerebral hemorrhage are well-documented sequelae, but subarachnoid hemorrhage is an uncommon complication of RCVS.

Methods And Results: We report six cases of RCVS associated with subarachnoid hemorrhage.

Suitability of temporal bone acoustic window: conventional TCD versus transcranial color-coded duplex sonography.

Purpose And Background: To determine whether the proportion of patients with suitable temporal bone acoustic windows is different for conventional transcranial Doppler sonography (TCD) and transcranial color-coded duplex sonography (TCCS), based on a head-to-head comparison in the same population of patients.

Subjects And Methods: Ninety patients, age 22-88 years (mean 57.1 +/- 11.

Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report.

Vertebral hemangiomas are common entities that rarely present with neurological deficits. The authors report the unusual case of a large L-3 vertebral hemangioma with epidural extension in a 27-year-old woman who presented with hip flexor and quadriceps weakness, foot drop, and leg pain. The characteristics of the mass on magnetic resonance imaging suggested an aggressive, hypervascular lesion.

De novo aneurysm formation and regression after brain arteriovenous malformation embolization: case report.

Background: The formation of de novo aneurysms is a known complication of vessel occlusion (Wright RL, Sweet WH. Carotid or vertebral occlusion in the treatment of intracranial aneurysms: value of early and late readings of carotid and retinal pressures. Clin Neurosurg 1962:9;163-192).

Stroke associated with Barth syndrome.

Barth syndrome is an inherited disorder characterized by dilated cardiomyopathy, neutropenia, growth retardation, and skeletal myopathy. We describe a case of acute stroke owing to Barth syndrome that required intra-arterial thrombolysis. This case suggests that cardiovascular complications can be observed in patients with Barth syndrome.

Intra-arterial papaverine used to treat cerebral vasospasm reduces brain oxygen.

Introduction: Intra-arterial papaverine (IAP) is used to treat symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). IAP, however, can increase intracranial pressure (ICP). In this study we examined whether IAP alters brain oxygen (BtO2).

Carotid artery diameter in men and women and the relation to body and neck size.

Background And Purpose: To explore relationships among gender, body size, neck size, and the diameters of the common carotid artery (CCA) and internal carotid artery (ICA).

Methods: Using multivariate regression, the best predictors of sonographic diameters of CCA and ICA were determined based on age, height, weight, body mass index, body surface area, neck circumference, neck length, and blood pressure.

Results: Measurements were obtained in 500 consecutive patients (age 52+/-15 years; 61% women).

Normal reference intervals and ranges of side-to-side and day-to-day variability of ocular blood flow Doppler parameters.

The study presents normal reference intervals and ranges of "normal" side-to-side and day-to-day variability of ocular blood flow Doppler parameters. Peak-systolic (PSV), end-diastolic velocity (EDV) and impedance indices in the ophthalmic artery (OA), the central retinal artery (CRA) and the short posterior ciliary artery (SPCA) of both orbits were determined with color-coded duplex sonography in 140 healthy volunteers (range 18 to 83 y; 68 men and 72 women). Decreases in flow velocities and concomitant increases in impedance indices were found in all arteries with advancing age.

Otologic manifestations of petrous carotid aneurysms.

Background And Purpose: The petrous and cavernous segments of the extradural internal carotid artery take a complex course through the skull base before entering the subarachnoid space distal to the cavernous sinus. Despite the protection from trauma afforded by the anatomy, the petrous and carotid internal carotid artery (ICA) segments of the vessel remains subject to disease, the most important of which are aneurysms. Aneurysms affecting the petrous portion of the vessel are extremely uncommon, and presentation with otologic symptoms is unusual.

Rapid cognitive decline following lumbar puncture in a patient with a dural arteriovenous fistula.

Background: Dural arteriovenous fistulas (DAVFs) are frequently accompanied with raised intracranial pressure and clinical findings suggestive of pseudotumor cerebri. However, unlike pseudotumor cerebri, the clinical response to lumbar cerebrospinal fluid (CSF) removal can vary from beneficial to acute clinical deterioration leading to death. The criteria for the safe use of lumbar puncture (LP) in patients with a DAVF are not well established.

Outcomes for overlapping stents in the extracranial carotid artery.

Various diseases of the carotid artery are treatable by stenting. However, few reports of overlapping carotid stents exist. As a result, the indications, long-term outcomes, and potential complications of this technique remain largely unknown.