Assessment of clot length with multiphase CT angiography in patients with acute ischemic stroke.

Introduction Existing stroke literature demonstrates that rapid recanalization of vessels improves long-term prognosis after acute ischemic stroke. However, further optimization of the speed of the thrombectomy procedure, used to recanalize a blocked vessel, is limited by our minimal knowledge of the clot dimensions pre-procedure. Knowing the clot dimensions would allow planning of the thrombectomy procedure with the appropriate size and length of stent retriever, and determination of the correct site of the stent deployment ensuring total coverage of the clot by the stent retriever.

Inflow Angle of Small Paraophthalmic Aneurysms Is a Determinant of Adjacent Sphenoid Bone Remodeling.

Objective: Large internal carotid artery aneurysms can cause remodeling of the sphenoid bone with subsequent hemorrhage into the sinus. No reports have demonstrated small unruptured lesions causing similar bone remodeling. The purpose of this study was to demonstrate our experience with small unruptured paraophthalmic aneurysms causing sphenoid bone remodeling, specifically when the optimal aneurysm inflow angle is present.

Canadian Registry of LVIS Jr for Treatment of Intracranial Aneurysms (CaRLA).

Introduction: Stents reduce the rate of angiographic recurrence of intracranial aneurysms. The newest stent for intracranial use is the Low-profile Visible Intraluminal Support device (LVIS Jr).

Objective: To assess the efficacy of the new stent in a multicenter retrospective registry.

320-Row Multidetector CT Angiography in the Detection of Critical Cerebrovascular Anomalies.

Background: The acquisition of a new 320-row multidetector computed tomography angiography (CTA) scanner at the Montreal Neurological Institute and Hospital has provided higher quality imaging with less radiation exposure and shorter time of acquisition. However, its reliability has not been fully proven in critical vascular lesions when it comes to replacing a more invasive examination such as cerebral angiography. We wished to validate the accuracy of this equipment to investigate four common indications for patients to undergo conventional digital subtraction angiography: subarachnoid hemorrhage, vasospasm, unusual intracerebral hemorrhage, and unruptured aneurysm.

Paradoxically Decreased Mean Transit Time in Patients Presenting With Acute Stroke.

Objective: Computed tomography perfusion (CTP) has become a mainstay in acute stroke management. The aim of this study was to investigate the occurrence of an unreported phenomenon of a paradoxically decreased mean transit time (MTT) in the cerebral area of ischemia.

Methods: In this retrospective study, patients with an acute anterior circulation ischemic stroke were selected.

320-Row Multidetector Computed Tomographic Angiogram in the Evaluation of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study.

Objective: To objectively assess the accuracy of 320-row multidetector computed tomographic (CT) angiography to diagnose cerebral vasospasm after a subarachnoid hemorrhage using a new quantitative method.

Methods: Fifty-four arterial segments were measured in 8 patients who had subarachnoid hemorrhage and underwent digital subtraction angiography within 24 hours after CT angiography for clinical suspicion of cerebral vasospasm.

Results: A correlation between arterial diameters measurements made on CT angiography and digital subtraction angiography was observed.

A novel mutation in the CSF1R gene causes a variable leukoencephalopathy with spheroids.

Hereditary diffuse leukoencephalopathy with neuroaxonal spheroids is a neurodegenerative disease associated with mutations in the colony-stimulating factor 1 receptor gene (CSF1R). A 44-year-old woman with a 7-year history of depression presented with neurological signs and a recent cognitive decline. The diagnosis of hereditary diffuse leukoencephalopathy with neuroaxonal spheroids was suspected based on the findings of a predominant frontal leukoencephalopathy and neuroaxonal spheroids on brain biopsy.

Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol.

Introduction: For the treatment of cerebral vasospasm, current therapies have focused on increasing blood flow through blood pressure augmentation, hypervolemia, the use of intra-arterial vasodilators, and angioplasty of proximal cerebral vessels. Through a large case series, we present our experience of treating cerebral vasospasm with a protocol based on maintenance of homeostasis (correction of electrolyte and glucose disturbances, prevention and treatment of hyperthermia, replacement of fluid losses), and the use of intravenous milrinone to improve microcirculation (the Montreal Neurological Hospital protocol). Our objective is to describe the use milrinone in our practice and the neurological outcomes associated with this approach.