Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial.

Rationale: Meta-analyses of case series of non-arteritic central retinal artery occlusion (CRAO) indicate beneficial effects of intravenous thrombolysis when initiated early after symptom onset. Randomized data are lacking to address this question.

Aims: The REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION) investigates intravenous alteplase within 4.

Treatment-Relevant Findings in Transesophageal Echocardiography After Stroke: A Prospective Multicenter Cohort Study.

Background And Purpose: Cardiac ultrasound to identify sources of cardioembolism is part of the diagnostic workup of acute ischemic stroke. Recommendations on whether transesophageal echocardiography (TEE) should be performed in addition to transthoracic echocardiography (TTE) are controversial. We aimed to determine the incremental diagnostic yield of TEE in addition to TTE in patients with acute ischemic stroke with undetermined cause.

Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion - Current Approaches and Future Directions.

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke which affects the retina. Intravenous thrombolysis is emerging as a compelling therapeutic approach. However, it is not known which patients may benefit from this therapy because there are no imaging modalities that adequately distinguish viable retina from irreversibly infarcted retina.

Intravenous Fibrinolysis for Central Retinal Artery Occlusion: A Cohort Study and Updated Patient-Level Meta-Analysis.

Background And Purpose: Central retinal artery occlusion results in sudden, painless, usually permanent loss of vision in the affected eye. There is no proven, effective treatment to salvage visual acuity and a clear, unmet need for an effective therapy. In this work, we evaluated the efficacy of intravenous tissue-type plasminogen activator (IV alteplase) in a prospective cohort study and an updated systematic review and meta-analysis.

Silent Brain Infarctions and Leukoaraiosis in Patients With Retinal Ischemia: A Prospective Single-Center Observational Study.

Background And Purpose: We aimed to determine the incidence of co-occurring cerebral ischemia, extent of cerebral small vessel disease, and vascular risk profile of patients with acute retinal ischemia.

Methods: RETIS (Frequency of Acute Silent Brain Infarction and Systematic Evaluation of Stroke Risk in Retinal Ischemia) was a single-center, prospective, observational study comprising ophthalmologic examination, brain magnetic resonance imaging, and extensive diagnostic work-up of vascular risk factors and stroke cause. Silent brain infarctions were identified on diffusion-weighted imaging, leukoaraiosis was quantified on fluid-attenuated inversion recovery sequences, and carotid artery stenosis was assessed by carotid ultrasound.

Stenosis in Middle Cerebral Artery Duplication: Assessment With Transcranial Color-Coded Duplex Sonography.

Duplication of the middle cerebral artery is an unusual anatomic variant. Stenosis of one of its branches can be an exceptional cause of stroke and is very difficult to diagnose with transcranial duplex sonography. We report 2 patients with duplication of the middle cerebral artery in whom stenosis of one of its branches led to ischemic stroke and describe the sonographic findings in comparison to other neuroimaging modalities.

Sonothrombolysis with BR38 Microbubbles Improves Microvascular Patency in a Rat Model of Stroke.

Background: Early recanalization of large cerebral vessels in ischemic stroke is associated with improved clinical outcome, however persisting hypoperfusion leads to poor clinical recovery despite large vessel recanalization. Limited experimental sonothrombolysis studies have shown that addition of microbubbles during treatment can improve microvascular patency. We aimed to determine the effect of two different microbubble formulations on microvascular patency in a rat stroke model.

Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion.

Background And Purpose: Transorbital sonography may help establish diagnosis of central retinal artery occlusion (CRAO). Next to Doppler sonographic proof of CRAO, an intra-arterial spot sign can be detected in some cases. We hypothesized that it reflects calcified components.

Aquaporin-4 autoantibodies increase vasogenic edema formation and infarct size in a rat stroke model.

Background: Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system, which is characterized by autoantibodies directed against the water channel aquaporin-4 (AQP4). As one of the main water regulators in the central nervous system, APQ4 is supposed to be involved in the dynamics of brain edema. Cerebral edema seriously affects clinical outcome after ischemic stroke; we therefore aimed to investigate whether NMO-antibodies may exert the same functional effects as an AQP4-inhibitor in-vivo in acute ischemic stroke.

Platelet rich clots are resistant to lysis by thrombolytic therapy in a rat model of embolic stroke.

Background: Early recanalization of occluded vessels in stroke is closely associated with improved clinical outcome. Microbubble-enhanced sonothrombolysis is a promising therapy to improve recanalization rates and reduce the time to recanalization. Testing any thrombolytic therapy requires a model of thromboembolic stroke, but to date these models have been highly variable with regards to clot stability.

A traveling "spot sign" in recurrent amaurosis fugax and central retinal artery occlusion.

Sudden monocular blindness is frequently caused by central retinal artery occlusion (CRAO) from embolic sources. Treatment options are insufficient, and spontaneous prognosis toward visual recovery is poor. In addition to ophthalmologic evaluation, transorbital sonographic assessment of the central retinal artery may help establish early diagnosis by Doppler sonographic proof of occlusion and, in some cases, by B-mode detection of an intra-arterial "spot sign".

Impact of bubble size in a rat model of cerebral air microembolization.

Background: Cerebral air microembolization (CAM) is a frequent side effect of diagnostic or therapeutic interventions. Besides reduction of the amount of bubbles, filter systems in the clinical setting may also lead to a dispersion of large gas bubbles and therefore to an increase of the gas-liquid-endothelium interface. We evaluated the production and application of different strictly defined bubble diameters in a rat model of CAM and assessed functional outcome and infarct volumes in relation to the bubble diameter.

Jugular valve incompetence in transient global amnesia. A problem revisited.

Background And Purpose: Previous studies have suggested that transient global amnesia (TGA) may be provoked by cerebral venous congestion due to a reflux during Valsalva maneuver (VM) caused by internal jugular venous valve incompetence (IJVVI). We investigated the hemodynamic consequences of postural changes on IJVVI and on intracranial veins in patients with TGA and control subjects.

Materials And Methods: IJVVI was assessed by means of extracranial color-coded duplex sonography during VM in 28 patients with TGA and 25 controls.

Ultrasound destruction of air microemboli as a novel approach to brain protection in cardiac surgery.

Objective: Evaluation of a novel approach to eliminate air microemboli from extracorporeal circulation via ultrasonic destruction.

Design: In vitro proof-of-concept study.

Setting: Research laboratory.

[Sonographic diagnostics in neurological emergency and intensive care medicine].

Background: This article gives an up-to-date overview of neurosonographic emergency and intensive care diagnostics.

Methods: Selective literature research from 1984 with critical appraisal and including national and international guidelines.

Results: Fast and valid diagnostics in acute stroke is the main field of application of neurosonography.

The potential of neurosonography in neurological emergency and intensive care medicine: monitoring of increased intracranial pressure, brain death diagnostics, and cerebral autoregulation– part 2.

Transcranial B-mode sonography is an easy to use bedside imaging modality to monitor significant changes of the brain parenchyma such as in malignant middle cerebral infarction or intracerebral hemorrhage. The elevation of intracranial pressure can be followed with various neurosonographical techniques: Measurements of the ventricular width, midline shift, arterial resistance, and optic nerve sheath diameter. They should be viewed as complementary to each other and to other imaging modalities.

Sonographic assessment of the optic nerve sheath and transorbital monitoring of treatment effects in a patient with spontaneous intracranial hypotension: case report.

Objective: To investigate the potential of the ultrasound-based evaluation of the optic nerve sheath in a patient with spontaneous intracranial hypotension due to cervical cerebrospinal fluid (CSF) leakage.

Methods: Repeated measurements of the optic nerve sheath diameter (ONSD) using B-mode sonography were performed before treatment initiation, during medical treatment, and during a course of repeated placement of epidural blood patches.

Results: On admission, transorbital sonography revealed a decreased ONSD of 4.

Cerebral hemodynamic failure presenting as limb-shaking transient ischemic attacks.

Limb-shaking transient ischemic attacks (TIA) may occur in patients with insufficient brain perfusion due to an underlying occlusive disease. We present the case of a 64-year-old patient who suffered from repetitive TIA presenting with shaking movements of the right-sided extremities and accompanying speech arrest. Symptoms are documented in the online supplementary video (www.

Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension.

The aim of this work was to investigate the potential of ultrasound-based optic nerve sheath diameter (ONSD) measurements in detecting raised intracranial pressure in patients with idiopathic intracranial hypertension (IIH) and to describe ONSD response to lumbar puncture. In ten patients with newly diagnosed IIH, transorbital sonography was carried out to assess ONSD, OND (optic nerve diameter), and optic disc elevation before and after lumbar puncture. Twenty-five patients with other neurological disorders served as controls.

The perfect crime? CCSVI not leaving a trace in MS.

Background: Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease of the central nervous system, believed to be triggered by an autoimmune reaction to myelin. Recently, a fundamentally different pathomechanism termed 'chronic cerebrospinal venous insufficiency' (CCSVI) was proposed, provoking significant attention in the media and scientific community.

Methods: Twenty MS patients (mean age 42.

High frequency of silent pulmonary embolism in patients with cryptogenic stroke and patent foramen ovale.

Background And Purpose: Deep vein thrombosis and pulmonary embolism (PE) prove venous embolic activity and enforce the suspicion of paradoxical embolism in patients with stroke with patent foramen ovale. Because it has implications in secondary prevention, we investigated the frequency of silent PE in such a cohort of patients.

Methods: Patients with cryptogenic stroke or transient ischemic attack and patent foramen ovale who underwent a ventilation perfusion scintigraphy were identified from a stroke registry.

Decrease in shunt volume in patients with cryptogenic stroke and patent foramen ovale.

Background: In patients with patent foramen ovale (PFO) there is evidence supporting the hypothesis of a change in right-to-left shunt (RLS) over time. Proven, this could have implications for the care of patients with PFO and a history of stroke. The following study addressed this hypothesis in a cohort of patients with stroke and PFO.

Intra- and interobsever reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults.

Background: The use of an ultrasound-based evaluation of the optic nerve sheath diameter (ONSD) has previously been demonstrated for detecting raised intracranial pressure. In order to be feasible in clinical workup, the test qualities of transorbital ultrasonography need to be determined. The aim of this study was therefore to establish normal values and to assess the intra- and interobserver reliability of this method.