Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days.

Background And Purpose: Recent studies have demonstrated that endovascular reperfusion therapy improves clinical outcomes at 90 days after ischemic stroke. However, the effects on long-term outcomes are not well known. We hypothesized that successful reperfusion might be associated with long-term improvement beyond 90 days after endovascular therapy.

Primary Intracranial Leiomyosarcoma with Intratumoral Hemorrhage: Case Report and Review of Literature.

Background: Primary intracranial leiomyosarcoma is a very rare occurrence, and primary leiomyosarcoma with intratumoral hemorrhage has not been described previously. We present a case of a rapidly enlarging primary intracranial leiomyosarcoma with intratumoral hemorrhage.

Case Description: A 41-year-old female presented with right hemiparesis and gait disturbance.

Effect of choice of treatment modality on the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.

Objective: Shunt-dependent hydrocephalus (SDHC) may arise after aneurysmal subarachnoid hemorrhage (aSAH) as CSF resorptive mechanisms are disrupted. Using propensity score analysis, the authors aimed to investigate which treatment modality, surgical clipping or endovascular treatment, is superior in reducing rates of SDHC after aSAH.

Methods: The authors' multicenter SAH database, comprising 3 stroke centers affiliated with Kyoto University, Japan, was used to identify patients treated between January 2009 and July 2016.

Severe Hypoglycemia-induced Right Hemiparesis with Reversible Diffusion Restriction in the Left Internal Capsule Due to Combination Therapy Using Disopyramide and Clarithromycin.

Severe hypoglycemia is known to cause acute focal neurological symptoms. In cases with a medical history of diabetes mellitus (DM), the diagnosis and treatment of hypoglycemia-induced neurological symptoms are simple. However, severe hypoglycemia can occur in patients who are not taking hypoglycemic agents such as insulin or long-acting sulfonylurea drugs.

Short-Term Results of Carotid Endarterectomy and Stenting After the Introduction of Carotid Magnetic Resonance Imaging: A Single-Institution Retrospective Study.

Objective: Although carotid artery stenting (CAS) has been gaining popularity as an alternative to carotid endarterectomy (CEA), perioperative stroke rate following contemporary CAS remains significantly higher than stroke rate after CEA. The purpose of this study was to assess perioperative (within 30 days) therapeutic results in patients with carotid stenosis (CS) after introduction of preoperative carotid magnetic resonance imaging plaque evaluation in a single center performing both CEA and CAS.

Methods: Based on prospectively collected data for patients with CS who were scheduled for carotid revascularization, retrospective analysis was conducted of 295 consecutive patients with CS.

Dural arteriovenous fistula in the falx cerebri treated with transarterial embolization using n-butyl cyanoacrylate.

Background: A dural arteriovenous fistula in the falx cerebri is a relatively rare lesion, with only two cases reported till date. One was treated with direct surgery, and the other was followed-up conservatively. Advances in catheter design and embolic materials have made safe and curative transarterial embolization of dural arteriovenous fistulas possible in the current era.

X-ray Angiography Perfusion Analysis for the Balloon Occlusion Test of the Internal Carotid Artery.

Background: A perfusion study should be performed during the balloon occlusion test (BOT) to prevent ischemic events after therapeutic carotid occlusion. We evaluated the efficacy of X-ray angiography perfusion analysis during the BOT.

Methods: Twenty-one consecutive patients who underwent the BOT of the internal carotid artery were included.

Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting.

Background: Reduced cerebrovascular reserve (CVR) is associated with increased risk of ischemic events in carotid steno-occlusive diseases.

Objective: To determine whether pretreatment CVR can predict postoperative ischemic lesions after carotid artery stenting (CAS) by retrospective analysis.

Methods: We retrospectively reviewed the medical records of 46 patients (42 men; mean age 74.

Milrinone via lumbar subarachnoid catheter for vasospasm after aneurysmal subarachnoid hemorrhage.

Introduction: Delayed ischemic neurological deficit (DIND) due to symptomatic vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to elucidate the safety and feasibility of intrathecal milrinone infusion via lumber subarachnoid catheter for prevention of DIND after aSAH.

Methods: We diagnosed 425 consecutive patients with aSAH who received clipping or coil embolization within 48 h after arrival.

Triple balloon protection technique using the mo.ma ultra with the carotid GuardWire for carotid stenting: technical note.

Background: We describe the "triple balloon protection technique" (TBPT) using the Mo.Ma Ultra in combination with the Carotid GuardWire during carotid artery stenting (CAS). This technique is expected to prevent distal embolism to the internal and external carotid arteries, and is suitable for East Asians in whom the origin of the superior thyroid artery is lower than that in Caucasians.

Perimesencephalic nonaneurysmal subarachnoid hemorrhage with unilateral third cranial nerve palsy: two case reports.

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage and is usually not associated with any focal deficit. We describe two rare cases of PNSAH with unilateral third cranial nerve palsy. Both patients were treated conservatively.

Prediction of mortality by hematological parameters on admission in patients with subarachnoid hemorrhage.

This retrospective study investigated the correlations between red blood cell (RBC) count, hemoglobin, and hematocrit on admission, and mortality in 140 patients with subarachnoid hemorrhage (SAH). Correlations between the hematological parameters RBC count, hematocrit, hemoglobin, white blood cell (WBC) count, and platelet count on admission and mortality were investigated. Association of each variable with mortality was tested by univariate and multivariate logistic regression analysis.

Symptomatic low-grade carotid stenosis with intraplaque hemorrhage and expansive arterial remodeling is associated with a high relapse rate refractory to medical treatment.

Background: Carotid plaque characteristics influence future risk of stroke considerably. However, the severity of stenosis does not accurately reflect plaque burden in patients with expansive arterial remodeling.

Objective: To determine the therapeutic outcome of symptomatic carotid low-grade stenosis with vulnerable plaque based on magnetic resonance imaging (MRI) characterization.

[in-hospital mortality in patient with acute ischemic and hemorrhagic stroke].

There is a lack of evidence to compare in-hospital mortality with different types of stroke. The purpose of this study was to elucidate the in-hospital mortality after acute ischemic/hemorrhagic stroke and compare the factors associated with the mortality among stroke subtypes. All patients admitted to Kurashiki Central Hospital in Japan between January 2009 and December 2009, and diagnosed with acute ischemic/hemorrhagic stroke were included in this study.

Ischemic stroke due to dissection of the middle cerebral artery treated by superficial temporal artery-middle cerebral artery anastomosis--case report.

A 62-year-old man presented with dissection of the right middle cerebral artery (MCA) manifesting as mild headache, right hemiparesis, and slurred speech. Magnetic resonance (MR) imaging and MR angiography revealed fresh infarction in the right basal ganglia, and severe stenosis and dilatation of the right MCA. Digital subtraction angiography approximately 24 hours after admission revealed a linear contrast defect indicating an intimal flap of the M(1) segment.

Variant deep cerebral venous drainage in idiopathic subarachnoid hemorrhage.

Variant deep cerebral venous drainage, primarily involving the basal vein of Rosenthal (BVR), may be a cause of idiopathic subarachnoid hemorrhage (SAH). In this study, deep venous drainage was compared between 13 patients with idiopathic SAH and 35 control patients with aneurysmal SAH diagnosed by digital subtraction angiography (DSA). Venous return was evaluated by DSA on 25 sides in patients with idiopathic SAH and 67 sides in patients with aneurysmal SAH, and the relationship between the BVR and the vein of Galen was classified into 3 categories: types A (normal continuous), B (normal discontinuous), and C (primitive variant).

[Trends in mortality rates for subarachnoid hemorrhage, from 1999 through 2008: single center experience].

We retrospectively reviewed the mortality rate of the patients with subarachnoid hemorrhage (SAH) who received initial treatment in Kurashiki Central Hospital, for the 10-year period from 1999 through 2008. The overall mortality was 18.1% (120/662).

[Strategy for revascularization of chronic carotid occlusion with contralateral carotid stenosis].

Background And Purpose: The optimal therapeutic approach for chronic carotid occlusion with contralateral carotid stenosis (ICO-ICS) remains uncertain. The aim of this study was to elucidate the safety and efficacy of initial vascular reconstruction for ICS in patients with ICO-ICS.

Patients And Methods: Eleven patients with ICO-ICS who demonstrated severe cerebral hypoperfusion in the hemisphere ipsilateral to ICO were treated in our institution between February 2003 and November 2007.

[Detection of intraplaque hemorrhage with use of screening black-blood MRI].

The evaluation of plaque characteritics as well as the degree of luminal narrowing is important in the management of carotid stenosis. Several reports have shown that intraplaque hemorrhage (IPH), which plays a pivotal role in plaque vulnerability, emits high signal intensity on T1-weighted images of high-resolution black-blood (BB) MRIs. When an MRI is used to screen for vulnerable plaque, a short scanning duration and a simple MRI protocol are required.

Evaluation of carotid artery atherosclerotic plaque distribution by using long-axis high-resolution black-blood magnetic resonance imaging.

Object: The goal of this study was to evaluate the usefulness of long-axis black-blood MR (BB-MR) imaging for assessing plaque morphology and distribution in patients with atherosclerotic carotid artery (CA) stenosis.

Methods: Sixty-eight carotid arteries in 67 patients who were scheduled to undergo CA endarterectomy or CA stent placement due to atherosclerotic stenosis were included in this study. The patients had undergone CA BB-MR imaging and digital subtraction (DS) angiography within 3 weeks of revascularization.

Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases.

Objective: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We focused on determining independent predictors associated with the recurrence of CSDH.

Methods: We retrospectively reviewed 343 consecutive surgical cases of CSDH.

[Plaque characterization using carotid MRI in acute ischemic cerebrovascular syndromes (three case reports)--can carotid MRI be useful as an adjunct to the diagnosis of TIA in which the ischemic lesions were recognized at a later date?].

Recent diffusion-weighted imaging (DWI) studies describe a relevant ischemic lesion in almost half of all patients with transient ischemic attack (TIA). We report 3 cases of TIA in which the ischemic lesions were recognized on DWI at a later date ("late-imaged TIA"). Three men (average age, 72.

Occlusive thrombosis with neovascularization of the internal carotid artery--two case report--.

Two patients presented with sudden onset of occlusive thrombosis of the atherosclerotic carotid artery. The patients underwent carotid endarterectomy. Histological examination of the specimens clearly showed the presence of pre-existing atherosclerotic plaque with moderate stenosis and occlusive organized thrombus.