Paradoxical increase in skin inflammation in the absence of CCR4.

The chemokine receptors are seven transmembrane, G-protein-coupled surface receptors that play key roles in the migration and localization of leukocytes to the skin during physiologic and inflammatory states. Their ligands, chemokines, are small secreted proteins that initiate leukocyte chemoattraction. Recent data indicate that known subsets of T helper (Th) cells express signature chemokine receptors (e.

Neurocritical care of a reperfused brain.

Cerebral hyperperfusion and reperfusion injuries are not infrequently encountered following in reperfusion of ischemic or hypoperfused brain. Mechanism of injury could be related to tissue plasminogen activator toxicity, oxidative stress, and hyperperfusion due to impaired cerebral autoregulation in already maximally dilated cerebral vasculature and compromised cerebral hemodynamic reserve. Reperfusion injury can present as headaches and seizures in mild forms and as subarachnoid hemorrhage, intracranial hemorrhage, cerebral edema, and encephalopathy in its most severe manifestation.

Rare vascular complication of percutaneous balloon compression of trigeminal neuralgia treated endovascularly.

Trigeminal neuralgia is commonly treated with percutaneous balloon compression due to the high success rate, technical simplicity and cost efficiency.1-3 The procedure carries certain risks, most notably dysesthesias and masseter muscle weakness.4 5 However, more severe complications are rare.

Using a distal access catheter in acute stroke intervention with penumbra, merci and gateway. A technical case report.

This technical report describes the successful use of the newly introduced Distal Access Catheter, initially designed to work with the Merci Retrieval System with the Penumbra aspiration system as the main aspiration catheter. Both devices, one a clot retriever and the other a thrombo-aspiration device, can be used and deployed via the same catheter saving time during acute stoke intervention. Moreover, the larger inner diameter of the distal access catheter may allow more effective clot aspiration.

Limb-shaking transient ischemic attack masquerading as lumbar radiculopathy from pericallosal artery stenosis treated successfully with intracranial angioplasty and stenting.

The pericallosal artery is rarely associated with intracranial atherosclerotic disease and, until recently, was usually not amenable to endovascular therapy with balloon angioplasty and stenting. We present an elderly patient with postural left leg-shaking episodes secondary to pericallosal artery stenosis, which was treated initially with primary intracranial balloon angioplasty, and subsequently, angioplasty and stenting as a result of recurrent stenosis. Both procedures were preformed without complications, and the patient remained free of symptoms on 6-month follow-up.

The use of a covered stent graft for obliteration of high-flow carotid cavernous fistula presenting with life-threatening epistaxis.

Background: We present a rare complication of trans-sphenoidal adenectomy (TSA) for pituitary macroadenoma: carotid cavernous fistula (CCF) that was treated with endovascular therapy. The incidence of internal carotid artery (ICA) injury following TSA is 1% and may spontaneously heal by packing and rarely manifest as symptomatic CCF/aneurysm. Treatment of post-TSA CCF may be challenging due to the breach of nasal floor and may be prone to recurrence.

Management of intracranial pressure.

Although intracranial hypertension may arise from diverse pathology, several basic principles remain paramount to understanding its dynamics; however, the management of elevated intracranial pressure (ICP) may be very complex. Initial management of common ICP exacerbants is important, such as addressing venous outflow obstruction with upright midline head positioning and treating agitation and pain with sedation and analgesia. Surgical decompression of mass effect may rapidly improve ICP elevation, but the impact on outcome is unclear.

Diagnostic cerebral angiography: the interventional neurology perspective.

Background/objective: Cerebral angiography (CA) is increasingly used in clinical practice with advances in neurointerventional therapy. We present our CA experience performed by neurologists at an academic institution.

Method: CA performed between July 2005 and March 2008 was reviewed.

Pediatric cerebral angiography: analysis of utilization and findings.

Pediatric neuroendovascular procedures are being performed with increasing frequency, for various indications. Reported here is the experience of interventionally trained neurologists performing pediatric cerebral diagnostic angiography between August 1, 2005, and April 30, 2008, at a single tertiary institution. Data regarding patient demographics, diagnostic indication and angiographic diagnosis, procedural complications, and procedural specifications were recorded to assess practice patterns and to track procedural morbidity.

Measurement of antiplatelet inhibition during neurointerventional procedures: the effect of antithrombotic duration and loading dose.

Background/objective: Symptomatic thromboembolic events are the most common complications associated with aneurysm coiling, and carotid and intracranial stenting. Our objective is to assess the effect of aspirin (ASA) and clopidogrel dose and duration on platelet inhibition using a point of care assay in neurointerventional (NI) suite.

Method: The dose, duration, and point of care platelet function assay data for clopidogrel and aspirin therapy were prospectively collected between February 2006 and November 2007.

The influence of surgery in MEN-1 syndrome: observations over 150 years.

Background: Efficacy and timing of operative intervention in patients with multiple endocrine neoplasia type 1 (MEN-1) syndrome remains controversial. This report utilizes a novel approach to evaluate the influence of evolving operative interventions for patients with MEN-1 syndrome.

Methods: Six generations from a large MEN-1 family pedigree were studied.

The stroke and neurovascular program at the medical college of wisconsin and froedtert hospital.

The Stroke and Neurovascular Program at the Medical College of Wisconsin and Froedtert Hospital, in Milwaukee, is a comprehensive, interdisciplinary center for stroke medicine. The program encompasses an acute stroke team, a neuro-intensive care unit, a stroke care unit, and a stroke rehabilitation program. The staff includes specialists with fellowship training in stroke, neurocritical care, neurointerventional therapy, vascular neurosurgery, interventional neuroradiology, and stroke rehabilitation.

New triple procedure: Descemet's stripping and automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation.

Purpose: To evaluate visual acuity (VA), graft clarity, and refractive outcome of Descemet's stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting Fuchs' endothelial dystrophy and immature senile cataracts.

Design: Pilot, prospective, noncomparative, surgical case series.

Participants: Twenty-one eyes of 21 consecutive patients with coexisting visually significant immature senile cataracts and Fuchs' corneal dystrophy with guttata of Descemet's membrane and either microcystic epithelial edema or stromal edema presenting to a single academic eye institute.

Early results of small-incision Descemet's stripping and automated endothelial keratoplasty.

Purpose: To describe our technique and early results of Descemet's stripping and automated endothelial keratoplasty (DSAEK), identify perioperative complications, and discuss their management.

Design: Prospective, noncomparative, surgical case series.

Participants: Twenty-six eyes of 26 patients who had corneal edema from Fuchs' endothelial dystrophy, pseudophakic bullous keratopathy, or aphakic bullous keratopathy.