Object: Multiple approaches have been used to treat carotid-cavernous fistulas (CCFs). The transvenous approach has become a popular and effective route. Onyx is a valuable tool in todays endovascular armamentarium. The authors describe the use of a balloon-assisted technique in the treatment of CCFs with Onyx and assess its feasibility, utility, and safety. Neurosurgical Focus. May 2012 / Vol. 32 / No. 5 / Page E14. DOI: 10.3171/2012.2.FOCUS1213.
Cerebral small vessel disease is an important cause of vascular cognitive impairment and dementia. On brain imaging, discrete lacunar infarcts and/or more diffuse regions of white matter hyperintensities or leucoaraiosis are seen. Magnetic resonance imaging plays a crucial role in diagnosis, and advanced magnetic resonance imaging techniques are providing new information on disease mechanisms and offering potential as surrogate disease markers. Longitudinal studies have demonstrated detectable progression of lesion load over short time periods, and weak correlations with cognition. Stronger correlations with cognition have been found with diffusion tensor imaging, which is more sensitive to white matter tract structure, supporting a role for disconnection in the pathogenesis of cognitive impairment. Brain volume also consistently correlates with cognition in asymptomatic small vessel disease, sporadic small vessel disease, and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Gradient echo magnetic resonance imaging identifies microbleeds in a significant proportion of patients with small vessel disease, although their role in clinical management remains to be determined. Surrogate markers to monitor disease progression and evaluate new therapies would have major clinical use. The greater sensitivity of diffusion tensor imaging parameters and brain volume to change, and the stronger correlation of these parameters with cognition, suggest that they may be more powerful surrogates. However, data from longitudinal and intervention studies are required to determine if this is indeed the case. In this systematic review, we describe the use of both conventional and advanced magnetic resonance imaging techniques in patient groups with the full spectrum of clinical small vessel disease, from normal populations with WMH to patients groups with lacunar stroke and dementia. International Journal of StrokeVolume 6, Issue 1, Article first published online: 4 JAN 2011. Copyright © 2011 The Authors. International Journal of Stroke. Copyright © 2011 World Stroke Organization Vol 6, February 2011, 47–59
SUMMARY: IgG4-related disease is characterized by histologic fibrosis with IgG4-positive plasma cell infiltration. Our study evaluated MR imaging features of IgG4-related disease in the head and neck and brain. Images from 15 patients were retrospectively evaluated for the location, signal intensity, and enhancement patterns of lesions. Lacrimal gland enlargement was observed in 8 cases. Other lesions included orbital pseudotumor in 5, pituitary enlargement in 5, and cranial nerve enlargement in 7; the infraorbital nerve was involved in 4. All lesions were hypointense on T2-weighted images, which is typical for IgG4-related lesions. Multiple sites were involved in the head and neck and brain in 11 patients. The diagnosis of IgG4-related disease should be considered in a patient presenting with T2 hypointense lacrimal gland, pituitary, or cranial nerve enlargement, or a T2 hypointense orbital mass, especially if multiple sites in the head and neck are involved in the presence of elevated serum IgG4. Published online before print June 14, 2012, doi: 10.3174/ajnr.A3147. Copyright © 2012 American Society of Neuroradiology
Chronic cerebrospinal venous insufficiency (CCSVI) represents a recently described condition that may potentially contribute to the symptoms experienced by patients with multiple sclerosis. The evaluation of a prospective patient for CCSVI often involves an invasive evaluation with venography of the internal jugular and azygos veins. The purpose of this article is to review the normal anatomy of the internal jugular, vertebral, and azygos veins, as an understanding of these veins is necessary for appropriate interpretation of the venograms obtained to evaluate patients for CCSVI. Journal of Vascular and Interventional Radiology Volume 22, Issue 12 , Pages 1681-1690, December 2011. Copiryght © SIR, 2011
In 1969 Yaşargil first described direct extracranial-intracranial (EC-IC) bypass to increase cerebral perfusion.1 To assess the efficacy of this technique in preventing stroke in patients with athero-occlusive disease, a large multi-center randomized clinical trial was undertaken in 1985. No beneficial effect of surgical intervention was found when comparing the 1377 patients randomized to either surgical or medical therapy.2 Subgroup analysis failed to demonstrate a beneficial effect of surgery including the 808 patients with carotid artery occlusion. April 2012 - Volume 70 - Issue 4 - p N22–N23 doi: 10.1227/01.neu.0000413226.72843.1f. Copyright © by the Congress of Neurological Surgeons
BACKGROUND AND PURPOSE: Our aim was to compare 3D TOF-MRA sequences at 3T and 1.5T in the follow-up of coiled aneurysms. The follow-up of coiled intracranial aneurysms is mandatory to depict potential recanalization. 3D-TOF MRA is an appropriate tool for this purpose. Published online before print June 7, 2012, doi: 10.3174/ajnr.A3124. Copyright © 2012 American Society of Neuroradiology
BACKGROUND AND PURPOSE: The endovascular treatment of intracranial aneurysms with unfavorable anatomy (large aneurysms, wide-neck) is frequently challenging and is also associated with a high incidence of significant recurrences. The WEB, an intrasaccular flow disrupter, was designed for use in this type of aneurysm. We report our early experience with this device in this multicenter study. Published online before print June 7, 2012, doi: 10.3174/ajnr.A3191. Copyright © 2012 American Society of Neuroradiology
Object: Approximately 25% of patients with middle cerebral artery (MCA) occlusion will have a concomitant internal carotid artery (ICA) occlusion, and 50% of patients with an ICA occlusion will have a proximal MCA occlusion. Cervical ICA occlusion with MCA embolic occlusion is associated with a low rate of recanalization and poor outcome after intravenous thrombolysis. The authors report their experience with acute ischemic stroke patients who suffered tandem ICA/MCA (TIM) occlusions and underwent intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial MCA mechanical thrombectomy. Neurosurgical Focus. May 2012 / Vol. 32 / No. 5 / Page E16. DOI: 10.3171/2012.1.FOCUS11350.
One of the most important risk factors for stroke is hypertension. A number of studies have attempted to identify the most effective anti-hypertensive therapeutic group for stroke prevention. Using an epidemiologic approach we aimed to find correlations based on Hungarian data on stroke-mortality and on prescription routine of anti-hypertensive therapeutics in three different counties, showing significant difference in stroke mortality. BMC Cardiovascular Disorders Volume 12, Number 1 (2012), 15, DOI: 10.1186/1471-2261-12-15. Copyright © 2012 Papp et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License
BACKGROUND AND PURPOSE: Stenosis of the carotid artery may cause reduced hemodynamic and neural function that may be ameliorated with CAS. The goal of this study was to evaluate short- and long-term hemodynamic and clinical effects after CAS. Published online before print January 19, 2012, doi: 10.3174/ajnr.A2930 AJNR 2012 33: 1170-1176. Copyright © 2012 by American Journal of Neuroradiology
Depression is a common mental health consequence of stroke. The onset of depression often begins within the first few months after a stroke (1–4). The overall frequency of poststroke depression is estimated to be 33%, with varying rates during the acute, medium-term, and long-term phases of recovery (4). In general, the frequency of depression is greater among inpatient populations than subjects living within the community (5). You have free access to this content International Journal of StrokeVolume 7, Issue 3, Article first published online: 20 JAN 2012. Copyright © 2012 The Authors. International Journal of Stroke Copyright © 2012 World Stroke Organization
BACKGROUND AND PURPOSE: Development of a headache after aneurysm coil embolization is not uncommon but has received little attention. The authors prospectively analyze the characteristics and risk factors of a headache after coiling in patients treated for an unruptured cerebral aneurysm. Published online before print April 5, 2012, doi: 10.3174/ajnr.A3018. Copyright © 2012 American Society of Neuroradiology
BACKGROUND AND PURPOSE: Ulceration in carotid plaque is a risk indicator for ischemic stroke. Our aim was to compare plaque ulcer detection by standard TOF and CE-MRA techniques and to identify factors that influence its detection. Published online before print May 24, 2012, doi: 10.3174/ajnr.A3132. Copyright © 2012 American Society of Neuroradiology
The prevalence of hypertension in society is high and increasing. Untreated hypertension results in stroke, dementia, and damage to major organs. This article reviews the risks that hypertension causes and the issues nowgenerally accepted as playing a role in the low level of hypertension control. These include lack of public awareness of the significance of elevated blood pressure, lack of impetus to measure blood pressure, lack of sites to perform the measurements, occasional therapeutic inertia on the part of the medical community, and poor compliance with treatment on the part of affected individuals. Innovative measures that may result in improved management of this risk factor are discussed. These include ubiquitous blood pressure measurement sites, expanding therapeutic potential by involving allied health professionals, and offering rewards for treatment and for compliance. The article also emphasises that the ideal blood pressure target for the primary prevention of stroke remains unclear. You have free access to this content International Journal of StrokeVolume 6, Issue 2, Article first published online: 14 JAN 2011. Copyright © 2011 The Authors. International Journal of Stroke Copyright © 2011 World Stroke Organization Vol 6, April 2011, 144–149
Stroke is one of the leading causes of death globally. Awareness of stroke risk factors and warning signs are important for stroke prevention and seeking care. The purpose of this systematic review was to review existing literature that assessed the knowledge of stroke risk factors and warning signs and allowed separate gender analysis. We conducted a systematic review of all published studies (to August 2008) examining knowledge of stroke risk factors and warning signs that included women and provided results separated by gender. Two reviewers selected studies for inclusion, assessed quality, and extracted data. The database search identified 2158 references for screening and 158 were selected for possible inclusion. Twenty-two studies were reviewed including 20 cross-sectional and two pretest–posttest design surveys. Overall, better stroke knowledge was observed in women compared with men in the majority of the studies although there is a general lack of knowledge in both genders. Four out of 18 studies reported better risk factor knowledge and eight out of 15 studies reported better knowledge in stroke warning signs in women compared with men. Women tended to know more evidence-based stroke risk factors than men. Stroke knowledge also appeared to be related to country of study origin, age, education, and medical history. Stroke knowledge among different populations and both in men and women is suboptimal. More research is necessary to further investigate gender differences in stroke. You have free access to this content International Journal of StrokeVolume 6, Issue 1, Article first published online: 4 JAN 2011. Copyright © 2011 The Authors. International Journal of Stroke Copyright © 2011 World Stroke Organization Vol 6, February 2011, 60–66
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