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1.
Chinese Journal of Radiology ; (12): 196-200, 2022.
Article in Chinese | WPRIM | ID: wpr-932499

ABSTRACT

Objective:To explore the value of monoenergetic imaging on dual-layer spectral detector CT combined with individual injection protocol of contrast medium in brain CT angiography (CTA).Methods:Seventy-six patients who underwent brain CTA on the Philips IQon dual-layer spectral detector CT and individual injection protocol of contrast medium in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from August to November 2020 were retrospectively analyzed. Objective and subjective evaluation of image quality was performed in conventional energetic images (conventional group) which derived from 120 kVp hybrid iterative reconstruction algorithm and 50 keV virtual monoenergetic images (test group) which derived from spectral reconstruction algorithm. The objective evaluation content included CT values, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of internal carotid artery and middle cerebral artery, CT values and standard deviation (SD) of brain parenchyma. The subjective evaluation was completed by two senior radiologists according to the 5-point scale, and the inter-agreement between two radiologists was evaluated by Kappa test. Paired t test or Wilcoxon rank test was used for analysis between two groups. Results:The SNR and CNR of both internal carotid artery and middle cerebral artery, as well as CT values of internal carotid artery, middle cerebral artery and brain parenchyma, were significantly higher in test group than that in conventional group (all P<0.001). The subjective scores of two radiologists for test group were both 5 (5, 5) points, and the subjective scores for conventional group were both 4 (4, 4) points. The subjective scores of the radiologists were in good agreement, and the Kappa values were 0.74 and 0.84 respectively. The subjective scores of test group were significantly higher than that of conventional group ( Z=-11.15, P<0.001). Conclusion:Monoenergetic imaging on dual-layer spectral detector CT combined with individual injection protocol of contrast medium can improve SNR, CNR and the image quality of brain CTA.

2.
Rev. Finlay ; 10(4): 445-451, oct.-dic. 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1155451

ABSTRACT

RESUMEN Las malformaciones arteriovenosas cerebrales son anormalidades vasculares caracterizadas por una conexión fistulosa entre arterias y venas sin la intervención del lecho capilar normalmente existente. Se localizan con frecuencia en el territorio de las grandes arterias cerebrales, pero pueden aparecer en cualquier otro lecho vascular y son las causantes de hemorragias intracerebrales, epilepsia, signos neurológicos focales y otros síntomas. Se reporta el caso de una paciente de sexo femenino, de 64 años, hipertensa y diabética, que de forma aguda presenta cuadro de debilidad hemicorporal izquierda. Al examen físico presentaba, disartria, hemiparesia izquierda y signos meníngeos. La tomografía axial computarizada inicial mostró un hematoma intraparenquimatoso parietooccipital derecho con apertura al sistema ventricular. La angio-TAC mostró malformaciones arteriovenosas cerebrales parietooccipitales derechas. El tratamiento de este padecimiento depende de los factores del paciente, así como de factores angiográficos. Las diferentes opciones son: conducta expectante, tratamiento médico sintomático, resección quirúrgica, terapia endovascular, radiocirugía estereotáxica. Se presenta el caso clínico de un hematoma intraparenquimatoso secundario a una malformación arteriovenosa cerebral porque es un padecimiento poco frecuente en un adulto mayor.


ABSTRACT Cerebral arteriovenous malformations are vascular abnormalities characterized by a fistulous connection between arteries and veins without the intervention of the normally existing capillary bed. They are frequently located in the territory of the great cerebral arteries, but they can appear in any other vascular bed and are causes of intracerebral hemorrhages, epilepsy, focal neurological signs, and other symptoms. A case of a 64-year-old female patient, hypertensive and diabetic, who acutely presented with left hemicorporal weakness, is presented. On physical examination, she had dysarthria, left hemiparesis and meningeal signs. The initial computed tomography scan showed a right parietooccipital intraparenchymal hematoma opening to the ventricular system. CT angiography showed right parietooccipital cerebral arteriovenous malformations. Treatment of this condition depends on patient factors, as well as angiographic factors. The different options are: watchful waiting, symptomatic medical treatment, surgical resection, endovascular therapy, stereotaxic radiosurgery. The clinical case of an intraparenchymal hematoma secondary to a cerebral arteriovenous malformation is presented because it is a rare condition in an older adult.

3.
Arch. méd. Camaguey ; 24(1): e6700, ene.-feb. 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1088828

ABSTRACT

RESUMEN Fundamento: las arterias cerebelares han sido descritas como variables en su anatomía, característica importante por su valor en la terapéutica endovascular y las complicaciones quirúrgicas. Objetivo: caracterizar anatómicamente el patrón común y las variantes del origen de las arterias cerebelares. Métodos: se realizó un estudio descriptivo en 50 encéfalos obtenidos de Medicina Legal del Hospital Universitario Amalia Simoni en la provincia Camagüey, se disecó cada sistema arterial cerebelar. Resultados: la arteria cerebelar posteroinferior se originó de la vertebral en el 90 %, como variantes cinco se originaron de la basilar y cinco ausentes. La media de su grosor externo fue 1,6 mm. La cerebelar anteroinferior se originó en todos los casos de la basilar, con asimetría en el nivel de origen y doble en el 10 %. El grosor presentó una media de 1,39 mm. La cerebelar superior se originó de la basilar en el 94 % y de la arteria cerebral posterior en el 6 %, se presentó doble en un 17 %. El grosor tuvo una media de 1,73 mm. Conclusiones: el patrón común se caracteriza por el origen de la arteria cerebelar posteroinferior en la arteria vertebral, y de las arterias cerebelar posteroinferior y superior en la arteria basilar. Como variantes, la cerebelar posteroinferior se origina en la basilar o está ausente; la anteroinferior es doble y con asimetría y la superior parte de la cerebral posterior o se presenta doble. La media de los grosores externos de cada uno de los tres sistemas arteriales cerebelares presenta valores menores de dos milímetros.


ABSTRACT Background: the cerebellar arteries have been described as variable in terms of anatomy; which is quite relevant due to the impact on endovascular therapeutic and surgical complication. Objective: to characterize the common pattern and anatomical variants of the origin of cerebellar arteries. Methods: a descriptive study was conducted on 50 human brains obtained from the Legal Department of Amalia Simoni Teaching Hospita, in Camagüey. The cerebellar arterial system of each brain was further dissected. Results: the back-inferior cerebellar artery arose from the vertebral one in 90 % of samples; variants included five that arose from the basilar artery and five absent; its outer diameter average was 1.6 mm. The anteroinferior cerebellar artery arose from the basilar in all cases, asymmetrical at its origin level and 10 % was double; its outer diameter average was 1.39 mm. The superior cerebellar artery arose from the basilar in 94% of cases and from the posterior cerebral artery in 6%, 17 % was double; and its outer diameter average was 1.73 mm. Conclusions: the anatomical origin of the posteroinferior cerebellar artery is from the vertebral artery as common pattern while the anteroinferior and superior cerebellar arteries arise from basilar artery. Anatomical variants includes the origin of the posteroinferior cerebellar artery from the basilar or being absent; double or asymmetric anteroinferior cerebellar artery and superior cerebellar artery with origin at the posterior cerebral artery and/or double. The average of the outer diameter of each cerebellar arteries is less than two millimeters.

4.
Int. j. morphol ; 37(3): 997-1002, Sept. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1012387

ABSTRACT

La arteria estriada medial distal hace parte de la circulación encefálica, nace de la arteria cerebral anterior generalmente a nivel de la arteria comunicante anterior, aunque según distintos estudios su origen varía, siendo así difícil de determinar con exactitud. Su importancia clínica radica en la prevalencia de aneurismas encontrados en esta arteria, que posteriormente podrían causar complicaciones debido a la región que irrigan, siendo estas las secuelas somático-vitales y neuropsicológicas, además de su inadecuado abordaje quirúrgico sin prever las alteraciones que puedan ser ocasionados; a causa de lo anterior es de vital importancia que los profesionales de la salud tengan previo conocimiento de la anatomía y la prevalencia de esta arteria en la población. Se realizó un estudio observacional de tipo descriptivo en donde se analizó la arteria estriada medial distal en 70 encéfalos, piezas de los anfiteatros de Medicina de la Universidad de Ciencias Aplicadas y Ambientales U.D.C.A. (Bogotá), la Universidad Científica del Sur UCSUR (Lima); fijados en formol al 10 %, se realizaron mediciones morfométricas mediante calibrador digital y se tomó el registro fotográfico con una cámara Canon. Posteriormente se ejecutó el análisis estadístico mediante el programa IBM SPSS Stadistics 24. Se encontró una prevalencia del 88,6 % de al menos una arteria estriada medial distal en población colombiana y un 97,1 % de la población peruana. Se identificó un diámetro externo promedio de 0,64 mm en población colombiana y de 0,68 mm en población peruana. Se observó una longitud promedio de 2,5 cm en ambas poblaciones. Se evidenció el mayor lugar de origen en la porción A2 de la ACA con un 37,1 % de población colombiana y un 51,4 % de población peruana. Se debe conocer adecuadamente la anatomía y las correspondientes variaciones anatómicas de esta arteria para así poder realizar un adecuado abordaje neurológico y neuroquirúrgico.


The distal medial striate artery is part of the brain circulation, born from the anterior cerebral artery generally at the level of the anterior communicating artery, although according to different studies its origin varies, being thus difficult to determine with accuracy. Its clinical importance lies in the prevalence of aneurysms found in this artery, which could later cause complications due to the region they irrigate, these being the somatic-vital and neuropsychological sequelae, in addition to its inadequate surgical approach without foreseeing the alterations that may be caused; Because of the above it is of vital importance that health professionals have prior knowledge of the anatomy and prevalence of this artery in the population. An observational descriptive study was carried out in which the distal medial striated artery in 70 brain cells, pieces from the Medicine amphitheatres of the Universidad de Ciencias Aplicadas y Ambientales U.D.C.A. (Bogotá), the Universidad Científica del Sur UCSUR (Lima); fixed in 10 % formalin, morphometric measurements were made by automatic calibrator and the photographic record was taken with a Canon camera. Subsequently, the statistical analysis was executed through the IBM SPSS Statistics program 24. A prevalence of 88.6 % of at least one distal medial striate artery was found in the Colombian population and 97.1 % of the Peruvian population. An average external diameter of 0.64 mm was identified in the Colombian population and 0.68 mm in the Peruvian population. An average length of 2.5 cm was observed in both populations. The largest place of origin was evidenced in the A2 portion of the ACA with 37.1 % of the Colombian population and 51.4 % of the Peruvian population. The anatomy and the corresponding anatomical variations of this artery must be adequately known to be able to perform an adequate neurological and neurosurgical approach.


Subject(s)
Humans , Brain/blood supply , Anterior Cerebral Artery/anatomy & histology , Peru , Cerebral Arteries/anatomy & histology , Prevalence , Cross-Sectional Studies , Colombia
5.
Article in Chinese | WPRIM | ID: wpr-823482

ABSTRACT

The geometric morphology of intracranial arteries has unique characteristics and laws.Congenital variation is also often seen in clinical work.Both have certain clinical significance in the occurrence and development of cerebrovascular diseases,as well as in anatomy and function.This article summarizes some of the findings on the morphology and variation of intracranial arteries in cerebrovascular disease research in recent years,and reviews the imaging techniques of intracranial arteries as well as the clinical significance of geometric morphology and congenital variation.

6.
Article in Chinese | WPRIM | ID: wpr-797208

ABSTRACT

The geometric morphology of intracranial arteries has unique characteristics and laws. Congenital variation is also often seen in clinical work. Both have certain clinical significance in the occurrence and development of cerebrovascular diseases, as well as in anatomy and function. This article summarizes some of the findings on the morphology and variation of intracranial arteries in cerebrovascular disease research in recent years, and reviews the imaging techniques of intracranial arteries as well as the clinical significance of geometric morphology and congenital variation.

7.
Chinese Journal of Radiology ; (12): 877-881, 2019.
Article in Chinese | WPRIM | ID: wpr-796663

ABSTRACT

Objective@#To study the different ischemic characteristics of cerebral gray matter and deep white matter in patients with chronic cerebral artery severe stenosis or occlusion.@*Methods@#A retrospective study was conducted on 30 patients with chronic unilateral cerebral artery severe stenosis or occlusion from April 2014 to April 2018 in our hospital. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time of peak time (TTP) and time to delay(TTD) of cerebral cortex gray matter and deep white matter in the blood supply area of the responsible artery (the affected side) and the contralateral hemisphere (the healthy side) were measured. Statistical analysis of the perfusion parameters of cerebral cortex gray matter and deep white matter in the affected side and contralateral side were performed using SPSS13.0 software package. T test was used for variance homogeneity, and t′ test was used for variance discrepancy, and P<0.05 was statistically significant.@*Results@#The average values of CBF and CBV of the ipsilateral and contralateral cerebral cortex were increased than those of ipsilateral and contralateral cerebral deep white matter respectively(P<0.01). MTT, TTP and TTD of the ipsilateral and contralateral cerebral cortex were decreased than that of ipsilateral and contralateral cerebral deep white matter (P<0.01); CBF of ipsilateral cerebral cortex and CBV of ipsilateral cerebral deep white matter were not different from those of the contralateral cerebral cortex and deep white matter respectively, but CBF of ipsilateral cerebral deep white matter is decreased than that of the contralateral deep white matter (P<0.01). CBV of ipsilateral cerebral cortex is increased than that of the contralateral cerebral cortex (P<0.01). MTT, TTP and TTD of ipsilateral cerebral cortex and deep white matter were increased than those of contralateral cerebral cortex and deep white matter respectively(P<0.01).@*Conclusion@#Deep cerebral white matter perfusion decreased more significantly than cortical gray matter in the supply region of chronic cerebral artery severe stenosis or occlusion. CT perfusion imaging can quantify the degree of chronic cerebral ischemia and can provide quantitative diagnostic information for clinical treatment and efficacy evaluation.

8.
Chinese Journal of Radiology ; (12): 877-881, 2019.
Article in Chinese | WPRIM | ID: wpr-791367

ABSTRACT

Objective To study the different ischemic characteristics of cerebral gray matter and deep white matter in patients with chronic cerebral artery severe stenosis or occlusion. Methods A retrospective study was conducted on 30 patients with chronic unilateral cerebral artery severe stenosis or occlusion from April 2014 to April 2018 in our hospital. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time of peak time (TTP) and time to delay(TTD) of cerebral cortex gray matter and deep white matter in the blood supply area of the responsible artery (the affected side) and the contralateral hemisphere (the healthy side) were measured. Statistical analysis of the perfusion parameters of cerebral cortex gray matter and deep white matter in the affected side and contralateral side were performed using SPSS13.0 software package. T test was used for variance homogeneity, and t′test was used for variance discrepancy, and P<0.05 was statistically significant. Results The average values of CBF and CBV of the ipsilateral and contralateral cerebral cortex were increased than those of ipsilateral and contralateral cerebral deep white matter respectively(P<0.01). MTT, TTP and TTD of the ipsilateral and contralateral cerebral cortex were decreased than that of ipsilateral and contralateral cerebral deep white matter (P<0.01); CBF of ipsilateral cerebral cortex and CBV of ipsilateral cerebral deep white matter were not different from those of the contralateral cerebral cortex and deep white matter respectively, but CBF of ipsilateral cerebral deep white matter is decreased than that of the contralateral deep white matter (P<0.01). CBV of ipsilateral cerebral cortex is increased than that of the contralateral cerebral cortex (P<0.01). MTT, TTP and TTD of ipsilateral cerebral cortex and deep white matter were increased than those of contralateral cerebral cortex and deep white matter respectively(P<0.01). Conclusion Deep cerebral white matter perfusion decreased more significantly than cortical gray matter in the supply region of chronic cerebral artery severe stenosis or occlusion. CT perfusion imaging can quantify the degree of chronic cerebral ischemia and can provide quantitative diagnostic information for clinical treatment and efficacy evaluation.

9.
Article in Chinese | WPRIM | ID: wpr-734308

ABSTRACT

Objective To investigate the value of "one-stop" scanning of coronary and head and neck CTA in patients with normal body mass index (18 kg/m2 ≤ BMI ≤ 25 kg/m2) using low tube voltage (80 kVp).Methods In a retrospective analysis 80 patients with normal body mass index who had completed "one-stop" scanning of coronary and head and neck CTA were divided into A and B groups according to different scanning method,and 40 consecutive cases were selected in each group.Scanning parameters of group A and group B were tube voltage 80 kV,coronary CTA tube current 550 mA,head and neck CTA tube current 500 mA,and tube voltage 100 kV,coronary CTA tube current 450 mA,head and neck CTA tube current 400 mA separately.Subjective evaluation and objective evaluation were performed on the image quality of the two groups.CT values of coronary artery and head and neck CTA trunk branch vessel,contrast-to-noise ratio (CNR),image noise (SD) and effective dose between the two groups were compared.Results The image quality of both groups met the diagnostic requirements,and there was no statistically significant difference in subjective scores between two groups (P>0.05).The CT values of coronary arteries,the main branches of the head and neck (the common carotid artery,the internal carotid artery) and SD of head and neck CTA were significantly different between two groups (t=4.737,6.552,3.359,2.165,2.685,4.617,P<0.05).There was no statistically significant difference in SD of coronary CTA,CT values and CNR between head and neck vessels (middle cerebral artery) in group A and group B (P>0.05).The effective dose of coronary CTA in group A (1.16±0.20) mSy was reduced by 51.1% than that in group B (2.37±0.77) mSv.The effective dose of head and neck CTA in group A (0.37±0.03) mSv was reduced by 47.9% than that in group B (0.71 ± 0.17) mSv.Conclusions The image quality with subjective evaluation met the diagnostic requirements when using a low-tube voltage for "one-stop"scanning of coronary and head and neck CTA.The CNR values were basically consistent with the conventional scanning method,and the patient effective dose was reduced by about 50%.

10.
Rev. bras. ciênc. vet ; 24(1): 12-17, jan.-mar.2017. il.
Article in Portuguese | LILACS | ID: biblio-966947

ABSTRACT

Objetivou-se descrever e sistematizar as artérias da base do encéfalo. Foram utilizados dez gerbils que se encontravam armazenados em freezer no laboratório de Morfofisiologia Animal Aplicada da Universidade Federal Rural do Semiárido. Os animais foram descongelados, incisados na linha mediana para identificação do ventrículo esquerdo, o qual foi perfurado e injetados 3ml de Látex Neoprene 650 na concentração de 20% e no pigmento vermelho. Posteriormente aguardou-se cerca de 1 minuto em virtude da polimerização do Látex e logo após foram fixados por imersão em solução aquosa de Formaldeído a 3,7% e após 72 horas, tiveram os encéfalos removidos da calota craniana para análise de sua superfície ventral. Foi visto que o sistema vertebrobasilar e carótico estiveram presentes em todos os animais analisados, mostrando-se responsável pela vascularização do encéfalo caudal e rostral, respectivamente. As principais artérias observadas no modelo padrão incluem as ímpares: basilar, espinhal ventral, ramo medial da artéria cerebral rostral e as pares: vertebral, cerebelar caudal, cerebelar média, trigeminal, cerebelar rostral, ramo terminal da basilar, carótida interna, cerebral caudal, hipofisária, cerebral média, cerebral rostral, lateral do bulbo olfatório e etmoidal interna. Conclui-se com base nos resultados que a irrigação da superfície ventral encefálica do gerbil foi suprida pelos sistemas vertebro-basilar e carótico de forma equivalente, pertencendo assim ao modelo do tipo II. O circuito arterioso apresentou-se aberto caudalmente e fechado rostralmente, fato que difere do relatado em roedores como capivara, cutia, preá, chinchila e nutria.


The objective was to describe and systematize the arteries of the base of the brain. Ten gerbils were used, which were stored in a freezer in the Laboratory of Applied Animal Morphophysiology of the Federal Rural Semi-Arid University. The animals were thawed, incised in the midline to identify the left ventricle, which was punctured and injected 3 ml of Latex Neoprene 650 at a concentration of 20% and red pigment. After about one minute the polymerization of the Latex was delayed and afterwards fixed by immersion in 3.7% aqueous Formaldehyde solution and after 72 hours the brain was removed from the skull cap for analysis of its ventral surface. It was observed that the vertebro-basilar and carotid system were present in all animals analyzed, being responsible for the vascularization of the caudal and rostral encephalon, respectively. The main arteries observed in the standard model include the odd: basilar, ventral spinal, medial branch of the rostral cerebral artery and, the pairs: vertebral, cerebellar caudal, cerebellar medial, trigeminal, cerebellar rostral, terminal branch of the basilar, internal carotid, caudal cerebral, Pituitary, middle cerebral, rostral, lateral, olfactory and internal ethmoidal. Based on the results, the irrigation of the ventral brain surface of the gerbil was supplied by the vertebro-basilar and carotic systems in an equivalent way, thus belonging to the type II model. The arterial circuit was open caudally and closed rostrally, a fact that differs from that reported in rodents such as capybara, agouti, cavy, chinchilla and nutria


Subject(s)
Animals , Gerbillinae
11.
Article in Chinese | WPRIM | ID: wpr-692902

ABSTRACT

Objective To investigate the effects of aspirin on the morphology and wall structure of the intracranial aneurysm induced by hemodynamics.Methods Twenty-six SD rats were randomly divided into three groups:a control group,a model group,and an aspirin group.The right common carotid artery,left external carotid artery,and pterygopalatine artery were ligated in order to change the hemodynamics of left internal carotid artery.After 3-month induction,the anterior communicating artery complex were harvested after heart perfusion.The aneurysm-like structure was observed using a scanning electron microscope and was graded.The changes of elastic hyer and smooth muscle cells in the tunica media were detected by pathological examination.Results Aneurysm-like remodeling was observed both in the model group and in the aspirin group,and there was no statistical differences in morphological grade between the 2 groups (P =0.054).Pathological examination showed the folds or loss of the internal elastic lamina and thinned media smooth muscle layer both in the model group and in the aspirin group.The length of thinned media in the model group was significantly higher than that in the aspirin group (173.50 ± 17.62 μm vs.153.50 ± 12.04 μ,m;t=2.964,P=0.008).Conclusions Aspirin can slow down the pathological remodeling of intracranial aneurysm wall,but it cannot completely inhibit the formation of intracranial aneurysm.

12.
Article in Chinese | WPRIM | ID: wpr-673089

ABSTRACT

The incidence of variation of cerebrovascular structure is higher in population.Previous studies have shown that the variation of the cerebrovascular structure is an independent risk factor for ischemia stroke.This article reviews the common cerebrovascular variation and its relationship with ischemic stroke.

13.
Chinese Journal of Neurology ; (12): 354-357, 2017.
Article in Chinese | WPRIM | ID: wpr-608336

ABSTRACT

Objective To explore the role of bright vessel sign (BVS) on raw three dimensional arterial spin labeling (3D ASL) image in evaluating occlusion of intracranial artery. Methods One hundred and twenty-two patients who were highly suspected of acute cerebral infarction were enrolled and analyzed. All patients were performed magnetic resonance scan with diffusion weighted image (DWI), 3D ASL and magnetic resonance angiography (MRA) sequences within 24 hours after admission. The presence or absence of restricted lesion on DWI, BVS and occlusion of intracrainal artery on MRA was reviewed. The sensitivity, specificity, positive predictive value, negative predictive value of BVS and consistency of BVS and MRA in assessing occlusion of intracranial artery were assessed. Results The sensitivity, specificity, positive predictive value and negative predictive value of BVS in assessing occlusion of intracranial artery were 83%, 99%, 95% and 96%, respectively.And the presence or absence of BVS on ASL was highly consistent with MRA in assessing occlusion of intracranial artery (κ=0.86, P<0.01). Conclusion BVS has a good sensitivity and high specificity in identifying occlusion of intracranial artery, and it is highly consistent with MRA.

14.
Article in Chinese | WPRIM | ID: wpr-485325

ABSTRACT

Objective:To evaluate the effectiveness and safety of endovascular treatment in solving symptomatic cerebral artery tandem lesions.Methods:From June 201 2 to February 201 4,1 2 cases (24 lesions)with symptomatic cerebral artery tandem lesions were accepted for the endovascular treatment. The distributions of the tandem lesions were as follows:the common carotid artery and internal carotid ar-tery (1 case),the internal carotid artery and the proximal of the carotid cavernous sinus segment (3 ca-ses),the internal carotid artery and the distal of the carotid cavernous sinus segment (4 cases),the in-tracranial segment of internal carotid artery and middle cerebral artery M1 segment (2 cases),the first segment of vertebral artery and intracranial segment of vertebral artery (2 cases).All of these cases were treated from distal lesions to proximal lesions except for tandem lesions in the internal carotid artery and the distal of the carotid cavernous sinus segment in order to obtain better support.Tandem lesions were treated in the same operation with local anesthesia or general anesthesia.The procedures of the 1 2 cases retrospectively were analyzed and the peri-operation complications and responsibility region recurrent is-chemic stroke incidents observed.Results:All tandem lesions were solved successfully all at once.There were no peri-operation complications or recurrent ischemic stroke incidents.There were no recurrent is-chemic stroke incidents or stent restenosis cases in the follow-up.Conclusion:It is safe and effective for selective endovascular treatment in solving symptomatic cerebral artery tandem lesions at the same time, but we should take careful preoperative evaluation and improve the operation plan.

15.
Article in Chinese | WPRIM | ID: wpr-488174

ABSTRACT

High-resolution magnetic resonance imaging (HRMRI) is a safe, non-invasive, inexpensive, accurate and reproducible clini-cal imaging modality, and the results can acutely reflect the extent of atherosclerotic disease and have high predictive values for future clini-cal events. It uses black blood imaging techniques and can obtain sufficient sensitivity for submillimetre imaging. HRMRI has been used widely to visualize the vessel wall and differentiate the components of atherosclerotic plaques. It is of important clinical meaning to evaluate plaque vulnerability with HRMRI, which is related to the remodeling pattern, plaque burden, intraplaque hemorrhage and contrast enhance-ment, and plaque distribution, etc.

16.
Article in English | WPRIM | ID: wpr-58504

ABSTRACT

Reversible cerebral vasoconstriction syndrome (RCVS) is a group of syndromes characterized by reversible segmental constriction of cerebral arteries. Posterior reversible encephalopathy syndrome (PRES) is another clinical-radiologic syndrome characterized by reversible, posterior-predominant brain edema. Although the exact causes of these reversible syndromes are poorly understood, these entities may share some common pathophysiologic elements leading to hemorrhagic strokes and rarely, deep intracerebral hemorrhage (ICH). Recent studies have suggested that endothelial dysfunction is a common pathophysiologic factor associated with these syndromes. We report on two young female patients who presented with deep ICH and were later diagnosed as RCVS and PRES. Both patients suffered from vasoconstriction and delayed ischemic stroke. Early detection of distinguishing clinical-radiologic features associated with these reversible syndromes and removing triggers would facilitate successful treatment with no complications.


Subject(s)
Brain Edema , Cerebral Arteries , Cerebral Hemorrhage , Constriction , Female , Humans , Posterior Leukoencephalopathy Syndrome , Stroke , Vasoconstriction , Vasospasm, Intracranial
17.
Journal of Stroke ; : 144-158, 2015.
Article in English | WPRIM | ID: wpr-24746

ABSTRACT

The anatomy of the arterial system supplying blood to the brain can influence the development of arterial disease such as aneurysms, dolichoectasia and atherosclerosis. As the arteries supplying blood to the brain develop during embryogenesis, variation in their anatomy may occur and this variation may influence the development of arterial disease. Angiogenesis, which occurs mainly by sprouting of parent arteries, is the first stage at which variations can occur. At day 24 of embryological life, the internal carotid artery is the first artery to form and it provides all the blood required by the primitive brain. As the occipital region, brain stem and cerebellum enlarge; the internal carotid supply becomes insufficient, triggering the development of the posterior circulation. At this stage, the posterior circulation consists of a primitive mesh of arterial networks that originate from projection of penetrators from the distal carotid artery and more proximally from carotid-vertebrobasilar anastomoses. These anastomoses regress when the basilar artery and the vertebral arteries become independent from the internal carotid artery, but their persistence is not uncommon in adults (e.g., persistent trigeminal artery). Other common remnants of embryological development include fenestration or duplication (most commonly of the basilar artery), hypoplasia (typically of the posterior communicating artery) or agenesis (typically of the anterior communicating artery). Learning more about the hemodynamic consequence that these variants may have on the brain territories they supply may help understand better the underlying physiopathology of cerebral arterial remodeling and stroke in patients with these variants.


Subject(s)
Adult , Aneurysm , Arteries , Atherosclerosis , Basilar Artery , Brain , Brain Stem , Carotid Arteries , Carotid Artery, Internal , Cerebellum , Cerebral Arteries , Circle of Willis , Embryology , Embryonic Development , Female , Hemodynamics , Humans , Learning , Parents , Pregnancy , Stroke , Vertebral Artery
18.
Article in Korean | WPRIM | ID: wpr-189698

ABSTRACT

BACKGROUND: The demographics of the stroke population consist mainly of elderly patients. Transcranial Doppler is an effective method for intracranial flow detection, but can be limited due to the poor temporal window (PTW), which is frequent in the elderly. Therefore, we investigated whether the low frequency 1.6-MHz probe can be useful to improve flow detection for PTW. METHODS: All 201 participants had a history of transient ischemic attack or minor ischemic stroke. Firstly, we analyzed the success rate of recording intracranial blood flow via temporal window by using 2.0-MHz (high frequency, HF) and 1.6-MHz (low frequency, LF) probes for a maximum of 10 minutes. Secondly, mean flow velocity (MFV) and pulsatile index (PI) of insonated spectrum of 25 patients with good temporal window were compared between the two probes. RESULTS: Seventy-eight patients were female and the mean age was 64.1+/-12.4 years. Among 402 windows, 125 (31.1%) were undetected when using the 2.0-MHz probe. Fifty-five patients were detected for the spectrum by the 1.6-MHz probe. However, 70 (17.4%) still remained as PTW. Between the two probes, there were no significant differences of variables from the middle cerebral arteries: MFVs (HF 61.0+/-14.1 vs. LF 61.3+/-14.8 cm/sec, p=0.403 in the right; HF 59.6+/-13.4 vs. LF 59.3+/-13.3 cm/sec, p=0.232 in the left) and PIs (HF 0.82+/-0.17 vs. LF 0.82+/-0.18, p=0.929 in the right; HF 0.82+/-0.20 vs. LF 0.83+/-0.17, p=0.605 in the left). CONCLUSIONS: Conventional 2.0-MHz probe had relatively high proportion of PTW but 1.6-MHz probe was feasible to improve flow detection for PTW.


Subject(s)
Aged , Cerebral Arteries , Demography , Female , Humans , Ischemic Attack, Transient , Middle Cerebral Artery , Stroke , Temporal Bone , Ultrasonography, Doppler, Transcranial
19.
Journal of Stroke ; : 36-43, 2014.
Article in English | WPRIM | ID: wpr-198659

ABSTRACT

BACKGROUND AND PURPOSE: Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. METHODS: We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. RESULTS: In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). CONCLUSIONS: Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.


Subject(s)
Basilar Artery , Carotid Artery, Internal , Cerebral Arteries , Cerebral Infarction , Cerebrovascular Disorders , Constriction, Pathologic , Hospital Distribution Systems , Humans , Magnetic Resonance Imaging , Middle Cerebral Artery , Prevalence , Prognosis , Republic of Korea , Retrospective Studies , Stroke , Vertebral Artery
20.
Article in Chinese | WPRIM | ID: wpr-447788

ABSTRACT

Objective To investigate the CT angiography (CTA) in the diagnosis of intracranial atherosclerosis.Methods Sixty-eight cases of suspected ischemic cerebrovascular disease patients were enrolled in this study,and all patients underwent CTA.Parallel image post-processing was done.CTA characteristics were observed and compared with digital subtraction angiography (DSA) results.Results A total of 376 lesions in 68 cases were examined,112 lesions were found in CTA; intracranial atherosclerotic plaques mainly distributed in the internal carotid artery (53 lesions),anterior cerebral,middle and posterior artery (39 lesions) and vertebral-basilar artery (20 lesions).In narrow artery segment,stenosis with calcified plaque was in 32 lesions,mostly in the middle cerebral artery,the cavernous segment of the internal carotid artery,clinoids segment and intracranial vertebral artery.For non-calcified plaque,CTA showed fuzzy.DSA showed 128 total lesions,and severe stenosis rate in CTA [9.31% (35/376)] and DSA [9.31% (35/376)] was consistent.Thirty-eight patients were correctly diagnosed.Conclusions CTA as a minimally invasive intracranial atherosclerosis diagnostic methods,consumes less time with low cost and high spatial resolution.It is suitable for clinical universal application.

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