Effectiveness of Mechanical Embolectomy for Septic Embolus in the Cerebral Artery Complicated with Infective Endocarditis

There has been a controversy over data of thrombolytic and endovascular surgical treatment about cerebral infarction secondary to infective endocarditis. We report a woman who received early mechanical embolectomy as a treatment of acute stroke with infective endocarditis. A 35-yr-old woman was hospitalized due to right hemiparesis. Brain image showed cerebral infarction at the middle cerebral artery and echocardiography demonstrated vegetation at the mitral valve. She was successfully treated with embolectomy and parenteral antibiotics without any neurologic sequelae. This report shows that the early retrieve of septic cerebral emboli can be a helpful treatment of acute stroke associated with endocarditis.

Three-dimensional digital subtraction angiography vs two-dimensional digital subtraction angiography for detection of ruptured intracranial aneurysms: a study of 86 aneurysms.

AIMS: Three-dimensional reconstruction of intracranial vessels is of interest for evaluation of aneurysms. This study determined diagnostic difference of three-dimensional digital subtraction angiography (3D-DSA, volume-rendering image) versus 2D-DSA for evaluating ruptured intracranial aneurysms, particularly focusing on the size of aneurysms as depicted in both images. SETTINGS AND DESIGN: Sixty-nine patients underwent 3D-DSA and 2D-DSA. The relative size of an aneurysm, which is the ratio of the maximal diameter of an aneurysm to the diameter of a major vessel, was compared between imaging techniques. In addition, relative sizes of smaller aneurysms (< 5 mm) were compared with those of larger aneurysms (>10 mm). Statistical analysis used: For comparison of aneurysm size and location of aneurysm, statistical analysis was performed with the Yates chi square test; statistical significance was set with a P value of less than 0.05. RESULTS: Sixty-three (73.3%) of the 86 total aneurysms were bigger when measured with 3D-DSA versus 2D-DSA. When measured with 3D-DSA, 28 (84.8%) of the 33 smaller aneurysms were bigger, and 50% of the larger aneurysms were bigger versus measurements of 2D-DSA images (P < 0.05). In ACA and ICA territories, which tended to have smaller mean aneurysmal size, relative size of the aneurysm was bigger when measured with 3D-DSA (81.5% and 81.0%, respectively). In MCA, where the mean aneurysmal size was the largest, relative size of aneurysms was bigger when measured with 3D-DSA in 15 cases (53.6%, P < 0.05). In the posterior circulation, aneurysm size was similar between 3D-DSA and 2D-DSA measurements. CONCLUSIONS: 3D-DSA, especially volume-rendering images, tends to depict ruptured intracranial aneurysms bigger than 2D-DSA. This is particularly true with cerebral aneurysms that are < 5 mm in size and are located in the anterior circulation, especially ICA and ACA territories.

Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage.

OBJECTIVE: We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm. MATERIAL AND METHODS: A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery. RESULTS: A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm. CONCLUSIONS: CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.

Traumatic middle cerebral artery occlusion: case report and review of pathogenesis.

Traumatic occlusion of the middle cerebral artery (MCA) is a rare cause of cerebral infarct. We describe a case of MCA occlusion following blunt head trauma. The literature reports some 65 cases of MCA occlusion following non-penetrating blunt trauma to the head. Arterial dissection, cerebral vasospasm and thrombosis have been some of the theories discussed in the pathogenesis of this condition. We review the pathogenesis based on anatomy of the M1 segment.