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1.
MedUNAB ; 24(2): 262-267, 20210820.
Article in Spanish | LILACS | ID: biblio-1291953

ABSTRACT

Introducción. La arteria basilar se forma de las arterias vertebrales, cursa sobre el puente y se bifurca originando las arterias cerebrales posteriores. Irriga parte del tronco encefálico, cerebelo, tálamo y los lóbulos occipitales y temporales cerebrales. Su obstrucción es rara (1% de los accidentes isquémicos), puede ocurrir en cualquier parte de su trayecto, con cuadro clínico diverso. En jóvenes se añaden otros factores de riesgo distintos a los cardiovasculares, se incluye el consumo de sustancias psicoactivas. El objetivo de este artículo es presentar el caso de un adulto joven, su evolución posterior a la intervención endovascular y la asociación, pasada por alto, al consumo de cannabinoides. Caso clínico. Individuo de 23 años con 14 horas de parálisis facial periférica derecha, diplopía, disartria, hemiparesia e hiperreflexia izquierda, disfagia, náuseas y emesis. Tomografía Axial Computarizada de cráneo simple sin alteraciones. Posteriormente, al realizarse resonancia magnética nuclear, se evidencia isquemia pontomesencefálica y focos isquémicos agudos lacunares en lóbulos cerebelosos. Se consideró comprometido el territorio de la arteria basilar, por lo que se realizó angiotomografía que evidenció una obstrucción crítica de dicho vaso a nivel del tercio distal. Se realizó trombectomía con stent-retriever con recanalización total de la arteria basilar con flujo en toda su extensión. Al egreso fue clasificado como TOAST idiopático. Conclusiones. Las escalas etiológicas para stroke creadas para adultos mayores sobreestiman la etiología idiopática en pacientes jóvenes, lo cual puede ocasionar que el consumo de cannabis sea pasado por alto como causante pese a la asociación reportada por la literatura.


Introduction. The basilar artery is formed from the vertebral arteries, runs over the pons and bifurcates, originating the posterior cerebral arteries. It irrigates part of the brainstem, cerebellum, thalamus, and the occipital and temporal lobes of the brain. Its obstruction is rare (1% of ischemic accidents), it can occur in any part of its path, with a diverse clinical condition. In young people, other risk factors other than cardiovascular ones are added; psychoactive substance use is included. The objective of this article is to present the case of a young adult, his evolution after endovascular intervention and the association, overlooked, to the consumption of cannabinoids. Clinical case. 23-year-old man with 14 hours of right peripheral facial paralysis, diplopia, dysarthria, left hyperreflexia and hemiparesis, dysphagia, nausea and emesis. Simple skull Computerized Axial Tomography without alterations. Subsequently, when a nuclear magnetic resonance was performed, pontomesencephalic ischemia and acute lacunar ischemic foci in the cerebellar lobes were evidenced. The basilar artery territory was considered compromised, so a CT angiography was performed, which revealed a critical obstruction of said artery at the level of the distal third. A stent-retriever thrombectomy was performed with total recanalization of the basilar artery with flow in its entirety. Upon discharge, he was classified as "idiopathic" according to the TOAST classification. Conclusions. The etiological scales for stroke created for older adults overestimate idiopathic etiology in young patients, which may cause cannabis use to be overlooked as a cause despite the association reported in the literature.


Introdução. A artéria basilar é formada pelas artérias vertebrais, passa pela ponte e se bifurca, originando as artérias cerebrais posteriores. Irriga parte do tronco cerebral, cerebelo, tálamo e os lobos occipital e temporal do cérebro. Sua obstrução é rara (1% dos acidentes isquêmicos), podendo ocorrer em qualquer parte de seu trajeto, com quadro clínico diverso. Nos jovens, são adicionados outros fatores de risco além dos cardiovasculares, incluindo o consumo de substâncias psicoativas. O objetivo deste artigo é apresentar o caso de um adulto jovem, sua evolução após a intervenção endovascular e a associação, despercebida, ao consumo de canabinoides. Caso clínico. Indivíduo de 23 anos com 14 horas de paralisia facial periférica direita, diplopia, disartria, hemiparesia e hiperreflexia esquerda, disfagia, náuseas e vômitos. Tomografia axial computadorizada de crânio simples sem alterações. Posteriormente, quando foi realizada a ressonância magnética nuclear, foram evidenciados isquemia pontomesencefálica e focos agudos de isquemia lacunar nos lobos cerebelares. O território da artéria basilar foi considerado comprometido, por isso foi realizada uma angiotomografia, que revelou uma obstrução crítica do referido vaso no terço distal. Foi realizada trombectomia stent-retriever com recanalização total da artéria basilar com fluxo em sua totalidade. No momento da alta, foi classificado como TOAST idiopática. Conclusões.As escalas etiológicas para AVC criadas para idosos superestimam a etiologia idiopática em pacientes jovens, o que pode fazer com que o uso de cannabis seja negligenciado como causa, apesar da associação relatada na literatura.


Subject(s)
Cerebrovascular Disorders , Basilar Artery , Cannabis , Reperfusion , Intracranial Embolism and Thrombosis , Young Adult
2.
Braz. dent. sci ; 24(1): 1-7, 2021. ilus
Article in English | LILACS, BBO | ID: biblio-1145575

ABSTRACT

Objective: Patients with Trigeminal Neuralgia often consults a dentist for relief of their symptoms as the pain seems to be arising from teeth and allied oral structures. Basilar artery Dolichoectasia is an unusual and very rare cause of secondary Trigeminal Neuralgia as it compresses the Trigeminal nerve Root Entry Zone. Case reports: We report three cases of Trigeminal Neuralgia caused by Basilar artery Dolichoectasia compression. The corneal reflex was found absent in all three of the cases along with mild neurological deficits in one case. Multiplanar T1/T2W images through the brain disclosed an aberrant, cirsoid (S-shaped) and torturous Dolichoectasia of basilar artery offending the Trigeminal nerve Root Entry Zone. Discussion:Based on these findings we propose a protocol for general dentist for diagnosis of patients with trigeminal neuralgia and timely exclusion of secondary intracranial causes. Conclusion: General dentists and oral surgeons ought to consider this diagnosis in patients presenting with chronic facial pain especially pain mimicking neuralgia with loss of corneal reflex or other neurosensory deficit on the face along with nighttime pain episodes. Timely and accurate diagnosis and prompt referral to a concerned specialist can have an enormous impact on patient survival rate in such cases (AU)


Objetivo: Pacientes com Neuralgia do Trigêmeo frequentemente consultam um dentista para alívio de seus sintomas visto que a dor parece surgir dos dentes e estruturas orais relacionadas. A Dolicoectasia da artéria basilar é uma causa incomum e muito rara de Neuralgia do Trigêmeo secundária, pois comprime a zona de entrada da raiz do nervo trigêmeo. Relatos de casos: Relatamos três casos de Neuralgia do Trigêmeo causada por compressão por Dolicoectasia da artéria basilar. O reflexo da córnea se encontrava ausente em todos os três casos, juntamente com leves déficits neurológicos em um caso. Imagens multiplanares T1/T2W através do cérebro revelaram uma Dolicoectasia cirsóide (em forma de S) anômala e tortuosa da artéria basilar que atingiu a zona de entrada da raiz do nervo trigêmeo. Discussão: Com base nesses achados, propomos para o dentista clínico-geral um protocolo para diagnóstico de pacientes com Neuralgia do Trigêmeo e exclusão oportuna de causas intracranianas secundárias. Conclusão: Os dentistas clínicos-gerais e cirurgiões orais devem considerar este diagnóstico em pacientes que apresentam dor facial crônica, especialmente dor que mimetiza neuralgia com perda do reflexo da córnea ou outro déficit neurossensorial na face junto com episódios de dor noturna. O diagnóstico oportuno e preciso e o encaminhamento imediato a um especialista em questão podem ter um enorme impacto na taxa de sobrevida do paciente em tais casos (AU)


Subject(s)
Humans , Trigeminal Neuralgia , Basilar Artery , Blinking , Facial Pain
3.
Article in English | WPRIM | ID: wpr-880683

ABSTRACT

OBJECTIVES@#Cervicocerebral artery dissection (CAD) is one of the important causes for ischemic stroke in young and middle-aged people. CAD is dangerous and untimely diagnosis and treatment are likely to result in severe disability. Early diagnosis and timely intervention can greatly improve the prognosis of patients. This study was to investigate the imaging features of CAD on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) and to analyze the influential factors of vascular recanalization.@*METHODS@#A total of 19 CAD patients with both baseline HRMR-VWI and follow-up data of vascular imaging in the period from April 2017 to December 2019 in Department of Radiology, Xiangya Hospital, Central South University were retrospectively analyzed. The diseased vessels were divided into a recovery group and a unrecovered group. After treatment, diseased vessels with no residual arterial dissection and no residual stenosis in the lumen were included in the recovery group. Diseased vessels with stenosis, occlusion or residual dissection were included in the unrecovered group. Diseased vessels were divided into a ischemic stroke group and a non-ischemic stroke group according to the presence or absence of ischemic stroke in the area supplied by the diseased vessels. Differences in clinical data and HRMR-VWI imaging findings were compared between the groups.@*RESULTS@#A total of 26 vessels were involved, including 14 (53.8%) internal carotid artery extracranial segment, 8 (30.8%) vertebral artery extracranial segment, 3 (11.5%) vertebral artery intracranial segment, and 1 (3.9%) basilar artery. Ischemic stroke occurred in 16 diseased vascular supply areas. Intramural hematoma was all observed in the baseline HMR-VWI of the affected vessels. There were 18 vessels (69.2%) in the recovery group and 8 vessels (30.8%) in the unrecovered group. Compared with the vessels in the recovery group, the vessels in the unrecovered group were mostly found in the intracranial segment (@*CONCLUSIONS@#Intramural hematoma is a common imaging manifestation of CAD and can be shown clearly and accurately on HRMR-VWI. Recanalization rate of CAD is high, and the recanalization of CAD in intracranial segment is slower than that of CAD in extracranial segment, which can prolong the review time.


Subject(s)
Basilar Artery , Dissection , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Middle Aged , Retrospective Studies , Stroke
4.
Pesqui. vet. bras ; 40(6): 484-492, June 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1135642

ABSTRACT

The nutria (Myocastor coypus) is a medium-sized, semi-aquatic rodent valued by the skin and meat industry. This study aimed to describe and systematize the caudal cerebral artery on the brain surface in nutria, establishing a standard model and its main variations in this species. The thirty animals used were euthanized according to animal welfare rules. The vessels were filled with latex stained with red pigment and the samples were fixed in formaldehyde. In nutria, the brain was vascularized by the vertebral basilar system. The terminal branches of the basilar artery originated the rostral cerebellar, caudal cerebral, rostral choroidal and middle cerebral arteries, and its terminal branch, the rostral cerebral artery. The terminal branch of the basilar artery projected the caudal cerebral artery, which is usually a single medium-caliber vessel, into the transverse fissure of the brain. The caudal cerebral artery was presented as a single (66.7% of the cases to the right and 76.7% to the left) and double vessel (33.3% of the cases to the right and 23.3% to the left). It originated the rostral mesencephalic artery, the proximal component, and the caudal inter-hemispheric artery. The terminal branches of the rostral and caudal tectal mesencephalic arteries formed a typical anastomotic network. The caudal inter-hemispheric artery emitted central branches, the caudal choroidal artery, hemispherical occipital arteries, rostral tectal mesencephalic branches and distal components, and anastomosed "in osculum" with the terminal branches of the rostral inter-hemispheric artery. The caudal choroidal artery anastomosed with the rostral choroidal artery, where it branched out on the thalamic mass, vascularizing all diencephalic structures and the hippocampus. The caudal cerebral artery and its terminal branches anastomosed with the terminal branches of the rostral and middle cerebral arteries in a restricted region of the caudal pole of the cerebral hemisphere. The vascularization area of the caudal cerebral artery and its central branches in the paleopallial of the piriform lobe is extremely restricted, caudomedially.(AU)


A nutria (Myocastor coypus) é um roedor semi-aquático de tamanho mediano, apreciado na indústria de peles e carne. Este trabalho tem por objetivo descrever e sistematizar a artéria cerebral caudal na superfície do cérebro em nutria, estabelecendo um modelo padrão e suas principais variações e territórios nesta espécie. Os trinta animais utilizados foram eutanasiados segundo as regras de bem-estar animal, os vasos foram preenchidos com látex, corado em vermelho e as peças foram fixadas em formoldeído. O cérebro foi vascularizado exclusivamente pelo sistema vértebro-basilar. Os ramos terminais da artéria basilar originaram as artérias cerebelar rostral, cerebral caudal, corióidea rostral, cerebral média e seu ramo terminal, a artéria cerebral rostral. O ramo terminal da artéria basilar lançou a artéria cerebral caudal, um vaso normalmente único, de médio calibre, para o interior da fissura transversa do cérebro. A artéria cerebral caudal foi um vaso único em 66,7% à direita e em 76,7% à esquerda e mostrou-se dupla em 33,3% à direita e em 23,3% à esquerda. Ela lançou a artéria tectal mesencefálica rostral, componente proximal e a artéria inter-hemisférica caudal. Os ramos terminais das artérias tectais mesencefálicas, rostral e caudal, formavam uma rede anastomótica típica. A artéria inter-hemisférica caudal lançou ramos centrais, a artéria corióidea caudal, as artérias hemisféricas occipitais, os ramos tectais mesencefálicos rostrais, componentes distais e anastomosou-se "em ósculo" com o ramo terminal da artéria inter-hemisférica rostral. A artéria corióidea caudal anastomosava-se com a artéria corióidea rostral, onde ramificavam-se sobre a massa talâmica, vascularizando todas as estruturas do diencéfalo e hipocampo. A artéria cerebral caudal com seus ramos terminais apresenta anastomoses com os ramos terminais das artérias cerebrais rostral e média em uma região restrita do pólo caudal do hemisfério cerebral. A área de vascularização da artéria cerebral caudal com seus ramos centrais no páleo-palio do lobo piriforme é extremamente restrita, caudo-medialmente ao mesmo.(AU)


Subject(s)
Animals , Otters/anatomy & histology , Basilar Artery/anatomy & histology , Cerebral Arteries/anatomy & histology
5.
Clinics ; 75: e1212, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055876

ABSTRACT

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.


Subject(s)
Humans , Basilar Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imaging , Ultrasonography, Doppler, Transcranial/methods , Magnetic Resonance Angiography , Blood Flow Velocity , Microcirculation
6.
Rev. costarric. cardiol ; 21(1): 23-27, ene.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1042860

ABSTRACT

Resumen Los eventos cerebrovasculares afectan el territorio de la circulación posterior pueden tener un comportamiento benigno,sin embargo, la oclusión de la arteria basilar suele tener consecuencias devastadoras. El uso de trombolísis sistémica ointra-arterial y la terapia endovascular son opciones terapéuticas con recuperación funcional apropiada. Se reportan doscasos de trombosis arterial basilar cuyo diagnóstico temprano permitió un manejo combinado entre embolectomía endovasculary trombólisis con resultados adecuados.


Abstract Stroke of the posterior cerebral circulation may have a benign course but basilar artery thrombosis usually have devastating consequences. Systemic thrombolysis and endovascular treatment are promising options with appropriate functional outcomes. We report two cases of basilar artery thrombosis in which early diagnosis and treatment with endovascular embolectomy and thrombolysis showed good results.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thrombosis , Basilar Artery , Vertebrobasilar Insufficiency , Thrombolytic Therapy , Costa Rica
7.
Rev. méd. Chile ; 146(11): 1356-1360, nov. 2018. graf
Article in Spanish | LILACS | ID: biblio-985711

ABSTRACT

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.


Subject(s)
Humans , Female , Aged, 80 and over , Giant Cell Arteritis/diagnostic imaging , Basilar Artery/diagnostic imaging , Vertebral Artery/diagnostic imaging , Oculomotor Nerve Diseases/diagnostic imaging , Brain Ischemia/diagnostic imaging , Oculomotor Nerve/diagnostic imaging , Temporal Arteries/diagnostic imaging , Giant Cell Arteritis/etiology , Giant Cell Arteritis/pathology , Basilar Artery/pathology , Vertebral Artery/pathology , Magnetic Resonance Imaging/methods , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve Diseases/pathology , Brain Ischemia/etiology , Brain Ischemia/pathology , Ultrasonography, Doppler/methods , Oculomotor Nerve/pathology
8.
Int. j. morphol ; 36(2): 544-550, jun. 2018. tab, graf
Article in English | LILACS | ID: biblio-954152

ABSTRACT

Geometric features of vertebrobasilar system influence occurrence of posterior circulation atherosclerosis, aneurysms, stroke and neuroradiological procedures. These features show ethnic variation, but data from black Africans in Sub Saharan Africa are scarce. This study aimed to describe geometric features of vertebrobasilar system in a black Kenyan population. It was a descriptive cadaveric study at Department of Human Anatomy, University of Nairobi. One hundred and seventy three formalin-fixed adult brains of individuals (99 male; 74 female; Age range 20 - 79) who had died of non cerebrovascular causes were studied. Level and angle of confluence of vertebral artery; diameter, length and bifurcation angles of basilar artery were measured. Data were analysed by SPSS version 21 for windows. The student t - test was used to determine the sex differences at 95 % confidence interval. Data are presented in macrographs, tables and bar charts. Confluence of vertebral arteries occurred at the sulcus bulbopontinus in 79.8 %; rostral to it in 11.5 % and caudal to it in 8.7 % of cases. Mean angle of vertebral artery confluence was 46.7º and 68.9º in males and females respectively (p£0.042). Mean length of the basilar artery was 26.8 mm; 26.3 mm in males and 27.1 mm in females (p=0.465). Mean diameter was 3.52 mm; 3.32 mm in males and 3.72 mm in females (p=0.002). The mean angle of basilar artery bifurcation was 120.3º ± 15.2; 99.3º ± 32.9 in males and 140.3º ± 16.1 in females (p=0.024). It was wider than 90º in 82.9 % of males and 95.9 % females (p=0.032). In 85 (49.1 %) it was wider than 120º. The vertebrobasilar system in the Kenyan population has geometric features that constitute risk factors for atherosclerosis. These features display sex dimorphism which may explain differences in prevalence of atherosclerosis and aneurysms. Neurosurgeons and neurologists should be aware of these differences. Individuals with risk prone geometric features should be followed up for atherosclerosis.


Las características geométricas del sistema vertebrobasilar influyen en la aparición de aterosclerosis en la circulación posterior, aneurismas, apoplejía, detectados durante procedimientos neurorradiológicos. Estas características muestran variación étnica, pero los datos de los africanos negros en el África Subsahariana son escasos. Este estudio tuvo como objetivo describir las características geométricas del sistema vertebrobasilar en una población negra de Kenia. Fue un estudio descriptivo cadavérico en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se estudiaron 173 cerebros adultos (99 varones, 74 mujeres, rango de edad 20-79), fijados en formalina, de individuos que habían fallecido por causas no cerebrovasculares. Se midieron el nivel y ángulo de confluencia de la arteria vertebral, diámetro, longitud y bifurcación de la arteria basilar. Los datos fueron analizados por SPSS versión 21 para Windows. La prueba t de Student se utilizó para determinar las diferencias de sexo con un intervalo de confianza del 95 %. Los datos se presentan en macrografías, tablas y gráficos de barras. La confluencia de las arterias vertebrales se produjo en el surco bulbopontino en el 79,8 %; rostral al surco en 11,5 % y caudal al surco en 8,7 % de los casos. El ángulo medio de la confluencia de la arteria vertebral fue 46,70 y 68,90 en hombres y mujeres, respectivamente (p£0,042). La longitud media de la arteria basilar fue de 26,8 mm; 26,3 mm en hombres y 27,1 mm en mujeres (p=0,465). El diámetro promedio fue de 3,52 mm; 3,32 mm en hombres y 3,72 mm en mujeres (p=0,002). El ángulo medio de la bifurcación de la arteria basilar fue de 120,30 ± 15,2; 99.30 ± 32,9 en hombres y 140,30 ± 16,1en mujeres (p=0,024). Era más amplio que 90º. En un 82,9 % de los hombres y 95,9 % de las mujeres (p=0,032) se observó un ángulo más amplio que 90°. En 85 (49,1 %) fue más amplio que 120°. El sistema vertebrobasilar en la población de Kenia tiene características geométricas que constituyen factores de riesgo para la aterosclerosis. Estas características muestran dimorfismo sexual que puede explicar las diferencias en la prevalencia de aterosclerosis y aneurismas. Los neurocirujanos y los neurólogos deben tener en cuenta estas diferencias. Las personas con características geométricas propensas al riesgo deben ser seguidas por aterosclerosis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Basilar Artery/anatomy & histology , Vertebral Artery/anatomy & histology , Sex Characteristics , African Continental Ancestry Group , Kenya
9.
Arq. neuropsiquiatr ; 76(5): 355-357, May 2018.
Article in English | LILACS | ID: biblio-950542

ABSTRACT

ABSTRACT Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.


RESUMO O acidente vascular cerebral isquêmico secundário à oclusão aguda da basilar (OAB) é uma condição relativamente rara, que cursa com elevada morbimortalidade. Até o momento atual, a melhor estratégia de recanalização arterial na fase aguda da OAB não está definida, principalmente pela carência de ensaios clínicos randomizados e controlados neste contexto. Neste artigo, revisamos aspectos históricos do diagnóstico e do tratamento desta condição, assim como o impacto do avanço tecnológico na evolução clínica e prognóstico desta condição. Ademais, descrevemos fatos históricos e a literatura fictícia relacionados à OAB. Concluímos que a OAB é um exemplo peculiar de como a arte pode auxiliar a medicina na descrição acurada de condições médicas.


Subject(s)
Humans , History, 19th Century , History, 20th Century , Arterial Occlusive Diseases/history , Basilar Artery , Medicine in Literature
10.
Acta neurol. colomb ; 34(3): 199-203, sep.2018. graf
Article in Spanish | LILACS | ID: biblio-983720

ABSTRACT

RESUMEN INTRODUCCIÓN: Los aneurismas disecantes de la arteria basilar tienen un curso clínico impredecible que, eventualmente, evoluciona a un accidente cerebrovascular hemorrágico o isquémico grave. Por otro lado, su abordaje terapéutico es controvertido y no existen líneas claras de tratamiento. CASO CLÍNICO: Presentamos el caso de una mujer de 28 años con un infarto del tallo cerebral secundario a aneurisma disecante de la arteria basilar, tratado exitosamente con dispositivo endoluminal redireccionador de flujo (FRED). CONCLUSIÓN: El tratamiento endovascular con FRED de los aneurismas disecantes parece ofrecer ventajas sobre las técnicas quirúrgicas abiertas y stents tradicionales, en casos seleccionados.


SUMMARY INTRODUCTION. Dissecting basilar artery aneurysms have an unpredictable course, eventually evolving to serious hemorrhagic or ischemic stroke; on the other hand, its therapeutic approach in controversial and there are no clear lines of treatment. CASE REPORT. We report a case of a 28-year-old female with brain stem infarction secondary to basilar dissecting aneurysm successfully treated by Flow-Redirection Endoluminal Device (FRED). CONCLUSION. Endovascular treatment of dissecting basilar artery aneurysms with FRED seems to offer advantages over traditional open surgical techniques and conventional stents in selected cases.


Subject(s)
Basilar Artery , Angiography , Stents , Dissection , Aneurysm
11.
Article in English | WPRIM | ID: wpr-788672

ABSTRACT

OBJECTIVE: Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them.METHODS: From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively. Detailed case-by-case analysis was performed based on preoperative, postoperative and follow-up radiologic examinations and operative findings. All clinical variables including age, sex, aneurysm size and location, type and number of applied clips, prognosis, and time to recurrence are evaluated. All patients are classified by causes of the recurrence. Possible risk factors that could contribute to those causes and overcoming ways are comprehensively discussed.RESULTS: All recurrent aneurysms after surgical clipping were 14 of 2364 (0.5%). Three cases were males and 11 cases were females. Mean age was 52.3. At first treatment, nine cases were ruptured aneurysms, four cases were unruptured aneurysms, and one case was unknown. Locations of recurrent aneurysm were determined; anterior communicating artery (A-com) (n=7), posterior communicating artery (P-com) (n=3), middle cerebral artery (n=2), anterior cerebral artery (n=1) and basilar artery (n=1). As treatment of the recurrence, 11 cases were treated by surgical clipping and three cases were treated by endovascular coil embolization. Three cases of all 14 cases occurred in a month after the initial treatment. Eleven cases occurred after a longer interval, and three of them occurred after 15 years. By analyzing radiographs and operative findings, several main causes of the recurrent cerebral aneurysm were found. One case was incomplete clipping, five cases were clip slippage, and eight cases were fragility of vessel wall near the clip edge.CONCLUSION: This study revealed main causes of the recurrent aneurysm and contributing risk factors to be controlled. To manage those risk factors and ultimately prevent the recurrent aneurysm, neurosurgeons have to be careful in the technical aspect during surgery for a complete clipping without a slippage. Even in a perfect surgery, an aneurysm may recur at the clip site due to a hemodynamic change over years. Therefore, all patients must be followed up by imaging for a long period of time.


Subject(s)
Aneurysm , Aneurysm, Ruptured , Anterior Cerebral Artery , Arteries , Basilar Artery , Embolization, Therapeutic , Female , Follow-Up Studies , Hemodynamics , Humans , Intracranial Aneurysm , Male , Medical Records , Middle Cerebral Artery , Neurosurgeons , Prognosis , Recurrence , Retrospective Studies , Risk Factors , Surgical Instruments
12.
Neurointervention ; : 129-132, 2018.
Article in English | WPRIM | ID: wpr-730253

ABSTRACT

A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained. The intravascular imaging demonstrated that the flow diverter had good wall apposition and concentric neointimal growth over the braid with exception to the areas that the PED was not in contact with the endothelial wall, such as at the right PICA ostium and at the vertebrobasilar junction. The entire procedure was safe, and the patient had no complications. In this article, we describe for the first time the assessment of the status of endothelial “healing” of the PED shield at 8-weeks.


Subject(s)
Aneurysm , Basilar Artery , Cerebral Arteries , Female , Follow-Up Studies , Humans , Middle Aged , Pica , Retreatment , Tomography, Optical Coherence , Vertebral Artery
13.
Article in English | WPRIM | ID: wpr-765242

ABSTRACT

OBJECTIVE: Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. METHODS: From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively. Detailed case-by-case analysis was performed based on preoperative, postoperative and follow-up radiologic examinations and operative findings. All clinical variables including age, sex, aneurysm size and location, type and number of applied clips, prognosis, and time to recurrence are evaluated. All patients are classified by causes of the recurrence. Possible risk factors that could contribute to those causes and overcoming ways are comprehensively discussed. RESULTS: All recurrent aneurysms after surgical clipping were 14 of 2364 (0.5%). Three cases were males and 11 cases were females. Mean age was 52.3. At first treatment, nine cases were ruptured aneurysms, four cases were unruptured aneurysms, and one case was unknown. Locations of recurrent aneurysm were determined; anterior communicating artery (A-com) (n=7), posterior communicating artery (P-com) (n=3), middle cerebral artery (n=2), anterior cerebral artery (n=1) and basilar artery (n=1). As treatment of the recurrence, 11 cases were treated by surgical clipping and three cases were treated by endovascular coil embolization. Three cases of all 14 cases occurred in a month after the initial treatment. Eleven cases occurred after a longer interval, and three of them occurred after 15 years. By analyzing radiographs and operative findings, several main causes of the recurrent cerebral aneurysm were found. One case was incomplete clipping, five cases were clip slippage, and eight cases were fragility of vessel wall near the clip edge. CONCLUSION: This study revealed main causes of the recurrent aneurysm and contributing risk factors to be controlled. To manage those risk factors and ultimately prevent the recurrent aneurysm, neurosurgeons have to be careful in the technical aspect during surgery for a complete clipping without a slippage. Even in a perfect surgery, an aneurysm may recur at the clip site due to a hemodynamic change over years. Therefore, all patients must be followed up by imaging for a long period of time.


Subject(s)
Aneurysm , Aneurysm, Ruptured , Anterior Cerebral Artery , Arteries , Basilar Artery , Embolization, Therapeutic , Female , Follow-Up Studies , Hemodynamics , Humans , Intracranial Aneurysm , Male , Medical Records , Middle Cerebral Artery , Neurosurgeons , Prognosis , Recurrence , Retrospective Studies , Risk Factors , Surgical Instruments
14.
Article in Korean | WPRIM | ID: wpr-766634

ABSTRACT

Multiple large-vessel occlusive stroke is rare in clinical practice, and its prognosis is usually poor. A 58-year-old female with atrial fibrillation experienced left hemiparesis and drowsy mentality, and was diagnosed with ischemic stroke due to acute occlusion of right carotid and basilar artery. Successful mechanical thrombectomy was performed for both occlusions with clot aspiration technique, and favorable outcome was achieved at 3-month. Endovascular revascularization therapy in acute occlusion of multiple large vessels seems feasible when favorable outcome can be expected.


Subject(s)
Atrial Fibrillation , Basilar Artery , Carotid Artery, Internal , Female , Humans , Middle Aged , Paresis , Prognosis , Stroke , Thrombectomy
15.
Journal of Stroke ; : 92-98, 2018.
Article in English | WPRIM | ID: wpr-740606

ABSTRACT

BACKGROUND AND PURPOSE: Subclinical atherosclerotic plaques are common in patients with pontine infarctions (PIs) but without basilar artery (BA) stenosis. We hypothesized that BA plaque locations may differ by PI type and vertical location as well as vertebrobasilar artery geometry. METHODS: Ninety-six patients with PI but without BA stenosis on magnetic resonance imaging (MRI) and magnetic resonance angiography were enrolled. PIs were classified by type (paramedian, deep, or lateral) and vertical location (rostral, middle, or caudal). Patients underwent high-resolution MRI to evaluate BA plaque location (anterior, posterior, or lateral). The mid-BA angle on anteroposterior view and angle between the BA and dominant vertebral artery (BA-VA angle) on lateral view were measured. RESULTS: The PIs were paramedian (72.9%), deep (17.7%), and lateral (9.4%) type with a rostral (32.3%), middle (42.7%), and caudal (25.0%) vertical location. The BA plaque locations differed by PI type (P=0.03) and vertical location (P < 0.001); BA plaques were most frequent at the posterior wall in paramedian (37.1%) and caudal (58.3%) PIs and at the lateral wall in lateral (55.5%) and middle (34.1%) PIs. The BA-VA and mid-BA angles differed by BA plaque and PI vertical location; the greatest BA-VA angle was observed in patients with posterior plaques (P < 0.001) and caudal PIs (P<0.001). Greatest mid-BA angles were observed with lateral BA plaques (P=0.03) and middlelocated PIs (P=0.03). CONCLUSIONS: Greater mid-BA angulation may enhance lateral plaque formation, causing lateral and middle PIs, whereas greater BA-VA angulation may enhance posterior plaque formation, causing paramedian or caudal PIs.


Subject(s)
Arteries , Basilar Artery , Brain Stem Infarctions , Constriction, Pathologic , Hemodynamics , Humans , Infarction , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Plaque, Atherosclerotic , Vertebral Artery
16.
Journal of Stroke ; : 342-349, 2018.
Article in English | WPRIM | ID: wpr-717271

ABSTRACT

BACKGROUND AND PURPOSE: Vasa vasorum (VV) have been believed to be rare or non-existent in small-caliber intracranial arteries. In a series of human cerebral artery specimens, we identified and examined the distribution of VV in association with co-existing intracranial atherosclerosis. METHODS: We obtained cerebral artery specimens from 32 consecutive autopsies of subjects aged 45 years or above. We scrutinized middle cerebral artery (MCA), vertebral artery (VA), and basilar artery (BA) for the presence of adventitial VV. We described the distribution of VV, and the characteristics of co-existing atherosclerotic lesions. RESULTS: Among 157 intracranial arteries, adventitial VV were present in 74 of the 157 specimens (47%), involving MCA (n=13, 18%), BA (n=14, 19%), and VA (n=47, 64%). Although qualitatively these 74 adventitial VV distributed similarly in arteries with or without atherosclerotic lesions (disease-free arteries n=4/8; arteries of pre-atherosclerosis n=17/42; and arteries of progressive atherosclerosis n=53/107), the presence of adventitial VV in intracranial VA was associated with a heavier plaque load (1.72±1.66 mm2 vs. 0.40±0.32 mm2, P < 0.001), severer luminal stenosis (25%±21% vs. 12%±9%, P=0.002), higher rate of concentric lesions (79% vs. 36%, P=0.002), and denser intraplaque calcification (44% vs. 0%, P=0.003). Histologically, intracranial VA with VV had a larger diameter (3.40±0.79 mm vs. 2.34±0.58 mm, P < 0.001), thicker arterial wall (0.31±0.13 mm vs. 0.23±0.06 mm, P=0.002), and a larger intima-media (0.19±0.09 mm vs. 0.13± 0.04 mm, P=0.003) than VA without VV. CONCLUSIONS: Our study demonstrated the distribution of adventitial VV within brain vasculature and association between vertebral VV and progressive atherosclerotic lesions with a heavier plaque load and denser intraplaque calcification.


Subject(s)
Arteries , Atherosclerosis , Autopsy , Basilar Artery , Brain , Cerebral Arteries , Constriction, Pathologic , Humans , Intracranial Arteriosclerosis , Middle Cerebral Artery , Phenobarbital , Vasa Vasorum , Vertebral Artery
17.
Article in English | WPRIM | ID: wpr-717044

ABSTRACT

OBJECTIVE: Protocols for posterior circulation ischemic stroke have not been established by randomized clinical trials. Mechanical endovascular thrombectomy (MET) devices are evolving, and many of these devices already developed or in development are suitable for posterior circulation MET. MATERIALS AND METHODS: We investigated the medical records of patients who underwent MET for posterior circulation ischemic stroke from January 2012 to August 2016. Fifteen patients were included. MET was performed in patients with or without injected intravenous tissue plasminogen activator. MET was considered in patients with a National Institute of Health Stroke Scale score of 4 or more, older than 18 years, with definite occlusion of the basilar artery or posterior cerebral artery (PCA), and who arrived at the hospital within 24 hours from onset. RESULTS: The direct catheter aspiration technique was used in five cases, and the stent retrieval technique was used in seven cases. The stent retrieval technique with the direct aspiration technique was used in three cases. Recanalization failed in two cases. Basilar occlusion without PCA involvement is the only effective factor of successful recanalization (p = 0.03). Successful recanalization (p = 0.005) and the presence of a posterior communicating artery (p = 0.005) affected the good outcome at discharge. CONCLUSION: An early diagnosis and active MET may improve the patient outcome. MET may help recanalization and good flow restoration and the potential for a good outcome.


Subject(s)
Arteries , Basilar Artery , Catheters , Early Diagnosis , Humans , Medical Records , Passive Cutaneous Anaphylaxis , Posterior Cerebral Artery , Stents , Stroke , Thrombectomy , Tissue Plasminogen Activator
18.
Acta neurol. colomb ; 33(4): 260-266, oct.-dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-886457

ABSTRACT

RESUMEN INTRODUCCIÓN: El 10 % de los ictus afecta la circulación posterior, tiene una importante repercusión neurológica y llegan a comprometer la vida. El manejo inicial de estos pacientes incluye la trombolisis farmacológica y mecánica para reestablecer el flujo de la irrigación de estructuras vitales como el mesencéfalo y las estructuras del puente. METODOLOGÍA: Se presenta el caso de un paciente de 81 años que presentó inestabilidad de la marcha con hemianopsia izquierda. Se documentó en angiotomografía la oclusión de la arterial basilar, arterial vertebral izquierda y la estenosis crítica de arteria vertebral derecha. Debido a que la cateterización de las arterias vertebrales no era posible, se decidió acceder a la arteria basilar a través de la arteria comunicante posterior. RESULTADOS: Se realizó una adecuada revascularización de la arteria basilar, comprobada por arteriografía. Sin embargo, 12 horas después, el paciente presentó reoclusión de territorio basilar que provocó muerte cerebral. CONCLUSIÓN: Los pacientes con difícil cateterización de circulación posterior por oclusión o estenosis crítica proximal del territorio posterior, con patencia y permeabilidad del polígono de Willis, serían candidatos a este tipo de procedimiento, se deben realizar más estudios con pacientes que presenten condiciones similares para optimizar su desenlace neurológico posterior a ictus en territorio de estructuras vitales.


SUMMARY INTRODUCTION: 10% of the strokes affect the posterior circulation, with important neurological deficit and they may compromise the life. Initial management of these patients includes pharmacological thrombolysis and mechanical thrombectomy to re-establish the flow of irrigation from vital structures such as the midbrain and brainstem. METHOD: We present the case of an 81-year-old patient, with unsteady gait with left hemianopsia. Basilar and left vertebral artery occlusion were demonstrated by angiotomography, and critical right vertebral artery stenosis. Due a catheterization of the vertebral arteries was not possible, Basilar artery access through a posterior communicating artery was performed. RESULTS: Adequate revascularization of the basilar artery was performed, by angiography. However, 12 hours later, the patient presented the re-occlusion of the basilar artery that caused brain death. CONCLUSION: Patients with occlusion or severe stenosis in posterior circulation with patency and permeability of the Willis polygon would be candidates for this type of procedure. Further studies are needed to confirm the neurological outcome after stroke in the territory of vital structures with limited vascular access.


Subject(s)
Basilar Artery , Vertebral Artery , Thrombectomy
19.
Arq. neuropsiquiatr ; 75(10): 697-702, Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-888254

ABSTRACT

ABSTRACT Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.


RESUMO Os aneurismas do topo da artéria basilar (BTAs) têm anatomia complexa tornando-os tecnicamente difíceis de serem tratados. Nós descrevemos nossos resultados cirúrgicos em BTAs. Métodos: De 2004 a 2015 (12 anos), foram tratados no Hospital do Servidor Público Estadual de São Paulo um total de 25 BTAs pequenos e 2 BTAs gigantes. Resultados: Nos 23 pacientes portadores de aneurismas direcionados anteriormente ou neutros, cem por cento dos aneurismas foram tratados (oclusão de 100% na angiografia de seguimento). Em pacientes com aneurismas direcionados posteriormente (2 pacientes), houve colo residual. Todos os pacientes submetidos ao tratamento cirúrgico de pequenos aneurismas apresentaram Glasgow Outcome Scale (GOS) tardio de 4 ou 5. Nos 2 aneurismas gigantes, houve 2 casos de mortalidade (100%). Conclusão: Em mãos experientes, o tratamento cirúrgico destas lesões pode ser realizado com taxas de sucesso bastante elevadas e baixa morbidade.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Surgical Instruments , Basilar Artery/surgery , Intracranial Aneurysm/surgery , Microsurgery/methods , Treatment Outcome , Microsurgery/instrumentation
20.
Article in English | WPRIM | ID: wpr-18761

ABSTRACT

A 29-year-old man developed sudden dysarthria and right-sided weakness 3 days before admission to hospital. He was diagnosed with parotitis in the emergency room of Soonchunhyang University Gumi Hospital. The plasma levels of homocysteine were elevated (30.48 mg/dL). A brain magnetic resonance imaging scan revealed a high signal intensity lesion in the left paramedian pons and computed tomography angiography showed a marked narrowing of the mid-basilar artery. We report a rare case of spontaneous basilar artery dissection caused by a recent infection and hyperhomocysteinemia.


Subject(s)
Adult , Angiography , Arteries , Basilar Artery , Brain Stem Infarctions , Brain Stem , Brain , Dysarthria , Emergency Service, Hospital , Homocysteine , Humans , Hyperhomocysteinemia , Magnetic Resonance Imaging , Parotitis , Plasma , Pons
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