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1.
Pesqui. vet. bras ; 40(4): 315-323, Apr. 2020. tab, ilus
Article in English | ID: biblio-1135615

ABSTRACT

We studied the arterial circle in the brain of five specimens of the Alouatta belzebul primate. The material had the arterial system perfused (water at 40°C), injected with stained latex (Neoprene 650), fixed in aqueous formaldehyde solution (10%) and dissected for vessel verification. The arterial circle of this primate is composed of two vascular systems: the vertebra-basilar and the carotid ones, which anastomose to close the arterial circuit. In the caudal portion of the arterial circle, there are the vertebral arteries and their branches: the rostral spinal artery and the caudal inferior cerebellar artery. The anastomosis of the vertebral arteries gives rise to the basilar artery. It presented an anatomical variation at the beginning of its path, forming a double basilar artery, called arterial island. In its course, it emitted branches giving rise to the rostral inferior cerebellar artery, the pontine arteries, the rostral cerebellar arteries, the satellite rostral cerebellar arteries and its terminal branch, the caudal cerebral artery, which presented itself in two segments: the pre-communicating one and post-communicating, joining the internal carotid artery and originating the caudal communicating artery. This group of arteries and anastomoses enclose the caudal portion of the arterial circle. From the right and left internal carotid arteries begins the rostral portion of the arterial circle, which consists of the right and left rostral cerebral arteries and the right and left middle cerebral arteries. The rostral cerebral arteries anastomose into a single trunk, giving rise to the interhemispheric artery, and in A. belzebul and Sapajus libidinosus, the rostral communicating artery is absent. The interhemispheric artery goes to the midbrain region and the corpus callosum knee divides into pericalous artery and callosarginal artery, which will supply the pre and post-central regions of the cerebral hemispheres of this species, as well as other non-human and human primates. It is noted that in the first part of the left rostral cerebral artery, there is a direct inosculation between the recurrent branch of the rostral cerebral artery and left middle cerebral artery to supply the entorhinal region. This fact also occurs in Pongo spp. The middle cerebral artery travels along the lateral sulcus where it emits several superficial branches to irrigate the superior and inferior lateral cortical regions of the frontal, parietal and temporal lobes. It is not part of the arterial circle but is the terminal branch of the internal carotid artery. A. belzebul can be considered to depend on two sources of supply to the brain: the vertebra-basilar and carotid systems, contributing to the intervention of veterinarians during clinical and surgical procedures in other primates, as well as the preservation of wild animals.(AU)


Estudamos o círculo arterial no encéfalo de cinco espécimes do primata Alouatta belzebul. O material teve o sistema arterial perfundido (água a 40°C), injetado com látex corado (Neoprene 650), fixado em solução aquosa de formaldeído (10%) e dissecado para verificação dos vasos. O círculo arterial deste primata é composto por dois sistemas vasculares: vértebro-basilar e o sistema carotídeo, que se anastomosam para fechar o circuito arterial. Na porção caudal do círculo arterial encontra-se as artérias vertebrais e seus ramos: artéria espinal rostral e a cerebelar inferior caudal. A anastomose das artérias vertebrais dá origem a artéria basilar. Esta apresentou uma variação anatômica no início do seu trajeto, formando uma dupla artéria basilar, denominada ilha arterial. Em seu trajeto emitiu ramos dando origem a artéria cerebelar inferior rostral, as artérias pontinas, as artérias cerebelares rostrais, as artérias cerebelares rostrais satélites e o seu ramo terminal, a artéria cerebral caudal, que apresentou-se em dois segmentos: o pré-comunicante e pós-comunicante, unindo-se a artéria carótida interna e originando a artéria comunicante caudal. Este grupo de artérias e anastomoses encerram a porção caudal do círculo arterial. Das artérias carótidas internas direita e esquerda, inicia-se a porção rostral do círculo arterial, ao qual é constituído pelas artérias cerebrais rostrais direita e esquerda e as artérias cerebrais médias direita e esquerda. As artérias cerebrais rostrais se anastomosam em um tronco único dando origem a artéria inter-hemisférica e em A. belzebul e Sapajus libidinosus, a artéria comunicante rostral se encontra ausente. A artéria inter-hemisférica segue para região média do encéfalo e no joelho do corpo caloso se divide em artéria pericalosa e artéria calosomarginal, que vão suprir as regiões pré e pós-central dos hemisférios cerebrais desta espécie, assim como outros primatas não humanos e humano. Nota-se que na primeira parte da artéria cerebral rostral esquerda, ocorre uma inosculação direta entre o ramo recorrente da artéria cerebral rostral e artéria cerebral média esquerda para suprir a região entorrinal, esse fato também ocorre em Pongo spp. A artéria cerebral média segue seu trajeto pelo sulco lateral onde emite vários ramos superficiais para irrigar as regiões corticais supero e ínfero lateral do lobo frontal, parietal e temporal, esta não faz parte do círculo arterial mas é o ramo terminal da artéria carótida interna. Pode-se considerar que A. belzebul depende de duas fontes de suprimento para o encéfalo: os sistemas vértebro-basilar e carotídeo, contribuindo na intervenção de médicos veterinários durante os procedimentos clínicos e cirúrgicos em outros primatas, assim como na preservação de animais silvestres.(AU)


Subject(s)
Animals , Brain/blood supply , Circle of Willis/anatomy & histology , Alouatta/anatomy & histology
2.
Int. j. morphol ; 37(3): 1095-1100, Sept. 2019. graf
Article in English | LILACS | ID: biblio-1012402

ABSTRACT

This study investigated the anatomy of the arteries of the brain, including the arterial circle of the brain, its branches and junctions, in five camel (Camelus dromedarius, Linnaeus 1758) following intravascular injection of colored latex via common carotid artery. The course and distribution of the arterial supply to the brain was described and morphological analysis was made. The basilar artery contributed to the blood supply of the brain in the camel in contrast to the situation in other Artiodactyla order.


En presente estudio se analizó la anatomía de las arterias del encéfalo en cinco camellos (Camelus dromedarius, Linnaeus 1758). Después de administrar una inyección intravascular de látex coloreado en la arteria carótida común se estudiaron las arterias incluyendo al círculo arterial del cerebro, sus ramas y uniones. Fueron descritos en detalle el curso y la distribución del suministro arterial al encéfalo y se realizó un análisis morfológico. La arteria basilar contribuyó al suministro de sangre del encéfalo del camello, diferenciando este aspecto en otras especies de Artiodactyla.


Subject(s)
Animals , Brain/blood supply , Camelus/anatomy & histology , Circle of Willis/anatomy & histology , Cerebral Arteries/anatomy & histology
3.
Arq. bras. neurocir ; 37(02): 154-156, 24/07/2018.
Article in English | LILACS | ID: biblio-912286

ABSTRACT

Inadvertent occlusion of a fetal-type posterior communicating artery in aneurysm surgery could result in posterior circulation infarction and neurological morbidity. The case of a patient with an unruptured posterior communicating artery aneurysm with lateral projection and a fetal-type posterior communicating artery is presented. The utility of the carotid-oculomotor window as a surgical corridor to safely find the fetaltype posterior communicating artery is discussed.


A oclusão da artéria comunicante posterior do tipo fetal em cirurgia de aneurisma pode resultar em infarto da circulação posterior e morbidade neurológica. Apresentamos o caso de um paciente com aneurisma não roto da artéria comunicante posterior com projeção lateral e uma artéria comunicante posterior do tipo fetal. Discutimos a utilidade da janela carótida-oculomotora como um corredor cirúrgico para encontrar com segurança a artéria comunicante posterior do tipo fetal.


Subject(s)
Humans , Female , Aged , Intracranial Aneurysm/surgery , Circle of Willis/surgery , Microsurgery
4.
Article in English | WPRIM | ID: wpr-758834

ABSTRACT

In Mongolian gerbils, bilateral common carotid artery occlusion (BCCAO) for several minutes induces ischemia, due to an incomplete circle of Willis, resulting in delayed neuronal cell death in the Cornet d'Ammon 1 (CA1) region of the hippocampus. Neuronal cell death in the hippocampus and changes in behavior were examined after BCCAO was performed for 5 min in the gerbils. One day after BCCAO, the pyramidal neurons of the CA1 region of the hippocampus showed degenerative changes (clumped chromatin in nuclei). At 5 and 10 days after BCCAO, extensive neuronal cell death was observed in the hippocampal CA1 region. Cognitive performance was evaluated by using the radial maze and passive avoidance tests. In the radial maze test, which examines win-stay performance, the number of errors was significantly higher in ischemic gerbils than in sham-operated gerbils on days 1 and 2 post-operation. In the passive avoidance test, the latency and freezing times were significantly shorter in ischemic gerbils than in sham-operated gerbils on the days 1, 2, and 4–6 post-operation. These results indicate that transient forebrain ischemia impairs cognitive performance, even immediately after the ischemic insult when there are only subtle signs of neuronal cell death.


Subject(s)
CA1 Region, Hippocampal , Carotid Artery, Common , Cell Death , Chromatin , Circle of Willis , Freezing , Gerbillinae , Hippocampus , Ischemia , Neurons , Prosencephalon , Pyramidal Cells
5.
Rev. chil. cir ; 70(1): 35-39, 2018. tab
Article in Spanish | LILACS | ID: biblio-899653

ABSTRACT

Resumen Introducción En la endarterectomía carotídea (EC) durante el clampeo, la perfusión cerebral se mantiene por circulación contralateral a través del Polígono de Willis, que se relaciona con la presión de muñón carotídeo (PM). Si ésta es menor a 50 mmHg existe riesgo de Accidente Cerebrovascular (ACV) por hipoperfusión y está indicado uso de shunt para asegurar suficiente circulación cerebral, pero también se puede elevar transitoriamente la presión arterial sistémica haciendo innecesario el uso de shunt. Objetivo Mostrar los resultados de EC con medición de PM para evaluar la perfusión cerebral del hemisferio clampeado con manejo hemodinámico intraoperatorio minimizando el uso de shunt. Material y Métodos Estudio retrospectivo de 73 pacientes sometidos a EC bajo anestesia general con medición de PM, manejo hemodinámico intraoperatorio y uso selectivo de shunt. Se analizaron variables demográficas, clínicas y morbimortalidad perioperatoria. Resultados 73 pacientes, edad promedio 71,1 años, 69,9% sintomáticos. En 54 pacientes la PM fue superior a 50 mmHg y no se usó shunt, en 19 la PM fue menor a 50 mmHg y con manejo hemodinámico intraoperatorio se elevó en 16 que no requirieron shunt. Sólo en 3 casos la PM no alcanzó los 50 mmHg y se usó un shunt de Pruitt-Inahara. Dos pacientes sintomáticos presentaron déficit neurológico central transitorio postoperatorio y 2 pacientes fallecieron por infarto cardíaco. Conclusión La EC con medición de PM y manejo hemodinámico minimizó el uso de shunt transitorio y fue un procedimiento seguro para tratar los pacientes con estenosis carotídea con indicación quirúrgica.


Introduction During carotid endarterectomy (CEA) clamping cerebral perfusion is maintained by contralateral circulation through the Circle of Willis and it is correlated to the stump pressure (SP). If it is below 50 mmHg there is risk of stroke due to hypoperfusion and a shunt must be used, but systemic blood pressure can be temporarily elevated making the use of shunt unnecessary. Aim Results of CEA with SP measurement to evaluate cerebral perfusion in cross-clamped hemisphere and hemodynamic intraoperative management reducing the use of shunt. Material and Methods Retrospective study of CEAs performed in 73 patients under general anaesthesia with SP measurement, hemodynamic management and selective use of shunt. Demographics, clinical and perioperative morbimortality variables were analized. Results 73 patients, average age 71.1 years, 69.9% symptomatic. In 54 patients SP was above 50 mmHg and shunt was not used, in 19 SP was below 50 mmHg, it was elevated through intraoperative hemodynamic management and shunt was not needed. In only 3 cases SP did not reach 50 mmHg and a Pruitt-Inahara shunt was used. Two patients presented postoperative transient central neurological deficit and 2 died due to myocardial infarction. Conclusion CEA with SP measurement and hemodynamic management reduced the use of carotid shunting and it was a safe procedure to treat patients with severe carotid stenosis who need surgical intervention.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Blood Pressure , Monitoring, Intraoperative , Endarterectomy, Carotid , Carotid Stenosis/surgery , Carotid Stenosis/physiopathology , Postoperative Complications , Blood Pressure Determination , Arteriovenous Shunt, Surgical , Retrospective Studies , Circle of Willis/physiopathology , Treatment Outcome
7.
Int. j. morphol ; 35(3): 1121-1128, Sept. 2017. ilus
Article in English | LILACS | ID: biblio-893103

ABSTRACT

One of the most common causes of stroke is rupture of aneurysms whose approach requires knowledge of anatomical variants. The aim of this study was to determine the prevalence of anatomical variants of the anterior cerebral artery (ACA) and the anterior communicating artery (AComA) by 3D computed tomography angiography (3D CTA) in Mexican individuals. A retrospective, observational, cross-sectional descriptive study of 283 patients, independent of sex or age, in which morphometric measurements of cerebral vessels were evaluated using contrasted 3D CTA from a period of two years was performed. We found at least one "atypical" variant in a third of the study population (33.93 %). The most common "atypical" variant was the absence of the AComA (14.1 %). A significant association between the hypoplastic variant of the right A1 segment and hypoplasia of the left A1 and the right A2 was found, while hypoplasia of the left A1 was associated with hypoplasia of the right A2. There is a difference in the prevalence of anatomical variants of the ACA-AComA complex in Mexican population in relation to other populations. The typical variant is the most prevalent form in the study population. However, the presence of atypical variants represents an important number that should be taken into account in clinical and surgical procedures.


Una de las causas más frecuentes de accidente cerebrovascular es la ruptura de aneurismas cuyo abordaje requiere el conocimiento de las variantes anatómicas. El presente estudio tuvo como objetivo determinar la prevalencia de variantes anatómicas de la Arteria Cerebral Anterior (ACA) y la Arteria Comunicante Anterior (AComA) mediante angiotomografías computarizadas 3D (angioTAC 3D) de individuos mexicanos. Se realizó un estudio retrospectivo, observacional, transversal y descriptivo en el que se evaluaron angioTAC contrastados con reconstrucción 3D de 283 pacientes, sin considerar género ni edad, obtenidas durante un periodo de dos años a los que se les realizaron mediciones morfométricas en los vasos de interés. Se encontró al menos una variante "atípica" en un tercio de la población estudiada (33,93 %). La variante "atípica" más común fue la ausencia de AComA (14,1 %). Se encontró asociación significativa entre la variante hipoplásica del segmento A1 derecha y la hipoplasia de A1 izquierda y A2 derecha; mientras que la hipoplasia de A1 izquierda se asoció a la variante hipoplasia de A2 derecha, encontrándose mayor tendencia de aparición de aneurismas en función del menor diámetro del segmento A2 derecho de la ACA. Existe diferencia en la prevalencia de variantes anatómicas del complejo ACA-AComA en población mexicana con respecto a otras poblaciones. La variante típica constituye la forma más prevalente en la población estudiada. Sin embargo, la presencia de variantes atípicas representa una cifra importante que deberá tomarse en cuenta en procedimientos clínicos y quirúrgicos.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Anatomic Variation , Circle of Willis/anatomy & histology , Circle of Willis/diagnostic imaging , Multidetector Computed Tomography/methods , Cross-Sectional Studies , Image Interpretation, Computer-Assisted , Imaging, Three-Dimensional , Retrospective Studies
8.
Arq. neuropsiquiatr ; 75(7): 429-432, July 2017. tab
Article in English | LILACS | ID: biblio-888296

ABSTRACT

ABSTRACT The circle of Willis is an important collateral system that maintains perfusion to the stenotic area from the contralateral carotid and basilar artery to the region of reduced brain perfusion. The aim of the present study was to compare the circle of Willis anomaly in patients with unilateral symptomatic and asymptomatic carotid artery disease. Results In this retrospective study, we analyzed 175 patients who presented at our outpatient stroke clinic between January, 2013 and June, 2015 with either unilateral symptomatic or asymptomatic carotid artery disease, and who had had CT angiography imaging performed. Demographic properties, carotid artery stenosis and the anomaly of the circle of Willis was recorded. Conclusion There was no statistically significant difference in patients with symptomatic and asymptomatic carotid artery disease in terms of the anomaly of the circle of Willis.


RESUMO O Círculo de Willis é um importante sistema colateral que mantém a perfusão à área estenótica da carótida contralateral e da artéria basilar para a região de perfusão cerebral reduzida. O objetivo do presente estudo foi comparar a anomalia do Círculo de Willis em pacientes com doença carotídea assintomática e sintomática unilateral. Resultados Neste estudo retrospectivo, foram analisados 175 pacientes que foram à nossa clínica ambulatorial de AVC, entre janeiro de 2013 e junho de 2015, com doença carotídea assintomática ou sintomática unilateral, e que fizeram angiografia por tomografia computadorizada. Propriedades demográficas, estenose da artéria carótida e anomalia do Círculo de Willis foram registradas. Conclusão Não houve diferença estatisticamente significativa em pacientes com doença carotídea sintomática e assintomática em termos de anomalia do Círculo de Willis.


Subject(s)
Humans , Male , Female , Middle Aged , Carotid Artery Diseases/complications , Circle of Willis/abnormalities , Stroke/etiology , Carotid Artery Diseases/diagnostic imaging , Retrospective Studies , Risk Factors , Circle of Willis/diagnostic imaging , Stroke/diagnostic imaging , Computed Tomography Angiography
9.
Rev. chil. neurocir ; 42(2): 168-173, nov. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-869771

ABSTRACT

La presente revisión del tema Vasoespasmo y Déficit Isquémico Cerebral tardío (DIT) en la Hemorragia subaracnoidea aneurismática tiene como objetivo actualizar su manejo, basado en las hipótesis mas aceptadas que se han logrado para explicar su patogénesis. Se efectúa una introducción con conceptos generales, se revisan las bases patogénicas del Vasoespasmo y se plantea su manejo, tomando en cuenta su diagnóstico, monitorización, profilaxis y manejo avanzado de acuerdo a las últimas Guías de Manejo Clínico y según medicina basada en las evidencias.


The objective of the present review on cerebral vasospasm and cerebral delayed isquemic deficit due to subarachnoid haemorrhage secondary to ruptured cerebral aneurysm, is to update their management, based on the most accepted pathophysiological hypotesis explaining their pathogenetic mechanisms. An introduction is performed presenting general concepts, review of the most recent research works explaining their pathogenesis, and the management is stated touching diagnosis, monitoring, prophylaxis, and advanced management according with the last clinical guidelines for his management using medicine based on evidences.


Subject(s)
Humans , Male , Female , Aneurysm, Ruptured , Brain Ischemia , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/drug therapy , Intracranial Aneurysm , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/drug therapy , Circle of Willis/pathology , Neurophysiological Monitoring/methods , Severity of Illness Index , Tomography, Spiral Computed/methods
10.
Int. j. med. surg. sci. (Print) ; 3(3): 963-970, sept. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-1094875

ABSTRACT

El objetivo del trabajo fue escribir la técnica quirúrgica y reportar la experiencia de nuestro hospital en el uso del abordaje pterional modificado como primera elección para el clipaje de aneurismas del círculo arterial cerebral en cualquier ubicación e incluso múltiples. Realizamos un estudio retrospectivo y reportamos una serie de 37 pacientes (25 mujeres y 12 hombres) con diagnóstico de aneurismas derivados del círculo arterial cerebral de distintas ubicaciones, desde enero del 2012 hasta marzo del 2015. Se presenta la experiencia de 51 aneurismas incluidos 8 casos de aneurismas múltiples y 9 aneurismas gigantes.Todos los aneurismas fueron clipados mediante un abordaje pterional modificado. Se describieron yesquematizaron los pasos del procedimiento quirúrgico secuencialmente. Mediante este análisis se estableceque el abordaje frontotemporoesfenoidal modificado (pterional) permite el acceso quirúrgico para el clipajede estas lesiones vasculares provenientes del círculo arterial cerebral lo cual correlaciona con la evidencia previa. La descripción detallada de la técnica quirúrgica favorece una adecuada comprensión de la anatomía quirúrgica y permite la reproducción de esta técnica.


The objective of the study was to describe our surgical and technical experience by reporting a series of 51 aneurysms treated by a pterional craniotomy as a unique approach foraneurismatic lesions of the cerebral arterial circle (Willis polygon). Retrospective study that reportsa series of 37 patients (25 females and 12 males) with diagnosis of aneurismatic lesions from different localization in the Willis polygon from January 2012 to March 2015. Fifty one (51)aneurismatic lesions were treated by a unique pterional craniotomy, including 8 cases of multiple aneurismatic disease and 9 giant aneurysms. Every lesion was clipped by the same pterional modified approach. Every step of this procedure was described and illustrated sequentally. This analysis establishes that the modified fronto temporoesfenoidal (pterional) craniotomy allows surgical access to the clipping of these vascular lesions, from the circle of Willis which correlates with previous evidence. The detailed description of the surgical technique promotes a proper understanding of surgical anatomy and allows playback of this technique.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Intracranial Aneurysm/surgery , Circle of Willis/surgery , Craniotomy/methods , Retrospective Studies , Treatment Outcome
11.
Journal of Stroke ; : 179-186, 2016.
Article in English | WPRIM | ID: wpr-113530

ABSTRACT

BACKGROUND AND PURPOSE: The outcomes of acute internal carotid artery (ICA) terminus occlusions are poor. We classified ICA terminus occlusions into 2 groups according to the occlusion pattern of the circle of Willis and hypothesized that clinical outcomes would significantly differ between them. METHODS: Consecutive patients with acute ICA terminus occlusions evaluated by baseline computed tomographic angiography were enrolled. We investigated the occlusion patterns in the circle of Willis, retrospectively classified patients into simple ICA terminus occlusion (STO; with good Willisian collaterals from neighboring cerebral circulation) and complex ICA terminus occlusion (CTO; with one or more of A2 anterior cerebral artery, fetal posterior cerebral artery occlusion, or hypoplastic/absent contralateral A1; or with poor collaterals from anterior communicating artery) groups, and compared their baseline characteristics and outcomes. RESULTS: The STO group (n=58) showed smaller infarct volumes at 72 hours than the CTO group (n=34) (median, 81 mL [interquartile range, 38-192] vs. 414 mL [193-540], P<0.001) and more favorable outcomes (3-month modified Rankin Scale 0-3, 44.8% vs. 8.8%, P<0.001; 3-month mortality, 24.1% vs. 67.6%, P<0.001). In multivariable analyses, STO remained an independent predictor for favorable outcomes (odds ratio 6.1, P=0.010). CONCLUSIONS: Favorable outcomes in STO group suggested that the outcomes of acute ICA terminus occlusions depend on Willisian collateral status. Documenting the subtypes on computed tomographic angiography would help predict patient outcome.


Subject(s)
Angiography , Anterior Cerebral Artery , Carotid Artery Thrombosis , Carotid Artery, Internal , Cerebral Infarction , Circle of Willis , Collateral Circulation , Endovascular Procedures , Humans , Mortality , Posterior Cerebral Artery , Retrospective Studies
12.
Article in Korean | WPRIM | ID: wpr-10044

ABSTRACT

Moyamoya disease (MMD) is a steno-occlusive disease of the cerebral artery around the circle of Willis. It was first described in 1957 in Japan and named because the characteristic appearance of the basal collaterals in cerebral angiography looks like “a puff of smoke” (moyamoya in Japanese). MMD is one of the major causes of stroke in children worldwide, however most common in Korea, Japan and China. In 2011 the ring finger protein 213 gene (RNF213) was identified as a susceptibility gene for MMD. The RNF213 R4810K variant is an Asian founder mutation common to above nations with carrier rates of 0.5-2% of the general population but a 1/150 penetrance of clinical MMD. MMD patients in Korea and Japan harbors RNF213 R4810K variant in 70-90%. In MMD arterial stenosis was found to occur systematically, not only in the intracranial cerebral arteries but also in renal, coronary, pulmonary arteries, suggesting that MMD is a systemic vasculopathy. These extracranial vasculopathy (ECV) is rare but important as a cause of renovascular hypertension, ischemic heart disease, and pulmonary hypertension especially in children with MMD or family members of MMD. Clinical features of ECV will be reviewed in this article.


Subject(s)
Asian Continental Ancestry Group , Cerebral Angiography , Cerebral Arteries , Child , China , Circle of Willis , Constriction, Pathologic , Coronary Vessels , Fingers , Humans , Hypertension, Pulmonary , Hypertension, Renovascular , Japan , Korea , Moyamoya Disease , Myocardial Ischemia , Penetrance , Pulmonary Artery , Renal Artery , Stroke
13.
Rev. chil. neurocir ; 41(1): 59-70, jul. 2015. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-836045

ABSTRACT

Introducción: La cirugía de la hemorragia subaracnoidea aneurismática (HSA) realizada en las primeras 72 horas es beneficiosa. Cuando los casos arriban transcurrido este período el mejor momento quirúrgico es controversial. Objetivo. Evaluar la influencia sobre los resultados de la cirugía en la HSA de un protocolo para decidir el momento quirúrgico apoyado en el monitoreo con Doppler transcraneal (DTC). Material y Método: Se comparan los resultados quirúrgicos al alta y al año de seguimiento según la escala de Glasgow para resultados (EGR), en una serie de 233 casos con HSA rotos operados Enero de 2006 - Diciembre de 2010 y seguidos hasta Enero de 2012, en los que la cirugía en el período intermedio se decidió teniendo en cuenta las velocidades de flujo de los segmentos proximales del polígono de Willis registradas por DTC, con los de un grupo control histórico operado Diciembre de 1983 - Diciembre de 2005 sin la ayuda de dicho monitoreo. Resultados: La mortalidad al alta y al año en la serie de estudio fue de 4,3 y 4,5 por ciento y en el grupo control 7 y 7,7 por ciento respectivamente. Se observaron resultados satisfactorios (grados 4 y 5 en EGR) en el 93,1 al alta y 92,8 por ciento al año en la serie de estudio. Entre los controles históricos estos índices fueron 85,6 y 88,1 por ciento respectivamente (p = 0,004 y p = 0,036). Conclusiones: Los resultados del tratamiento microquirúrgico de la HSA se benefician con la atención protocolizada y la consideración de los resultados del DTC para seleccionar el momento quirúrgico.


Background: Aneurysmal subarachnoid hemorrhage (SAH) surgery, practiced in the first 72 hours is beneficial. The optimal surgical timing, for microsurgical clipping of ruptured intracranial aneurysms, remains controversial when patients arrive between 4 and 14 days. Some surgeons favor a prompt operation regardless the timing. Other ones prefer to wait 2 weeks. Most patients in developing countries are taken to neurosurgical attention late, which not permit an early surgery. Object. To evaluate the surgical outcome in a series of patients with subarachnoid hemorrhage (SAH) managed according to a dynamic protocol. Methods: The authors evaluated surgical outcome by means of Glasgow Outcome Scale (GOS) score in a series of 233 patients with SAH who received neurosurgical clipping in the years 2006-2010 and were followed until January 2012, whose surgical timing was decided according to transcranial Doppler (TD) monitoring. These outcomes were compared with results in a series of 445 historic controls operated 1983-2005. Results: Series mortality at the discharge and at the year were 4.3 and 4.5 percent, and 7 and 7.7 percent in the control group respectively. Series show good outcomes (grade 4 and grade 5 in GOS score) in 93.1 at the discharge and 92.8 percent at the year. Among the historic controls cases with good outcome were 85.6 and 88.1 percent respectively (p = 0.004 y p = 0.036). Conclusions: Surgical outcomes of SAH can be favored by the impact of protocolized attention and TD to decide the best surgical timing in SAH.


Subject(s)
Humans , Aneurysm, Ruptured , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/surgery , Subarachnoid Hemorrhage , Time Factors , Ultrasonography, Doppler, Transcranial/methods , Circle of Willis , Glasgow Outcome Scale
14.
Neurology Asia ; : 7-14, 2015.
Article in English | WPRIM | ID: wpr-628387

ABSTRACT

Objective: We investigated whether circle of Willis (COW) morphology on 3D time-of-flight (TOF) MR angiography differs between young normal subjects, older normal subjects, and patients with carotid atherosclerotic plaques. Methods: One hundred seventy-seven subjects were grouped according to age into a young group (20 – 40 years; n = 91) and an older group (> 60 years; n = 86). Subjects underwent brain MR examination as part of a health check-up. Fifty-three patients with carotid atherosclerotic plaque were also included for evaluation in this study. COW morphology on 3D TOF MR angiography was analyzed in terms of completeness or incompleteness of the anterior and posterior components of the circle and completeness of the circle. Results: An incomplete pattern of anterior circulation was significantly more common in carotid atherosclerotic plaque patients (20.7%) than normal older subjects (5.5%) (p < 0.01). A complete posterior circulation pattern was more frequent in normal young subjects (46.5%) than in normal older subjects (16.5%) or the patient group (18.9%) (p < 0.01). Of patients with carotid artery stenosis, 18.9% had a bilateral incomplete connection and were significantly more likely to have an incomplete pattern than normal young (2.3%) or normal older subjects (2.2%) (p < 0.001). Conclusion: Young, healthy subjects were significantly more likely to have a complete pattern of posterior circulation than older subjects. Patients with carotid atherosclerotic plaques were significantly more likely to have incomplete anterior circulation and an incomplete circle than young, normal subjects.


Subject(s)
Circle of Willis
15.
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
16.
Journal of Stroke ; : 320-326, 2015.
Article in English | WPRIM | ID: wpr-33653

ABSTRACT

BACKGROUND AND PURPOSE: Quantitative magnetic resonance angiography (Q-MRA) enables direct measurement of volume flow rate (VFR) of intracranial arteries. We aimed to evaluate the collateral flows in internal carotid artery (ICA) occlusion with primary collateral pathway via circle of Willis using Q-MRA, and to compare them between patients who recently developed ipsilateral symptomatic ischemia and those who did not. METHODS: Between 2012 and 2014, 505 patients underwent Q-MRA in our institution. Among these, 33 patients who had unilateral ICA occlusion with primary collateral pathway were identified, and grouped into asymptomatic patients, stable patients with chronic infarction, and symptomatic patients with acute/subacute infarction. Mean VFR (mVFR) in intracranial arteries was measured and compared between the patients' groups. Kruskal-Wallis test was used for statistical analysis. RESULTS: Six patients were asymptomatic, fifteen with chronic infarction were stable, and twelve with acute/subacute infarction were symptomatic. The mVFR of ipsilateral middle cerebral artery in symptomatic patients was significantly lower than those in stable or asymptomatic patients (73.7+/-45.6 mL/min vs. 119.9+/-36.1 mL/min vs. 121.8+/-42.0 mL/min; P = 0.04). Total sum of the mVFR of ipsilateral anterior, middle, and posterior cerebral arteries was significantly lower in symptomatic patients than those in other groups (229.3 +/- 51.3 mL/min vs. 282.0+/-68.6 mL/min vs. 314.0+/-44.4 mL/min; P = 0.02). CONCLUSIONS: Q-MRA could be helpful to demonstrate the difference in the degree of primary collateral flow in ICA occlusion between the patients with recent symptomatic ischemia and those without.


Subject(s)
Arteries , Carotid Artery, Internal , Circle of Willis , Collateral Circulation , Humans , Infarction , Ischemia , Magnetic Resonance Angiography , Middle Cerebral Artery , Posterior Cerebral Artery
17.
Article in English | WPRIM | ID: wpr-101626

ABSTRACT

Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of the circle of Willis and collateral vessel formation at the base of the brain. Although relationships between Graves' disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence of the two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patients with thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya disease associated with Graves' disease who presented with episodic right-sided hemiparesis and syncope. These two girls who had Graves' disease had no history of other diseases or head trauma. A thyroid function test revealed a euthyroid state and a high thyroid-stimulating hormone (TSH) receptor antibody titer at that time. The patients were diagnosed with Moyamoya disease based on brain magnetic resonance angiography and cerebral four-vessel angiography. The patients underwent cranial revascularization by encephalo-duroarterio-synangiosis as soon as a diagnosis was made, which resulted in successful symptom resolution. They fared well and had no additional neurological symptoms as of their last follow-up visits. Here, we report these two cases of confirmed Moyamoya disease complicated by Graves' disease with a review of the literature, and discuss the possible association between the two diseases. To our knowledge, this is the first report in South Korea on Moyamoya disease associated with Graves' disease in adolescents with a euthyroid.


Subject(s)
Adolescent , Angiography , Brain , Circle of Willis , Craniocerebral Trauma , Diagnosis , Female , Follow-Up Studies , Graves Disease , Humans , Hyperthyroidism , Korea , Magnetic Resonance Angiography , Moyamoya Disease , Paresis , Stroke , Syncope , Thyroid Function Tests , Thyrotoxicosis , Thyrotropin
18.
Article in English | WPRIM | ID: wpr-55945

ABSTRACT

OBJECTIVE: Cerebral aneurysms (CAs) and abdominal aortic aneurysms (AAAs) are degenerative vascular pathologies that manifest as abnormal dilations of the arterial wall. They arise with different morphologies in different types of blood vessels under different hemodynamic conditions. Although treated as different pathologies, we examine common pathways in their hemodynamic pathogenesis in order to elucidate mechanisms of formation. MATERIALS AND METHODS: A systematic review of the literature was performed. Current concepts on pathogenesis and hemodynamics were collected and compared. RESULTS: CAs arise as saccular dilations on the cerebral arteries of the circle of Willis under high blood flow, high wall shear stress (WSS), and high wall shear stress gradient (WSSG) conditions. AAAs arise as fusiform dilations on the infrarenal aorta under low blood flow, low, oscillating WSS, and high WSSG conditions. While at opposite ends of the WSS spectrum, they share high WSSG, a critical factor in arterial remodeling. This alone may not be enough to initiate aneurysm formation, but may ignite a cascade of downstream events that leads to aneurysm development. Despite differences in morphology and the structure, CAs and AAAs share many histopathological and biomechanical characteristics. Endothelial cell damage, loss of elastin, and smooth muscle cell loss are universal findings in CAs and AAAs. Increased matrix metalloproteinases and other proteinases, reactive oxygen species, and inflammation also contribute to the pathogenesis of both aneurysms. CONCLUSION: Our review revealed similar pathways in seemingly different pathologies. We also highlight the need for cross-disciplinary studies to aid in finding similarities between pathologies.


Subject(s)
Aneurysm , Aorta , Aortic Aneurysm, Abdominal , Blood Vessels , Cerebral Arteries , Circle of Willis , Elastin , Endothelial Cells , Hemodynamics , Inflammation , Intracranial Aneurysm , Matrix Metalloproteinases , Myocytes, Smooth Muscle , Pathology , Peptide Hydrolases , Reactive Oxygen Species
19.
Med. interna (Caracas) ; 29(1): 52-61, 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-753322

ABSTRACT

La ruptura aneurismática es la causa más frecuente de hemorragia subaracnoidea y la embolización endovascular es un procedimiento neuroradiológico eficiente que minimiza la posibilidad de una nueva ruptura y sangrado a corto y largo plazo. Investigación de casos, descriptiva, retrospectiva, sin experimentación, de 78 historias clínicas de pacientes con diagnóstico de hemorragia subaracnoidea tratados en el servicio de medicina interna del Hospital Central de Maracay en el período enero 2011 – junio 2012. Predominó el género femenino, provenientes en su mayoría del centro del país, la edad promedio fue de 49 años, el mayor porcentaje recibió tratamiento electivo, con una estancia hospitalaria menor de 3 días. Las arterias afectadas pertenecieron especialmente al circuito anterior del Polígono de Willis. No se reportaron complicaciones fatales. La embolización es un instrumento terapéutico altamente eficaz, con pocas complicaciones perioperatorias y estancia hospitalaria corta.


Aneurysmal rupture is the most common cause of subarachnoid hemorrhage. Embolization is an efficient neuroradiological procedure that minimizes the possibility of a new rupture and bleeding. This is a descriptive case review, retrospective, not experimental, of the medical records of 78 patients with non-traumatic subarachnoid hemorrhage treated at the department of internal medicine of the Hospital Central Maracay, Venezuela from January 2011 to June 2012. Female gender predominated, the average age was 49 years; the highest percentage received elective treatment, with a hospital stay of less than 3 days. The affected arteries were mostly from the anterior circuit of Willis poligon. There were no fatal complications. Embolization is a highly effective therapeutic instrument, with few complications and shorter hospital stay.


Subject(s)
Humans , Adult , Female , Aneurysm , Circle of Willis/injuries , Embolization, Therapeutic/methods , Subarachnoid Hemorrhage/diagnosis , Endovascular Procedures/methods , Internal Medicine , Neurology
20.
Braz. j. morphol. sci ; 30(2): 132-139, 2013. ilus
Article in English | LILACS | ID: lil-699342

ABSTRACT

The cerebral arterial circle is a polygonal shape-like arterial anastomosis placed in the brain base, whereit rounds the optic quiasm and the tuber cinereum, and also related to the interpeduncular fossa and theanterior perfurated substance. It is formed by the proximal parts of the anterior, middle and posterior cerebralarteries, and the right and left posterior communicating arteries. In order to describe the cerebral arterial circledisposition we investigated the brains of twenty rats. For each animal, the heart left ventricle was probed andacetone, distilled water at 37 °C and a solution of Neoprene Latex “450” stained with a specific red pigmentwere injected in sequence into it. To fix the brain in a better way, we isolated the head and made an apertureat the dorsal wall of the cranium and the whole specimen was fixed in a 15% formaldehyde solution. We tookoff the brain from the skull with the aid of a cold light source monocular magnifier. To take the photographicdata we used a semi-professional camera. The results showed that the cerebral arterial circle in rats is formedby branches of both internal carotid arteries and of the basilar artery, and is closed rostrally by the rostralcommunicating artery, and caudally by the right and left terminal branches of the basilar artery. We concludedfrom our data that the cerebral arterial circle in rats is compound by branches of both internal carotid arteriesand basilar artery, and that it is rostrally and caudally closed.


Subject(s)
Animals , Rats , Basilar Artery/anatomy & histology , Carotid Artery, Internal/anatomy & histology , Circle of Willis/anatomy & histology , Dissection
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