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1.
Int. j. morphol ; 41(5): 1580-1586, oct. 2023. ilus, tab
Article in English | LILACS | ID: biblio-1521044

ABSTRACT

SUMMARY: Middle cerebral artery (MCA), which has the largest irrigation area of the arteries that feed the brain, is an important artery whose microanatomy should be well known because of its vascular variation. In pathologies which are known to affect the cerebrovascular system such as type 2 diabetes mellitus (T2DM) and hypertension, morphometric characteristics of MCA gain importance. The aim of this study is to compare the morphometric characteristics of M1 segment of MCA in T2DM and hypertensive patients with those of healthy control group by using computed tomographic angiography (CTA). The study was carried out with retrospective morphometric analysis of CTA images of 200 individuals between 40 and 65 years of age. The individuals were grouped in four as hypertensive patients (group 1), patients with T2DM (group 2), patients with hypertension and T2DM (group 3) and healthy control group (group 4). Length and diameter measurements of M1 segment were performed and recorded by using 3D CTA images. While statistically significant difference was found between bilateral M1 segment diameters of both women and men (p0.05). As a result of the post hoc analysis performed, it was concluded that right and left M1 segment diameter of group 1, group 2 and group 3 was found to be different from group 4 in both sexes (p<0.05). We believe that this study will both be a guide in radio-anatomic assessments to be performed and also increase microanatomic level of information in the surgical treatment of the artery by showing the morphometric changes that occur in M1 segment of MCA in T2DM diseases.


La arteria cerebral media (ACM), que otorga la mayor área de irrigación de las arterias que alimentan el cerebro, es un vaso importante cuya microanatomía debe ser bien conocida por su variación vascular. En patologías que afectan al sistema cerebrovascular, como la diabetes mellitus tipo 2 (DM2) y la hipertensión, las características morfométricas de la ACM cobran importancia. El objetivo de este estudio fue comparar las características morfométricas del segmento M1 de la ACM en pacientes con DM2 e hipertensos con las del grupo control sano mediante el uso de angiografía por tomografía computada (TC). El estudio fue realizado através de análisis morfométrico retrospectivo de imágenes de TC de 200 individuos entre 40 y 65 años de edad. Los individuos fueron divididos en cuatro grupos, como pacientes hipertensos (grupo 1), pacientes con DM2 (grupo 2), pacientes con hipertensión y DM2 (grupo 3) y grupo control sano (grupo 4). Las mediciones de longitud y diámetro del segmento M1 se realizaron y registraron utilizando imágenes 3D TC. Si bien se encontraron diferencias estadísticamente significativas entre los diámetros bilaterales de los segmentos M1 de mujeres y hombres (p0,05). Como resultado del análisis post hoc realizado, se concluyó que el diámetro de los segmentos M1 derecho e izquierdo del grupo 1, grupo 2 y grupo 3 fue diferente del grupo 4 en ambos sexos (p<0.05). Creemos que este estudio será una guía en las evaluaciones anátomo-radiológicas y también mejorará el nivel de información microanatómica en el tratamiento quirúrgico al mostrar los cambios morfométricos que ocurren en el segmento M1 de la ACM en las enfermedades con DM2.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Middle Cerebral Artery/diagnostic imaging , Diabetes Mellitus, Type 2 , Computed Tomography Angiography , Hypertension
3.
Rev. méd. Maule ; 37(2): 76-80, dic. 2022.
Article in Spanish | LILACS | ID: biblio-1428590

ABSTRACT

The evaluation of labor is the clinical process by which variables are analyzed in order to determine whether the patient is in labor, which by definition includes regular uterine contractions that increase in frequency and intensity, associated with dilation cervical. This is done through the anamnesis and physical examination, specifically through the evaluation of contractions and vaginal examination, the latter is intended to specify the degree of dilation, cervical effacement that the patient presents and also allows to a certain degree, establish the presentation, attitude and variety of position in which the fetus is located. From this premise, it is proposed that vaginal examination, since it is operator dependent, is not an objective evaluation, therefore, there is a need to reach consensus on the evaluation, and in order to carry it out, evaluation with ultrasound is proposed, which has as a purpose to objectify the variety of position and presentation of the fetus. Due to the above, this article aims to capture the knowledge that is currently possessed about the uses and methodology that intrapartum ultrasound presents.


Subject(s)
Humans , Female , Pregnancy , Umbilical Arteries/diagnostic imaging , Cesarean Section , Placenta/diagnostic imaging , Pregnancy Outcome , Ultrasonography, Prenatal , Ultrasonography, Doppler , Middle Cerebral Artery/diagnostic imaging
4.
repert. med. cir ; 31(1): 20-32, 2022. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1366955

ABSTRACT

Introducción: La segunda causa de muerte a nivel mundial corresponde a los ataques cerebrovasculares (ACV), de los cuales más de dos terceras partes son de origen isquémico. Causan discapacidad a largo plazo por lo que conocer la anatomía de la circulación cerebral y las posibles manifestaciones clínicas del ACV isquémico permite sospechar, diagnosticar y brindar un manejo oportuno y apropiado, reduciendo el impacto en la salud y la calidad de vida del paciente y sus cuidadores. Objetivo: relacionar los últimos hallazgos en la anatomía arterial cerebral, los mecanismos fisiopatológicos y las manifestaciones clínicas del ACV isquémico de la arteria cerebral media (ACM). Materiales y métodos: revisión de la literatura mediante la búsqueda con términos MeSH en la base de datos Medline, incluyendo estudios, ensayos y metaanálisis publicados entre 2000 y 2020 en inglés y español, además de otras referencias para complementar la información. Resultados: se seleccionaron 59 publicaciones, priorizando las de los últimos 5 años y las más relevantes del rango temporal consultado. Conclusiones: son escasos los estudios sobre la presentación clínica de los ACV, lo que sumado a la variabilidad interindividual de la irrigacióncerebral, dificulta la determinación clínica de la localización de la lesión dentro del lecho vascular. La reperfusión del área de penumbra isquémica como objetivo terapéutico se justifica por los mecanismos fisiopatológicos de la enfermedad.


Introduction: Cerebrovascular accidents (CVAs) are the second leading cause of death worldwide, of which more than two thirds are ischemic. They cause long-term disability, therefore, knowledge on the cerebral circulation anatomy and possible clinical manifestations of ischemic CVAs allows us to suspect, diagnose and provide timely and appropriate management, reducing the negative impact on the health and quality of life of patients and caregivers. Objective: to list the latest findings on cerebral arterial anatomy, pathophysiological mechanisms and clinical manifestations of ischemic middle cerebral artery (MCA) CVAs. Materials and methods: a literature review using a MeSH terms search in the Medline database, including studies, trials and meta-analyses published in English and Spanish between 2000 and 2020, using other complementary references. Results: 59 publications were selected prioritizing those published in the past 5 years and the most relevant in said period. Conclusions: there are few studies on the clinical presentation of CVAs, which, added to the interindividual variability of cerebral circulation anatomy, makes clinical identification of lesion location, within the vascular bed, difficult. Reperfusion of the ischemic penumbra region, as a therapeutic objective, is based on the pathophysiological mechanisms of the disease.


Subject(s)
Middle Cerebral Artery , Stroke , Signs and Symptoms , Anatomy
6.
Arq. bras. neurocir ; 40(2): 130-136, 15/06/2021.
Article in English | LILACS | ID: biblio-1362199

ABSTRACT

Stroke is the third most common cause of death worldwide. About 10% to 15% of strokes related to the territory of the carotid artery are associated with its complete occlusion. There is an important subgroup of patients with cerebrovascular occlusive diseases who might benefit from an external-carotid-to-internal-carotid bypass. In the present study, we report a case of a 53-year-old male patient with stenosis of the M2 branch of themiddle cerebral artery (MCA), with a history of 20 episodes of transient ischemic accidents (TIA)s, in whom an anastomosis of the M4 branch of the superficial temporal artery-MCA was performed. The patient was discharged in three days, and in the two years of follow-up, they were no more TIAs.We also conducted a review of the literature on cerebrovascular occlusive disease and extracranial-intracranial bypass surgery. New methods to evaluate cerebral hemodynamics made it possible to classify a new subgroup of patients with symptomatic cerebrovascular disease and documented cerebrovascular compromise in whom the drug therapy fails, who can benefit from the extracranial-intracranial bypass. Our case report illustrates the advantages of revascularization in these selected patients.


Subject(s)
Humans , Male , Middle Aged , Temporal Arteries/surgery , Cerebral Revascularization/rehabilitation , Middle Cerebral Artery/surgery , Ischemic Stroke/surgery , Anastomosis, Surgical/methods , Cerebral Angiography/methods , Craniotomy/methods , Stroke/mortality , Ischemic Stroke/diagnostic imaging
8.
Belo Horizonte; s.n; 2021. 24 p. ilus., tab..
Thesis in Portuguese | LILACS, InstitutionalDB, ColecionaSUS | ID: biblio-1379150

ABSTRACT

Acidente Vascular Encefálico (AVE) é a doença mais comum do sistema nervoso central, sendo segunda causa de morte e terceira de incapacidade no mundo. Há previsão de que a incidência de AVE dobre até 2050. Melhorias recentes na terapêutica têm demostrado eficácia na redução mortalidade, complicações e sequelas tardias. Trombectomia realizada em caráter urgente é a medida terapêutica mais eficaz para reduzir a mortalidade e as sequelas, permitindo que cerca de 50% dos pacientes retomem vida independente em até 90 dias. OBJETIVO Descrever um simulador sintético e biológico utilizando placentas bovinas e humanas capaz de reproduzir os aspectos técnicos de uma trombose da artéria cerebral média, o local mais comum de AVE de grande impacto funcional, e descrever as nuances e variações da trombectomia que podem ser testadas e validadas. MATERIAIS E MÉTODOS Sete neurocirurgiões participaram da execução dos exercícios de simulação nos quais fora utilizadas 74 placentas humanas, preparadas para simulação de trombectomias em sistema de perfusão aclaradas a manequim. O processo avaliativo constou das seguintes estapas 1 - Validação do simulador: validade de face, conteúdo e construto 2 - Trombectomia microcirúrgica: realização de procedimentos, com arteriotomia longitudinal e com arteriotomia transversal. 3 - Trombectomia endovascular CONCLUSÃO o modelo híbrido desenvolvido mediante à avaliação de Face, Conteúdo e Constructo possua qualidades suficientes que justifiquem sua adoção como subsidio à capacitação de neurocirurgiões em diversas modalidades de treinamento


Stroke is the most common disease of the central nervous system, being the second leading cause of death and third incapacity in the world. The incidence of stroke is predicted to double by 2050. Recent improvements in therapy have been shown to be effective in reducing late mortality, complications and sequelae. Urgently performed thrombectomy is the most effective therapeutic measure to reduce mortality and sequelae, allowing approximately 50% of patients to resume independent life within 90 days. OBJECTIVE To describe a synthetic and biological simulator using bovine and human placentas capable of reproducing the technical aspects of a thrombosis of the middle cerebral artery, the most common site of stroke with great functional impact, and to describe the nuances and variations of thrombectomy that can be tested and validated. MATERIALS AND METHODS Seven neurosurgeons participated in the execution of simulation exercises in which 74 human placentas were used, prepared to simulate thrombectomy in a perfusion system cleared on a mannequin. The evaluation process consisted of the following steps 1 - Simulator validation: face, content and construct validity 2 - Microsurgical thrombectomy: performance of procedures, with longitudinal arteriotomy and transverse arteriotomy. 3 - Endovascular thrombectomy CONCLUSION the hybrid model developed through the evaluation of Face, Content and Construct has sufficient qualities to justify its adoption as a subsidy for the training of neurosurgeons in various training modalities


Subject(s)
Humans , Male , Female , Placenta , Thrombectomy , Embolectomy , Stroke , Simulation Exercise , Central Nervous System , Middle Cerebral Artery
9.
Rev. argent. neurocir ; 34(4): 245-261, dic. 2020. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1150433

ABSTRACT

Objetivo: Describir la anatomía quirúrgica de la fisura silviana (FS) a través de disecciones cadavéricas y neuroimágenes; desarrollar su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 10 hemisferios cadavéricos humanos fijados y un cráneo humano en seco, a través de la disección de fibras blancas y de la anatomía arterial y neural, utilizando un microscopio quirúrgico. Las arterias cerebrales fueron inyectadas con silicona coloreada. La anatomía quirúrgica fue correlacionada con la anatomía neuroimagenológica. Finalmente, se recolectó la experiencia microquirúrgica adquirida y, a su vez, la anatomía del Complejo Silviano, fue revisada. Resultados: La FS se extiende desde la cara basal a la lateral del cerebro. Cada superficie tiene una parte superficial (tronco silviano y sus ramos), intermedia (compartimientos anterior y opercular lateral) y profunda (compartimiento esfenoidal, hendidura insular anterior y lateral y la región retroinsular). En 7 de los 10 hemisferios, el surco central no se intersectó con la FS en la superficie lateral del cerebro. En el 80% de los hemisferios, la principal bifurcación de la arteria cerebral media se localizó en o proximal al limen insular. Debajo de la pars triangularis se localiza el punto más ancho de la superficie lateral de la FS. Los autores comienzan la disección de la misma en o proximalmente a este punto. Conclusiones: El conocimiento anatómico profundo y su aplicación a las neuroimágenes, son herramientas esenciales para el planeamiento prequirúrgico y son requisitos mandatorios para operar con seguridad a través y alrededor de la FS


Objective: The aim of this study is to describe the microsurgical anatomy of the sylvian fissure, through cadaveric dissections and neuroimaging and to elucidate its clinical application for microsurgery. Methods: One human skull and ten cadaveric human hemispheres were studied through white matter fiber dissections and arterial and neural anatomy of the sylvian fissure and insular dissections under the microscope. The cerebral arteries were perfused with colored latex. The surgical anatomy was correlated with neuroimaging anatomy. Finally, the microsurgical experienced gained applying this anatomical knowledge was gathered, and the literature about the anatomy of the sylvian complex was revised, as well. Results: The Sylvian fissure extends from the basal to the lateral surface of the brain. Each surface has a superficial (sylvian stem and its rami), intermediate (anterior and lateral opercular compartments) and deep parts (sphenoidal compartment, anterior and lateral insular clefts and retroinsular region). In 7 out of 10 hemispheres, the central sulcus did not intersect with the sylvian fissure on the lateral surface of the brain. In 80% of the hemispheres, the middle cerebral artery main bifurcation was localized at or proximal to the limen insulae. Beneath the pars triangularis, the widest point of the lateral surface of the sylvian fissure is located. The authors start dissecting the sylvian fissure at this point. Conclusion: The thorough anatomical knowledge with its clinical application in modern neuroimaging are essential tools for preoperative planning and are mandatory requisites to safely operate through and around the sylvian fissure anatomical complex.


Subject(s)
Humans , Aneurysm , Middle Cerebral Artery , Anatomy , Neoplasms
10.
Cambios rev. méd ; 19(1): 80-85, 30/06/2020. ^ehttps://www.youtube.com/watch?v=Fj5QxieLXiIilus.
Article in Spanish | LILACS | ID: biblio-1122683

ABSTRACT

INTRODUCCIÓN. La enfermedad cerebrovascular ha sido una de las primeras causas de muerte y la principal causa de discapacidad a nivel mundial, que incluye a nuestro país. La utilidad y efectividad de la trombectomía mecánica es aceptada por la comunidad médica especializada y el no considerar en forma consistente este recurso a los pacientes candidatos para la misma ha constituido un retraso para nuestra práctica médica. Se relata la experiencia con pacientes de ictus isquémico y trombosis venosa de seno lateral. OBJETIVO. Reportar la experiencia de los resultados obtenidos en el tratamiento del ictus isquémico y trombosis venosa intracraneal mediante trombectomía mecánica por aspiración. MATERIALES Y MÉTO-DOS. Se presentó tres casos de pacientes con sintomatología neurológica relacionada a ictus isquémico y trombosis venosa cerebral, que fueron tratados mediante trombectomía mecánica entre diciembre del 2018 y Noviembre del 2019 mediante técnica de aspiración directa de primer paso. Se aplicó la Escala de Accidentes Cerebrovasculares del Instituto Nacional de Salud. RESULTADOS. La oclusión se produjo en territorio de arteria cerebral media y venoso superficial intracraneal. La recanalización fue satisfactoria en los tres casos, no presentaron complicaciones y con mejoría neurológica inmediata post procedimiento, sin secuelas. DISCUSIÓN. El ictus isquémico y la trombosis venosa son patologías de etiología múltiple dentro de las patologías vasculares neurológicas, de manera principal ateroscleróticas, cardioembólicas o condiciones protrombóticas, sin embargo al tratarse de eventos agudos requirió de la resolución inmediata mediante técnicas mecánicas neurointervencionistas, para evitar secuelas graves y permanentes e incluso el deceso del enfermo. CONCLUSIÓN. La utilización de modernas técnicas de neurointervencionismo, en especial la técnica de aspiración de primer paso, ha permitido dar mayor oportunidad de recuperación y so-brevida a quienes padecen de tromboembolias agudas en vasos cerebrales, tanto arteriales como venosas y se demostró por el nivel de evidencia que en manos entrenadas son la única alternativa de tratamiento en oclusión de vasos mayores.


INTRODUCTION. Cerebrovascular disease is one of the leading causes of death and the leading cause of disability worldwide, including our country. The usefulness and effectiveness of mechanical thrombectomy is accepted by the specialized medical community and the failure to consistently consider this resource to pa-tients who are candidates for it has constituted a delay in our medical practice. The experience with patients with ischemic stroke and lateral sinus venous thrombosis is reported. OBJECTIVE. Report the experience of the results obtained in the treatment of ischemic stroke and intracranial venous thrombosis by mecha-nical aspiration thrombectomy. MATERIALS AND METHODS. Three cases of patients with neurological symptoms related to ischemic stroke and cerebral venous thrombosis were presented, who were treated by mechanical thrombectomy between december 2018 and November 2019 using the first step direct aspira-tion technique. The Stroke Scale of the National Institute of Health was applied. RESULTS. The occlusion occurred in the territory of the middle cerebral artery and intracranial superficial venous. Recanalization was satisfactory in all three cases, there were no complications and immediate neurological improvement after the procedure, without sequelae. DISCUSSION. ischemic stroke and venous thrombosis are pathologies of multiple etiology within neurological vascular pathologies, mainly atherosclerotic, cardioembolic or prothrom-botic conditions, however, when dealing with acute events, they required immediate resolution by means of neurointerventional mechanical techniques, to avoid serious sequelae and permanent and even the death of the patient. CONCLUSION. The use of modern neurointerventional techniques, especially the first step aspiration technique, has given a greater chance of recovery and survival to those who suffer from acute thromboembolism in cerebral vessels, both arterial and venous, and it was demonstrated by the level of evidence that in trained hands they are the only treatment alternative for occlusion of major vessels.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Brain , Clot Retraction , Thrombectomy , Stroke , Lateral Sinus Thrombosis , Anticoagulants , Thrombosis , Cerebrovascular Disorders , Cause of Death , Venous Thrombosis , Middle Cerebral Artery , Transverse Sinuses
11.
Rev. argent. neurocir ; 34(1): 62-62, mar. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1151254

ABSTRACT

Objetivo: Presentar la resolución quirúrgica de un aneurisma gigante de arteria cerebral media mediante técnica de Trapping y By-Pass. Introducción: La tasa de mortalidad a 5 años de pacientes con aneurismas gigantes es del 80%. Debido a su cuello ancho en ocasiones el clipado directo no es posible, requiriendo realizar Trapping del aneurisma seguido de revascularización mediante By-Pass. Material y Método: Se analizaron datos de historia clínica, imágenes complementarias pre y postquirúrgicas, así como imágenes de video intraoperatorias de un paciente portador de aneurisma gigante de arteria cerebral media intervenido en nuestro centro. Resultados: Mediante abordaje Pterional se localizó arteria temporal superficial y sus ramos. Luego de una cuidadosa disección del saco aneurismático se intentó el clipado primario, debido a su cuello ancho, aterosclerosis asociada y trombo intrasacular, el flujo en la rama temporal de arteria cerebral media era comprometido por el clip. Se decidió la oclusión del aneurisma mediante técnica de trapping y, en mismo tiempo quirúrgico, realización de By Pass extra-intracraneano de arteria temporal superficial a rama temporal de arteria cerebral media. A su vez se secciono el aneurisma y se removió el trombo contenido en su interior, logrando disminuir el efecto de masa ejercido por el mismo. Se corroboro permeabilidad intraquirurgica mediante Doppler y en el postoperatorio alejado mediante angiotomografía con reconstrucción 3D. El paciente evoluciono sin complicaciones asociadas con un Rankin modificado de 1. Conclusión: Se presentó resolución quirúrgica de aneurisma gigante de arteria cerebral media mediante técnica de Trapping seguida de By-Pass extra-intra craneano temporo-silviano


Objective: To present the surgical resolution of a giant aneurysm of the middle cerebral artery using Trapping and By-Pass technique. Introduction: The 5-year mortality rate of patients with giant aneurysms is 80%. Due to its wide neck, sometimes-direct clipping is not possible, requiring trapping of the aneu-rysm followed by bypass revascularization. Material and Method: Clinical history data and intraoperative video images of a pa-tient with a giant aneurysm of the middle cerebral artery were analyzed. Results: The superficial temporal artery and its branches were identified through a Pterional approach. After careful aneurysm dissection, primary clipping was attempted, but the flow in the temporal branch of the middle cerebral artery was compromised. Due to its wide neck, associated atherosclerosis and intrasaccular thrombus, an Extra-intracranial bypass was performed from superficial temporal artery to temporal branch of middle cerebral artery, followed by trapping technique of the aneurysm. Then the aneu-rysm was sectioned and the thrombus contained inside was removed, decreasing the mass effect exerted by it. A Doppler probe was used to corroborate bypass permeability, as well as 3D reconstruction angiotomography during the postoperative period. The pa-tient was discharged without associated complications and a modified Rankin scale of 1. Conclusion: Surgical resolution of a giant middle cerebral artery aneurysm was present-ed by Trapping technique followed by extra-intra-cranial temporo-Silvian bypass


Subject(s)
Aneurysm , Intracranial Aneurysm , Middle Cerebral Artery
12.
Arq. neuropsiquiatr ; 77(5): 310-314, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011347

ABSTRACT

ABSTRACT Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10-1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06-1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60-0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.


RESUMO Objetivo: Investigar o valor preditivo do ultrassom de Doppler transcraniano (TCD) para doença de pequenos vasos (SVD) em pacientes idosos. Métodos: ultrassonografia de TCD e ressonância magnética (RM) foram realizadas em 184 idosos portadores de SVD cerebral. As relações das características clínicas e os parâmetros ultrassonográficos do TCD com lesão grave de substância branca (WML) no desempenho da RM foram investigados por análise univariada e análise multivariada. Resultados: A análise univariada mostrou que, a idade, a velocidade média de fluxo (MFV) da artéria média cerebral (MCA) esquerda, a MFV da MCA direita e o índice de pulsatilidade (PI) médio estiveram significativamente relacionados à WML grave (P <0,05). A análise de regressão logística multivariada mostrou que apenas a idade (razão de chances: 1,21; IC95%: 1,10-1,36; P <0,01) e o PI da MCA (razão de dominância: 1,13; IC 95%: 1,06-1,80; P = 0,02) estiveram significativamente relacionados a WML grave. A análise dos parâmetros ultrassonográficos do TCD mostrou que, quando o ponto de corte do IP do MCA foi 1,04, ele pôde identificar à WML grave. A área sob a curva foi de 0,70 (IC 95%: 0,60-0,80). A sensibilidade e especificidade foram de 63,0% e 72,0%, respectivamente. Os valores preditivos positivos e negativos foram de 35,4% e 86,6%, respectivamente. Conclusão: O PI da MCA na ultrassonografia do TCD está significativamente relacionado à WML grave. A ultrassonografia TCD pode orientar a ressonância magnética seletiva para detecção da WML.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Magnetic Resonance Imaging/methods , Ultrasonography, Doppler, Transcranial/methods , Cerebral Small Vessel Diseases/diagnostic imaging , Reference Values , Severity of Illness Index , Pulsatile Flow , Logistic Models , Multivariate Analysis , Predictive Value of Tests , Reproducibility of Results , Middle Cerebral Artery/physiopathology
13.
Rev. méd. hered ; 30(2): 105-109, abr. 2019. ilus
Article in Spanish | LILACS, LIPECS | ID: biblio-1058676

ABSTRACT

El mixoma cardí­aco es una neoplasia benigna; cuando se localiza en la aurí­cula izquierda es potencialmente generadora de émbolos, y se constituye en una causa rara de patologí­a embólica cerebral. Su diagnóstico es muchas veces incidental en estudios de imagen solicitados por otras circunstancias clí­nicas. Se presenta el caso de un paciente con probable mixoma auricular izquierda que genera un infarto maligno en el territorio de la arteria cerebral media derecha y en el que la ecocardiografí­a a pie de cama del paciente se convirtió en un instrumento diagnóstico de relevancia. (AU)


Cardiac myxoma is a benign neoplasm, when it is located in the left atrium it is potentially associated with systemic embolism, and it is a rare cause of cerebral embolism. The diagnosis of cardiac myxoma is usually incidental, being found as a results of searching for other clinical conditions. We present the case of a patient who probably had a cardiac myxoma of the left atrium that induced a malignant infarction in the territory of the left medial cerebral artery, bedside heart ultrasound was a relevant diagnostic procedure in this patient. (AU)


Subject(s)
Humans , Female , Middle Aged , Echocardiography , Brain Ischemia , Middle Cerebral Artery , Heart Atria , Myxoma
14.
São Paulo med. j ; 137(1): 92-95, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004738

ABSTRACT

ABSTRACT CONTEXT: Presence of an arachnoid cyst and a non-ruptured intracystic brain aneurysm is extremely rare. The aim of this paper was to describe a case of a patient with an arachnoid cyst and a non-ruptured aneurysm inside it. Clinical, surgical and radiological data were analyzed and the literature was reviewed. CASE REPORT: A patient complained of chronic headache. She was diagnosed as having a temporal arachnoid cyst and a non-ruptured middle cerebral artery aneurysm inside it. Surgery was performed to clip the aneurysm and fenestrate the cyst. CONCLUSIONS: This report raises awareness about the importance of intracranial vascular investigation in patients with arachnoid cysts and brain hemorrhage.


Subject(s)
Humans , Female , Middle Aged , Intracranial Aneurysm/diagnostic imaging , Arachnoid Cysts/diagnostic imaging , Middle Cerebral Artery/diagnostic imaging , Magnetic Resonance Imaging , Cerebral Angiography , Intracranial Aneurysm/surgery , Arachnoid Cysts/surgery , Middle Cerebral Artery/surgery
15.
Journal of Korean Neurosurgical Society ; : 649-660, 2019.
Article in English | WPRIM | ID: wpr-788821

ABSTRACT

OBJECTIVE: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration.METHODS: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm).RESULTS: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1.CONCLUSION: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.


Subject(s)
Adult , Humans , Aneurysm , Aortic Dissection , Dilatation, Pathologic , Hemorrhage , Intracranial Aneurysm , Middle Cerebral Artery , Natural History , Rupture
16.
Journal of Korean Neurosurgical Society ; : 193-200, 2019.
Article in English | WPRIM | ID: wpr-788763

ABSTRACT

OBJECTIVE: Endovascular treatment (EVT) outcomes for acute M2 segment of middle cerebral artery occlusion remains unclear because most results are obtained from patients with large artery occlusion in the anterior circulation. The objective of this study was to assess procedural outcomes for acute M2 occlusion and compare outcomes according to thrombus location (M1 vs. M2).METHODS: A systematic review was performed for online literature published from January 2004 to December 2016. Primary outcome was successful recanalization rate and symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used if heterogeneity was less than 50%.RESULTS: Eight articles were included. EVT showed successful recanalization rate of 69.1% (95% confidence interval [CI], 54.9–80.4%) and S-ICH rate of 6.1% (95% CI, 4.5–8.3%). The rates of good clinical outcome at 3 months and mortality were 59.4% (95% CI, 49.9–68.2%) and 14.9% (95% CI, 11.4–19.3%), respectively. According to thrombus location (M1 vs. M2), successful recanalization (odds ratio [OR], 1.539; 95% CI, 0.293–8.092; p=0.610) and S-ICH (OR, 1.313; 95% CI, 0.603–2.861; p=0.493) did not differ significantly. Good clinical outcome was more evident in M2 occlusion after EVT than that in M1 occlusion (OR, 1.639; 95% CI, 1.135–2.368; p=0.008). However, mortality did not differ significantly according to thrombus location (OR, 0.788; 95% CI, 0.486–1.276; p=0.332).CONCLUSION: EVT seems to be technically feasible for acute M2 occlusion. Direct comparative studies between EVT and medical treatment are needed further to find specific beneficiary group after EVT in patient with M2 occlusion.


Subject(s)
Humans , Arteries , Infarction , Infarction, Middle Cerebral Artery , Intracranial Hemorrhages , Middle Cerebral Artery , Mortality , Population Characteristics , Stroke , Thrombectomy , Thrombosis
17.
Journal of Korean Neurosurgical Society ; : 201-208, 2019.
Article in English | WPRIM | ID: wpr-788762

ABSTRACT

OBJECTIVE: In patients with internal carotid artery (ICA) occlusion, collateral middle cerebral artery (MCA) flow has a protective role against ischemia. However, some of these patients may experience initial major neurological deficits and major worsening on following days. Thus, we investigated the safety and efficacy of endovascular treatment (EVT) for ICA occlusion with collateral MCA flow by comparing clinical outcomes of medical treatment versus EVT.METHODS: The inclusion criteria were as follows : 1) acute ischemic stroke with ICA occlusion and presence of collateral MCA flow on transfemoral cerebral angiography (TFCA) and 2) hospital arrival within 12 hours from symptom onset. The treatment strategy was made by the attending physician based on the patient’s clinical status and results of TFCA.RESULTS: Eighty-one patients were included (30 medical treatment, 51 EVT). The EVT group revealed a high incidence of intracranial ICA occlusion, longer ipsilesional MCA contrast filling time, and a similar rate of favorable clinical outcome despite a higher mean baseline the National Institutes of Health Stroke Scale (NIHSS) score. By binary logistic regression analysis, intravenous recombinant tissue plasminogen activator and EVT were independent predictors of favorable clinical outcome. In subgroup analysis based on stroke etiology, the non-atherosclerotic group showed a higher baseline NIHSS score, higher incidence of EVT, and a higher rate of distal embolization during EVT in comparison with the atherosclerotic group.CONCLUSION: In patients with ICA occlusion and collateral MCA flow, decisions regarding treatment strategy based on TFCA can help achieve favorable clinical outcomes. EVT strategy with respect to etiology of ICA occlusion might help achieve better angiographic outcomes.


Subject(s)
Humans , Carotid Artery, Internal , Cerebral Angiography , Collateral Circulation , Incidence , Ischemia , Logistic Models , Middle Cerebral Artery , Stroke , Thrombectomy , Tissue Plasminogen Activator
18.
Experimental Neurobiology ; : 458-473, 2019.
Article in English | WPRIM | ID: wpr-763781

ABSTRACT

The function of microglia/macrophages after ischemic stroke is poorly understood. This study examines the role of microglia/macrophages in the focal infarct area after transient middle cerebral artery occlusion (MCAO) in rhesus monkeys. We measured infarct volume and neurological function by magnetic resonance imaging (MRI) and non-human primate stroke scale (NHPSS), respectively, to assess temporal changes following MCAO. Activated phagocytic microglia/macrophages were examined by immunohistochemistry in post-mortem brains (n=6 MCAO, n=2 controls) at 3 and 24 hours (acute stage), 2 and 4 weeks (subacute stage), and 4, and 20 months (chronic stage) following MCAO. We found that the infarct volume progressively decreased between 1 and 4 weeks following MCAO, in parallel with the neurological recovery. Greater presence of cluster of differentiation 68 (CD68)-expressing microglia/macrophages was detected in the infarct lesion in the subacute and chronic stage, compared to the acute stage. Surprisingly, 98~99% of transforming growth factor beta (TGFβ) was found colocalized with CD68-expressing cells. CD68-expressing microglia/macrophages, rather than CD206⁺ cells, may exert anti-inflammatory effects by secreting TGFβ after the subacute stage of ischemic stroke. CD68⁺ microglia/macrophages can therefore be used as a potential therapeutic target.


Subject(s)
Brain , Haplorhini , Immunohistochemistry , Infarction, Middle Cerebral Artery , Inflammation , Macaca mulatta , Magnetic Resonance Imaging , Microglia , Middle Cerebral Artery , Primates , Stroke , Transforming Growth Factor beta
19.
Journal of Korean Neurosurgical Society ; : 649-660, 2019.
Article in English | WPRIM | ID: wpr-765395

ABSTRACT

OBJECTIVE: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration. METHODS: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm). RESULTS: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1. CONCLUSION: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.


Subject(s)
Adult , Humans , Aneurysm , Aortic Dissection , Dilatation, Pathologic , Hemorrhage , Intracranial Aneurysm , Middle Cerebral Artery , Natural History , Rupture
20.
Neurointervention ; : 137-141, 2019.
Article in English | WPRIM | ID: wpr-760592

ABSTRACT

Distal intracranial occlusions can sometimes cause significant neurological deficits. Endovascular thrombectomy in these vessels may improve outcome but carry a higher risk of haemorrhagic complications due to the small calibre and tortuosity of the target vessel. We report two cases of isolated M2/3 artery occlusion causing dense hemiplegia that was successfully treated with stent retrieval thrombectomy. A “semi-deployment technique” of a 3 mm stentriever was employed at the M2/3 bifurcation of the middle cerebral artery. Partial stent unsheathing allowed adequate clot engagement while avoiding excessive tension by the stent metal struts along the tortuous course of a distal vessel. Complete revascularization was achieved after first-pass of the stent retriever without complication, resulting in good clinical outcome in both cases. The described semi-deployment technique reduces the radial and tractional force exerted by the stentreiver on small branches, and may reduce the risk of vessel laceration or dissection in distal vessel thrombectomy.


Subject(s)
Arteries , Endovascular Procedures , Hemiplegia , Lacerations , Middle Cerebral Artery , Stents , Stroke , Thrombectomy , Traction
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