Effect of arteriosclerotic intracranial arterial vessel wall enhancement on downstream collateral flow / 中华医学杂志(英文版)

BACKGROUND@#The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear. Regardless of the mechanism underlying IAVWE on VWI, damage to the patient's nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow. The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow.@*METHODS@#The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery (MCA) M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset. The patients were divided into 4 groups according to IAVWE and the stenosis ratio (Group 1, n = 17; Group 2, n = 19; Group 3, n = 13; Group 4, n = 14), and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling (3D-pCASL) and RAPID software. The National Institutes of Health Stroke Scale (NIHSS) scores of the patients were also recorded. Two-factor multivariate analysis of variance using Pillai's trace was used as the main statistical method.@*RESULTS@#No statistically significant difference was found in baseline demographic characteristics among the groups. IAVWE, but not the stenosis ratio, had a statistically significant significance on the late-arriving retrograde flow proportion (LARFP), hypoperfusion intensity ratio (HIR), and NIHSS scores ( F = 20.941, P <0.001, Pillai's trace statistic = 0.567). The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables: LARFP ( R2 = 0.088, F = 10.899, P = 0.002), HIR ( R2 = 0.234, F = 29.354, P <0.001), and NIHSS ( R2 = 114.339, F = 33.338, P <0.001).@*CONCLUSIONS@#Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits. It was an independent factor affecting downstream collateral flow and NIHSS scores, which should be a focus of future studies.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR2100053661.

Vasculitis primaria del sistema nervioso central: presentación de caso clínico / Primary vasculitis of the central nervous system: presentation of clinical case / Vasculite primária do sistema nervoso central: apresentação do caso clínico

La vasculitis Primaria del Sistema Nervioso Central (VPSNC) se refiere a un grupo de enfermedades que resultan de la inflamación y destrucción de los vasos sanguíneos de la medula espinal, encéfalo y meninges, tanto en el sector venoso como arterial. La presentación es heterogénea y poco sistematizable. El diagnóstico se establece con un cuadro clínico compatible, una angiografía que evidencie vasculitis y/o biopsia del parénquima encefálico o meninges. Las alteraciones en los estudios de imagen son constantes pero inespecíficas para el diagnóstico y se acompañan habitualmente de alteraciones en el líquido cefalorraquídeo (LCR) y electroencefalograma (EEG) Presentamos un paciente con probable VPSNC basados en un cuadro clínico compatible, hallazgos imagenológicos sugestivos, junto con alteraciones en LCR y EEG. Se realizó tratamiento en base a corticoides e inmunosupresores con mala respuesta y evolución.

The primary central nervous system vasculitis (VPSNC) refers to a group of diseases that result from inflammation and destruction of the blood vessels of the spinal cord, brain and meninges, both in the venous and arterial sector. The presentation is heterogeneous and unsystematized. The diagnosis is made based on compatible symptoms, supported by an angiography showing evidence of vasculitis and/or biopsy of the brain parenchyma or meninges. Alterations in imaging studies are consistent but nonspecific for diagnostic and are usually accompanied by alterations in the electroencephalogram (EEG) and cerebrospinal fluid (CSF). We present a clinical case of probable VPSNC based on clinical presentation and findings on imagenological studies suggestive vasculitis, along with alterations in CSF and EEG. Treatment was based on Corticosteroids and immunosuppressive agents with poor response and evolution.

Vasculite Primária do Sistema Nervoso Central (VPSNC) refere-se a um grupo de doenças que resultam de inflamação e destruição dos vasos sanguíneos na medula espinal, o sector venosa arterial cerebral e meninges, ambos. A apresentação é heterogênea e não muito sistematizável. O diagnóstico é estabelecido com um quadro clínico compatível, uma angiografia que evidencia vasculite e / oubiópsia do parênquima cerebral ou meninges. Alterações nos estudos de imagemsão constantes, mas não específica para o diagnóstico e são normalmente acompanhadas por alterações no líquido cefalorraquidiano (LCR) e eletroencefalograma (EEG) descrevem um paciente com VPSNC provável com base em um quadro clínico, achados de imagem sugestivos compatíveis, em conjunto com alterações no CSF e EEG. O tratamento foi realizado com base em corticosteróides e imunos supressores compouca resposta e evolução.

Lenticulostriate Artery Involvement is Predictive of Poor Outcomes in Superficial Middle Cerebral Artery Territory Infarction

PURPOSE: Patients with superficial middle cerebral artery (MCA) territory infarction may have concomitant lenticulostriate artery (LSA) territory infarction. We investigated the mechanisms thereof and the outcomes of patients with superficial MCA territory infarction according to the presence or absence of LSA involvement. MATERIALS AND METHODS: Consecutive patients with first-ever infarction in the unilateral superficial MCA territory were included in this study. They were divided into the superficial MCA only (SM) group and the superficial MCA plus LSA (SM+L) group. RESULTS: Of the 398 patients, 84 patients (21.1%) had LSA involvement (SM+L group). The SM+L group more frequently had significant stenosis of the proximal MCA or carotid artery and high-risk cardioembolic sources. Stroke severity and outcomes were remarkably different between the groups. The SM+L group showed more severe neurologic deficits (National Institute of Health Stroke Scale score 10.8±7.1 vs. 4.0±5.0, p2) at 3 months was more common in the SM+L group (64.3% vs. 15.9%, p<0.001). During a mean follow-up of 26 months, 67 patients died. All-cause (hazard ratio, 2.246) and stroke (hazard ratio, 9.193) mortalities were higher in the SM+L group than the SM group. In multivariate analyses, LSA involvement was an independent predictor of poor functional outcomes and stroke mortality. CONCLUSION: LSA territory involvement is predictive of poor long-term outcomes in patients with superficial MCA territory infarction.

Angiolipoma intracraniano adjacente a aneurisma sacular cerebral: relato de caso e revisão da literatura / Intracranial Angiolipoma Associated with Cerebral Saccular Aneurysm: Case Report and Review of Literature

Angiolipomas são neoplasias benignas compostas por adipócitos maduros e proliferação vascular angiomatosa de rara ocorrência no Sistema Nervoso Central. É relatado o caso de angiolipoma em cisterna silviana adjacente a aneurisma sacular de artéria cerebral média. São discutidas as características imagenológicas do tumor e a possibilidade de uma origem comum com lesões vasculares intracranianas. Este é o primeiro caso relatado de angiolipoma intracraniano associado a aneurisma de artéria cerebral média.

Angiolipomas are benign neoplasms composed of mature fat cells and vascular angiomatous proliferation of rare incidence in Central Nervous System.It's related a case of angiolipoma in Sylvian fissure associated with cerebral saccular aneurysm of medial cerebral artery. Imagenologic characteristics of the tumor and a possible common origin with intracranial vascular lesions are discussed. This is the first reported case of intracranial angiolipoma involving medial cerebral artery aneurysm.

Anomalies, aneurysm and histology of the middle cerebral artery in Nigerian Africans

The histology of the middle cerebral artery (MCA) in Nigerian Africans has not been previously studied. One hundred MCAs obtained at autopsy from fifty adult Nigerians were studied. The vessels were processed and stained with Ehrlich's haematoxylin and eosin, elastic Van Gieson and Masson's trichrome stains. Early branches were given off before the perforators in two middle cerebral arteries, and there was one accessory MCA, making an incidence of anomalies of 3 percent. No aneurysm was observed in any of the cases. The internal elastic laminas were well developed but the external elastic laminas of the vessels were poorly developed. Close to the bifurcations the tunica media tapered gradually and at the bifurcations, the tunica media was completely deficient being replaced by the tunica adventitia (Forbus raphé). The tunica adventitia was thicker at the bifurcations (0.21mm) compared to other sites of the vessel. The average thickness of the MCA tunica media at its origin was 0.12mm while that of the tunica adventitia was O.lOmm. These results are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The seemingly low frequency of MCA aneurysms in Nigerian Africans is not due to its anomalies or histology.

La histología de la arteria cerebral media (ACM) de los africanos de Nigeria no ha sido previamente estudiada. Fueron examinadas 100 ACM, obtenidas en autopsias de 50 individuos nigerianos adultos. Las arterias fueron procesadas y teñidas con hematoxilina y eosina de Ehrlich, Van Gieson para fibras elásticas y tricrómico de Masson. Ramas proximales se originan antes de la división en dos arterias cerebrales medias, y había una ACM accesoria, constituyendo una incidencia de anomalías del 3 por ciento. No se observó aneurisma en ninguno de los casos. La lámina elástica interna estaba bien desarrollada, pero la lámina elástica externa de los vasos estaba pobremente desarrollada. Cerca de la bifurcación la túnica media es gradualmente cónica, la túnica media es totalmente deficiente siendo sustituida por la túnica adventicia (Forbus raphé). La túnica adventicia es más gruesa en las bifurcaciones (0.21mm) en comparación con otros lugares del buque. El grosor medio de la túnica media de ACM en su origen fue 0.12mm mientras que el de la túnica adventicia de O.lOmm. Estos resultados son similares a los que han sido descritos en la literatura para Caucásicos. Es importante la afirmación que las anomalías anatómicas de la ACM son raras. La aparentemente baja frecuencia de los aneurismas de ACM en nigerianos africanos no es debido a sus anomalías o a la histología.

A "Benign" Sphenoid Ridge Meningioma Manifesting as a Subarachnoid Hemorrhage Associated with Tumor Invasion into the Middle Cerebral Artery

Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.

Endovascular management of intracranial pial arterio-venous fistulas.

From 1996-2002 we treated 5 consecutive cases of pial fistula. There were 3 patients with a single hole-single channel pial fistula and two patients had a complex pial fistula. Three patients presented with intracerebral hematoma and had a focal neurological deficit. One patient presented with history of seizures and 1 patient had headache. The results of the treatment were analyzed both clinically and angiographically. The follow-up period ranged from 6 months to 6 years. All fistulas were treated with concentrated glue. The glue cast included the distal part of the feeding artery, A-V connection and the proximal part of the vein. Post-embolisation angiography showed complete occlusion of two single-hole fistulas and one complex pial A-V fistula and near total occlusion of one single-hole and one complex pial A-V fistula. Four patients had excellent clinical outcome. One patient with single-hole fistula had a hemorrhagic venous infarct resulting in transient hemiparesis.

Menkes disease: case report of an uncommon presentation with white matter lesions

Menkes disease is a rare X-linked disorder related to a defect in the copper metabolism. According to the current literature, the most frequent neuroimaging findings are cortical atrophy, chronic subdural effusion or hygroma, and vascular abnormalities. White matter lesions may be present before other features of the disease and may evolve into atrophy. We hereby report a case of Menkes disease with typical history and progression, and an early phase imaging study with important white matter abnormalities, which could have lead to diagnostic difficulties

Correlation between endothelial injury and cerebral vasospasm following a double subarachnoid hemorrhage in the rat hemorrhage

While a wide array of pathological changes occur in cerebral arteries following subarachnoid hemorrhage [SAH], the most consistent is endothelial damage. Since the endothelium normally modulates reflexes that influence vascular tone, any damage to it may represent a significant contributor to cerebral vasospasm following SAH. This experimental study investigates the correlation between endothelial injury of rat basilar [BA] and middle cerebral arteries [MCA] and vasospasm following a double SAH. Animals were divided into three groups of control [nonsurgical-noninjected], saline-injected, and blood-injected rats. Rats in the blood-injected group were injected with two 0.3 mL doses of autologous blood into the subarachnoid space at intervals of 72 hours. Rats were killed at different time intervals to study the time course of endothelial injury along with vasospasm following the second SAH with scanning electron microscopy and image analysis system, respectively. Cerebral arteries exposed to blood demonstrated severe pathological alterations during acute [30 min. to 2 hrs.] and chronic [48 hrs.] periods of time post second SAH. Concurrent with endothelial injury, there was widening of inter-endothelial tight junctions. Morphometric evaluation revealed severe arterial constriction starting at 30 min. [p<0.01] and again at 48 hrs. [p<0.05] post second SAH. The correlation between the time course of ultrastructural alteration of endothelial cells with arterial constriction provides further morphological contribution to the major complication of SAH-cerebral vasospasm

Aneurismas de la arteria cerebral media: estrategias quirúrgicas / Middle cerebral artery aneurysm: surgical strategies

En 1947 Dandy publica una monografía sobre aneurismas intracraneanos y en ella refleja el pesimismo que le generó el intervenir pacientes con aneurismas de la arteria cerebral media. Hoy en día, éstos continúan teniendo una morbimortalidad alta, a pesar de los adelantos en las técnicas microquirúrgicas, imagenológicas y anestésicas. Esta revisión analiza los aspectos más relevantes relacionados con los diferentes abordajes quirúrgicos, dependiendo de la proyección del saco.