Endovascular treatment of cervical intramedullary arteriovenous malformation.

Intramedullary arteriovenous malformations (AVMs) in the cervical region are a rare clinical condition. They represent a therapeutic challenge, as the lesions may cause serious functional disorders due to their location within or immediately adjacent to the critical ascending and descending sensorimotor pathways. In this case report, we present a patient with a cervical intramedullary AVM that was treated with endovascular therapy. Our experience suggests that endovascular treatment is an effective and safe method for treating AVMs located in the cervical region of the spinal cord. More studies are needed to establish appropriate treatment protocols depending on the clinical course, the anatomy of the lesion, and the region in which it is found.

Endovascular treatment of intracranial aneurysms with remodelling using Leo+ stents.

BACKGROUND AND PURPOSE: Endovascular embolization is an approved method of treatment of cerebral aneurysms. Several difficulties can be caused by wide-neck aneurysms. In these cases vascular remodelling is required. It can be performed with the use of balloons or intracranial stents. This method allows expansion of the therapeutic indications for aneurysm embolization. MATERIAL AND METHODS: We present the results of the Leo+ stent implantation with embolization with coils in nine consecutive patients treated between May 2007 and September 2008 in the Institute of Psychiatry and Neurology. RESULTS: In 3 cases embolization was complete, in 4 subtotal, and in 2 partial. In 3 cases the procedure was complicated by stroke: in 2 patients directly after the procedure and in 1 patient 45 days after embolization. 1 patient died due to a recurrent stroke over 1 year after the procedure. Technical failure was noted in 1 patient (stent misplacement from target vessel - the middle cerebral artery to the internal carotid artery, and therefore it did not cover the neck of the aneurysm). CONCLUSIONS: Vascular remodelling with intracranial stents in treating wide-neck intracranial aneurysms is a promising method allowing the indications for endovascular embolization to be increased. Nevertheless, it seems to carry a relatively high risk of cerebrovascular thromboembolic complications, especially ischaemic stroke. It also seems that the procedure itself might cause some technical difficulties. The full clinical safety and efficacy need further evaluation.

Mechanical embolectomy in acute ischaemic stroke--report of the first two cases.

Intravenous thrombolysis is the only approved treatment for acute ischaemic stroke administered within 3 hours of onset. Mechanical embolectomy with the MERCI device is a new treatment option for patients with occlusion of a large cerebral artery who do not meet the current license criteria for thrombolysis, are admitted up to 15 hours from onset, or do not respond to treatment with recombinant tissue plasminogen activator (rt-PA). This is a report of the first two cases of acute ischaemic stroke treated with the MERCI device at our department. One did not meet the inclusion criteria for systemic thrombolysis, and the second did not improve despite rt-PA treatment. In both cases improvement of flow in the MCA was achieved and moderate neurological improvement was observed at 3-month follow-up. More studies and controlled trials are needed to establish the utility of mechanical embolectomy in the treatment of stroke.

[Safe extirpating of AFJ after preoperative tumor obliteration with tissue adhesive glue]. / Bezpieczne usuniecie AFJ po przedoperacyjnej obliteracji guza klejem tkankowym.

The purpose of this work is to present the method of operating juvenile nasopharyngeal angiofibroma with the use of preoperative obliteration with tissue adhesive glue (Histoacryl). Authors described the case of 15 years old patient, who was admitted to ENT Department because of epistaxis, nasal obturation and returning headaches. To explain this problem, the routine diagnostics CT and angio-CT scan was applicated. Angiography confirmed well vascularized tumor supplied from facial and palatine arteries. Therapy based on the obliteration of tumor vessels with the glue-tissue was applied. As the next step the tumour was surgically extirpated. The application of this method gave a very good, simply bloodless operation effects. It allows a very good, simple and fully precise tumor extirpation. The extirpation of AFJ which is a highly vascularized tumor with the previous obliteration of the supplying vessels is a safe procedure and results in complete removal of the tumour.

Concomitant heterozygous factor V Leiden mutation and homozygous prothrombin gene variant (G20210A) in patient with cerebral venous thrombosis.

BACKGROUND: Factor V Leiden mutation represents the most common genetic risk factor of venous thrombosis in Caucasian population. A common mutation in prothrombin gene, which is due to G-->A transition at position 20210, is also associated with elevated prothrombin concentration and thrombosis. Both this mutations may constitute concomitant risk factors for deep venous thrombosis. CASE REPORT: A 29-years old woman was admitted in the Emergency Department because of severe headache with vomiting that she suffered for a few days without any neurological deficits. In the Emergency she presented first in her life tonic-clonic seizures followed by right hemiparesis and aphasia and than was admitted to hospital. CT and MR scan showed a large lesion in the left fronto-parietal region with extent edema, which was first diagnosed as tumor. Following MR showed more lesions and typical signs of sinus thrombosis. She improved quickly after stroke without any anticoagulant treatment. Genetic study revealed factor V Leiden mutation and homozygous mutation G20210A in prothrombin gene. CONCLUSIONS: Both mutations found in this case, alone, are not a high risk factors for venous thrombosis but together may increase 5-10 fold risk of venous thrombosis. Venous stroke must be considered always in acute neurological events with organic brain lesions, especially in young

[Endovascular embolization of cerebral arteriovenous malformation (AVM)]. / Wewnatrznaczyniowa embolizacja naczyniaków mózgu.

UNLABELLED: The paper presents the technique and outcomes of brain arteriovenous malformation (AVM) endovascular treatment using a glue-lipiodol mixture. Embolization was attempted in 33 AVM patients (18 women). In 6 cases (18%) AVMs were complicated by brain aneurysms. In 20 patients (61% of cases) the presence of AVM was manifested by intracranial bleeding. RESULTS: 87 procedures were performed; the nidus was completely embolized in every case, total occlusion of AVM was obtained in 12 (35%) cases, subtotal (i.e. 75%) in 13 (36%) cases, and 50% occlusion--in 9 (28%) cases. Out of 8 (24%) cases in which complications occurred, one patient (2%) died.

[Internal carotid artery wall dissection as a cause of stroke in 19 year old patient. Case report]. / Rozwarstwienie wewnatrzczaszkowego odcinka tetnicy szyjnej wewnetrznej jako przyczyna udaru niedokrwiennego mózgu u 19-letniej pacjentki--przypadek kliniczny.

The authors report a case of stroke in a young adult patient caused by intracranial internal carotid artery dissection--result of rapid neck movement. The patient developed hemiparesis, but all neurologic symptoms completely regressed after rehabilitation and now (18 months) after stroke there are no neurological symptoms.