Arterial Dissection of an Anomalous Right Vertebral Artery Arising From the Right Common Carotid Artery Associated With an Acute Right Middle Cerebral Artery Stroke.

In rare cases, the right vertebral artery can have its origin from the right proximal common carotid artery. This anatomical variant can be incidental, but if trauma to the vertebral artery occurs, there can be devastating neurological deficits. Our patient was an adult female who initially presented with new-onset left arm weakness and dysarthria. After a CT angiogram and ultrasound imaging were performed, she was found to have an acute right middle cerebral artery (MCA) stroke in association with dissection of the anomalous right vertebral artery. The patient underwent urgent mechanical thrombectomy in the right MCA and thrombolysis in cerebral infarction (TICI) grade 3 recanalization was successfully achieved. The patient made a complete recovery with no neurological sequelae. A follow-up CT angiogram after six months showed resolution of the dissection and restored patency of the right vertebral artery.

Pediatric Cerebral Spetzler-Martin Grade 5 Arteriovenous Malformation.

Brain arteriovenous malformations (AVMs) are a type of intracranial high-flow vascular malformation composed of enlarged feeding arteries and draining veins. Without a capillary bed connection, there can be damage to the walls of the arteries and veins, which causes abnormally high blood flow. AVMs are rarely found in children and are thought to expand over time until they become symptomatic. We present an interesting case of a pediatric male who initially presented with seizure-like episodes and was found to have a large frontoparietal Spetzler-Martin (SM) grade 5 AVM after cerebral digital subtraction angiography. Unfortunately, given how much eloquent brain and deep cortical structures were intertwined in the SM5 AVM, risk-benefit analysis favored observation over surgical management. The patient's clinical presentation and imaging findings are described followed by a discussion of the epidemiology, grading system, and treatment of AVMs. After extensive literature review, this clinical entity has been previously reported but is relatively rare in children with prognosis and therapy correlating to the severity of the SM index.

Re-expansion of Osteoporotic Compression Fractures Using Bilateral SpineJack Implants: Early Clinical Experience and Biomechanical Considerations.

Thoraco-lumbar osteoporotic compression fractures have a higher incidence of continued collapse with development of deformity and progression to vertebra plana when untreated and even after vertebral augmentation (VA) or balloon kyphoplasty (BKP). Even when there is the restoration of height and improvement in angulation, multiple long-term follow-up series have repeatedly documented that over time, many patients lose the initial height correction and in a smaller group the vertebral body re-collapses leading to the development of progressive deformity with an increased risk for adjacent level fractures. At first, larger balloons and more cement were used to try and avoid these problems, but it did not reduce the risk of adjacent fractures. Several procedures were developed to place various types of intervertebral implants combined with bone cement to maintain the initial height correction. Initial studies with these implants showed a reduction in adjacent level fractures but the systems did not proceed to market. The SpineJackR (SJ) system (Stryker Corp, Kalamazoo, MI), consisting of bilateral expandable titanium implants supplemented with bone cement, was first used approximately 10 years ago in Europe and recently gained FDA approval in the United States. This system provides more symmetric and balanced lateral and anterior support and is effective with lesser amounts of bone cement compared to BKP. Follow-up studies have documented that there is equal or better pain control, with better long-term results based both on maintaining vertebral height restoration and deformity correction. Most importantly, statistically it clearly reduces the risk of adjacent level fractures by at least 60%. The biomechanical effects of intravertebral implants for osteoporotic fractures in regard to the risk of adjacent level fractures and preliminary experience with the use of the SJ is reviewed.