ABSTRACT
Blunt injury of the carotid artery is uncommon but serious injury with high mortality and morbidity. The symptomatology may be inconspicuous, in other case a neurological deficit is present. The cause is mainly head hyperexstension and rotation, basal scull fracture, compression, blunt stroke. The diagnosis is usually confirmed by CT scan, CT angiography, MRI. In the therapy in present prevail heparin anticoagulation and endovascular stent implantation in some cases.
Subject(s)
Carotid Artery Injuries/diagnosis , Wounds, Nonpenetrating/diagnosis , Accidents, Traffic , Adult , Carotid Artery Injuries/surgery , Carotid Artery, Internal , Female , Humans , Tomography, X-Ray Computed , Wounds, Nonpenetrating/surgeryABSTRACT
Digital subtraction angiography (DSA) is considered to be the 'gold standard' for confirmation of severe (70-99%) stenoses of internal carotid arteries (ICAs). However, it is associated with a risk of complications. The aim of this study was to assess the accuracy of ultrasonography (US), computed tomographic angiography (CTA), and their combined use for the detection and quantification of severe carotid stenoses, when compared with DSA. Severe ICA stenoses were diagnosed by US in a set of 29 patients. All patients also underwent CTA and DSA. Sensitivity, specificity, positive (PPV), negative predictive values (NPV), and Pearson's correlation coefficient were used in the evaluation of the percentage of stenosis results. Homogeneity chi2 test was applied when assessing statistical significance. Severe stenosis was diagnosed in 34 ICAs. Two ICAs with uninterpretable CTA finding were excluded. The number of ICAs with stenoses 70-99%/<70%- US 32/0; CTA 29/3; US + CTA 29/3; DSA 24/8. Pearson's correlation coefficient - US 0.601; CTA 0.725; US + CTA 0.773. Sensitivity/specificity/PPV/NPV - US 1.0/0.75/0.75/xxx; CTA 1.0/0.844/0.828/1.0; US + CTA 1.0/0.844/0.828/1.0. Homogeneity chi2 test results - US, P = 0.002; CTA, P = 0.098; US + CTAG, P = 0.098. US in combination with CTA can be used for relatively secure diagnostics of severe ICA stenoses. Thus, invasive DSA can be avoided in a substantial number of patients.
Subject(s)
Carotid Stenosis/diagnosis , Angiography, Digital Subtraction , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Cerebral Angiography , Humans , Predictive Value of Tests , Prospective Studies , Tomography, X-Ray Computed , UltrasonographyABSTRACT
BACKGROUND AND PURPOSE: Stroke is the third most common cause of death in the Czech Republic (CR). Specialized in-patient stroke unit care improves the outcome of stroke patients. The aim of the study was to chart and improve the current facilities. METHODS: Neurological in-patient departments exist in 75% of the districts in the CR, and in the capital Prague. Questionnaires were sent to all 79 neurological in-patient departments. A chi2 test was used for the evaluation of statistical significance. RESULTS: There is better access to intensive/intermediary care beds (statistically not significant) and to angiography (statistically significant) in the districts with a population density of over 151 inhabitants per km2 than in districts with a lower population density (p = 0.09 and p = 0.008). Stroke patients have access within 1 hour to computed tomography of the brain in all but one, and to laboratory tests in all districts with a neurological in-patient department(s). There is no statistically significant difference in the availability of ultrasound examination of extracranial brain arteries between the sparse, and more populated districts (p = 0.715). CONCLUSIONS: Facilities for the establishment of stroke units are quite good in the majority of highly populated areas; however, they are worse in some of the larger towns. The results of the study must be used to further improve the development of stroke care in the CR.
Subject(s)
Health Services Accessibility , Hospitals, District/statistics & numerical data , Intensive Care Units/supply & distribution , Stroke/therapy , Catchment Area, Health , Czech Republic , Hospital Bed Capacity , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Needs Assessment , Outcome and Process Assessment, Health Care , Patient Admission/statistics & numerical data , Population Density , Progressive Patient Care/statistics & numerical data , Stroke/diagnostic imaging , Surveys and Questionnaires , Tomography, X-Ray Computed/statistics & numerical data , Ultrasonography , Waiting ListsABSTRACT
Cerebral arteriovenous malformations (AVMs) are considered to be congenital disorders. However, their familial occurrence has so far been described in only 19 families in the literature. The authors report on two cases in one family and review the literature. A 45-year-old female subject with sudden onset of headache and vomiting due to a subarachnoid haemorrhage from a small AVM in the posterior part of the corpus callosum near the midline on the left side was studied. Irradiation of the AVM using Leksell's gamma knife led to its complete obliteration. Her older sister presented with temporal seizures at the age of 49 and later also with left hemiparesis, left hemihypaesthesia and dizziness - caused by a large AVM in the right temporal lobe. This AVM was treated by a combination of embolization and irradiation by the Leksell's gamma knife.
