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1.
Indian J Pathol Microbiol ; 63(4): 651-653, 2020.
Article in English | MEDLINE | ID: mdl-33154329

ABSTRACT

Developmental vascular anomalies of brain are non-modifiable risk factors for the development of aneurysms and are prone for rupture. We report one such association in a 44-year-old gentleman who succumbed to subarachnoid hemorrhage (SAH) secondary to ruptured distal anterior cerebral artery aneurysm associated with vascular anomalies in the anterior and posterior circulation that included trifurcation of anterior cerebral artery and bilateral fetal posterior cerebral arteries. We identified multiple anomalies in circle of Willis that could have contributed to the formation of aneurysm and early rupture. Knowledge of these variations is essential to plan early and optimum management with close follow-up.


Subject(s)
Anterior Cerebral Artery/pathology , Intracranial Aneurysm/diagnostic imaging , Posterior Cerebral Artery/pathology , Subarachnoid Hemorrhage/etiology , Adult , Cerebrovascular Disorders/congenital , Fatal Outcome , Humans , Intracranial Aneurysm/pathology , Male , Tomography, X-Ray Computed
2.
Prenat Diagn ; 40(7): 813-824, 2020 06.
Article in English | MEDLINE | ID: mdl-32274806

ABSTRACT

OBJECTIVE: To establish whether fetal cerebral vasoreactivity (CVRO2 ), following maternal hyperoxia, is predicted by fetal cerebral and uteroplacental Doppler pulsatility indices (PI) at baseline, fetal pulmonary vasoreactivity to oxygen (PVRO2 ), gestational age (GA), or sex. METHODS: Pulsatility index of middle (MCA), anterior (ACA), posterior cerebral (PCA), umbilical (UA), uterine (UtA), and branch of the pulmonary arteries (PA) were obtained, by ultrasound, before (baseline), during (hyperoxia) and after 15 minutes of maternal administration of 8 L/min of 100% oxygen, through a non-rebreathing face mask, in normal singleton pregnancies within 20 to 38 weeks' gestation. CVRO2 was defined as changes greater than zero in z score of PI of the cerebral arteries from baseline to hyperoxia. Logistic modeling was applied to identify CVRO2 predictors. RESULTS: A total of 97 pregnancies were eligible. In the overall population, median z scores of PI of MCA, ACA, and PCA did not differ between study phases. Based on the logistic model, baseline z scores for cerebral PI and GA were the best predictors of CVRO2 . CONCLUSIONS: In low-risk pregnancies, fetal CVRO2 to hyperoxia does not occur uniformly but depends on cerebral PI and GA at baseline. These findings may provide useful reference points when oxygen is administered in high-risk pregnancies.


Subject(s)
Cerebrovascular Disorders/etiology , Fetal Diseases/etiology , Hyperoxia/complications , Acute Disease , Adult , Blood Flow Velocity , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/physiopathology , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/physiopathology , Cross-Sectional Studies , Female , Fetus/blood supply , Gestational Age , Humans , Hyperoxia/physiopathology , Pregnancy , Pregnancy Complications/physiopathology , Pulsatile Flow , Ultrasonography, Prenatal , Vasodilation/physiology , Young Adult
3.
Handb Clin Neurol ; 162: 295-314, 2019.
Article in English | MEDLINE | ID: mdl-31324316

ABSTRACT

While cardiorespiratory monitoring is standard for newborns in the NICU, monitoring of brain hemodynamics and oxygenation is usually sporadic and targeted to newborns with suspected or confirmed neurologic disorders. This is unfortunate, since critically ill newborns, both preterm and term-born, are at high risk of brain injury and would benefit from improved techniques for continuous monitoring of brain hemodynamics and oxygenation, in addition to monitoring of systemic hemodynamics and oxygenation. Near-infrared spectroscopy (NIRS) and, to a lesser extent, Doppler ultrasound are techniques that have been used in research and increasingly for clinical purposes to measure and monitor brain hemodynamics and oxygenation in newborns. NIRS monitoring can be useful for detection of diverse pathologic conditions that occur frequently in very preterm newborns and in selected populations of term newborns at risk for brain injury related to disturbances of systemic hemodynamics. This chapter reviews the current state of the art with regard to brain-monitoring techniques and the research directed at this important area, and it concludes with suggestions for the use of currently available tools to manage newborns at high risk of neurologic injury from disturbances in brain hemodynamics and oxygenation.


Subject(s)
Brain Chemistry , Cerebrovascular Circulation , Neurophysiological Monitoring/methods , Oxygen Consumption , Adult , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/therapy , Female , Humans , Infant, Newborn , Pregnancy , Spectroscopy, Near-Infrared
5.
World J Pediatr ; 11(2): 134-40, 2015 May.
Article in English | MEDLINE | ID: mdl-24974211

ABSTRACT

BACKGROUND: Perinatal stroke is a common cause of neurologic disability. Being clinically under-recognized, its true incidence is not known. Maternal thrombophilia is likely to be a predisposing factor. To date, a general consensus for evaluation of babies born to mothers with genetic thrombotic predisposition is missing. This study was undertaken to assess the frequency of cerebral abnormalities in the offspring of women with homozygous C677T mutation in the MTHFR gene, and to seek for association with additional maternal or pregnancy risk factors. METHODS: Mother-infant pairs were consecutively recruited from October 2006 through February 2013. Neonates underwent a thorough physical examination at birth, and a cerebral ultrasound examination (cUS) was performed within 24 hours of their life. In neonates with major cerebral lesions, a thrombophilia panel test was obtained. Follow-up cUS was performed in babies with major or minor cerebral abnormalities. RESULTS: Ninety-one neonates (47 males) were enrolled. By cUS, abnormalities were detected in 18 (19.8%) neonates. Twelve neonates were diagnosed with a minor lesion; a major ischemic/hemorrhagic lesion was found in 6 neonates. There were a neat male preponderance and significant associations with a history of suspected miscarriage, maternal coagulation factors gene mutations, and reduced protein S or protein C activity. CONCLUSIONS: Our data confirmed a high incidence of cerebral abnormalities in neonates born to women with C677T homozygous mutation in the MTHFR gene. cUS at birth proved to be an effective screening tool or a diagnostic test, that should be routinely performed in babies born to mothers with known thrombotic predisposition.


Subject(s)
Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/genetics , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Mutation, Missense , Adult , Cerebrovascular Disorders/epidemiology , Female , Genetic Predisposition to Disease , Genotype , Homozygote , Humans , Incidence , Infant, Newborn , Male , Prospective Studies , Risk Factors , Ultrasonography
7.
Acta Neurochir Suppl ; 107: 89-93, 2010.
Article in English | MEDLINE | ID: mdl-19953377

ABSTRACT

A case of remarkable vertebrobasilar insufficiency due to congenital multiple occlusive cerebro-vascular anomalies is presented. Anomalies are of the anterior and posterior circulation, presumably induced by "segmental vulnerability" and modified by infection of recurrent tonsillitis. Symptoms of repeated faintness and black-out attacks and deterioration of cognitive function compromised the quality of life considerably. Successful treatment was achieved by combination of a new type of posterior circulation revascularization procedure, namely occipital artery - superior cerebellar artery bypass via the supracerebellar transtentorial SCTT approach in the sitting position in combination with a standard superficial temporal artery STA-MCA bypass.


Subject(s)
Cerebellum/surgery , Cerebral Revascularization/methods , Cerebrovascular Disorders , Neurosurgical Procedures/methods , Cerebellum/diagnostic imaging , Cerebellum/pathology , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/surgery , Female , Humans , Magnetic Resonance Angiography/methods , Magnetic Resonance Imaging/methods , Positron-Emission Tomography/methods , Young Adult
8.
Radiologe ; 50(2): 152-64, 2010 Feb.
Article in German | MEDLINE | ID: mdl-20012004

ABSTRACT

Diseases of the corpus callosum include developmental disorders, immunomodulated CNS diseases, vascular malformations, disturbances of metabolism including the electrolyte homeostasis, secondary degenerations and mechanical injuries. This report provides information on the differential diagnosis of reversible and irreversible pathological changes of the corpus callosum with special focus on the localization, which often allows conclusions on the pathogenesis to be drawn.


Subject(s)
Brain Diseases/diagnosis , Brain Diseases/pathology , Brain Mapping , Corpus Callosum/pathology , Diffusion Magnetic Resonance Imaging , Image Enhancement , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Agenesis of Corpus Callosum , Angiography, Digital Subtraction , Atrophy , Brain Diseases/congenital , Cerebral Angiography , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/pathology , Diagnosis, Differential , Dominance, Cerebral/physiology , Humans , Magnetic Resonance Angiography , Sensitivity and Specificity
9.
Zhongguo Zhen Jiu ; 29(10): 791-3, 2009 Oct.
Article in Chinese | MEDLINE | ID: mdl-19873913

ABSTRACT

OBJECTIVE: To observe the therapeutic effect of eye acupuncture on cognition disorders in patients of chronic cerebral circulation insufficiency (CCCI). METHODS: Sixty cases were randomly divided into an observation group and a control group, 30 cases in each group. All patients were treated with oral administration of compound Danshen tablets, and the observation group was treated with eye acupuncture based on the pharmacotherapy and upper energizer area, kidney area, spleen area were selected. Their therapeutic effects were observed after 8 weeks. RESULTS: The total effective rate of 80.0% in the observation group was better than that of 53.3% in the control group (P<0.05). The score of mini-mental state (MMSE) in the observation group was also higher than that in the control group (P<0.05). CONCLUSION: Eye acupuncture has a good effect on cognition disorders in patients of CCCI and can enhance life quality of the patients.


Subject(s)
Acupuncture Therapy , Cerebrovascular Circulation , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/therapy , Cerebrum/blood supply , Eye , Acupuncture Points , Aged , Cerebrovascular Disorders/physiopathology , Chronic Disease/therapy , Eye/anatomy & histology , Female , Humans , Male , Middle Aged , Treatment Outcome
10.
Pediatr Radiol ; 39(3): 260-4, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19104796

ABSTRACT

Cerebral perfusion-weighted imaging (PWI) in neonates is known to be technically difficult and there are very few published studies on its use in preterm infants. In this paper, we describe one convenient method to perform PWI in neonates, a method only recently used in newborns. A device was used to manually inject gadolinium contrast material intravenously in an easy, quick and reproducible way. We studied 28 newborn infants, with various gestational ages and weights, including both normal infants and those suffering from different brain pathologies. A signal intensity-time curve was obtained for each infant, allowing us to build perfusion maps. This technique offered a fast and easy method to manually inject a bolus gadolinium contrast material, which is essential in performing PWI in neonates. Cerebral PWI is technically feasible and reproducible in neonates of various gestational age and with various pathologies.


Subject(s)
Cerebrovascular Disorders/diagnosis , Contrast Media/administration & dosage , Gadolinium DTPA/administration & dosage , Magnetic Resonance Imaging/methods , Cerebrovascular Circulation , Cerebrovascular Disorders/congenital , Equipment Design , Female , Humans , Infant, Newborn , Injections, Intravenous/instrumentation , Male , Prospective Studies
11.
Clin Radiol ; 63(2): 210-9, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18194699

ABSTRACT

The septum pellicidum is a thin midline brain structure the function of which is poorly understood. Despite its small size, it is the site of a considerable number of anatomical variants, congenital anomalies, and acquired lesions. The review presents the imaging appearances of some of the more common congenital and acquired lesions of the septum pellucidum.


Subject(s)
Brain Diseases/diagnosis , Septum Pellucidum/abnormalities , Septum Pellucidum/anatomy & histology , Brain Diseases/congenital , Brain Neoplasms/congenital , Brain Neoplasms/diagnosis , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/diagnosis , Humans , Magnetic Resonance Imaging , Tomography, X-Ray Computed
13.
Ross Fiziol Zh Im I M Sechenova ; 92(3): 292-8, 2006 Mar.
Article in Russian | MEDLINE | ID: mdl-16739638

ABSTRACT

Experimental studies show depressive behavior in rats caused by hypothyroidism and antidepressant effect of thyroid hormones. The present study analyses changes in the hippocampal and cerebellar cortex local blood flow in the progeny of rats suffering from iodine deficiency before mating and during the whole period of gestation. The diet with very low iodine content results in a decrease of local blood flow in both brain structures, but the greatest changes were observed in hippocampus. Addition of the iodine to the diet eliminates the above blood flow changes.


Subject(s)
Cerebellar Cortex/blood supply , Hippocampus/blood supply , Hypothyroidism/complications , Iodine/deficiency , Maternal-Fetal Exchange , Pregnancy Complications/metabolism , Prenatal Exposure Delayed Effects , Animals , Animals, Newborn , Cerebellar Cortex/embryology , Cerebellar Cortex/growth & development , Cerebrovascular Circulation , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/physiopathology , Female , Hippocampus/embryology , Hippocampus/growth & development , Male , Pregnancy , Pregnancy Complications/blood , Rats , Regional Blood Flow , Thyroxine/blood , Thyroxine/metabolism , Triiodothyronine/blood , Triiodothyronine/metabolism
15.
Cerebrovasc Dis ; 22(1): 33-9, 2006.
Article in English | MEDLINE | ID: mdl-16567935

ABSTRACT

BACKGROUND: The causes of basal ganglia-thalamic hemorrhage in the young are not well established. Therefore, its clinical profile, etiology, and risk factors were studied. METHODS: Retrospectively, collected data were evaluated using the chi(2) test and logistic regression analysis. RESULTS: Gender differences occurred in the clinical profile, risk factors, and etiological spectrum. Large hematoma, Glasgow Coma Scale

Subject(s)
Basal Ganglia/pathology , Cerebral Hemorrhage/etiology , Thalamus/pathology , Adolescent , Adult , Alcoholism/complications , Alcoholism/epidemiology , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/surgery , Cerebrovascular Disorders/congenital , Female , Glasgow Coma Scale , Hematoma/complications , Hematoma/pathology , Humans , Hypertension/complications , Hypertension/epidemiology , Logistic Models , Male , Middle Aged , Neurosurgical Procedures , Prognosis , Recurrence , Retrospective Studies , Risk Factors , Sex Characteristics , Smoking/epidemiology
18.
Neurol India ; 52(1): 43-53, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15069238

ABSTRACT

Vein of Galen malformations are unique congenital malformations of the cerebral vasculature that result in persistence and 'aneurysmal' dilatation of the venous structures. The varied clinical presentations and their distinctive and complex angioarchitecture make it important for the caring physician to understand their embryological and pathophysiological aspects. Management of these lesions--both in the neonatal period and at the time of definitive intervention, is challenging. Considering the rarity of these lesions, there are very few studies that have been able to compare the results of different techniques in the management. Continuing developments in the diagnostic as well as interventional aspects during the last two decades have radically changed the management of these lesions. Antenatal diagnosis and referral to a center with facilities for advanced neonatal cardiac care as well as for interventional neuroradiological therapy can go a long way in improving the prognosis in these children.


Subject(s)
Cerebral Veins/abnormalities , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/therapy , Adult , Cerebral Veins/embryology , Cerebrovascular Disorders/classification , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/genetics , Cerebrovascular Disorders/physiopathology , Child , Diagnostic Imaging , Humans , Infant, Newborn
19.
Acta Neurochir (Wien) ; 143(6): 625-9, 2001.
Article in English | MEDLINE | ID: mdl-11534681

ABSTRACT

We report a rare case with tetralogy of Fallot (TOF) and agenesis of the internal carotid artery (ICA) who presented serious intracerebral haematomas. In the literature, this is the first documented case having these complications simultaneously. Extreme hypoxic insults followed by recovery were detected by O2 saturation monitor before two bleeds. Chronic brain hypoxia could make the vasculature weak, which was shown in the histological examination. A 2-year-old girl was transferred to us with a general convulsion due to intracerebral haematoma. She had been showing general cyanosis from birth due to TOF. Repeated intracerebral haemorrhages ended her life. Histological study showed dilated vascular channels in the subarachnoid space and necrotizing vasculature obstructed by fibrinous thrombi adjacent to the haematoma. Fibrosis of the vessel wall with infiltration of macrophages suggested subacute or chronic lesions rather than acute necrosis due to the multiple haemorrhages. The intracerebral haematomas and agenesis of the ICA were observed as unilateral hemispheric vascular complications of TOF. Chronic brain hypoxia could play an important role in weakening the vessel wall and erythrocytosis caused obstructing thrombi. We speculate these factors generated the intracerebral haematomas.


Subject(s)
Brain/blood supply , Carotid Artery, Internal/abnormalities , Cerebral Hemorrhage/complications , Cerebrovascular Disorders/congenital , Hematoma/etiology , Tetralogy of Fallot/complications , Brain/diagnostic imaging , Cerebral Angiography , Cerebral Hemorrhage/pathology , Child, Preschool , Fatal Outcome , Female , Hematoma/pathology , Humans , Tetralogy of Fallot/pathology , Tetralogy of Fallot/surgery
20.
J Child Neurol ; 15(5): 290-4, 2000 May.
Article in English | MEDLINE | ID: mdl-10830194

ABSTRACT

This paper describes 59 patients, 3 months to 16 years of age, who were seen consecutively in the same center for cerebral arterial infarction. It focuses on the mechanism of stroke. The pathophysiologic process could be established for 78% of the children. Arteriopathic stroke (31 patients, or 53%) was the most common. The arteriopathies were either progressive (moyamoya in 4 patients, or 7%) or nonprogressive (27 patients, or 46%). The latter form occurred in two patterns: dissection of cervicocephalic arteries (12 patients, or 20%) and transient cerebral arteriopathy of unknown origin but probably angiitis (15 patients, or 25%). Cardiac or transcardiac embolic stroke occurred in 12% of the series and systemic diseases in 14%. There was a favorable outcome in 70% of patients having stroke due to nonprogressive arterial disease and stroke due to unidentified mechanisms. In contrast, only 26% of patients with embolic stroke, systemic disease, or moyamoya had a favorable outcome. Recurrences were more frequent and severe in this latter group. It is concluded that it is important to determine the mechanism of childhood stroke, because it strongly influences outcome, the recurrence risk, and treatment choice.


Subject(s)
Cerebrovascular Disorders/complications , Intracranial Embolism/complications , Stroke/etiology , Stroke/physiopathology , Adolescent , Cerebral Angiography , Cerebrovascular Disorders/congenital , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/physiopathology , Child , Child, Preschool , Female , Humans , Infant , Intracranial Embolism/diagnosis , Intracranial Embolism/physiopathology , Male , Outcome Assessment, Health Care , Recovery of Function , Recurrence , Retrospective Studies , Risk , Risk Factors , Stroke/diagnosis , Stroke/therapy , Survival Analysis , Treatment Outcome
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