Acute symptomatic seizures and epilepsy after mechanical thrombectomy. A prospective long-term follow-up study.

INTRODUCTION: New treatments for acute ischaemic stroke, such as mechanical thrombectomy, can achieve reperfusion of large ischaemic tissue. Some studies have suggested that reperfusion therapies can increase the risk of suffering acute symptomatic seizure (ASS) and poststroke epilepsy (PSE). The aim of the study was to determine the incidence of ASS and PSE in patients undergoing thrombectomy, and related factors. PATIENTS AND METHODS: This was a retrospective single-centre study including patients with ischaemic stroke and NIHSS> 8 treated with thrombectomy with a follow-up ≥5 years. We evaluated several epidemiological, radiological, clinical and electroencephalographic variables. RESULTS: Of the 344 included patients, 21 (6.1%) presented ASS, 53 (15.40%) died in the acute phase, and 13 (4.46%) died during the first year. The degree of reperfusion (p 0.029), advanced age (p 0.035), and haemorrhagic transformation (p 0.038) increased the risk of suffering ASS, with degree of reperfusion being an independent factor, OR 2.02 (1.21-4.64). The incidence of PSE was 4.12% in the first year, 3.72% in the second, and 1.61% in the fifth. The accumulated incidence at 5 years was 8.93%. Related risk factor for suffering PSE was ASS (p < 0.001), yielding an OR value of 2.00 (1.28-3.145). CONCLUSIONS: Thrombectomy doesn´t increase the risk of ASS. A higher percentage of reperfusion, advanced age, and haemorrhagic transformation are associated with an increased risk of ASS. ASS is a risk factor for suffering PSE. In terms of mortality, having suffered ASS and/or PSE does not increase acute or long-term mortality.

Posttreatment Infarct Volumes when Compared with 24-Hour and 90-Day Clinical Outcomes: Insights from the REVASCAT Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Endovascular therapy has become the standard of care for patients with disabling anterior circulation ischemic stroke due to proximal intracranial thrombi. Our aim was to determine whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in posttreatment infarct volume in the Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT) trial. MATERIALS AND METHODS: The REVASCAT trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 206 enrolled subjects (endovascular treatment, n = 103; control, n = 103), posttreatment infarct volume was measured in 204 subjects. Posttreatment infarct volumes were compared with treatment assignment and recanalization status. Appropriate statistical models were used to assess the relationship among baseline clinical and imaging variables, posttreatment infarct volume, the 24-hour NIHSS score, and functional status with the 90-day modified Rankin Scale score. RESULTS: The median posttreatment infarct volume in all subjects was 23.7 mL (interquartile range = 68.9 mL) and 16.3 mL (interquartile range = 50.2 mL) in the endovascular treatment arm and 38.6 mL (interquartile range = 74.9 mL) in the control arm (P = .02 for endovascular treatment versus control subjects). Baseline NIHSS (P < .01), site of occlusion (P < .03), baseline NCCT ASPECTS (P < .01), and recanalization status (P = .02) were independently associated with posttreatment infarct volume. Baseline NIHSS (P < .01), time from symptom onset to randomization (P = .02), treatment type (P = .04), and recanalization status (P < .01) were independently associated with the 24-hour NIHSS scores. The 24-hour NIHSS score strongly mediated the relationship between treatment type and 90-day mRS (P < .01 for indirect effect when adjusted for age), while posttreatment infarct volume did not (P = .26). CONCLUSIONS: Endovascular treatment saves brain and improves 90-day clinical outcomes primarily through a beneficial effect on the 24-hour stroke severity.

[Spontaneous closure of a intracraneal dural arteriovenous fistula by controlled hypotension during a general anesthesia procedure. A case report]. / Cierre espontáneo de fístula arteriovenosa dural intracraneal tras hipotensión controlada bajo anestesia general. A propósito de un caso.

Intracranial dural arteriovenous fistulas (DAVF) are arteriovenous communications within the duramater, which seem to be pathophysiologically related to a venous sinus thrombosis. DAVF may require invasive treatment, although rarely spontaneous occlusion has been reported. The present case is a 48-year-old male with a diagnosed type III DAVF of the right lateral sinus. Complete endovascular embolization was not possible to perform, so he was considered a candidate for surgical treatment. During perioperative management, under general anesthesia, the intraoperative arteriographyc monitoritation showed a spontaneous closure of the DAVF after induced controlled hypotension, resulting in complete cure. We conclude that controlled hypotension could become an alternative for treatment of DAVF in high risk patients or when there is no chance for embolization.patients or when there is no chance for embolization. Neurología 2003;18(10):746-749

[Trans-ethmoid meningocele diagnosed in adults. Description of one case]. / Meningocele transetmoidal. Diagnóstico en edad adulta: presentación de un caso.

The meningocele and encephalocele are extracranial herniation of single meninges or meninges with brain tissue, through cranial defect. This pathology can be classificated according to contain or localization. The trans-etmoidal encephalocele is the 5% of meningoencephaloceles, and they are the 8-19% of all neural tube dysraphism. We report a 54 year-old woman with a spontaneous rhinorrhea due to an trans-ethmoidal meningocele associate with a recurrent meningitis. The computed tomographic (CT) revealed a trans-ethmoidal meningocele and she was treated with surgery. In presence of a patient with recurrent meningitis is necessary value the possibility of rhinorrhea, and an exhausted radiology study will be fulfill for identify the opening in the skull through leak CSF, and offer the best treatment. The transetmoidal can be a cause of rhinorrhea. The CT scan study of anterior fosa is a good method for diagnostic of this pathology, however, the IRM is the election method.

Chondroblastoma of the temporal bone: CT and MR appearance.

The authors report a case of chondroblastoma in the unusual location of the temporal bone. CT findings do not differ dramatically from other reports: the lesion appeared as a soft-tissue density mass in the right temporal bone, with bony destruction and thinning of cortical margins. MR findings are more rare: on coronal T1-weighted images the lesion appeared as a mass, isointense to gray matter, centered in the right petrous bone; on axial T2-weighted images, as a mixed-intensity signal mass. They conclude that MR is an accurate indicator of the location and extension of the tumor, but that CT gives more specific information regarding bone involvement.