Headache and MRI Changes after Endovascular Treatment of a Cerebral Aneurysm.

BACKGROUND: The main complications after endovascular therapy of intracranial aneurysms are aneurysm rupture and thromboembolic events. Yet, the widespread use of magnetic resonance imaging (MRI) in follow-up of these patients also demonstrates other, rarely known complications such as aseptic meningitis and foreign body reaction. CASE PRESENTATION: A small aneurysm in the right posterior communicating artery was treated with endovascular therapy in a 65 year old woman. Two weeks after successful interventional treatment, the patient developed a headache. On MRI performed five months after intervention, vasogenic edema was seen in the vascular territory of the right internal carotid artery. The edema and the symptoms diminished without specific treatment within a year. INTERPRETATION: The clinical and radiological presentation of this case are suggestive of a foreign body reaction, a treatable condition that radiologists and clinicians should be aware of.

Neurointerventional treatment in acute stroke. Whom to treat? (Endovascular treatment for acute stroke: utility of THRIVE score and HIAT score for patient selection).

PURPOSE: Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT. METHODS: Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high age and evaluated the scores in respect of technical efficacy. RESULTS: Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome. CONCLUSIONS: Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged ≥80 years.

[Craniocervical artery dissection]. / Kraniocervikal arteriedisseksjon.

BACKGROUND: In recent years, new radiographic diagnostics have increased our knowledge about dissection of the carotid and vertebral arteries as a cause of stroke, probably an underdiagnosed condition. Carotid dissection is now considered one of the most frequent aetiologies of ischaemic stroke in patients less than 50 years of age and it accounts for 20% of all cases under the age of 30. MATERIAL AND METHODS: In this paper we describe clinical course and investigations in four patients who had dissection of the precerebral arteries. RESULTS: Three patients had carotid artery dissection, one vertebral artery dissection. Three patients had ischaemic symptoms. One patient had symptoms following physiotherapy to the neck. INTERPRETATION: Patients with craniocervical arterial dissection should be investigated with ultrasound techniques and MRI or CT; antiplatelet agents or anticoagulation therapy should be considered.