Last-recorded P2Y12 reaction units value is strongly associated with thromboembolic and hemorrhagic complications occurring up to 6 months after treatment in patients with cerebral aneurysms treated with the pipeline embolization device.

BACKGROUND AND PURPOSE: A recent study identified a preprocedural P2Y12 reaction units value of <60 or >240 as a strong independent predictor of perioperative thromboembolic and hemorrhagic complications after treatment of cerebral aneurysms with the Pipeline Embolization Device. This study aimed to determine whether a last-recorded P2Y12 reaction units value of <60 or >240 predicts thromboembolic and hemorrhagic complications up to 6 months after treatment of cerebral aneurysms with the Pipeline Embolization Device in the same patient cohort. MATERIALS AND METHODS: We recorded patient and aneurysm characteristics, P2Y12 receptor antagonist administered, P2Y12 reaction units value with VerifyNow, procedural variables, and thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures at our institution during an 8-month period. Complications causing a permanent disabling neurologic deficit or death were considered major. Multivariate regression analysis was performed to identify independent predictors of thromboembolic and hemorrhagic complications. RESULTS: Forty-four patients underwent 48 Pipeline Embolization Device procedures at our institution during the study period. There were 11 thromboembolic and hemorrhagic complications up to 6 months after treatment in our cohort (22.9%), 5 of which were major (10.4%). A last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all (P = .002) and major (P = .03) thromboembolic and hemorrhagic complications in our cohort. Most patients (71%) required, on average, 2 adjustments to the dose or type of P2Y12 receptor antagonist to remain within the 60-240 target P2Y12 reaction units range. CONCLUSIONS: In our cohort, a last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all and major thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures.

Diagnostic yield of catheter angiography in patients with subarachnoid hemorrhage and negative initial noninvasive neurovascular examinations.

BACKGROUND AND PURPOSE: The yield of DSA in patients with SAH and negative initial noninvasive neurovascular examinations (CTA or MRA) is not well-understood. This study aimed to determine the yield of DSA for the detection of causative vascular lesions in this clinical scenario. MATERIALS AND METHODS: We examined the yield of DSA for the detection of causative vascular lesions in a cohort of patients presenting to our institution with SAH and negative initial noninvasive neurovascular examinations during a 5-year period. Two experienced neuroradiologists independently evaluated the NCCT to determine the SAH pattern (diffuse, perimesencephalic, or peripheral sulcal) and the catheter angiograms to assess the presence of a causative vascular lesion. RESULTS: Fifty-five patients were included in the study, with a mean age of 58.2 years (median, 58 years; range, 25-88 years). Twenty-eight patients were men (50.9%), and 27 were women (49.1%). The initial noninvasive examination was a CTA in 47 patients (85.5%) and an MRA in 8 patients (14.5%). Thirty-three patients had diffuse SAH (60%); 11, perimesencephalic SAH (20%); and 11, peripheral sulcal SAH (20%). DSA demonstrated a causative vascular lesion in 6 patients (10.9%), 5 of whom had diffuse SAH (yield of 15.2%) and 1 of whom had peripheral sulcal SAH (yield of 9.1%). No causative vascular lesions were found in patients with perimesencephalic SAH. CONCLUSIONS: DSA is a valuable tool in the evaluation of patients with diffuse and peripheral sulcal SAH who have negative initial noninvasive neurovascular examinations, demonstrating a causative vascular lesion in 15.2% and 9.1% of patients, respectively.

Magnetic resonance imaging in a patient with I-cell disease.

Autopsy reports in I-cell disease patients describe no salient abnormality of central nervous system morphology. Magnetic resonance imaging of the cranium in a patient with I-cell disease showed ventriculomegaly with frontal lobe atrophy and bifrontal leukomalacia. Central nervous system morphological abnormalities may occur in a subset of patients with I-cell disease.

Hydrosyringomyelia and diastematomyelia detected by MRI in myelomeningocele.

Magnetic resonance imaging of the spine in 45 patients with myelomeningocele revealed hydrosyringomyelia in 24 and diastematomyelia in two. No patient at initial imaging manifested symptoms referable to hydrosyringomyelia; both patients with diastematomyelia had flaccid lower extremities. One patient developed an upper extremity monoparesis which resolved with syringo-peritoneal shunt placement; no other patient manifested symptoms or required surgery. Ventriculoperitoneal shunt malfunction produced reversible distention of the syrinx in another patient who remained asymptomatic.

Carotid-cavernous sinus fistula following Le Fort I osteotomy.

A case report of a carotid-cavernous sinus fistula, a rare complication following orthognathic surgery, is presented. The anatomy and pathophysiology of the condition is discussed as they relate to the development of clinical signs and symptoms, and an attempt is made to explain this complication on the basis of a spectrum of possible internal carotid injuries following orthognathic surgery.

Diastematomyelia of the cervical spinal cord with tethering in an adult.

A case of cervical diastematomyelia associated with spinal cord tethering in an adult is presented. The differences between cervicodorsal and lumbar region spinal dysraphic states are emphasized with a review of the embryological factors involved. Possible causes and subsequent treatment are outlined.

Lymphoma after organ transplantation: radiologic manifestations in the central nervous system, thorax, and abdomen.

The radiographic findings of post-transplantation lymphoma in 15 patients are demonstrated. Variations in patterns from those of lymphomas in nonimmunosuppressed patients, etiologic factors, histologic features, and differential diagnosis are discussed. The common finding of central lucency of masses seen on CT scans correlated with necrosis seen at histologic examination. In the post-transplant patient, single or multiple masses, particularly if centrally lucent, should suggest post-transplantation lymphoma. Histologic proof with anatomic localization is important, however, to determine appropriate therapy.

Multiple extracranial arterial lesions following closed craniocervical trauma.

Lesions of the cervical carotid and vertebral arteries resulting from closed craniocervical trauma are being recognized with increasing frequency. This paper describes a patient with severe stenosis and aneurysm formation of both distal internal carotid arteries and stenosis of the left vertebral artery, who presented with only head noise. A multiple vessel angiographic examination is necessary to demonstrate the extent of vascular injury and complications and the collateral circulation.

Use of contrast infusion in cranial extracerebral computed tomography.

Previous reports have demonstrated the lack of enhancement of extracerebral cranial lesions. Six patients are presented in whom the orbits, nasopharynx, temporal bones and paranasal sinuses were scanned and the intracranial extracerebral component of lesions in these areas delineated with contrast infusion. As well, two tuberculum sphenoidale meningiomas are presented to demonstrate the importance of visualizing the suprasellar region when performing orbital scans.

Cerebellar hemorrhage in adults. Diagnosis by computerized tomography.

A series of 10 adult patients with cerebellar hemorrhage diagnosed by computerized tomography (CT) is described. Hypertension was the most common etiological factor, accounting for 70% of the cases. The clinical presentation appeared to fall into two basic groups. The first group (60% of the cases) ran a progressive course with early brain-stem compression. The second group had a benign course with findings of focal cerebellar dysfunction. The CT findings reflected the two clinical categories. The scans of Group 1 patients revealed a lorge hematoma (greater to or equal to 3cm) and substantial ventricular dilatation. In contrast, scans of Group 2 patients demonstrated a small hematoma (less than 3 cm) without ventricular dilatation. Use of CT scanning allowed the accurate diffferentiation of cerebellar hemorrhage from primary brain-stem and intraventricular hemorrhage. The findings of the CT investigations proved very helpful in defining appropriate therapy.