[A male patient with acute, reversible blindness]. / Een man met acute, reversibele blindheid.

BACKGROUND: Intra-arterial thrombectomy (IAT) in occlusions of the posterior cerebral artery (PCA) is uncommon and not a proven therapeutic solution, but can be performed in individual cases. CASE DESCRIPTION: An 80 year old man visited the emergency room after experiencing acute blindness. This was caused by a new hemianopia for the left visual field due to an occlusion of the right PCA, on top of a pre-existing hemianopia for the right visual field. Auxiliary testing showed an old ischemic stroke of the right occipital lobe, and a new occlusion of the right PCA. After deliberation with the patient, it was decided to perform IAT, because of the debilitating effect of the current neurological disabilities. IAT was succesfull and the patient completely recovered to the pre-existing level of functioning. CONCLUSION: Although there is no indisputable evidence to suggest that IAT in occlusions of the PCA is safe and effective, this case illustrates that IAT can be considered on an individual basis. Based on individual patient characteristics and shared decision making, IAT can be performed after carefull consideration of the risks and benefits.

Three-dimensional ultrasound imaging of fetal brain fissures in the growth restricted fetus.

OBJECTIVES: To examine differences in growth trajectories of fetal brain fissures in the growth restricted fetus (FGR) compared to controls. METHODS: We selected a subgroup of 227 women with a singleton pregnancy from the Rotterdam Periconceptional Cohort. Participants received three-dimensional ultrasound (3D-US) examinations of the fetal brain at 22, 26 and 32 weeks of gestational age (GA). The left and right Sylvian, insula and parieto-occipital fissures (POF) were measured in standardized planes. Linear mixed models with adjustment for potential confounders were applied to estimate differences between the trajectories of brain fissure depth measurements of FGR and controls. RESULTS: 22 FGR and 172 controls provided 31 and 504 3D-US respectively for longitudinal brain fissure depth measurements. Success rates for the Sylvian and insula depth measurements were over 80% and for POF over 62% at all GA. In FGR compared to controls, the trajectory of the right Sylvian fissure depth was significantly decreased (ß = -4.30, 95%CI = -8.03;-0.56, p = 0.024) while its growth rate was slightly increased (ß = 0.02, 95%CI = 0.00;0.04, p = 0.04), after adjustment for GA, head circumference, gender, educational level and parity. CONCLUSIONS: The small differences in brain fissure measurements between 22 and 32 weeks GA in FGR warrant further investigation in larger cohorts with postnatal follow-up.

Prenatal influence of congenital heart defects on trajectories of cortical folding of the fetal brain using three-dimensional ultrasound.

OBJECTIVE: The objective of the study is to investigate the prenatal influence of congenital heart defects (CHD) on trajectories of fetal cortical folding using three-dimensional ultrasound (3D US). METHOD: We included 20 CHD fetuses and 193 controls for studying the fetal brain at 22, 26 and 32 weeks' gestational age (GA). The Sylvian, insula and parieto-occipital fissure (POF) depths were measured using 3D US, and reliability was evaluated. Doppler indices of the umbilical artery and middle cerebral artery were measured to calculate the cerebro-placental ratio. Associations between CHD and cortical folding were estimated using linear mixed models. RESULTS: Brain fissure measurements were successful in over 80% of 3D US scans, except for the POF at 32 weeks' GA (65%). All measurements showed a good reliability (intraclass correlation coefficients > 0.84). Growth trajectories of the left insula depth (ß = -2.753, 95% CI = -5.375; -0.130, p = 0.040) and right POF (ß = -3.762, 95% CI = -7.178; -0.346, p = 0.031) were decreased in CHD compared with controls, whereas growth rates were increased (ß = 0.014, 95% CI = 0.001; 0.027, p = 0.036 and ß = 0.024, 95% CI = 0.007; 0.041, p = 0.006). In contrast to controls, we found no associations between cerebro-placental ratio and cortical folding in CHD. CONCLUSION: Fetal cortical folding can be evaluated reliably by measuring brain fissure depths. Trajectories of cortical folding between 22 and 32 weeks' GA seem to be influenced by CHD. © 2017 John Wiley & Sons, Ltd.