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ASPECT Score and Its Application to Vasospasm in Aneurysmal Subarachnoid Haemorrhage: a Case –Control Study
AbstractDelayed cerebral ischaemia (DCI) is a significant complication of aneurysmal subarachnoid haemorrhage (aSAH) and is strongly associated with poorer outcome. The Alberta Stroke Program Early Computer Tomography (ASPECT) score is an established scoring tool, used in acute ischaemic stroke, to quantify early ischaemic changes on CT head scans. We aim to identify if ASPECT scoring correlates with functional outcome in DCI following aSAH. Retrospective case –control study. Inclusion criteria: admission to the Department of Neurosurgery at Leeds Teaching Hospitals NHS Trust (a tertiary neurosurgical centre in the Unite...
Source: Translational Stroke Research - August 9, 2022 Category: Neurology Source Type: research

Current treatment of central retinal artery occlusion: a national survey
ConclusionsThis survey shows that there is significant variability in treatment practices for acute CRAO in the US. Because of the high cerebrovascular and cardiovascular risk reported in this population of patients, it is notable that the approach to risk factor screening is also highly variable and many programs do not routinely refer patients to an emergency department for urgent evaluation. Finally, there appears to be equipoise among treatment teams regarding the efficacy of systemic fibrinolysis, as 53% of programs report a willingness to treat at least some patients with this modality.
Source: Journal of Neurology - December 13, 2017 Category: Neurology Source Type: research

Teaching NeuroImages: Artery of Percheron thrombosis causing selective downgaze palsy
A 47-year-old man with migraines presented with sudden onset of vertical diplopia, dysarthria, right facial weakness, and downgaze palsy (figure 1). Brain MRI revealed ischemic strokes in the midbrain periaqueductal gray, bilateral thalamic–midbrain junction, and thalamus (figure 2, A–C). Gradient echo and T1 MRI showed hypointensity in the interpeduncular fossa (figure 2, D and E). No flow could be visualized in this structure on CT angiogram or catheter angiogram, demonstrating a thrombosed artery of Percheron (figure 2, F–H). Downgaze palsy, which improved 18 months later, may result from bilateral les...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Sechler, M., Singh, J., El Husseini, N. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Giant cell arteritis presenting with acute ischemic strokes due to diffuse intracranial stenoses
A 72-year-old woman with unremarkable medical history was admitted with acute ischemic strokes (AIS) in multiple arterial distributions in anterior and posterior circulation (figure 1A and supplemental data at Neurology.org). Elevated erythrocyte sedimentation rate (98 mm/h) prompted the evaluation of superficial temporal arteries (STA) with duplex sonography (halo sign; figure 1B) and contrast angiography (right STA [figure 2A] and multiple intracranial arterial stenoses [figure 2, A–D]). STA biopsy confirmed the diagnosis of giant cell arteritis (GCA; figure 1, C and D).
Source: Neurology - October 9, 2017 Category: Neurology Authors: Kargiotis, O., Safouris, A., Petrou, V. N., Magoufis, G., Stamboulis, E., Tsivgoulis, G. Tags: MRI, Ultrasound, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: RCVS causing simultaneous convexity subarachnoid hemorrhage and hemimedullary infarction
A 34-year-old previously healthy man presented with thunderclap headache, dysphagia, dysarthria, and oscillopsia. Neurologic examination revealed right-beating nystagmus, dysphagia, hypophonia, right hemianesthesia, and left hemiparesis. Brain imaging showed convexity subarachnoid hemorrhage (figure 1A) and left hemimedullary infarct (figure 1B). Catheter angiography showed tapering of left vertebral artery and diffuse segmental vasoconstriction (figure 2). Routine serum and CSF results were unremarkable. Thorough infectious, immunologic, and coagulopathy workup was negative. Reversible cerebral vasoconstriction syndrome (...
Source: Neurology - September 18, 2017 Category: Neurology Authors: Selvan, P., Levine, S. R. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Infarction, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

In light of recently published clinical trials and their implication for clinical practice, does a large catchment area acute hospital require 24  hour CT neck and head angiography and/or neuro-interventional services in the setting of acute ischaemic stroke?
ConclusionUHL should provide routine CT angiography to all patients presenting with acute ischaemic stroke in line with current guidelines. The need for provision of neuro-interventional services on-site proved more difficult to assess and requires further analysis.
Source: Irish Journal of Medical Science - August 15, 2017 Category: General Medicine Source Type: research

Teaching NeuroImages: Artery of Percheron aneurysm masquerading as ICH spot sign
A 50-year-old Japanese woman presented with left thalamic intracerebral hemorrhage (ICH). CT angiography demonstrated an ICH spot sign and intracranial vasculopathy consistent with Moyamoya disease (figure 1). Conventional angiography demonstrated that the spot sign was actually a pseudoaneurysm arising from the artery of Percheron (figure 2). Intracranial aneurysms may complicate Moyamoya disease and occur at the circle of Willis, distal peripheral arteries, or Moyamoya vessels at a ratio of 3:1:1.1 Aneurysms in thalamo-perforating arteries are rare2 and an artery of Percheron aneurysm in Moyamoya disease has not been rep...
Source: Neurology - August 7, 2017 Category: Neurology Authors: Moughamian, A. J., Morshed, R. A., Colorado, R. A., Liner, Z., Cooke, D., Hemphill, J. C. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Abnormal cervical and cerebral vasculature in 22q11 deletion syndrome
A 12-day-old girl with a postnatal microarray diagnosis of 22q11.2 deletion syndrome was transferred for surgical repair of truncus arteriosus. Neurologic examination at the time of transfer was unremarkable. Brain MRI on day of life 9 demonstrated an absent left internal carotid flow void. Magnetic resonance angiography of the head (figure, A) and neck (figure, B) was subsequently obtained prior to cardiac repair. Patients with 22q11 deletion syndromes may have abnormal cervical vessel development.1 Children with congenital heart disease have an elevated stroke risk, particularly for periprocedural stroke.2 Understanding ...
Source: Neurology - July 3, 2017 Category: Neurology Authors: Mithal, D. S., Kurz, J. E. Tags: All Cerebrovascular disease/Stroke, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, All Genetics RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Takayasu arteritis: Neuroimaging progression after immunosuppressant treatment
A 29-year-old woman presented with a 2-year history of heel pain, constitutional symptoms, and increased acute phase reactants. CT and magnetic resonance (MR) angiography revealed a thickening of aortic walls and a thread-like appearance of bilateral subclavian and common carotid arteries. The findings were consistent with Takayasu arteritis (TA)1 and the patient was prescribed methylprednisolone, followed by azathioprine. Follow-up MR angiography, 6 years later, showed an important improvement with only a mild luminal narrowing of both common carotid arteries (figures 1 and 2, A and B). TA is a large-artery inflammatory d...
Source: Neurology - May 15, 2017 Category: Neurology Authors: Martinez Rodriguez, L., Caminal Montero, L., Pena Suarez, J., Garcia-Cabo Fernandez, C., Calleja Puerta, S. Tags: MRI, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Ischemic Stroke Outcomes in Oman: Experience of a University Hospital Based Stroke Registry (P6.278)
Conclusions:Ischemic stroke in Oman reflects the high morbidity/mortality seen in most communities in the region. Characteristics of incident stroke such as stroke recurrence, type, severity and cardiovascular comorbidity are likely the major determinants of stroke outcome. A relatively lower prevalence of extracranial artery disease and possible greater prevalence of multiple stroke mechanisms may also influence on outcomes and merit further study.Disclosure: Dr. Gujjar has nothing to disclose. Dr. Ramachandiran has nothing to disclose. Dr. Al-Asmi has nothing to disclose. Dr. Ganguly has nothing to disclose. Dr. Shoaib h...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Gujjar, A., Ramachandiran, N., Al-Asmi, A., Ganguly, S., Shoaib, R., Al-Asmi, A. Tags: Cerebrovascular Disease Health Services Research Source Type: research

Teaching NeuroImages: Crying thalamus: Manifestation of acute ischemic stroke
This report serves to remind clinicians of the importance of detailed neurologic assessment under such circumstances.
Source: Neurology - February 26, 2017 Category: Neurology Authors: Obeidat, A. Z., Broderick, J. P. Tags: MRI, DWI, All Clinical Neurology, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Superficial siderosis due to a dural cervical arteriovenous fistula
A 58-year-old man presented to our hospital with cerebellar ataxia, pyramidal signs, dysarthria, bilateral deafness, and cognitive impairment. These symptoms were consistent with superficial siderosis (SS) of the CNS, confirmed by MRI (figure A).1 Cerebral angiography showed a dural arteriovenous fistula perispinal and pontic with venous drainage in the left foramen C1-C2, fed by meningeal branches of the vertebral artery (figure, B). The fistulous point was clipped. SS of CNS is a rare disease resulting from hemosiderin deposition on the surface of the CNS and cranial nerves.2 At diagnosis, the etiology may...
Source: Neurology - February 19, 2017 Category: Neurology Authors: Madkouri, R., Grelat, M. Tags: All Cerebrovascular disease/Stroke, All Spinal Cord, Arteriovenous malformation, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Imaging of the ulcerated carotid atherosclerotic plaque: a review of the literature
AbstractCarotid atherosclerotic disease constitutes a major modern health problem whose diagnosis primarily relies on imaging. Grading of stenosis has been long used as the main factor for risk stratification and guiding of management. Nevertheless, increasing evidence has shown that additional plaque characteristics such as plaque composition and surface morphology play an important role in the occurrence of symptoms, justifying the term “vulnerable plaque”. Carotid plaque surface characteristics either in the form of surface irregularities or ulceration represent an important factor of vulnerability and are associate...
Source: Insights into Imaging - February 2, 2017 Category: Radiology Source Type: research

Sonothrombolysis for acute ischemic stroke - Break on through to the other side
Conclusions: Sonothrombolysis appears to be a safe way to augment the effect of tPA without increasing the door to needle time with the added advantage of observing flow through the occluded artery in real time.
Source: Neurology India - January 11, 2017 Category: Neurology Authors: Sanjith Aaron Sunithi Mani AT Prabhakar P Suresh Babu Sanjeev Kumar Rohith Ninan Benjamin Ajith Sivadasan Karthik Muthusamy Anil Kumar B Patil Vivek Mathew Mathew Alexander Source Type: research

Teaching NeuroImages: Intracranial vertebral dissection in a 15-year-old boy with sickle cell disease
A 15-year-old boy with sickle cell disease became unresponsive after sudden-onset headache. There was no antecedent trauma. A head CT scan demonstrated subarachnoid hemorrhage at the medulla (figure). Magnetic resonance angiography of the head and neck identified the patient's known bilateral internal carotid artery stenosis (a moyamoya-like arteriopathy associated with stroke in sickle cell disease) and a new right vertebral artery dissection, which was confirmed on conventional angiography (figure). Prior MRI performed as part of routine cerebral monitoring did not reveal any preexisting abnormality of the vertebral artery.
Source: Neurology - December 11, 2016 Category: Neurology Authors: Siegler, J. E., Banwell, B., Ichord, R. N. Tags: Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke RESIDENT AND FELLOW SECTION Source Type: research

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