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Advances in Transcranial Doppler US: Imaging Ahead Neurologic/Head and Neck Imaging
Transcranial Doppler ultrasonography (US) is a noninvasive, portable technique for evaluating the intracranial vasculature. It has found its most useful clinical application in the detection of vasospasm involving the cerebral vessels after subarachnoid hemorrhage due to aneurysm rupture. The technique has become an integral part of monitoring and managing patients with subarachnoid hemorrhage in the neurologic intensive care unit. In addition, it has proved useful for evaluating the intracranial vasculature in patients with sickle cell disease, stroke, or brain death. Transcranial US originated as a "blind" nonimaging stu...
Source: Radiographics recent issues - January 15, 2013 Category: Radiology Authors: Kirsch, J. D., Mathur, M., Johnson, M. H., Gowthaman, G., Scoutt, L. M. Tags: Neuroradiology, Ultrasound, Vascular Imaging, Head and Neck Neurologic/Head and Neck Imaging Source Type: research

Compliance with Early Use of Prophylactic Anticoagulation after Intracerebral Hemorrhage (P02.047)
CONCLUSIONS: Despite implementation of guideline-based practice, 12% of our ICH patients did not receive early prophylactic anticoagulation despite a clear lack of contraindication. Continued quality improvement towards guideline-driven care may be enhanced by the use of checklists to overcome individual physician biases and preferences.Disclosure: Dr. Hoang has nothing to disclose. Dr. John has nothing to disclose. Dr. Garg has received research support from the AHA. Dr. Busl has nothing to disclose. Dr. Temes has nothing to disclose. Dr. Bleck has nothing to disclose. Dr. Prabhakaran has nothing to disclose.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Hoang, T., John, S., Garg, R., Busl, K., Temes, R., Bleck, T., Prabhakaran, S. Tags: P02 Cerebrovascular Disease II Source Type: research

Angiogram-Negative Subarachnoid Hemorrhage: Outcomes Data and Review of the Literature
We report data for 31 patients who presented to our institution from 2006 to the present. We performed a retrospective chart review, and report outcome data that include rates of rehemorrhage, hydrocephalus, vasospasm, permanent ischemic deficits, headaches, and outcomes based on modified Rankin Scale scores. We also performed a review of the literature and meta-analysis of the data therein. We compared rates of complications in the PMH subgroup and the diffuse-type hemorrhage subgroup. The chart review revealed no poor outcomes and no rehemorrhages in the patients with PMH. In the diffuse hemorrhage subgroup, 1 patient ha...
Source: Journal of Stroke and Cerebrovascular Diseases - April 1, 2012 Category: Neurology Authors: Scott Boswell, William Thorell, Steve Gogela, Elizabeth Lyden, Dan Surdell Tags: Original Articles Source Type: research

Endovascular Therapy for Asymptomatic Unruptured Intracranial Aneurysms: JR-NET and JR-NET2 Findings Clinical Sciences
Conclusions— The radiographic results of EVT for asymptomatic UIAs in Japan were acceptable, with low mortality and morbidity rates.
Source: Stroke - September 23, 2013 Category: Neurology Authors: Shigematsu, T., Fujinaka, T., Yoshimine, T., Imamura, H., Ishii, A., Sakai, C., Sakai, N., for the JR-NET Investigators Tags: Aneurysm, AVM, hematoma Clinical Sciences Source Type: research

Treatment of moyamoya disease in the adult population with pial synangiosis.
Conclusions Pial synangiosis is a safe and durable method of cerebral revascularization in adult patients with moyamoya and can be considered as a potential treatment option for moyamoya disease in adults. PMID: 24405066 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - January 3, 2014 Category: Neurosurgery Authors: Lin N, Aronson JP, Manjila S, Smith ER, Scott RM Tags: J Neurosurg Source Type: research

Impaired Cerebral Autoregulation Is Associated With Vasospasm and Delayed Cerebral Ischemia in Subarachnoid Hemorrhage Clinical Sciences
Conclusions— Dynamic cerebral autoregulation is impaired in the early days after SAH. Including autoregulation as part of the initial clinical and radiographic assessment may enhance our ability to identify patients at a high risk for developing secondary complications after SAH.
Source: Stroke - February 24, 2014 Category: Neurology Authors: Otite, F., Mink, S., Tan, C. O., Puri, A., Zamani, A. A., Mehregan, A., Chou, S., Orzell, S., Purkayastha, S., Du, R., Sorond, F. A. Tags: Other diagnostic testing, Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage, Doppler ultrasound, Transcranial Doppler etc., Other Research Clinical Sciences Source Type: research

A pain in the neck
A 41-year-old woman presented to the emergency department after developing severe neck pain while unloading groceries. The pain began at the base of her neck, radiated to the vertex of the skull, reached maximum intensity within 2–3 min, and was aggravated by head movement. Neurological examination was normal. Head CT showed focal hyperattenuation immediately anterior to the midbrain (figure 1) and angiogram showed no evidence of aneurysm (see online supplementary figure 1). Diagnosis: Perimesencephalic nonaneurysmal subarachnoid haemorrhage (PN-SAH). Originally described in 1985,1 PN-SAH has been reported in pa...
Source: Emergency Medicine Journal - October 17, 2014 Category: Emergency Medicine Authors: Lindor, R. A., Homme, J. L. Tags: Headache (including migraine), Pain (neurology), Stroke, Ethics Images in emergency medicine Source Type: research

P-008 Loading Doses of Aspirin and Clopidogrel Prior to Enterprise Stent-assisted Repair of Intracranial Aneurysm-A Single Center Experience
Conclusions Using loading doses of aspirin and clopidogrel in Enterprise stent-assisted repair of intracranial aneurysm is not only safe and feasible but associated with good clinical outcome. Therefore, loading doses of aspirin and clopidogrel is an alternative option for patients who are candidates for stent-assisted repair of intracranial aneurysm. Disclosures Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. J. Chou: None. K. Shehades: None. K. Sethi: None. D. Galyon: None. S. Bajwa: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Lodi, Y., Reddy, V., Devasenapathy, A., Chou, J., Shehades, K., Sethi, K., Galyon, D., Bajwa, S. Tags: Oral poster abstracts Source Type: research

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture.
Abstract Acute internal carotid artery (ICA) terminus occlusion is associated with extremely poor functional outcomes or mortality, especially when it is caused by plaque rupture of the cervical ICA with engrafted thrombus that elongates and extends into the ICA terminus. The goal of this study was to evaluate the efficacy and safety of surgical embolectomy in conjunction with carotid endarterectomy (CEA) for acute ICA terminus occlusion associated with cervical plaque rupture resulting in tandem occlusion. A retrospective review of medical records was performed. Clinical and radiographic characteristics were eval...
Source: Journal of Neurosurgery - January 9, 2015 Category: Neurosurgery Authors: Hasegawa H, Inoue T, Tamura A, Saito I Tags: J Neurosurg Source Type: research

Diffuse Patterns of Nonaneurysmal Subarachnoid Hemorrhage Originating from the Basal Cisterns Have Predictable Vasospasm Rates Similar to Aneurysmal Subarachnoid Hemorrhage
Nonaneurysmal subarachnoid hemorrhage (SAH) has been historically associated with a benign clinical course. However, recent studies have suggested that nonaneurysmal SAH can present with different hemorrhage patterns that may be associated with differential rates of morbidity. Herein, we analyze a retrospective consecutive cohort of patients with nonaneurysmal SAH to determine outcomes. We also seek to evaluate a validated radiographic grading scale to determine its utility in predicting vasospasm in the setting of different hemorrhage patterns.
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2015 Category: Neurology Authors: Brian P. Walcott, Christopher J. Stapleton, Matthew J. Koch, Christopher S. Ogilvy Source Type: research

Reversible Cerebral Vasoconstriction Syndrome
Reversible cerebral vasoconstriction syndrome (RCVS) is an underappreciated and poorly understood cause of thunderclap headache (TCH). Although self-limited in the majority of patients, incidence is increasing, with presentations overlapping considerably with life-threatening conditions, such as aneurysmal subarachnoid hemorrhage and stroke. In addition, radiographic findings seen in RCVS are also present in primary angiitis of the central nervous system (PACNS). Misdiagnosis of RCVS might subject patients to unnecessary invasive testing and immunosuppressive therapy.
Source: The Journal of Emergency Medicine - April 6, 2015 Category: Emergency Medicine Authors: Kenneth R.L. Bernard, Morris Rivera Tags: Selected Topics: Neurological Emergencies Source Type: research

Methamphetamine use is an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage
Conclusions Methamphetamine users have significantly worse outcomes at 1 and 3 years following aSAH. Further analysis is necessary to understand the pathological response associated with methamphetamine use in this setting.
Source: Journal of NeuroInterventional Surgery - April 13, 2015 Category: Neurosurgery Authors: Moon, K., Albuquerque, F. C., Mitkov, M., Ducruet, A. F., Wilson, D. A., Crowley, R. W., Nakaji, P., McDougall, C. G. Tags: Hemorrhagic stroke Source Type: research

Modifying flow in the ACA-ACoA complex: endovascular treatment option for wide-neck internal carotid artery bifurcation aneurysms
Conclusions We found that the proposed technique of flow modification can allow for hemodynamic conversion of ICAb to ‘side-wall’ aneurysm. In patients with good collateral flow through the anterior communicating complex, this treatment paradigm is safe and effective.
Source: Journal of NeuroInterventional Surgery - April 13, 2015 Category: Neurosurgery Authors: Nossek, E., Chalif, D. J., Levine, M., Setton, A. Tags: Hemorrhagic stroke Source Type: research

Balloon remodeling of complex anterior communicating artery aneurysms: technical considerations and complications
Conclusions Balloon remodeling should be considered for broad-based complex ACoA aneurysms. This technique provides a high rate of aneurysm occlusion with an acceptable complication profile, and avoids the need for dual antiplatelet therapy. The balloon trajectory will depend on aneurysm morphology and bilateral access may be useful in selected cases.
Source: Journal of NeuroInterventional Surgery - May 14, 2015 Category: Neurosurgery Authors: Moon, K., Albuquerque, F. C., Ducruet, A. F., Crowley, R. W., McDougall, C. G. Tags: Hemorrhagic stroke Source Type: research

Body-Mass Index (BMI) and Aneurysmal Subarachnoid Hemorrhage: Decreasing Mortality with Increasing BMI
Conclusions In our SAH population, higher BMI resulted in lower short- and long-term mortality, but no difference in functional outcome.
Source: World Neurosurgery - July 28, 2015 Category: Neurosurgery Source Type: research

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